Introduction: The use of gel implants in primary breast augmentation will be affected by the results of the clinical trials as well as by the recent FDA recommendations. It is expected that the use of gel implant might increase over the coming few years. The Goal of this study is to obtain data concerning the incidence of capsular contracture, complications, and outcome in patients having primary augmentation mammaplasty utilizing modern low bleed smooth-wall silicone gel implants.
Methods: This is a retrospective study of 100 consecutive patients with an average follow-up of 2 years. Data sheet collection included patient age, pre-operative assessment, implant size, shape, position, operative time, postoperative complications including capsular contracture as well as revision surgery. The patients were divided into two groups related to the type of breast implant (Mentor , Silimed), each group was further subdivided according to position of the implant ( sub glandular versus sub muscular) Exclusion criteria of this study included previous breast surgery and patients with severe ptosis who underwent mastopexy in addition to breast augmentation.
Results: The average patient age was 32 years. Average follow up was 24 month; the average operative time was 52 minutes. The over all incidence of capsular contracture (Baker III, IV) for both groups was 22.2% percent. Interestingly, only 8.4% of those patients chose to have open capsulotomies/capsulectomies.Subglandular placement of implants did not result in higher contration rates compared to submuscular placement. (10.7% versus 11.5%).Complications included implant asymmetry in one patient and pleural tear in another which was treated conservatively without any further morbidity. Two patients underwent revision, one patient for implant asymmetry and the other for scar revision.
Discussion: Preliminary data from this study indicates that subglandular placement of modern low-bleed gel implants does not increase the risk of capsular contracture. If longer follow up studies confirm these findings, surgeons will have a choice in patients with ptosis and other anatomic conditions in whom subglandular placement would yield superior results.