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Motiva Ergonomix Round SilkSurface Silicone Breast Implants: Outcome Analysis of 100 Primary Breast Augmentations over 3 Years and Technical Considerations

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Background: Macrotextured anatomical implants are frequently used in aesthetic breast surgery; however, several safety concerns linked to this implant type have been raised recently. In an attempt to address these shortcomings, Motiva Ergonomix implants have been introduced. Here, the authors describe the current world's largest experience with these novel devices in aesthetic breast surgery and evaluate the postoperative outcome of 100 primary breast augmentations. Methods: A retrospective assessment of 100 consecutive primary breast augmentation patients over a period of 3 years was conducted. Patients were followed for a minimum of 6 months postoperatively. Demographics, surgical data, and complications were recorded. In addition, a survey regarding the breast augmentation outcome was performed. Results: The reasons for surgery were mainly hypoplasia (52 percent) and ptosis (28 percent). All implants were placed by means of an inframammary approach in a submuscular pocket, and the average implant volume was 370 cc (range, 150 to 700 cc) with mostly full projection (65 percent). The revision rate was 7 percent. The authors observed four cases of implant malpositioning, one implant rupture, one implant exchange for aesthetic reasons, and one hematoma evacuation. Nevertheless, the authors achieved a 100 percent satisfaction rate with the postsurgical outcome among both patients and surgeons. Conclusions: Motiva Ergonomix implants provide reliable and satisfying results for both patients and surgeons. They can be used safely and effectively for aesthetic breast surgery. However, like all breast prostheses, Motiva Ergonomix implants are not completely free of complications and should be used only with advanced technique to achieve optimal results. Clinical question/level of evidence: Therapeutic, IV.
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... The MPP shifts to the middle pole of the breast when they lie flat on their back in a similar manner to a natural breast ( Figure 1). [21][22][23][24] The Motiva Ergonomix Round SilkSurface is equipped with a refined, smooth surface with a roughness of 3. 18 ...
... To date, previous studies have shown that incidences of CC range between 0.0% and 2.10% in a cohort of patients receiving the Motiva Ergonomix Round SilkSurf ace. 13,19,22,23,46 We found that CC occurred at an incidence of 1.4%; it was within the previous range and higher as compared with that reported during a 1-year period (0.0%). 13 Limitations of the current study are as follows: First, we included a small series of the patients under the retrospective design. Second, we conducted the current study in a cohort of the patients who visited a single local clinic in Seoul, Korea. ...
Article
Background The Motiva Ergonomix™ Round SilkSurface (Establishment Labs Holdings Inc., Alajuela, Costa Rica) is one the representative brands of the fifth-generation of a silicone gel-filled breast implant with a microtextured surface. Objectives In this study, we describe preliminary short-term safety outcomes of an implant-based augmentation mammaplasty using the Motiva Ergonomix™ Round SilkSurface in Korean women. Methods We performed a retrospective analysis of medical records in a total of 69 women (n=69) receiving an implant-based augmentation mammaplasty using the Motiva Ergonomix™ Round SilkSurface between September 26, 2017 and December 31, 2020. We analyzed incidences of postoperative complications. Results A total of 6 cases (8.7%) of postoperative complications occurred; these include 2 cases (2.9%) of early seroma, 1 case (1.4%) of capsular contracture, 2 cases (2.9%) of alterations in the shape and 1 case (1.4%) of foreign body sensation. Time-to-events were estimated at 266.81±273.17 days. Conclusions We describe our preliminary short-term safety outcomes of an implant-based augmentation mammaplasty using the Motiva Ergonomix TM Round SilkSurface in Korean women. But this deserves further large-scale studies with long periods of follow-up.
... For commercial re-use, please contact journals.permissions@oup.com Aesthetic Surgery Journal 2021, [1][2][3][4] to measure the "overall" complication rates, extending the follow-up period to an average of 26.9 months for the same population. This may confuse readers between device-related complications and technique-related complications, and the purpose of this letter is to provide clarity. ...
... There is a wealth of scientific evidence that explains why there is an improvement in device-related complications. 3,4,8,9,[11][12][13][14][15][16][17][18][19][20][21] These devices are now under clinical investigation in an FDA trial, whereas no new textured or polyurethane implants are undergoing such rigorous scrutiny. ...
