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Aesthetic Plastic Surgery

, Volume 36, Issue 4, pp 866–878 | Cite as

Breast Augmentation with Extra-projected and High-Cohesive Dual-Gel Prosthesis 510: A Prospective Study of 75 Consecutive Cases for a New Method (the Zenith System)

  • Egidio RiggioEmail author
Original Article

Abstract

Background

Extra-projected Natrelle 510 belongs to a new generation of silicone breast implants. A single-surgeon prospective study set out to investigate the device’s features, outcomes, and complications, and devise a proper measurement method based on the zenith system.

Methods

From December 2004 to June 2010, 75 subjects (150 implants) were enrolled in four cohorts: primary augmentation (66.7 %), primary mastopexy augmentation (17.3 %), secondary implant exchange (9.3 %), and secondary implant exchange + pexy (6.7 %). The system used to select the implant correlated the point of maximal projection (vertex-zenith) and nipple position. The surgical approach included (1) narrow pocket, preferably dual-plane; (2) device vertex 1–2.5 cm beneath nipple (zenith range = 12°–23°) related to a nipple-inframammary fold distance of 7–7.5 cm at maximal stretch and a nipple–sternum/lower-pole line distance of 4–5 cm; (3) inframammary fold lowered minimally; (4) vertex at ±1 cm from the midbreast meridian crossing the nipple; and (5) maximizing the biomechanical effects between soft-tissue dynamics, firmer gel pressure, and pectoralis major counterpressure to expand the lower skin (dynamic tension).

Results

Mean follow-up was 26.5 months (range = 6–72); in 20 subjects; follow-up was over 3 years (average = 50 months) with a 90.8 % patient satisfaction rate. This rate was lower in patients with preoperative ptosis. There was inframammary preservation with 60 % of the implants and modification in 40 % (0.80 ± 0.45 cm). The overall complication rate per implant was 16.6 % and included wound healing/scarring (7 %), malrotation (2.6 %, only 1 % after primary augmentation), rippling (2 %), capsular contracture (1.3 %), and bottoming-out (0.6 %). The revision rate was 6 %, of which 3.3 % were pocket revisions. Greater skills are required through the learning curve, patient education, case selection, planning using the nipple-vertex relationship (the zenith system), and improved surgical manipulation. Indications and contraindications were analyzed. Cosmetic results were compliant with different breast shapes, and excellent for the breast with poor projection, in thin subjects, and those with low BMI. Ptotic breast should require a larger amount of pexy, 510 did not lift the breast enough.

Conclusion

Based on vertex-nipple distance, dynamic tension, and skin extensibility, this new approach gives guidelines and methods to perform breast augmentation with extra-projected implants.

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 at www.springer.com/00266.

Keywords

Breast augmentation Extra-projected anatomical implants Silicone dual-gel prosthesis Sizing methods for breast surgery Mastopexy augmentation Biomechanical properties Implant complications 

Notes

Acknowledgments

The author thanks Enzo Mannino, M.D., and Marcello Bonavita, M.D., who helped me in the clinical management of the majority of patients enrolled in the study, and Ms. Bianca Protopapa for follow-up recruitments.

Disclosures

The author has no financial or commercial interest to declare in relation to the content of this article.

