PEER-REVIEW | BODY CONTOURING |
potential problem is that we do not know whether the implant will wear out in the long term owing to shearing forces. Incisions for implantation are made, in most
cases, at the natural grooves of the muscles. In the case of injuries, the old scar can be used for placement, but for other cases, a 4–5 cm incision is enough to make the pocket and to place the implant. Unlike Hodgkinson, the author does not use a transverse incision over the triceps tendon, but prefers a longitudinal incision following its edge. The author also does not use solid implants. Cohesive silicone implants behave well in these situations. They are strong enough to maintain a natural shape and are sufficiently elastic to allow normal activities, even in strenuous situations like
fitness and muscular training. The main complication so far has been displacement (one case of buttock augmentation and
one case of deltoid enhancement). These patients needed reoperation to replace the implant and reinforce the pocket. After this kind of operation, it is paramount not to train the muscles for at least 6 weeks. The author uses ultrasonography to check the position of the implant and movement in a dynamic evaluation. A closed ‘surveillance’ must be carried out in these patients and if needed, they should visit the office once per week. After this period the patient can resume normal activity.
Figure 11 (A) Montellano implant for triceps reconstruction. Muscular atrophy secondary to brachial plexus injury: (B) before and (C) postoperative result with Montellano implant (140 cc)
Incisions for
implantation are made at the natural grooves of the muscles. In the case of injuries, the old scar can be used for placement, but for other cases, a 4–5 cm incision is enough to make the pocket and to place the implant.
There are no restrictions with regard to training and exercise. The buttocks behave very well. Although it is quite painful in the first few days, the author has not experienced any seroma, haematoma, or infection using the intramuscular (Vergara’s) technique. Temporary sciatic nerve compression with pain can happen in some patients as the lower edge of the implant is located over the sciatic foramen. The intramuscular technique prevents the placement of the implant directly on the nerve; however, postoperative pain and Lasègue’s sign that some patients experience shortly after the operation seems to be related to the tension of the muscle and the extra volume caused by the surgical haematoma. It is self-limited and can be treated with NSAIDs (e.g. ibuprofen 600 mg three times per day) and relaxant drugs (e.g. metocarbamol 380 mg three times per day).
Calf implants
are also quite safe, though in the author ’s
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July/August 2014 |
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