Chapter
Breast-reconstructive techniques are based on autologous tissue transfer, use of implants, or a combination of both. Autologous microsurgical tissue transfer uses donor-site tissue and requires expertise in microsurgery. An allogenic breast reconstruction needs sufficient tissue coverage and its long-term outcome can be disappointing due to the implant’s impact on surrounding tissues. Fat grafting is minimally invasive but mainly indicated to reconstruct small volumes. Overall, several sessions of fat injections are needed, and results can be unpredictable. The hybrid approach uses fat grafting and an implant not only to achieve sufficient volume augmentation but also to provide central core projection of the breast. A major advantage is the prepectoral location of the implant. The technique uses a two-step approach with expander-implant exchange allowing a better control of the final breast shape. The injected fat results in a better implant covering and more natural result.
Article
Background: Breast augmentation is one of the most commonly requested and performed plastic surgery procedures. In order to prevent early postoperative complications such as seroma or hematoma, surgical drains could be useful. The aim is to perform a systematic review of the literature on the use of surgical drains in primary breast augmentation. Methods: This review was performed following the PRISMA guidelines. PubMed, SCOPUS, Web of Science and Cochrane Library databases were queried in search of clinical studies describing the use of surgical drains in women undergoing primary breast augmentation with implants and documenting seroma and/or hematoma formation rate and/or infection rate. Results: Initial search identified 2596 studies, and 162 were found relevant. Full-text review and application of our inclusion criteria to all retrieved papers produced 38 articles that met inclusion criteria. Among the included studies, 16 papers reported the use of surgical drains in breast augmentation, while in the remaining 22 articles drains were not used. Only 5 studies specifically investigated the role and effectiveness of surgical drains in augmentation mammaplasty and its possible relationship with complication rate such as seroma, hematoma or infection. Conclusions: Despite similar complication rates emerged from the analyzed articles, because of the heterogeneity of the studies, we were not able to demonstrate specifically whether drain use affects the rate of early postoperative complications such as seroma, hematoma and infection. Additional randomized controlled trials are strongly advocated in order to provide the necessary scientific evidence. Level of evidence iii: 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 .
Article
Background: In breast augmentation, breast base diameter has been recognized as an important variable in implant selection. However, breast implant volume also has a tremendous impact on the final result. Previous methods of preoperative volume determination have been limited to external devices in a bra. Computer-based three-dimensional simulation technology now allows the physician to effectively communicate with the patient preoperatively regarding volume. Methods: A cohort of 40 consecutive patients underwent routine breast augmentation with either anatomically shaped or round implants. Five methods of preoperative volume determination including the Crisalix three-dimensional computer imaging system (Crisalix Virtual Aesthetics, Lausanne, Switzerland), along with an associated virtual reality tool, were used to assess the preoperative desires of the patients. A postoperative questionnaire was used to assess patient satisfaction with each volume determination method. Results: Of the 40 patients, 100 percent were satisfied with their result; however, given the opportunity, 12 percent would have chosen a larger implant. The virtual reality tool and external sizers were shown to be the most effective in choosing an implant. The virtual reality tool was judged to be very helpful (62 percent), very accurate (78 percent), and important (88 percent) in helping patients choose their desired implant size. Conclusion: Prioritizing volume as an implant selection variable in breast augmentation results in a very high rate of patient satisfaction. Clinical question/level of evidence: Therapeutic, IV.
Article
Background Correct registration of implant characteristics is essential to monitor the safety of implants within implant registries. Currently, in the nationwide Dutch Breast Implant Registry (DBIR) these characteristics are being registered manually by plastic surgeons, resulting in administrative burden and potentially incorrect data entry. Objectives This study evaluated the accuracy of manually registered implant data, possible consequences of incorrect data, and the potential of a Digital Implant Catalog (DIC) on increasing data quality and reducing the administrative burden. Methods Manually entered implant characteristics (fill, shape, coating, texture) of newly inserted breast implants in DBIR, from 2015 to 2019, were compared with the corresponding implant characteristics in the DIC. Reference numbers were used to match characteristics between the two databases. The DIC was based on manufacturers’ product catalogs and was set as the gold standard. Results 57,361 DBIR records could be matched with the DIC. Accuracy of implant characteristics varied from 70.6 to 98.0 percent, depending on the implant characteristic. The largest discrepancy was observed for ‘texture’, the smallest for ‘coating’. All manually registered implant characteristics resulted in different conclusions about implant performance when compared to the DIC (P<0.01). Implementation of the DIC reduced the administrative burden from 14 to 7 variables (50 percent). Conclusions Implementation of a Digital Implant Catalog increases data quality in DBIR and reduces the administrative burden. However, correct registration of reference numbers in the registry by plastic surgeons remains key for adequate matching. Furthermore, all implant manufacturers should be involved and regular updates of the DIC are required.
