title: Maximizing the use of precapsular space and the choice of implant type in breast augmentation mammaplasty revisions: review of 49 consecutive procedures and patient satisfaction assessment.
abstract: BACKGROUND
  Capsular contracture, implant malposition and displacement, breast asymmetry, improper contour, and symmastia may compromise the aesthetic outcome of breast augmentation and usually require surgical correction. Correction of these deformities may be achieved by accommodating a new implant in a novel pocket created in the precapsular space in either the subpectoral or subglandular plane. This article describes a modality to correct adverse results of augmentation mammaplasty and evaluates patient satisfaction.
  
  
  METHODS
  Precapsular reaugmentation was performed in 49 patients who underwent cosmetic breast surgery revisions from 2004 to 2009. All patients had previously received breast implants but complained of implant malposition and dislocation, implant size change, capsular contracture, and symmastia. A precise neoprecapsular pocket was developed above the old anterior implant capsule wall, with dissection limited to create only the space necessary for proper placement of the implant. Patients were evaluated for resolution of symptoms, satisfaction, and complications.
  
  
  RESULTS
  Implant malposition and rippling, capsular contracture, breast asymmetry, and symmastia were the most common complaints from the first augmentation. Nineteen women had subpectoral implant placement, 12 had subglandular, and the rest (n = 18) had "dual-plane" location of their implants. We used textured silicone implants in 17 cases and polyurethane-coated prostheses in the remaining 32 cases. The average follow-up time was 24.1 months. Breast augmentation-related complications had resolved in all patients without any recurrence to date. The overall complication rate was very low and patient satisfaction with this procedure was extremely high.
  
  
  CONCLUSIONS
  The creation of a neoprecapsular pocket combined in peculiar cases with the placement of polyurethane-coated implants is a versatile option that offers an effective one-stage solution for the correction of cosmetic mammaplasty-induced deformities.
authors: Divisione di Chirurgia Plastica e Ricostruttiva, Clinica Ars Medica, Via C. Ferrero di Cambiano, 29, 00191, Roma, Italy. manuelfranciscocastello@gmail.com
authors: Manuel Francisco
authors: MF
authors: Castello
authors: Davide
authors: D
authors: Lazzeri
authors: Alessandro
authors: A
authors: Silvestri
authors: Tommaso
authors: T
authors: Agostini
authors: Christian
authors: C
authors: Pascone
authors: Claudio
authors: C
authors: Marcelli
authors: Diego
authors: D
authors: Gigliotti
authors: Carlo
authors: C
authors: D'Aniello
authors: Marco
authors: M
authors: Gasparotti
mesh_terms: D000328:Adult; D000368:Aged; D019928:Breast Implantation / Q000009:adverse effects* / Q000379:methods; D018427:Breast Implants / Q000009:adverse effects*; D015331:Cohort Studies; D003251:Constriction, Pathologic / Q000601:surgery; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D020034:Silicone Gels / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D020034:Silicone Gels