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... S kin contact of breast prostheses is considered by many to be a significant cause of ongoing subclinical infection leading to subsequent symptomatic capsular contracture (1)(2)(3)(4)(5). Many surgeons employ a no-touch technique, aiming to lower capsular contracture rates by eliminating skin contamination. ...
... Breast procedures are multiple and varied, comprising a number of alternatives [13,14,17,20,28]. Similarly, placement of implants can be performed only with round or anatomically shaped implants [22,25], or if the breast presents a certain degree of ptosis, mammopexy can be performed [20,28] using whichever technique is indicated. This mammopexy should be combined conjointly with the placement of implants if a certain degree of mammary hypotrophy exists, and depending on the condition of the mammary tissue . ...
Body contouring surgery is the most frequently performed aesthetic surgical procedure. Multiple and varied options exist for obtaining an adequate body contour, and most surgeries address the thoracoabdominal region. Because the success of a surgery depends greatly on the selection of the proper surgical procedure, this article presents an approach for selecting the best surgical option based on the characteristics of each patient. Considering this, surgeons approach a contour problem with two options: to modify the content or to modify the container. These options include five basic surgical procedures: pexia, dermolipectomy, liposuction, fat infiltration, and implant placement. Each patient requires a different technique and many need several procedures during the same surgical session to obtain the best results. Likewise, each procedure should be undertaken according to precise indications, depending on the aesthetic problem of the patient and the individual characteristics of the treated area. It is for this reason that the most important factors to be considered should be analyzed to determine the best surgical procedure and the combination of surgical procedures that will improve the thoracoabdominal contour for the same patient.
Silicone breast implants are used worldwide for breast augmentation. After an axillary, periareolar or inframmary incision has been made to create an adequately sized pocket; the surgeon usually uses his or her fingers to insert the implant. The use of fingers makes the insertion process time-consuming, a few minutes or more. There are some complications, including need to ensure that the incision is long enough for the implant to be inserted, scar hypertrophy caused by implant insertion friction damage to the edge of incision, and the occasional need to ask the surgical assistant to lend more fingers to facilitate satisfactory insertion and placement. In addition, the use of gloved fingers to repeatedly push on the implant can increase the risk of contamination, postoperative silicone microleakage, and capsular contracture. To resolve these problems, we developed an improved silicone breast implant injector (reusable stainless steel 2007; single use polypropylene 2018) that can be used more easily than fingers and other "no touch" devices. From 2013 to 2017, the first author, a plastic surgeon at our clinic, used the 2007 reusable stainless steel injector to perform breast augmentations in 53 patients (Ave. age 23.8 years; range 19-67 years), 5 (8.8%) receiving 250-ml implants, 41 (77.4%) 251-300-ml implants, and 7 (13.8%) 301-400-ml implants. Overall, results were satisfactory except for two patients (3.7%) in whom capsular contracture occurred. There were no ruptures. Use of the injector made it possible to shorten the length of the incisions from the traditional 4-7 to 3-4 cm and expedited insertion time from a few minutes to a few seconds. This "no touch" insertion technique reduced implant damage caused by finger pushing, leading to a decrease in silicone microleakage and capsular contracture rate. It was performed with no friction trauma to the incision edge or harm to the surgeon's fingers. It was found to be an effective alternative operative tool for the insertion of silicone breast implants.Level of evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
After a large number of patients with silicone breast implants worldwide had been evaluated [2, 9], it was concluded that such implants were not carcinogenic. This allowed for experimentation with rats to determine the benefits and potential risks associated with implants. By means of a high-precision monitor, temperature measurements were obtained from 100 silicone-implanted rats. These measurements then were divided into various groups to compare the reaction of their implanted and nonimplanted mammary glands at different hormone levels. The temperature measurements were analyzed and compared. Dysthermia was detected in the skin area immediately overlying the implant. The results also demonstrated that at high hormone levels, implants act as neutralizing agents. By contrast, glandular alterations with severe signs of anisocytosis and anisokoryosis were observed in nonimplanted glands.
This article represents a retrospective view of the author's 17-year experience with 2863 saline implants in 1327 patients and details his "no-touch" technique. The experience included almost an equal number of submammary and subpectoral procedures. The submammary procedures were done early on and were replaced with subpectoral procedures, done exclusively at the present time. There were significantly less complications--capsules, wrinkling (visible folds), and deflations--with the subpectoral procedures. Followup is longer for submammary procedures which could be the reason for the slight difference in number of deflations. Analyzing the results from three different periods, during which the technique changed, the last period in which the no-touch subpectoral technique was used had markedly fewer complications. The no-touch technique, which had been introduced in orthopedic surgery over 50 years ago, was added to the augmentation procedure in an attempt to eliminate any possible contact with skin or breast bacteria. There were no infections in the entire series, and, during the no-touch period, capsules were almost eliminated (0.6%). Saline implants can achieve excellent results when placed subpectorally using the no-touch technique.