Einfluss der Brustdimension bei der einzeitigen Augmentationsmastopexie auf die Implantatauswahl – Erfahrungen aus 103 konsekutiven Brustaugmentationen mit nanotexturierten Silikonimplantaten

Zusammenfassung

Hintergrund Laut aktueller Studienlage weist die einzeitige Augmentationsmastopexie (AM) geringe Komplikationen auf und ist mit einer niedrigeren Reoperationsrate verbunden, als wenn ein zweizeitiges Vorgehen erfolgt. Bei der AM kann sich die Brustdimension im Vergleich zu jenen Fällen ohne zusätzliche Straffungsindikation deutlich unterscheiden. Dabei blieben diese Unterschiede nur unzureichend untersucht. In der vorliegenden Studie sollen diese zunächst quantifiziert und im Anschluss die Auswirkung der Brustdimension auf die Implantatauswahl eruiert werden. Zudem soll der Einfluss der Mastopexie auf das Outcome von Augmentationen mit runden nanotexturierten Silikonimplantaten evaluiert werden.

Patienten und Methoden Über einen Zweijahreszeitraum wurden alle Patientinnen mit primären Brustaugmentationen mit nanotexturierten Implantaten in die Studie eingeschlossen. Soziodemografische Daten, präoperative Brustmaße, Spezifikationen der eingesetzten Implantate und Komplikationen der Augmentationsgruppe ohne Straffung wurden mit jenen der Gruppe mit AM verglichen. Die Zufriedenheit der Patientinnen und der Operateure wurde mittels Likert-Skalen dokumentiert.

Ergebnisse Insgesamt wurden 206 Brustaugmentationen bei n = 103 Patientinnen durchgeführt. Das mittlere Follow-up betrug 24,0 ± 4,3 Monate. Im Vergleich zur Augmentation ohne Straffungsindikation lagen bei der AM breitere Brustbasen und größere präoperative Körbchengrößen vor, p < 0,001. In der Folge wurden bei der AM Implantate mit breiteren Durchmessern und niedrigeren Volumina (p < 0,05) ausgewählt, welche mit geringeren Projektionen verbunden waren, p < 0,001. Die Gesamtrevisionsraten nach Augmentationen ohne (n = 51) und mit Straffung (n = 52) betrugen 5,9 % und 19,2 %, p < 0,05. Die AM erhöhte gewebebedingte Revisionen von 2,0 % auf 13,4 % (p < 0,05) ohne Einfluss auf implantatbedingte Revisionen (3,9 % vs. 5,8 %, p = 0,663). Die Gesamtinzidenz von Kapselkontrakturen lag bei 1,9 %. In beiden Gruppen zeigte sich eine annähernd gleichhohe Zufriedenheit.

Schlussfolgerung Im Vergleich zu Augmentationen ohne Straffung führen präoperativ breitere Brustbasen und größere Brustvolumina zur Auswahl von signifikant unterschiedlichen Implantatdimensionen bei der AM. Nanotexturierte Implantate sind verbunden mit niedrigen Komplikationsraten, wobei ein erhöhtes Risiko für gewebebedingte Revisionen nach AM verbleibt. Weitere Studien sind notwendig, um eventuelle Vor- und Nachteile gegenüber etablierten Implantaten zu evaluieren.

Abstract

Introduction According to current studies, one-stage augmentation mastopexy (AM) is associated with only minor complications and a lower reoperation rate compared with a staged procedure. In AM, breast dimension can differ notably compared with those cases without simultaneous mastopexy. However, these differences have only been insufficiently investigated. This study aims to quantify the differences and then evaluate the effect of breast dimension on implant selection. In addition, it evaluates the influence of mastopexy on the outcome of augmentation mammoplasties with round nanotextured silicone gel implants.

Patients and Methods Over a two-year period, all patients with primary augmentation mammoplasties using nanotextured implants were included in the study. Patients’ demographic data, breast measurements, specifications of the implants placed, and complications in the breast augmentation group without mastopexy were compared with those of the group with AM. The satisfaction of patients and surgeons was documented using Likert scales.

Results A total of 206 breast augmentations were performed in n = 103 patients. The mean follow-up was 24.0 ± 4.3 months. Compared with augmentations without an indication for simultaneous mastopexy, the AM group had wider breast bases and larger preoperative cup sizes; p < 0.001. As a result, implants selected for AM had greater diameters and lower volumes (p < 0.05) and were associated with smaller projections; p < 0.001. The total revision rates after augmentations without (n = 51) and with combined mastopexy (n = 52) were 5.9 % and 19.2 % (p < 0.05), respectively. AM increased tissue-related revisions from 2.0 % to 13.4 % (p < 0.05) without having an impact on implant-related revisions (3.9 % vs. 5.8 %, p = 0.663). The overall incidence of capsular contracture was 1.9 %. Satisfaction levels were approximately equal in both groups.