Article
Silicone gel-filled implants exist in a wide range of shapes and textures, and yet there are relatively few long-term large-scale studies, particularly on recently developed “semi-smooth” implants. The present study fills in this gap by presenting the 3-year findings from an ongoing 10-year multicenter prospective study on breast implants with four different surface types: smooth, semi-smooth, microtextured, and macrotextured. A total of 908 patients were recruited in 15 investigational sites across Europe and divided in three groups: 653 primary augmentations in Group 1, 144 revision augmentations in Group 2, and 111 reconstructions in Group 3. All 4 types of implant shells were manufactured by the same company using the same silicone material. Surgeons were free to choose their preferred technique and implant surface, but data was collected using a standardized software and included all complications, and satisfaction levels reported by the patients at each visit. The incidence of post-operative complications was estimated based on Kaplan-Meier risk rates, on a per patient basis. At 3 years post implantation, capsular contracture (Baker grade III/IV) was the most common complication, with a per-patient risk rate of 1.5% in Group 1. Interestingly, there was no capsular contracture in this group when semi-smooth implants were used. The risk of implant rupture in Group 1 was 0.2%. The preliminary findings of this 10-year prospective study indicate that, 3 years after the operation, the four types of silicone gel-filled implants investigated were safe, with a low complication rate in comparison with the most favorable results published in other similar studies.
Article
Zusammenfassung Hintergrund Laut aktueller Studienlage weist die einzeitige Augmentationsmastopexie (AM) geringe Komplikationen auf und ist mit einer niedrigeren Reoperationsrate verbunden, als wenn ein zweizeitiges Vorgehen erfolgt. Bei der AM kann sich die Brustdimension im Vergleich zu jenen Fällen ohne zusätzliche Straffungsindikation deutlich unterscheiden. Dabei blieben diese Unterschiede nur unzureichend untersucht. In der vorliegenden Studie sollen diese zunächst quantifiziert und im Anschluss die Auswirkung der Brustdimension auf die Implantatauswahl eruiert werden. Zudem soll der Einfluss der Mastopexie auf das Outcome von Augmentationen mit runden nanotexturierten Silikonimplantaten evaluiert werden. Patienten und Methoden Über einen Zweijahreszeitraum wurden alle Patientinnen mit primären Brustaugmentationen mit nanotexturierten Implantaten in die Studie eingeschlossen. Soziodemografische Daten, präoperative Brustmaße, Spezifikationen der eingesetzten Implantate und Komplikationen der Augmentationsgruppe ohne Straffung wurden mit jenen der Gruppe mit AM verglichen. Die Zufriedenheit der Patientinnen und der Operateure wurde mittels Likert-Skalen dokumentiert. Ergebnisse Insgesamt wurden 206 Brustaugmentationen bei n = 103 Patientinnen durchgeführt. Das mittlere Follow-up betrug 24,0 ± 4,3 Monate. Im Vergleich zur Augmentation ohne Straffungsindikation lagen bei der AM breitere Brustbasen und größere präoperative Körbchengrößen vor, p < 0,001. In der Folge wurden bei der AM Implantate mit breiteren Durchmessern und niedrigeren Volumina (p < 0,05) ausgewählt, welche mit geringeren Projektionen verbunden waren, p < 0,001. Die Gesamtrevisionsraten nach Augmentationen ohne (n = 51) und mit Straffung (n = 52) betrugen 5,9 % und 19,2 %, p < 0,05. Die AM erhöhte gewebebedingte Revisionen von 2,0 % auf 13,4 % (p < 0,05) ohne Einfluss auf implantatbedingte Revisionen (3,9 % vs. 5,8 %, p = 0,663). Die Gesamtinzidenz von Kapselkontrakturen lag bei 1,9 %. In beiden Gruppen zeigte sich eine annähernd gleichhohe Zufriedenheit. Schlussfolgerung Im Vergleich zu Augmentationen ohne Straffung führen präoperativ breitere Brustbasen und größere Brustvolumina zur Auswahl von signifikant unterschiedlichen Implantatdimensionen bei der AM. Nanotexturierte Implantate sind verbunden mit niedrigen Komplikationsraten, wobei ein erhöhtes Risiko für gewebebedingte Revisionen nach AM verbleibt. Weitere Studien sind notwendig, um eventuelle Vor- und Nachteile gegenüber etablierten Implantaten zu evaluieren.