References

  1. 1.
    Maxwell GP, Gabriel A (2009) The evolution of breast implants. Clin Plast Surg 36(1):1–13PubMedCrossRefGoogle Scholar
  2. 2.
    Hedén P (2009) Mastopexy augmentation with form stable breast implants. Clin Plast Surg 36(1):91–104PubMedCrossRefGoogle Scholar
  3. 3.
    Sampaio Góes JC (2010) Breast implant stability in the subfascial plane and the new shaped silicone gel breast implants. Aesthetic Plast Surg 34(1):23–28PubMedCrossRefGoogle Scholar
  4. 4.
    Spear SL, Hedén P (2007) Allergan’s silicone gel breast implants. Expert Rev Med Devices 4(5):699–708PubMedCrossRefGoogle Scholar
  5. 5.
    Stevens WG, Pacella SJ, Gear AJ, Freeman ME, McWhorter C, Tenenbaum MJ, Stoker DA (2008) Clinical experience with a fourth-generation textured silicone gel breast implant: a review of 1012 Mentor MemoryGel breast implants. Aesthet Surg J 28(6):642–647PubMedCrossRefGoogle Scholar
  6. 6.
    Jewell M (2009) Form-stable silicone gel breast implants. Clin Plast Surg 36(1):75–89PubMedCrossRefGoogle Scholar
  7. 7.
    Hedén P, Bronz G, Elberg JJ, Deraemaecker R, Murphy DK, Slicton A, Brenner RJ, Svarvar C, Van Tetering J, Van der Weij LP (2009) Long-term safety and effectiveness of style 410 highly cohesive silicone breast implants. Aesthetic Plast Surg 33(3):430–436 discussion 437–438PubMedCrossRefGoogle Scholar
  8. 8.
    Schots JM, Fechner MR, Hoogbergen MM, Van Tits HW (2010) Malrotation of the McGhan Style 510 prosthesis. Plast Reconstr Surg 126(1):261–265PubMedCrossRefGoogle Scholar
  9. 9.
    Riggio E (2011) Misleading malrotation of the Natrelle style 510 prosthesis. Plast Reconstr Surg 127(4):1738–1740PubMedCrossRefGoogle Scholar
  10. 10.
    Riggio E (2010) Extra-projected dual cohesive silicone gel anatomical implants: innovation for breast augmentation. In: Berhardt LV (ed), Advances in Medicine and Biology, vol. 8. New York: Nova Science Publishers, pp 273–295. Available via https://www.novapublishers.com/catalog/product_info.php?products_id=22172
  11. 11.
    Maher JL, Bennett DC, Grothaus P, Mahabir RC (2010) Breast augmentation: a geographical comparison. Can J Plast Surg 18(4):44–46Google Scholar
  12. 12.
    Hedén P (2006) Breast augmentation with anatomic high-cohesiveness silicone gel implants. In: Spear SL (ed) Surgery of the Breast: principles and art, vol. 2, 2nd edn. Lippincott Williams and Wilkins, Philadelphia, pp 1344–1366Google Scholar
  13. 13.
    Tebbetts JB (2006) Dual plane breast augmentation: optimizing implant-soft-tissue relationships in a wide range of breast types. Plast Reconstr Surg 118(7):81S–98SPubMedCrossRefGoogle Scholar
  14. 14.
    Tebbetts JB (2010) Augmentation mammaplasty: quantitative tissue assessment and planning. In: Spear SL (ed), Surgery of the breast: principles and art, vol. 2, 2nd edn. Lippincott Williams and Wilkins, Philadelphia, pp 1261–1288Google Scholar
  15. 15.
    Zeng YJ, Xu CQ, Yang J, Sun GC, Xu XH (2003) Biomechanical comparison between conventional and rapid expansion of skin. Br J Plast Surg 56(7):660–666PubMedCrossRefGoogle Scholar
  16. 16.
    Smalls LK, Randall Wickett R, Visscher MO (2006) Effect of dermal thickness, tissue composition, and body site on skin biomechanical properties. Skin Res Technol 12(1):43–49PubMedCrossRefGoogle Scholar
  17. 17.
    Del Palomar AP, Calvo B, Herrero J, López J, Doblaré M (2008) A finite element model to accurately predict real deformations of the breast. Med Eng Phys 30(9):1089–1097PubMedCrossRefGoogle Scholar
  18. 18.
    LaRoche DP, Lussier MV, Roy SJ (2008) Chronic stretching and voluntary muscle force. J Strength Cond Res 22(2):589–596PubMedCrossRefGoogle Scholar
  19. 19.
    Gefen A, Dilmoney B (2007) Mechanics of the normal woman’s breast. Technol Health Care 15(4):259–271PubMedGoogle Scholar
  20. 20.
    Carp SA, Selb J, Fang Q, Moore R, Kopans DB, Rafferty E, Boas DA (2008) Dynamic functional and mechanical response of breast tissue to compression. Opt Express 16(20):16064–16078PubMedCrossRefGoogle Scholar
  21. 21.
    Tebbetts JB, Teitelbaum S (2010) High- and extra-high-projection breast implants: potential consequences for patients. Plast Reconstr Surg 126(6):2150–2159 discussion 2160–2167PubMedCrossRefGoogle Scholar
  22. 22.
    Spear SL, Murphy DK, Slicton A, Walker PS (2007) Inamed silicone breast implant core study results at 6 years. Plast Reconstr Surg 120(Suppl 1):8S–16S discussion 17S–18SPubMedCrossRefGoogle Scholar
  23. 23.
    Jewell ML, Jewell JL (2010) A comparison of outcomes involving highly cohesive, form-stable breast implants from two manufacturers in patients undergoing primary breast augmentation. Aesthet Surg J 30(1):51–65PubMedCrossRefGoogle Scholar
  24. 24.
    Spear SL, Dayan JH, West J (2009) The anatomy of revisions after primary breast augmentation: one surgeon’s perspective. Clin Plast Surg 36(1):157–165PubMedCrossRefGoogle Scholar
  25. 25.
    Bengtson BP, Van Natta BW, Murphy DK, Slicton A, Maxwell GP (2007) Style 410 highly cohesive silicone breast implant core study results at 3 years. Plast Reconstr Surg 120(Suppl 1):40S–48SPubMedCrossRefGoogle Scholar
  26. 26.
    Bengtson BP (2009) Complications, reoperations, and revisions in breast augmentation. Clin Plast Surg 36(1):139–156PubMedCrossRefGoogle Scholar
  27. 27.
    Brown MH, Shenker R, Silver SA (2005) Cohesive silicone gel breast implants in aesthetic and reconstructive breast surgery. Plast Reconstr Surg 116(3):768–779 discussion 780–781PubMedCrossRefGoogle Scholar
  28. 28.
    Hedén P, Jernbeck J, Hober M (2001) Breast augmentation with anatomical cohesive gel implants: the world’s largest current experience. Clin Plast Surg 28(3):531–552PubMedGoogle Scholar
  29. 29.
    Matteucci P, Le Roux F (2004) Double capsules related to dynamic malrotation of breast implants: a causal link? Br J Plast Surg 57(3):289PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and International Society of Aesthetic Plastic Surgery 2012

Authors and Affiliations

  1. 1.Plastic and Reconstructive Surgery UnitFondazione IRCCS Istituto Nazionale TumoriMilanoItaly

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