Conclusion In comparison to augmentations without mastopexy, wider breast bases and larger breast volumes before surgery lead to the selection of significantly different implant dimensions in AM. Nanotextured silicone implants are associated with low complication rates, while an increased risk for tissue-related revisions of the combined procedure remains. Further studies are necessary in order to evaluate possible advantages and disadvantages over established implants.

Schlüsselwörter

Brustaugmentation - Ästhetisch-Plastische Chirurgie - nanotexturierte Implantate - einzeitige Augmentationsmastopexie - subglanduläre Augmentation - partiell submuskuläre Augmentation

Key words

Breast augmentation - nanotextured implants - subglandular augmentation - partial submuscular augmentation - one-stage augmentation mastopexy

• Literatur

• 1 Calobrace MB, Herdt DR, Cothron KJ. Simultaneous augmentation/mastopexy: a retrospective 5-year review of 332 consecutive cases. Plast Reconstr Surg 2013; 131: 145-156
• 2 Khavanin N, Jordan SW, Rambachan A. et al. A systematic review of single-stage augmentation-mastopexy. Plast Reconstr Surg 2014; 134: 922-931
• 3 Messa CAIV, Messa III CA. One-Stage Augmentation Mastopexy: A Retrospective Ten-Year Review of 2,183 Consecutive Procedures. Aesthet Surg J 2019; 39: 1352-1367
• 4 Stevens WG, Freeman ME, Stoker DA. et al. One-stage mastopexy with breast augmentation: a review of 321 patients. Plast Reconstr Surg 2007; 120: 1674-1679
• 5 Food and Drug Administration (FDA). FDA takes action to protect patients from risk of certain textured breast implants; requests Allergan voluntarily recall certain breast implants and tissue expanders from market. 24.07.2019 www.fda.gov/news-events/press-announcements/fda-takes-action-protect-patients-risk-certain-textured-breast-implants-requests-allergan Stand: 20.05.2020
• 6 Zingaretti N, Galvano F, Vittorini P. Smooth Prosthesis: Our Experience and Current State of Art in the Use of Smooth Sub-muscular Silicone Gel Breast Implants. Aesthetic Plast Surg 2019; 43: 1454-1466
• 7 Kricheldorff J, Fallenberg EM, Solbach C. et al. Breast Implant-Associated Lymphoma. Dtsch Arztebl Int 2018; 115: 628-635
• 8 Moellhoff N, Frank K, Wiggenhauser PS. et al. An algorithmic approach for diagnosis and treatment of breast implant-associated anaplastic large cell lymphoma. Handchir Mikrochir Plast Chir 2020; 52: 67-74
• 9 Collett DJ, Rakhorst H, Lennox P. et al. Current Risk Estimate of Breast Implant-Associated Anaplastic Large Cell Lymphoma in Textured Breast Implants. Plast Reconstr Surg 2019; 143: 30-40
• 10 Kang SH, Sutthiwanjampa C, Heo CY. et al. Current Approaches Including Novel Nano/Microtechniques to Reduce Silicone Implant-Induced Contracture with Adverse Immune Responses. Int J Mol Sci 2018; 19: 1171
• 11 Huemer GM, Wenny R, Aitzetmuller MM. et al. Motiva Ergonomix Round SilkSurface Silicone Breast Implants: Outcome Analysis of 100 Primary Breast Augmentations over 3 Years and Technical Considerations. Plast Reconstr Surg 2018; 141: 831-842
• 12 Sforza M, Zaccheddu R, Alleruzzo A. et al. Preliminary 3-Year Evaluation of Experience With SilkSurface and VelvetSurface Motiva Silicone Breast Implants: A Single-Center Experience With 5813 Consecutive Breast Augmentation Cases. Aesthetic Surg J 2018; 38: 62-73
• 13 Quirós MC, Bolaños MC, Fassero JJ. Six-Year Prospective Outcomes of Primary Breast Augmentation With Nano Surface Implants. Aesthetic Surg J 2018; 39: 495-508
• 14 Sim HB. Revisiting Prepectoral Breast Augmentation: Indications and Refinements. Aesthetic Surg J 2018; 39: 495-508
• 15 Sforza M, Hammond DC, Botti G. et al. Expert Consensus on the Use of a New Bioengineered, Cell-Friendly, Smooth Surface Breast Implant. Aesthetic Surg J 2019; 39: 95-102
• 16 Lam MC, Walgenbach-Brunagel G, Pryalukhin A. et al. Management of Capsular Contracture in Cases of Silicone Gel Breast Implant Rupture with Use of Pulse Lavage and Open Capsulotomy. Aesthetic Plast Surg 2019; 43: 1173-1185
• 17 Atlan M, Nuti G, Wang H. et al. Breast implant surface texture impacts host tissue response. J Mech Behav Biomed Mater 2018; 88: 377-385
