Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

A Prospective Analysis of Dynamic Loss of Breast Projection in Tissue Expander-Implant Reconstruction

  • Mioton, Lauren M. (Department of Plastic Surgery, Vanderbilt University School of Medicine) ;
  • Jordan, Sumanas W. (Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine) ;
  • Kim, John Y.S. (Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine)
  • Received : 2014.07.08
  • Accepted : 2015.02.22
  • Published : 2015.05.15
Download PDF
⟨ Previous Next ⟩

Abstract

Background Breast projection is a critical element of breast reconstruction aesthetics, but little has been published regarding breast projection as the firm expander is changed to a softer implant. Quantitative data representing this loss in projection may enhance patient education and improve our management of patient expectations. Methods Female patients who were undergoing immediate tissue-expander breast reconstruction with the senior author were enrolled in this prospective study. Three-dimensional camera software was used for all patient photographs and data analysis. Projection was calculated as the distance between the chest wall and the point of maximal projection of the breast form. Values were calculated for final tissue expander expansion and at varying intervals 3, 6, and 12 months after implant placement. Results Fourteen breasts from 12 patients were included in the final analysis. Twelve of the 14 breasts had a loss of projection at three months following the implant placement or beyond. The percentage of projection lost in these 12 breasts ranged from 6.30% to 43.4%, with an average loss of projection of 21.05%. Conclusions This study is the first prospective quantitative analysis of temporal changes in breast projection after expander-implant reconstruction. By prospectively capturing projection data with three-dimensional photographic software, we reveal a loss of projection in this population by three months post-implant exchange. These findings will not only aid in managing patient expectations, but our methodology provides a foundation for future objective studies of the breast form.

