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Ensuring implant predictability

Article-Ensuring implant predictability

Before (left) and after (right) saline textured tear drop implants with subpectoral placement.
San Diego — The numbers detailing teardrop or anatomic breast implant rotation rates in the recent literature are not impressive. With up to a 14 percent overall rotation rate with this style implant and a 9.8 percent deflation rate for all types of implants within seven years attached to the augmentation procedure, many cosmetic surgeons may be looking for a way to avoid these numbers.

Insurance New data from a six-year study analysis proves that there is a way to ensure that these implants are predictable in their performance and complications are kept minimal, according to Robert H. Burke, M.D., F.A.C.S., clinical associate professor, University of Michigan, and clinical assistant professor, Michigan State University.

Speaking at the American Academy of Cosmetic Surgery Annual Scientific Meeting, Dr. Burke brought forward his experience with the Inamed style 468, teardrop-shaped saline textured implant. In an effort to determine why and how often rotation continues to occur throughout documented literature, a retrospective chart review was conducted with only those women in whom bilateral augmentation mammoplasty was performed using the textured style 468 implant.

"In the end, our success in eliminating rotation and deflation came down to the type of implant and the technique used for placement," says Dr. Burke, director, Michigan Center for Cosmetic Surgery, Ann Arbor, Mich. "If you combine these two factors your outcome becomes very predictable."

Pocketing success In a review of 107 patients treated (214 implants placed) with an age range of 19 to 54 years and an average age of 36.3 years, the study discusses implants that were placed submuscularly through a lateral inframammary incision of 4 cm or less. The implant pocket was irrigated with a 1 percent Betadine solution followed by two irrigations with normal saline.

After using a diluted gentamycin solution to soak all implants, one dose of antibiotic solution (either cephaloxin or Cleocin) was administered intravenously prior to implant placement.

Ranging from 195 to 495 cc, the average size implant placed was 308.5 cc. The overall results show no infections, an absence of cases of permanent nipple or breast numbness or cases of implant malposition not associated with capsular contracture, and there were no developments of postoperative malrotations.

"Our results were definitely a result of using inframammary placement — a different technique than what was used in the previously documented studies that showed rotation," Dr. Burke explains. "A small incision of 4 cm or less is outlined along the inframammary fold lateral to the breast midline. A precise pocket, mirroring the implant, is developed under the pectoralis major muscle with medial and inferior muscle detachment.

"The difference is also in the teardrop textured implant in terms of it addressing not only aesthetics regarding upper breast fullness, but also its ability to be oriented correctly through placement in the submuscular pocket — a result that may also be correlated to its texture."

Noteworthy ratesWhile there were six grade III capsular contractions, significant enough at the one-year postoperative exam that resulted in capsulectomy and implant replacement, the overall complication rate throughout the six-year study was 4.6 percent. The deflation rate was 1.9 percent, and capsular contracture rate (grade III) remained low at 2.8 percent.

"The lack of malposition and postoperative implant movement or malrotation may be related to meticulous submuscular pocket development and placement," Dr. Burke says. "The combined prophylactic antibiotic protocol, implant pocket irrigation and soaking the implant in antibiotic solution was also 100 percent effective in that no infections were encountered.

"Although the inframammary approach is fairly common, this study confirms the predictability of this approach and the lack of significant complications when placing the teardrop implant," Dr. Burke says. "This should make both the cosmetic surgeons and breast implant patients choosing this type of implant happy."

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