• 18 Cappellano G, Ploner C, Lobenwein S. et al. Immunophenotypic characterization of human T cells after in vitro exposure to different silicone breast implant surfaces. PloS One 2018; 13: e0192108
• 19 James GA, Boegli L, Hancock J. et al. Bacterial Adhesion and Biofilm Formation on Textured Breast Implant Shell Materials. Aesthetic Plast Surg 2019; 43: 490-497
• 20 Chasan PE. Reductive Augmentation of the Breast. Aesthetic Plast Surg 2018; 42: 662-671
• 21 Castello MF, Silvestri A, Nicoli F. et al. Augmentation mammoplasty/mastopexy: lessons learned from 107 aesthetic cases. Aesthetic Plast Surg 2014; 38: 896-907
• 22 Tebbetts JB. Dual plane breast augmentation: optimizing implant-soft-tissue relationships in a wide range of breast types. Plast Reconstr Surg 2006; 118: 81-98 discussion 99–102
• 23 Barr S, Bayat A. Breast Implant Surface Development: Perspectives on Development and Manufacture. Aesthet Surg J 2011; 31: 56-67
• 24 Moyer HR, Ghazi BH, Losken A. The effect of silicone gel bleed on capsular contracture: a generational study. Plast Reconstr Surg 2012; 130: 793-800
• 25 Wong CH, Samuel M, Tan BK. et al. Capsular contracture in subglandular breast augmentation with textured versus smooth breast implants: a systematic review. Plast Reconstr Surg 2012; 130: 793-800
• 26 Barnsley GP, Sigurdson LJ, Barnsley SE. Textured surface breast implants in the prevention of capsular contracture among breast augmentation patients: a meta-analysis of randomized controlled trials. Plast Reconstr Surg 2012; 130: 793-800
• 27 Liu X, Zhou L, Pan F. et al. Comparison of the postoperative incidence rate of capsular contracture among different breast implants: a cumulative meta-analysis. PloS One 2015; 10: e0116071
• 28 Lista F, Austin RE, Saheb-Al-Zamani M. et al. Does Implant Surface Texture Affect the Risk of Capsular Contracture in Subglandular Breast Augmentation and Breast Augmentation-Mastopexy?. Aesthet Surg J 2020; 40: 499-512
• 29 Loch-Wilkinson A, Beath KJ, Knight RJW. et al. Breast Implant-Associated Anaplastic Large Cell Lymphoma in Australia and New Zealand: High-Surface-Area Textured Implants Are Associated with Increased Risk. Plast Reconstr Surg 2017; 140: 645-654
• 30 Magnusson M, Beath K, Cooter R. et al. The Epidemiology of Breast Implant-Associated Anaplastic Large Cell Lymphoma in Australia and New Zealand Confirms the Highest Risk for Grade 4 Surface Breast Implants. Plast Reconstr Surg 2019; 143: 1285-1292
• 31 Cardoso MJ, Wyld L, Rubio IT. et al. EUSOMA position regarding breast implant associated anaplastic large cell lymphoma (BIA-ALCL) and the use of textured implants. Breast 2019; 44: 90-93
• 32 FDA Food and Drug Administration. Allergan voluntarily recalls Biocell textured breast implants and tissue expanders. 2019 https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/allergan-voluntarily-recalls-biocellr-textured-breast-implants-and-tissue-expanders Stand: 08.12.2020
• 33 Sancar F. Breast Implant-Associated Lymphoma. JAMA 2019; 321: 1042
• 34 Hamdi M. Association Between Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) Risk and Polyurethane Breast Implants: Clinical Evidence and European Perspective. Aesthet Surg J 2019; 39: 49-54
• 35 Mendonca Munhoz A, Santanelli di Pompeo F, De Mezerville R. Nanotechnology, nanosurfaces and silicone gel breast implants: current aspects. Case Reports Plast Surg Hand Surg 2017; 4: 99-113
• 36 Spear SL, Pelletiere CV, Menon N. One-Stage Augmentation Combined with Mastopexy: Aesthetic Results and Patient Satisfaction. Aesthet Surg J 2000; 20: 155-164
• 37 Swanson E. All Seasons Vertical Augmentation Mastopexy: A Simple Algorithm, Clinical Experience, and Patient-reported Outcomes. Plast Reconstr Surg 2011; 128: 1282-1301
• 38 Hall-Findlay EJ. The three breast dimensions: analysis and effecting change. Plast Reconstr Surg 2011; 128: 1282-1301
• 39 Kovacs L, Eder M, Zimmermann A. et al. Three-dimensional evaluation of breast augmentation and the influence of anatomic and round implants on operative breast shape changes. Aesthetic Plast Surg 2012; 36: 879-887