Keywords

References

  1. Hirsch EM, Seth AK, Dumanian GA, et al. Outcomes of tissue expander/implant breast reconstruction in the setting of prereconstruction radiation. Plast Reconstr Surg 2012;129: 354-61. https://doi.org/10.1097/PRS.0b013e31823ae8b1
  2. Mioton LM, Smetona JT, Hanwright PJ, et al. Comparing thirty-day outcomes in prosthetic and autologous breast reconstruction: a multivariate analysis of 13,082 patients? J Plast Reconstr Aesthet Surg 2013;66:917-25. https://doi.org/10.1016/j.bjps.2013.03.009
  3. Gui GP, Tan SM, Faliakou EC, et al. Immediate breast reconstruction using biodimensional anatomical permanent expander implants: a prospective analysis of outcome and patient satisfaction. Plast Reconstr Surg 2003;111:125-38. https://doi.org/10.1097/00006534-200301000-00021
  4. Spear SL, Pelletiere CV. Immediate breast reconstruction in two stages using textured, integrated-valve tissue expanders and breast implants. Plast Reconstr Surg 2004;113:2098-103. https://doi.org/10.1097/01.PRS.0000122406.99750.C3
  5. Eriksen C, Lindgren EN, Frisell J, et al. A prospective randomized study comparing two different expander approaches in implant-based breast reconstruction: one stage versus two stages. Plast Reconstr Surg 2012;130:254e-264e. https://doi.org/10.1097/PRS.0b013e3182589ba6
  6. Eriksen C, Lindgren EN, Olivecrona H, et al. Evaluation of volume and shape of breasts: comparison between traditional and three-dimensional techniques. J Plast Surg Hand Surg 2011;45:14-22. https://doi.org/10.3109/2000656X.2010.542652
  7. McGeorge DD, Mahdi S, Tsekouras A. Breast reconstruction with anatomical expanders and implants: our early experience. Br J Plast Surg 1996;49:352-7. https://doi.org/10.1016/S0007-1226(96)90002-8
  8. Galdino GM, Nahabedian M, Chiaramonte M, et al. Clinical applications of three-dimensional photography in breast surgery. Plast Reconstr Surg 2002;110:58-70. https://doi.org/10.1097/00006534-200207000-00012
  9. Kovacs L, Eder M, Hollweck R, et al. New aspects of breast volume measurement using 3-dimensional surface imaging. Ann Plast Surg 2006;57:602-10. https://doi.org/10.1097/01.sap.0000235455.21775.6a
  10. Losken A, Seify H, Denson DD, et al. Validating three-dimensional imaging of the breast. Ann Plast Surg 2005;54: 471-6. https://doi.org/10.1097/01.sap.0000155278.87790.a1
  11. Nahabedian MY, Galdino G. Symmetrical breast reconstruction: is there a role for three-dimensional digital photography? Plast Reconstr Surg 2003;112:1582-90. https://doi.org/10.1097/01.PRS.0000085818.54980.C4
  12. Tepper OM, Small K, Rudolph L, et al. Virtual 3-dimensional modeling as a valuable adjunct to aesthetic and reconstructive breast surgery. Am J Surg 2006;192:548-51. https://doi.org/10.1016/j.amjsurg.2006.06.026
  13. Tepper OM, Unger JG, Small KH, et al. Mammometrics: the standardization of aesthetic and reconstructive breast surgery. Plast Reconstr Surg 2010;125:393-400. https://doi.org/10.1097/PRS.0b013e3181c4966e
  14. American Society of Plastic Surgeons. 2012 Plastic surgery statistics report [Internet]. Arlington Heights, IL: American Society of Plastic Surgeons; c2015 [July 19, 2013]. Available from: http://www.plasticsurgery.org/news-and-resources/ 2012-plastic-surgery-statistics.html.
  15. Quan M, Fadl A, Small K, et al. Defining pseudoptosis (bottoming out) 3 years after short-scar medial pedicle breast reduction. Aesthetic Plast Surg 2011;35:357-64. https://doi.org/10.1007/s00266-010-9615-6
  16. Tepper OM, Small KH, Unger JG, et al. 3D analysis of breast augmentation defines operative changes and their relationship to implant dimensions. Ann Plast Surg 2009;62:570-5. https://doi.org/10.1097/SAP.0b013e31819faff9
  17. Mentor. Mentor memory gel silicone gel-filled breast implants product insert data sheet [Internet]. Santa Barbara, CA: Mentor; c2014 [July 19, 2013]. Available from: http://www.fda.gov/downloads/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ UCM245623.pdf.
  18. Eriksen C, Stark B. Early experience with the crescent expander in immediate and delayed breast reconstruction. Scand J Plast Reconstr Surg Hand Surg 2006;40:82-8. https://doi.org/10.1080/02844310500410344
  19. Tepper OM, Karp NS, Small K, et al. Three-dimensional imaging provides valuable clinical data to aid in unilateral tissue expander-implant breast reconstruction. Breast J 2008; 14:543-50. https://doi.org/10.1111/j.1524-4741.2008.00645.x
  20. Wilhelmi BJ, Blackwell SJ, Mancoll JS, et al. Creep vs. stretch: a review of the viscoelastic properties of skin. Ann Plast Surg 1998;41:215-9. https://doi.org/10.1097/00000637-199808000-00019
  21. Mustoe TA, Bartell TH, Garner WL. Physical, biomechanical, histologic, and biochemical effects of rapid versus conventional tissue expansion. Plast Reconstr Surg 1989;83:687-91. https://doi.org/10.1097/00006534-198904000-00015
  22. Zeng YJ, Xu CQ, Yang J, et al. Biomechanical comparison between conventional and rapid expansion of skin. Br J Plast Surg 2003;56:660-6. https://doi.org/10.1016/S0007-1226(03)00217-0
  23. Vegas MR, Martin Del Yerro JL. Stiffness, compliance, resilience, and creep deformation: understanding implant-soft tissue dynamics in the augmented breast: fundamentals based on materials science. Aesthetic Plast Surg 2013;37:922-30. https://doi.org/10.1007/s00266-013-0197-y
  24. Zehm S, Puelzl P, Wechselberger G, et al. Inferior pole length and long-term aesthetic outcome after superior and inferior pedicled reduction mammaplasty. Aesthetic Plast Surg 2012; 36:1128-33. https://doi.org/10.1007/s00266-012-9938-6
  25. Kaufman D. Pocket reinforcement using acellular dermal matrices in revisionary breast augmentation. Clin Plast Surg 2012;39:137-48. https://doi.org/10.1016/j.cps.2012.02.001

Cited by

  1. Novel devices for implant-based breast reconstruction: is the use of meshes to support the lower pole justified in terms of benefits? A review of the evidence vol.12, pp.None, 2018, https://doi.org/10.3332/ecancer.2018.796
  2. The Effect of Implant Type on Nipple Position Geometry and Aesthetics Following Tissue Expander Reconstruction After Nipple Sparing Mastectomy vol.38, pp.6, 2015, https://doi.org/10.1093/asj/sjx210
  3. Impact of hormonal therapy and other adjuvant therapies on contralateral breast volume change after implant-based breast reconstruction vol.45, pp.5, 2018, https://doi.org/10.5999/aps.2018.00563
  4. Accuracy of Three Software Applications for Breast Volume Calculations from Three-Dimensional Surface Images vol.142, pp.4, 2018, https://doi.org/10.1097/prs.0000000000004728
  5. New software and breast boundary landmarks to calculate breast volumes from 3D surface images vol.41, pp.6, 2015, https://doi.org/10.1007/s00238-018-1431-2