Article
It is allegedly reported that the BellaGel® SmoothFine (HansBiomed Co. Ltd., Seoul, Korea) and Motiva ErgonomixTM (Establishment Labs Holdings Inc., Alajuela, Costa Rica) are representative brands of a microtextured breast implant in Korea. We compared short-term safety outcomes between them. We evaluated the patients who received breast augmentation using the BellaGel® SmoothFine (n = 264) or the Motiva Ergonomix™ (n = 76) for aesthetic purposes and those with available medical records. They were followed up during a mean period of 122.11 ± 95.37 (4-477) and 126.80 ± 116.29 (13-534) days in the corresponding order. Early seroma occurred at an incidence of 1.89 and 5.26% following breast augmentation using the BellaGel® SmoothFine and the Motiva ErgonomixTM, respectively. This difference reached statistical significance (p < 0.05). Of note, CC occurred at an incidence of 2.27 and 0.00% in the corresponding order. Cumulative incidences of postoperative complications depending on the type of breast implants showed no significant difference; statistical significance was analyzed using the log-rank test (χ2 = 1.71, df = 1, p = 0.19). Cumulative survival of the breast implant is shown in Table 3; the Motiva Ergonomix™ showed a longer survival as compared with the BellaGel® SmoothFine (130.13 ± 13.70 vs. 120.45 ± 5.76 days). In conclusion, we describe short-term treatment outcomes and safety of an implant-based breast augmentation using two representative brands of the fifth-generation silicone gel-filled breast implants in Korean women.
Article
Background: The Motiva Ergonomix™ Round SilkSurface (Establishment Labs Holdings Inc., Alajuela, Costa Rica) is the fifth generation of a silicone gel-filled breast implant that is commercially available in Korea. Objectives: In this study, we describe 4-year interim results of the safety of augmentation mammaplasty using the Motiva Ergonomix™ Round SilkSurface in Korean women. Methods: In the current multicenter, retrospective study, we performed a retrospective review of medical records of a total of 1314 patients who received augmentation mammaplasty using the Motiva Ergonomix™ Round SilkSurface at our hospitals between September 1, 2016, and August 31, 2020. For safety assessment, we analyzed incidences of postoperative complications and Kaplan-Meier complication-free survival of the patients. Results: We included a total of 873 patients (1746 breasts, mean age = 32.18 ± 6.88 years) in the current study. There were a total of 111 cases (12.70%) of postoperative complications; these include 24 cases (2.70%) of early seroma, 18 cases (2.10%) of hematoma, 18 cases (2.10%) of capsular contracture, 17 cases (1.95%) of dissatisfaction with shape, 16 cases (1.83%) of dissatisfaction with size, 9 cases (1.03%) of asymmetry, 6 cases (0.70%) of infection and 3 cases (0.34%) of rippling. Moreover, time-to-events were estimated at 918.34 ± 36.22 days (95% CI 845.44-988.52). Conclusions: Here, we describe 4-year interim results of the safety of augmentation mammaplasty using the Motiva Ergonomix™ Round SilkSurface in Korean women in a non-manufacturer-sponsored study. But further large-scale, prospective, multicenter studies with a long period of follow-up are warranted to establish our results. 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 Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Article
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Background: The Breast Implant Follow-up Study is a large, ongoing observational study of women who received Natrelle round silicone-filled or saline-filled breast implants. This analysis describes patient-reported outcomes in the cohort who underwent breast augmentation. Methods: Subjects prospectively completed two validated scales of the BREAST-Q (satisfaction with breasts and psychosocial well-being) preoperatively and at 1 and 4 years postoperatively. Effect size and z tests were used to compare differences between preoperative versus postoperative scores; multivariate mixed models were used to compare differences in scores between silicone-filled and saline-filled implants. Results: Of 17,899 subjects completing the BREAST-Q preoperatively, 14,514 (81.1 percent) completed the postoperative questionnaire (12,726 received silicone-filled implants and 1788 received saline-filled implants). Overall, satisfaction with breasts and psychosocial well-being increased significantly at postoperative year 1 (p < 0.0001 for both), and the improvement was sustained at year 4 (p < 0.0001 for both). Large effect sizes were observed for satisfaction with breasts (2.0 at year 1; 1.8 at year 4) and psychosocial well-being (1.2 at year 1; 1.0 at year 4). In the multivariate model, silicone-filled implants were associated with significantly greater improvement compared with saline-filled implants for satisfaction with breasts and psychosocial well-being at year 1 (p < 0.0001 for both) and year 4 (p < 0.0001 and p < 0.0019, respectively). Conclusions: Breast implants are effective in improving women's quality of life. The authors found significant and sustained improvements in satisfaction and psychosocial well-being in women undergoing breast augmentation with Natrelle silicone-filled or saline-filled implants. Clinical question/level of evidence: Therapeutic, IV.
