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Breast Augmentation

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Evidence-Based Cosmetic Breast Surgery

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Abstract

A supra-inframammary fold (supra-IMF) dissection preserves the inframammary fascial condensations. This safe dissection plane minimizes the risk of bottoming out or the dreaded double-bubble deformity. A trans-areola incision may be used to simultaneously correct inverted or protruding nipples. Finger dissection preserves the lateral intercostal nerve branches to the nipples. Subpectoral implant placement is preferred for optimal upper pole appearance. The lower sternal origin is released cautiously to avoid symmastia. “Dual plane” is a misnomer. Three-dimensional simulations are not yet capable of predicting postoperative appearance.

The patient’s size preference is most relevant in determining implant size, not tissue-based calculations. There is no evidence that large implant sizes (i.e., >350 cc) are especially risky. An average implant size of 390 cc is typical.

The mean overall pain rating is 5.9 on a scale of 1 (worst) to 10 (best). A 24-h recovery is unrealistic. Patients report being “back to normal” approximately 25 days after surgery and being able to sleep comfortably 18 days after surgery.

Although shaped “form-stable” implants have been heavily promoted, there is no evidence for their superiority over round implants. Their disadvantages include cost, firmness, and the possibility of malrotation. Anaplastic large cell lymphoma is linked to textured implants. Wrinkling can occur with both silicone gel and saline implants.

As expected, breast implants reliably increase breast projection, upper pole projection, and breast area. The nipple level is unchanged. The IMF normally descends after a breast augmentation. Breast self-consciousness drops from 86% before surgery to 13% after surgery. Breast augmentation reliably improves self-esteem (91%) and quality of life (64%). Nipple numbness is common after breast augmentation (39%), but persistent numbness is unusual (2.3%). Almost all women (98.7%) would repeat the surgery.

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    Eric Swanson MD

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Swanson, E. (2017). Breast Augmentation. In: Evidence-Based Cosmetic Breast Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-53958-4_3

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