title: Transition from Round to Shaped Implants in Immediate Breast Reconstruction: Our Preferred Approach and Clinical Outcomes.
abstract: BACKGROUND
  Smooth, round, silicone implants predominate device-based breast reconstruction in the USA; despite their prevalence, complications can include bottoming out, superior contour deformity, rippling, and/or lateral malposition. This complication profile increases the need for revision surgery and subsequent patient dissatisfaction. With the resurgence of shaped, textured, silicone implants in the USA, we report the senior author's success with these devices and outline a strategy to optimize outcomes in breast reconstruction surgery.
  
  
  METHODS
  A retrospective chart review was conducted on a prospectively collected IRB-approved database of nipple-sparing mastectomies (NSMs) with immediate breast reconstruction with smooth, round, silicone implants (Group A) in 2011 in comparison to textured, shaped, silicone implants (Group B) in 2012. Changes in operative technique were highlighted and extrapolated. Outcomes were reviewed.
  
  
  RESULTS
  In Group A, 128 NSMs were performed in 76 patients. In Group B, 109 NSMs were performed in 59 patients. Thirteen percent of patients in Group A had direct to implant reconstruction as compared with 21% in Group B. Patients with textured, shaped implants were more likely to have acellular dermal matrix (61 vs 34%, p < 0.0001) than those with smooth, round implants. Patients who had smooth, round implants were more likely to have postoperative nipple malposition (18 vs 0%, p < 0.0001,) and rippling (29 vs 0%, p < 0.0001.) Patients with textured, shaped implants had fewer operative revision reconstructions as compared with those with smooth, round implants (36.71 vs 12.8%, p < 0.0001) Based on these results, our technique has evolved and has eight key technical modifications.
  
  
  CONCLUSIONS
  With a few adaptations in surgical technique, the transition to textured, shaped, silicone devices for breast reconstruction can be seamless with superior breast contour and reduced complications/revision rates.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Division of Plastic Surgery, Department of Surgery, New York-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Imahiyerobo
authors.affiliation: Division of Plastic Surgery, Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College, 425 East 61st Street, 10th Floor, New York, NY, 10065, USA.
authors.forename: Kevin H
authors.initials: KH
authors.lastname: Small
authors.affiliation: Private Plastic Surgery Practice, Grand Rapids, MI, USA.
authors.forename: Robyn
authors.initials: R
authors.lastname: Sackeyfio
authors.affiliation: Hofstra North Shore Long Island Jewish School of Medicine, Long Island, NY, USA.
authors.forename: Hannah
authors.initials: H
authors.lastname: Hoffman
authors.affiliation: Division of Plastic Surgery, Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College, 425 East 61st Street, 10th Floor, New York, NY, 10065, USA. MiaTMD@aol.com.
authors.forename: Mia
authors.identifier: http://orcid.org/0000-0002-4837-6520
authors.initials: M
authors.lastname: Talmor
mesh_terms: D062088:Acellular Dermis; D000328:Adult; D000368:Aged; D019928:Breast Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D018427:Breast Implants / Q000009:adverse effects; D005260:Female; D006801:Humans; D015414:Mastectomy, Subcutaneous; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D013997:Time Factors; D015626:Tissue Expansion / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*
keywords: Breast reconstruction; Nipple-sparing mastectomy; Round implants; Shaped implants