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.
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.
Classification
 Implant-based
breast
Augmentation
Other techniques of breast
augmentation
 Lipofilling

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.
acute (7–10 days), intermediate (2–6 weeks), and
long term.

6.
a rare complication occurring in
less than 1% of patients in most series.
the first 6 to 12 hours

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.
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.
 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.
A common error with inexperienced
surgeons is lack of lower pole pocket dissection
resulting in excessively high placement of the
implant.

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.
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.
overdissection
laterally caused
a double bubble
type deformity
at the lateral breast
crease causing
unsightly bulging
and loss of lateral
breast
definition

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.
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.
• 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.
“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.
 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.
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.
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.
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.
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.
 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.
 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.
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.
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.
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.
 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.
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.
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.
 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.
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”.