Background:

Increased surface area of mammary implants is suggested as a causative agent for the development of biofilms, which may lead to capsular contraction. The aim of this study was to quantify the surface areas of round implants of different textures and examine how these data can be interpreted with regard to clinical observation.

Methods:

Surface areas of textured round breast implants were calculated from previously reported confocal scanning microscopic assessment, and dimensions sourced from 3 breast implant manufacturers (McGhan, Mentor, and Silimed). Statistical comparisons were made between manufacturers for different implant volumes, profiles, and texturing.

Results:

There was a difference in surface area between manufacturers for all implant profiles and between manufacturers for equivalent volume implants (F (3, 253) = 2,828.87; P < 0.001). Silimed polyurethane implants (mean area = 6.12 × 10⁶ mm²) was the highest. Natrelle (mean area = 1.2 × 10⁶ mm²) was the next highest, followed by Siltex (mean area = 4.8 × 10⁵ mm²). Mentor smooth implants (mean area = 4 × 10⁴ mm²) had the lowest mean surface area. There were no differences in surface area between the different profiles for Siltex, Silimed polyurethane, and Mentor smooth implants of the same volume.

Conclusions:

The increased surface area produced by texturing, although different between manufacturers, seems to provide protection against capsular contraction. Correlation with clinical data indicates that the surface area alone cannot account for these differences. Smooth implants, which have the smallest surface area have the highest incidence of capsular contraction. These data are at odds with the biofilm theory of capsular contraction.

Anaplastic large cell lymphoma (ALCL) is a rare form of lymphoma involving cells of the immune system. It is currently gaining interest because of an association between the development of ALCL and an increased risk in women who have had breast implant surgery. Although not confirmed, many theories exist as to the etiology of this association in women, and there is growing concern that ALCL is more prevalent in women with textured breast implants. In particular, the risk of developing ALCL appears to be related to increasing implant texturization or "surface roughness." This paper examines the current manner of defining and characterizing breast implant surface texture and challenges the appropriateness of applying this technology and linking it to ALCL. It is not a comprehensive review of the etiology of capsular contracture and ALCL, but it proposes an alternative perspective on surface texture measurements from that currently employed and its role in researching the etiology of ALCL. The authors hope that their article will provoke thought and reflection when considering the issues currently being highlighted with regard to texturing of breast implants.

The measurement of soft-tissue firmness has many potential applications in medical practice. This study reports a user-friendly, novel device that is capable of measuring changes in soft-tissue firmness in a reproducible manner. The study reports the development of the equipment and how it has been applied to breast implant surgery. The device was tested for both intra- and inter-observer variability on an in vitro model, using a breast implant. Once reproducibility was confirmed, breast firmness was measured on a series of patients who underwent sub-fascial breast augmentation (n = 50) to examine how it varied post-operatively. Firmness in the upper half of the breast increased to a maximum level two weeks post-surgery (0.44-0.61 Pa), reducing to pre-operative levels by 6 weeks (0.37-0.54 Pa). There was no further significant change at 12 weeks. Firmness in the nipple areolar complex (NAC) and at the lower outer quadrant (LOQ) followed a similar pattern, but remained firmer at 12 weeks. We interpret these patterns as implying that measurements taken at the upper half of the breast are indicative of post-operative oedema, whereas those at the NAC and LOQ represent changes in firmness produced by the breast implant composite. We consider the potential for this novel device in the measurement of soft-tissue firmness in aesthetic breast surgery and would encourage other researchers to explore novel applications. 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

Background: Sensory changes occur following breast augmentation, and describing the incidence, pattern, and course of deficit is important for informed consent.

Objectives: To examine sensory changes following subfascial breast augmentation, and the influence of change in breast volume caused by an implant.

Methods: One hundred and sixty-two consecutive patients undergoing subfascial breast augmentation were assessed for sensory changes using a Semmes Weinstein monofilament test before surgery, 2, 6, and 12 weeks postoperatively. Morphometric measurements allowed a breast volume to be calculated and the percentage change in volume produced by the implant.

Results: Most women (92.5%) regained preoperative levels of sensation in all areas of the breast, excepting the lower-outer quadrants (16.15%) by 12 weeks following surgery. Four percent of nipple-areolar complexes (NAC) failed return to preoperative levels of sensitivity by 12 weeks after surgery. Younger patients or those who have a high BMI and a measurably thicker soft tissue envelope were more likely to experience sensory deficits. Breast augmentation in this series produced calculated volume changes by an implant of between 12.1% and 102.7%. Within these limits there is no association between percentage increase in breast volume and sensory deficits.

Conclusions: The study demonstrates that for calculated volume increases of up to 102% of the initial breast volume, sensory loss at 12 weeks after surgery is 4% at the NAC. The commonest area of diminished sensitivity is the lower-outer quadrant (16.15%), relating to the use of the inframammary crease incision. It provides a useful adjunct in monitoring patient recovery following subfascial breast augmentation. LEVEL OF EVIDENCE 4: Therapeutic.

The minutes for the Annual General Meeting of the 2014 Australasian Society of Aesthetic Plastic Surgery note that there was a call by certain members to avoid the term “cosmetic” when referring to the work undertaken by the membership. Quite a lively debate ensued, when it was pointed out by one of the older (and quite possibly wiser) members, that whilst “aesthetic” may be a word commonly used within our craft group, it does not necessarily cross the path of the average member of public seeking assistance in altering some aspect of their appearance. A show of hands at the 2015 meeting in Sydney confirmed the membership's preference for the term “aesthetic” over “cosmetic.” Fortunately, the membership could all agree that they were in fact, primarily plastic surgeons!

By restricting ourselves to “aesthetic” rather than “cosmetic” surgery we might very well make ourselves incomprehensible to those who we wish to assist. There is an anxiety amongst some plastic surgeons to distinguish “what we do” from “those cosmetic surgeons,” who are, in some opinions, not surgeons at all.