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Breast augmentation complications

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Breast augmentation complications

  1. 1. Glandular hypomastia may be 1- a developmental (primary) 2-a sequela of thoracic hypoplasia (Poland syndrome) or other chest wall deformity 3- involutional process develop in the postpartum setting and may be exacerbated by breast-feeding or significant weight loss
  2. 2. affects a significant number of women in the United States. a negative body image.  feelings of inadequacy.  Low self-esteem .  adversely affect a patient’s interpersonal relationships, sexual fulfillment, and quality of life
  3. 3. Classification  Implant-based breast Augmentation Other techniques of breast augmentation  Lipofilling
  4. 4. Augmentation mammaplasty is an aesthetic procedure designed to increase the volume and size of the breast , other surgical goals include improvements in breast shape, symmetry, and nipple position. The procedure is accomplished by making an incision, surgically creating a space or “pocket” under the breast, and then inserting an appropriately sized breast implant.
  5. 5. acute (7–10 days), intermediate (2–6 weeks), and long term.
  6. 6. a rare complication occurring in less than 1% of patients in most series. the first 6 to 12 hours
  7. 7.  Infection of a breast implant, following reconstructive or cosmetic breast surgery, is the most important complication in the early postoperative period.  infection after cosmetic augmentation is a rare occurrence (1.1%–2.5%), some units report implant infection rates following postmastec tomy reconstruction of up to 35% .
  8. 8. Implant Malposition  Careful symmetrical implant placement is a critical component of successful breast augmentation surgery.  Prior developmental asymmetry can create postoperative asymmetry Developmental asymmetry. She declined periareolar mastopexy.
  9. 9.  the development of precise, symmetrical pocket dissection.  The footprint of the implant pockets should be exactly where the surgeon desires the implants to lie .  Excessive pocket development in any direction can result in implant displacement in an unwanted direction.
  10. 10. A common error with inexperienced surgeons is lack of lower pole pocket dissection resulting in excessively high placement of the implant.
  11. 11. Great care should be taken at the inframammary fold (IMF) to ensure that this is not overdissected, allowing descent of the implants along the chest wall beneath the breast gland. RT. Double bubble deformity with lowering of the right inframammary crease.
  12. 12. overdissection of the medial aspect of the breast can result in synmastia with direct contact between the implants resulting in distortion or obliteration of the cleavage She also had an underlying pectus excavatum deformity
  13. 13. overdissection laterally caused a double bubble type deformity at the lateral breast crease causing unsightly bulging and loss of lateral breast definition
  14. 14. Treatment of this problem is usually operative. Attempts can be made to use elasticated compression banding of the upper chest, but this is rarely successful
  15. 15. the nipples lay closer to the equator of the implant instead of at the junction of the middle and lower thirds Surgical intervention requires reopening of the incision with inferior capsulotomy to lower the implant to the correct level in relation to the inframammary crease. If the crease is very tight and well defined, it may require radial scoring in order to achieve an adequate release to create enough room for the implant to sit comfortably in its new position.
  16. 16. • Overdissection at the inframammary crease while releasing pectoralis major in dual-plane augmentation. • Failure to respect and re-create the IMF during closure after augmentation. When closing the inframammary incision , it is important to tack Scarpa’s fascia to the chest wall, to prevent the double bubble deformity. especially in very small-breasted women who have a tightly defined IMF with short IMF to nipple distance.
  17. 17. “popcorn capsulorrhaphy” refers to the technique of touching the implant capsule with electrocautery causing scattered small burns in the capsular tissue resulting in shrinkage and fibrosis of the capsule.
  18. 18.  one of the most common complications of any implant-based procedure in breast surgery.  The FDA in the United States reported rates of contracture were approximately 25% for breast augmentation and 35% for breast reconstruction. Capsular Contracture