Article
Background Following a Europe-wide scandal, substandard breast implants containing silicone for industry purposes produced by Poly Implant Prothèse (PIP&Rofil) were explanted due to its potential health risks. Objective We investigated whether these implants actually imposed a threat to patients’ health. Methods In this retrospective single-centre case–control study, we compared patients with breast augmentation receiving implant explantation (01/2011–01/2015). Data were collected retrospectively from the patients’ records. Patients were split into two groups: PIP&Rofil and implants of other manufacturers. ResultsA total of 307 patients with 495 breast implants met the inclusion criteria, 64 patients with 115 PIP&Rofil implants and 243 patients with 380 implants of other manufacturers. Comparison of descriptive statistics between the two groups revealed that for a variety of indicators (e.g. patient age, breast cancer, aesthetic vs. reconstructive indication, implant volume, submuscular vs. subglandular implant position) PIP implants differ from non-PIP implant patients. Raw mean comparison showed higher rupture rates for non-PIP implants, 28.42 % (PIP 23.48 %). However, when controlling for implant indwelling time, PIP implants had shown higher rupture rates. Both groups had similar rates of capsular contracture (PIP: 71.30 %, Others: 72.63 %) with different distribution of Baker Scores (Baker 2/3/4: PIP 5/8/13 and non-PIP 3/24/135). Conclusion Concerning patient symptoms, we did not find any objective reason to justify implant explantation of PIP&Rofil implants as a solely precautionary measure. As PIP&Rofil implants showed shorter retention periods until rupture and ruptured implants can cause symptoms or health problems, PIP&Rofil implants should be regularly monitored and explanted if there is evidence of rupture. Level of Evidence IIIThis 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
Article
Breast implant-associated anaplastic large cell lymphoma (ALCL) is a rare T-cell lymphoma arising around breast implants. Public awareness has increased following a safety communication warning of the association of breast implant-associated ALCL by the U.S. Food and Drug Administration in 2011. Difficulty with determining an accurate assessment of risk, including diagnosis, or standardized treatment regimen has led surgeons to commonly omit preoperative discussion of this rare and frequently misunderstood cancer. Risk disclosure is a form of respect for patient autonomy, and informed consent has positive practical and moral consequences for the practice of plastic surgery. A model of breast implant-associated ALCL informed consent implementation and health care provider education are reviewed with 1-year process follow-up at a tertiary cancer center. Breast implant-associated ALCL should be included during preoperative counseling on the risks of breast implantation when obtaining informed consent. Pertinent aspects of decision-making include disease awareness, presenting symptoms, and resources for concerned patients. Education of health care professionals and provision of patient-focused materials ensures effectiveness of the informed consent process.
