Current Advances for Aesthetic Improvement in Breast Reconstruction: Mimicking the Augmented Breast

Abstract

Background: Women seeking implant-based breast reconstruction increasingly request a round, projecting breast with an amplified upper pole that mimics the augmented breast. Two-stage reconstruction provides the opportunity to recreate a well-defined inframammary fold (IMF) with ptosis, to modify final implant characteristics (volume upsizing, high profile, gel implants) and correct contour irregularities with lipofilling at exchange to achieve this desired outcome. Methods/Technique: All patients completing two-stage breast reconstruction were added prospectively into a database. Patient demographics, oncologic phenotype and treatment, surgical details including IMF reconstruction, implant characteristics, and outcomes were reviewed. 2D and 3D photos and intraoperative videography were captured, further illustrating the technique. Results: 84 two-stage breast reconstructions were completed in 50 women between 5/2010-11/2013. Mean age at the time of mastectomy was 42.8 years and mean BMI was 30. At the time of exchange, the majority of implants were typically upsized from the final expansion volume, with a volume increase ranging from 10-150cc (mean increase 46cc). Mean expander fill volume and final implant volume were 595cc and 618cc respectively. Fifty-nine reconstructions (70%) included inframammary fold reinforcement. Sixty-eight (81%) of reconstructions utilized high profile or extra-high profile implants. Selective use of fat grafting was implemented later in the series. Conclusion: Current advances in two-stage implant based breast reconstruction are outlined to achieve upper pole fullness, anterior projection of the breast, and definition of the inframammary fold. These strategies afford reconstructive outcomes that parallel the desired aesthetic features of the augmented breast.

Age-dependent Characteristics in Women with Breast Cancer: Mastectomy and Reconstructive Trends at an Urban Academic Institution

“…10 We have found that a number of younger, urban women actively seek a reconstruction mimicking the augmented breast. 20 Subsequently, these women are significantly more likely to receive high or extra high profile implants with a decreasing odds of 0.94/year of increasing age (P 4 0.049) as utilization decreases from 83 per cent in the 20-year-old cohort to 0 in women over age 60 (Figs. 1 and 2).…”

“…Aspects of our surgical technique have been expanded in another publication. 20 In brief, our implant-based technique uses a two-stage reconstruction process where tissue expanders are placed initially and exchanged for permanent implants after the expansion phase. Resetting of the inframammary fold (IMF) fold, circumferential capsulotomy and implant upsizing can be carried out at the second stage.…”

“…This staging of the reconstructive process affords increased patient involvement and a shared understanding of the patient's reconstructive goals. 20 In addition, staging allows the reconstructive surgeon to bypass tissue constraints of the breast envelope when desiring a larger size. High or extra high profile implants can be implemented into the reconstructive armamentarium with careful reconstructive planning.…”

The Use of the Original Method of Restoring the Inframammary Fold During Two-Stage Breast Reconstruction

“…Первые попытки реконструкции ИмС проводились через наружный доступ [5,9,13], однако они не нашли популярности среди хирургов в результате наличия дополнительного рубца. В дальнейшем были разработаны методы восстановления складки с применением «внутреннего» доступа [3,7,11,12,15,16], которые, наряду со своими преимуществами, обладают определенными недостатками, наиболее частыми из которых являются: неровность контуров складки, умбиликации на коже [3,12,16], маленькая проекция, отсутствие возможности сформировать необходимый уровень птоза [8,12,15].…”

Significance of the inframammary crease for reconstruction of the breast and methods for its restoration (a review of literature)

“…6. Метод М. Nava: 1 -поверхностная фасция (фасция Скарпа); 2 -место рассечения капсулы эндопротеза и глубжележащих мягких тканей до поверхностной фасции, производится согласно предоперационной разметке новой ИМС; 3 -нижний свободный край поверхностной фасции; 4 -место подшивания поверхностной фасции к заднему листку капсулы эндопротеза на уровне новой ИМС [20]. Применение метода ограничено в связи с наличием умбиликаций на коже в проекции наложенных швов, а также отсутствием возможности сформировать эстетически приемлемый птоз реконструированной молочной железы.…”