title: Preoperative Saline Implant Deflation in Revisional Aesthetic Breast Surgery.
abstract: BACKGROUND
  Preoperative saline deflation is a clinically useful intervention in revisional breast surgery. It allows suspensory ligament recovery, reveals true glandular volume, and simplifies mastopexy markings. Presently unknown are the volumetric changes that occur after deflation.
  
  
  OBJECTIVE
  The authors report the three-dimensional (3D) changes that occur with preoperative deflation prior to revisional breast surgery.
  
  
  METHODS
  We reviewed available charts of revisional breast surgery patients who underwent preliminary saline implant deflation. Our protocol is deflation 4 weeks prior to revision. Three weeks following deflation, the patient is evaluated to finalize the operative plan, including the need for implants, mastopexy, and adjunctive procedures. A subset underwent 3D imaging to quantify the volumetric changes over the 3-week deflation period.
  
  
  RESULTS
  Between 2002 and 2014, 55 patients underwent saline implant deflation prior to 57 revisional surgeries. Seventeen were revised without implants and 40 with implants. The 3D subset of 10 patients showed a mean 15.2% volume increase and 0.18 cm notch-to-nipple distance decrease over the 3 weeks following deflation and prior to definitive surgical correction.
  
  
  CONCLUSIONS
  Breast volume increases and the notch-to-nipple distance decreases during the 3-week interval prior to reoperation. This "elastic breast recoil" occurs after the mass effect of the implant is removed, resulting in recovery of stretched suspensory ligaments and gland reexpansion. We believe 4 weeks is optimal for gland normalization. Ideal candidates include patients requiring secondary mastopexy without implants, implant downsizing in the same pocket, and secondary augmentation mastopexy. Preoperative saline deflation and 3D analyses are useful for preoperative planning in reoperative breast surgery.
authors.affiliation: Dr Wu is an Assistant Professor, Division of Plastic and Reconstructive Surgery, University of North Carolina, Chapel Hill, North Carolina, and a Next Generation Editor for Aesthetic Surgery Journal. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, Alabama; a Clinical Professor, Division of Plastic and Reconstructive Surgery, University of Wisconsin, Madison, Wisconsin; and is the CME/MOC Section Editor for Aesthetic Surgery Journal.
authors.forename: Cindy
authors.initials: C
authors.lastname: Wu
authors.affiliation: Dr Wu is an Assistant Professor, Division of Plastic and Reconstructive Surgery, University of North Carolina, Chapel Hill, North Carolina, and a Next Generation Editor for Aesthetic Surgery Journal. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, Alabama; a Clinical Professor, Division of Plastic and Reconstructive Surgery, University of Wisconsin, Madison, Wisconsin; and is the CME/MOC Section Editor for Aesthetic Surgery Journal.
authors.forename: James C
authors.initials: JC
authors.lastname: Grotting
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019928:Breast Implantation; D018427:Breast Implants; D005260:Female; D006801:Humans; D057910:Implant Capsular Contracture / Q000601:surgery; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D011300:Preoperative Care; D012086:Reoperation; D012189:Retrospective Studies; D055815:Young Adult