Article
The inframammary fold (IMF) is an important anatomical landmark with regards to aesthetic appearance of the breast. After implantation a new IMF often needs to be recreated, sutured, and secured to its new position to avoid displacement during the healing process.1,2 In order to obtain optimal results it is crucial to achieve a well-defined and accurately positioned IMF with the scar lying exactly in it. To prevent scar dislocation it is also important to provide sufficient length of skin between the nipple and the fold. This length should be adjusted according to the amount of covering gland and to the implants height and projection.3 In this series, all implants were placed with a dual-plane technique but the importance of securing and stabilizing the submammary fold after implantation applies to all planes of implant placement in breast augmentation via a submammary incision. The authors present a simple method that provides accurate, stable, and long lasting repositioning of the new IMF with a four-layer wound closure technique using barbed sutures. These sutures have recently become more popular across a number of surgical specialties as well as in plastic surgery,4,5 since their introduction in 1967 for tendon repair.6 Implant selection and preoperative markings were made according to the “AK method” described by Heden.1,3 After implantation, the first layer of the closure consists of securing the new IMF to the thoracic wall. A 0 PDO Quill (Surgical Specialties Corporation, Wyomissing, PA) bidirectional barbed suture is run with strong bites between the thoracic fascia (at the level of the implant lower pole) and Scarpa's fascia at the inferior edge of the wound (Figure 1). Figure 1. The first layer of closure is demonstrated on a 32-year-old woman. The barbed suture is run with strong bites …
Article
Methods: Five commercially available anatomically shaped breast implants from 3 different manufacturers (Allergan, Mentor, and Sebbin) were used. Scanning electron microscopy, X-ray microtomography, and scanning mechanical microscopy were used to characterize the shell texture. Human fibroblast adhesion onto the shells was evaluated. 3D models of the implants were obtained using CT-scan acquisitions to analyze their shape. Implant stiffness was evaluated using a tractiometer. Results: Major differences were observed in the topography of the textures of the shells, but this was not conveyed by a statistically significant fibroblast adhesion difference. However, fibroblasts adhered better on anatomically shaped textured implants than on smooth implants (p < 0.01). Our work pointed out differences in the Biocell(®) texture in comparison with older studies. The 3D analysis showed significant shape differences between the anatomically shaped implants of the 3 companies, despite similar dimensions. Implant stiffness was comparable among the 3 brands. Conclusions: Each texture had its specific topography, and this work is the first description of Sebbin anatomic breast implant texturation. Moreover, major discrepancies were found in the analysis of the Biocell(®) texture when comparing our results with previous reports. These differences may have clinical implications and are discussed. This study also highlighted major shape differences among breast implants from different manufacturers, which is quite counterintuitive. The clinical impact of these differences however needs further investigation. No level assigned: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .
Article
Breast implants are amongst the most widely used types of permanent implants in modern medicine and have both aesthetic and reconstructive applications with excellent biocompatibility. The double capsule is a complication associated with textured prostheses that leads to implant displacement; however, its etiology has yet to be elucidated. In this study, 10 double capsules were sampled from breast expander implants for in-depth analysis; histologically, the inner capsular layer demonstrated highly organized collagen in sheets with delamination of fibers. At the prosthesis interface (PI) where the implant shell contacts the inner capsular layer, scanning electron microscopy (SEM) revealed a thin layer which mirrored the three-dimensional characteristics of the implant texture; the external surface of the inner capsular layer facing the intercapsular space (ICS) was flat. SEM examination of the inner capsule layer revealed both a large bacterial presence as well as biofilm deposition at the PI; a significantly lower quantity of bacteria and biofilm were found at the ICS interface. These findings suggest that the double capsule phenomenon's etiopathogenesis is of mechanical origin. Delamination of the periprosthetic capsule leads to the creation of the ICS; the maintained separation of the 2 layers subsequently alters the biostability of the macro-textured breast implant. Copyright © 2015 Elsevier Ltd. All rights reserved.
Article
In breast augmentation, surgeons usually choose a pocket location for the implant behind breast parenchyma (retromammary), partially behind the pectoralis major muscle (partial retropectoral), or totally behind pectoralis major and serratus (total submuscular). Each of these implant pocket locations has specific indications, but each also has a unique set of tradeoffs. When applied to a wide range of breast types, each pocket location has limitations. Glandular ptotic and constricted lower pole breasts offer unique challenges that often are not solved without tradeoffs when using a strictly retromammary, partial retropectoral, or total submuscular pocket This article describes specific indications and techniques for a dual plane approach to breast augmentation in several different breast types, introducing techniques that combine retromammary and partial retropectoral pocket locations in a single patient to optimize the benefits of each pocket location while limiting the tradeoffs and risks of a single pocket location. A total of 468 patients had dual plane augmentation between January of 1992 and March of 1998 using the specific techniques of dual plane augmentation described in this article. All patients were treated as outpatients and received general anesthesia. Indications, operative techniques, results, and complications for this series of patients are presented. Dual plane augmentation mammaplasty adjusts implant and tissue relationships to ensure adequate soft tissue coverage while optimizing implant-soft-tissue dynamics to offer increased benefits and fewer tradeoffs compared with a single pocket location in a wide range of breast types.