  19. 19. Capsular contracture the development of an acellular collagenous sheath (scar tissue) surrounding the implant. around every foreign device placed in the body. For unclear reasons becomes reactive and contracts, resulting in a tight, distorted appearance of the breast.
  20. 20. Capsular contracture was classified by Baker in 1975 as follows: •• Grade I: Soft •• Grade II: Minimal contracture; implant palpable but not visible •• Grade III: Moderate contracture; implant palpable and visible •• Grade IV: Severe contracture; hard, painful breast, with distortion
  21. 21. Typically early contracture can be improved with aggressive displacement exercises. It is our practice to add a smooth muscle relaxant (Pavabid 150 mg po bid for 3 months; Pavabid is an oral formulation of Papaverine) to aid in the effect. For more severe or mature contractures, surgical release of the scar is required. Most commonly this procedure involves complete removal of the scar in the form of a capsulectomy
  22. 22. An 8 × 8 cm square sheet of porcine acellular dermal matrix sutured below the lower pole of an implant at capsulectomy and implant exchange for contracture reduction.
  23. 23.  is a function of implant type and soft tissue coverage.  The thinner the coverage the more likely a patient is to experience rippling. Rippling the lateral rippling due to lack of breast and subcutaneous fat for camouflage. acellular dermal matrix and smooth surface cohesive gel implants may be of value as no autologous fat donor sites.
  24. 24.  the rate of rupture increases over the life of the implant.  diagnosis is rare on clinical examination.  This is essential to avoid an unnecessary delay in diagnosis.  In this patient, the presenting complaint was nipple discharge of silicone implant material which has never before been documented. Silicone implant rupture
  25. 25. a complete capsulectomy removal of any free silicone. If the rupture is extra-capsular, resection of any visible or palpable granulomas present in the breast parenchyma
  26. 26. Breast implant- associated anaplastic large cell lymphoma (BIA-ALCL)  a type of peripheral T- cell non-Hodgkin’s lymphoma arising around breast implants.  first described in 1997 . In 2016, the WHO designated BIA-ALCL as a new clinical entity. PET CT shows peri-implant effusion (Eff) contained by a fibrous capsule (cap) on the left breast. The implant (Imp) appears distorted by the effusion.
  27. 27. Hypothesis for progression of immune responding T lymphocytes to BIA-ALCL. is caused by persistent T-cell immune reactions to chronic stimulation from bacteria and/or toxins implant derived, and subsequent genetic events.
  28. 28.  The US Food and Drug Administration (FDA) has reported a total of 573 cases and 33 deaths worldwide as of July 2019  Like other breast diseases, triple assessment is the golden rule for the diagnosis of BIA-ALCL. However, a proportion of cases may progress to disseminated disease or even death, highlighting the importance of awareness and understanding of BIA-ALCL
  29. 29. The U.S Food and Drug administration recommends that all women with silicone gel implants should undergo breast implant imaging 3 years after implant placement and then every 2 years thereafter MRI with a dedicated breast implant protocol is the most sensitive and specific imaging modality
  30. 30. A 46-year-old woman underwent breast augmentation surgery using a silicone implant for 6 years. She noted left breast enlargement associated with local pain for 2 months The ultrasound ___a voluminous intracapsular collection inside the left silicone implant capsule, collection contained suspension debris. drained by percutaneous aspiration, with the diagnosis of BIA-ALCL on her left breast at cytology. breast magnetic resonance imaging (BMRI)
  31. 31.  She underwent surgical explantation ( “en bloc”capsulectomy) of bilateral breast implants. Histopathology confirmed BIA-ALCL on her left breast and SIGBIC on her right breast.  No further treatment was required.  follow-up by BMRI was opted SIGBIC, silicone induced granuloma of breast implant capsule 1 week after bilateral “en bloc” capsulectomy.
  32. 32. Due to the influence of online media, women worldwide share their opinions regarding their surgical experiences . Surgeons should closely follow up with their patients and respect their wishes by removing the implants when requested . a better-informed consent process should be implemented, especially for breast augmentation surgery in order to avoid legal issues “Breast Implant Illness”.

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