Raffi Gurunluoglu1, Bulent Sacak, Jamie Arton. 1. Denver, Colo.; and Istanbul, Turkey From Plastic and Reconstructive Surgery, Denver Health Medical Center, University of Colorado Health Sciences Center; and the Department of Plastic, Reconstructive, and Aesthetic Surgery, Marmara University School of Medicine.
Abstract
BACKGROUND: Revision breast surgery following breast augmentation secondary to capsular contracture and implant rupture is not uncommon. Breast autoaugmentation using an inferior pedicle dermoglandular flap following implant removal was used in patients who did not want new implants, and outcomes were analyzed. METHODS: Thirty-nine breasts (38 breasts bilateral, one breast unilateral) in 20 consecutive patients (aged 38 to 66 years) were operated on. Breast implant-related problems in 39 breasts included capsular contracture (grade III to IV) in 30 breasts, asymmetry in 20, implant rupture/bleed in 15, and hematoma in nine. The size of implants removed was between 250 and 525 cc. Forty-five percent of implants were saline filled and 55 percent were silicone filled. Forty percent were removed from the subglandular plane and 60 percent from the submuscular plane. A deepithelialized inferior dermoglandular flap was used to reorient breast volume along with superior or superior medial pedicle mastopexy. Reorientation of volume of the inferior flap ranged between 125 and 300 cm(3). Mean follow-up was 13.5 months. RESULTS: BREAST-Q data showed improvement of satisfaction with breasts, psychosocial well-being, and sexual well-being after capsulectomy, implant removal, and autoaugmentation. There was a one-cup reduction in brassiere size in 17 patients, and the cup size remained the same in three patients. There was no evidence of fat necrosis. CONCLUSION: The inferior dermoglandular flap along with mastopexy was a safe, reasonable, and reliable method of reorienting breast volume and configuring breast shape in this series of patients for whom implant explantation was indicated and replacement was not an option secondary to concern with reimplantation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
BACKGROUND: Revision breast surgery following breast augmentation secondary to capsular contracture and implant rupture is not uncommon. Breast autoaugmentation using an inferior pedicle dermoglandular flap following implant removal was used in patients who did not want new implants, and outcomes were analyzed. METHODS: Thirty-nine breasts (38 breasts bilateral, one breast unilateral) in 20 consecutive patients (aged 38 to 66 years) were operated on. Breast implant-related problems in 39 breasts included capsular contracture (grade III to IV) in 30 breasts, asymmetry in 20, implant rupture/bleed in 15, and hematoma in nine. The size of implants removed was between 250 and 525 cc. Forty-five percent of implants were saline filled and 55 percent were silicone filled. Forty percent were removed from the subglandular plane and 60 percent from the submuscular plane. A deepithelialized inferior dermoglandular flap was used to reorient breast volume along with superior or superior medial pedicle mastopexy. Reorientation of volume of the inferior flap ranged between 125 and 300 cm(3). Mean follow-up was 13.5 months. RESULTS: BREAST-Q data showed improvement of satisfaction with breasts, psychosocial well-being, and sexual well-being after capsulectomy, implant removal, and autoaugmentation. There was a one-cup reduction in brassiere size in 17 patients, and the cup size remained the same in three patients. There was no evidence of fat necrosis. CONCLUSION: The inferior dermoglandular flap along with mastopexy was a safe, reasonable, and reliable method of reorienting breast volume and configuring breast shape in this series of patients for whom implant explantation was indicated and replacement was not an option secondary to concern with reimplantation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
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