Thomas M. Biggs

augmentation Mammaplasty: A Comparative Analysis

With the continuation of augmentation mammaplasty as a desirable operation for a large segment of the female population in the United States, the problem of fibrous capsular contracture that has been present since the inception of the operation has persisted. Various approaches to the problem have been entertained, and a lessening of the incidence has occurred as reviewed in our earlier report, which follows augmentation mammaplasty in our clinic from 1962 through 1979. In this retrospective study, no significant difference in contracture rate was seen based on patient smoking habits, operative approach used, or implant type. It is important to note that the total experience with the low-bleed implant was significantly lower in terms of number of patients meeting the criteria of this retrospective study than the standard gel mammary implant. Greater follow-up time and number of patients will be evaluated in future retrospective studies. We have demonstrated in this study that placement of the implant beneath the pectoral muscle has significantly diminished the incidence of capsular contracture both as Baker grades II, III, and IV and as Baker grades III and IV. The retropectoral site has become the preferred location for the prosthesis in our clinic. There is no appreciable alteration in the overall shape of the breasts from this approach, and therefore, it will continue to be the preferred method. Rates of incidence of hematoma, the most frequent adverse reaction after contracture, were not significantly different between the retropectoral and retromammary implant sites. An interesting, and somewhat unexpected, outcome of the study was the significantly higher contracture rate seen with the use of steroids versus no steroids in the pocket. This observation deserves further study.

Augmentation Mammaplasty: A Review of 18 Years

We have reviewed the experience of our clinic since 1962, when the first augmentation mammaplasty using a silicone implant was performed. All-inclusive, this review of 1,567 patients has taken us through a metamorphosis of improved prostheses and refined surgical and postoperative techniques that have resulted in a significantly lower incidence of breast firmness. Since the purpose of all aesthetic surgery is to improve the quality of life of the patient through an enhancement of her or his own self-image, the results of present-day augmentation mammaplasty with the Silastic gel prosthesis indicate that this surgery is worthwhile and should be continued. It is anticipated that further improvement in results will be noted when the problem of subclinical infection is resolved.

Adipose compartments of the upper eyelid: anatomy applied to blepharoplasty.

Many authors have indicated the presence of ectopic or accessory upper eyelid fat pads, but the effective rate of eyelid fat variations and the corresponding clinical features are still unclear. The purpose of this study was to evaluate the variability of upper lid fat and to define the anatomical landmarks of the adipose pockets of the upper lid. From January of 1998 to January of 2002, the authors investigated the upper eyelid fat compartments of 47 patients who underwent upper blepharoplasty. To support surgical findings, 11 fresh cadavers were also investigated; the anatomy of the intraorbital fat and of the upper eyelid fat compartments was reviewed. Ten patients (21.3 percent) showed an accessory fat pad in the upper lid, which was found on both sides in nine cases. In all patients, the third fat pad was situated lateral to the two classic compartments described by Castanares, behind the orbital septum. Surgical dissections demonstrated that this fat pad derived from the preaponeurotic fat. Anatomical dissections in three cadavers demonstrated an accessory fat compartment protruding under the inferior border of the lacrimal gland. This protruding fat derived from the preaponeurotic fat in all cases and might justify the clinical appearance of a bulge or fullness in the lateral third of the upper eyelid. In the authors’ experience, the presence of an accessory upper eyelid fat pad was a frequent finding during blepharoplasty; it could be found and actually resected in about 21 percent of all cases. Surgical and experimental findings put this element as a lateral physiological extension of the preaponeurotic fat that can anteriorly protrude under the inferior border of the lacrimal gland toward the orbital septum. The clinical appearance may be a bulge or fullness in the upper eyelid, and its resection can better define the lateral one third of the supratarsal fold.

Simultaneous bilateral breast reconstruction using latissimus dorsi myocutaneous flaps: a retrospective review of an institutional experience.

&NA; A single institutions experience in the simultaneous reconstruction of both breasts using bilateral latissimus dorsi myocutaneous flaps is presented. The procedure was performed on 24 patients by the attending staff of the department of plastic surgery at St. Joseph Hospital in Houston, Texas, between 1979 and 1999. Of the 24 patients reviewed, six had immediate reconstructions, 13 had delayed primary reconstructions, and five had secondary reconstructions of failed or unsatisfactory primary procedures. In the group with delayed reconstructions, the average time between mastectomy and reconstruction was 46.4 months, with a range from 7 days to 21 years. The operative method, results, and outcomes of our experience in these patients is presented. (Plast. Reconstr. Surg. 108: 1174, 2001.)

Mastopexy in conjunction with subcutaneous mastectomy.

A subcutaneous mastectomy without mastopexy can result in downward directed nipples, over-augmentation or asymmetry in cases of contralateral reconstruction. A mastopexy can prevent these problems without adding to the morbidity or complicating the procedure. The procedure described provides a dermal sling to support the implant and give greater protection to the implant through the closure.

Breast reconstruction after mastectomy

The mastectomy patient presenting to the plastic surgeon often relates a profound sense of deformity. The current state of the art in breast reconstruction allows the plastic surgeon to intelligently address this deformity with procedures capable of achieving pleasing aesthetic results. If adequate soft tissue is present, implantation in the submuscular plane has proved satisfactory. However, if soft tissue deficiencies exist, highly acceptable results have been consistently achieved using the latissimus dorsi myocutaneous flap.