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TREATMENT GUIDE | Figure 4 For a


deflated breast, the missing part is most commonly the


central mound. The round or cone-


shaped implants will perfectly fill this


distribution of volume. The nipple to


nipple distance being far larger than the suprasternal notch to nipple distance, in association with a horizontally-oriented gland footplate, may require horizontal distribution of implant’s volume (Figure 2). After having set the vertical placement


of the implant in the chest, the next step is to choose its projection. Breast tissue elasticity is one the parameters to consider here. The other one is the angle at the upper edge of the implant that better matches the chest wall transition to the gland without excessive bulging. There are usually at least four options


of implant projection: low, medium, high, and extra high. The goal is to fill a deflated, or to enlarge a small breast with the less noticeable implant and still achieve the expected augmentation.


The profile: round, anatomic, or cone-shaped After evaluating the distribution of the gland parenchyma, it is possible to add more volume where necessary. If there is a constricted lower breast, we may place a round or an anatomic implant and add


more volume at the lower pole (Figure 3). For a deflated breast, the missing part is most commonly the central mound. The round or cone-shaped implants will perfectly fill this (Figure 4). For the tall and thin patient


with a long suprasternal notch to nipple distance, the anatomic shape is the best option for its shallower angles at the upper edge, providing a smooth transition and more projection at the central mound.


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Conclusions These are the main guidelines for breast implantation, but other situations may


References


1. Handel N, Jensen JA, Black Q, Waisman JR, Silverstein MJ. The fate of breast implants: a critical analysis of complications and outcomes. Plast Reconstr Surg 1995; 96(7): 1521–33


2. Cohen BE, Biggs TM, Cronin ED, Collins DR Jr. Assessment and longevity of the silicone gel breast implant. Plast Reconstr Surg 1997; 99(6): 1597–601


3. Hammond DC, Hidalgo D, Slavin S, Spear S, Tebbetts J. Revising the


unsatisfactory breast augmentation. Plast Reconstr Surg 1999; 104(1): 277–83


4. Fryzek JP, Signorello LB, Hakelius L et al. Local complications and subsequent symptom reporting among women with cosmetic breast implants. Plast Reconstr Surg 2001; 107(1): 214–21


5. Tebbets JB. Breast implant selection based on tissue characteristics and dynamics: the TEPID approach. Plast Reconstr Surg 2002; 190(4): 1396–409


6. Tebbets JB, Adams WP Jr. Five critical decisions in breast augmentation using five measurements in 5 minutes: the high five decision support process. Plast Reconstr Surg 2005; 116(7): 2005–16


7. Adams WP Jr. The process of breast augmentation: four sequential steps to optimizing outcomes for patients. Plast Reconstr Surg 2008; 122(6): 1892–900


occur and according to the patient’s expectations and the surgeon’s experience, it is possible to adapt them for a better customisation.


Henrique P. Ladvocat Cintra is a member of the Brazilian Plastic Surgery Society, and Associate Professor of Plastic Surgery at the Ivo Pitanguy Institute


GFX, COGEL, IMPLEO Nagor Ltd


Description Founded in 1979, Nagor is the only British company dedicated to the specialist design, manufacture and supply of high quality silicone breast implants and related medical devices. Nagor’s commitment to quality is demonstrated by our ongoing research and development, which has seen investment in manufacturing processes, supported by the most


80 ❚


demanding of quality management. Customer satisfaction has led to a growing worldwide network of distribution partners in over 60 countries. Nagor is currently sponsoring a multicentre Prospective Post-Market Clinical Study to collect data on the long-term safety and performance of its gel-filled breast implants. Over 500 patients are participating in this UK study and


January/February 2012 | prime-journal.com are being followed up for 10 years..


Indications Mammary breast implants and associated devices for cosmetic and reconstruction surgery


Contact www.nagor.com


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