Reoperative Augmentation Mammoplasty: An Algorithm to Optimize Soft-Tissue Support, Pocket Control, and Smooth Implant Stability with Composite Reverse Inferior Muscle Sling (CRIMS) and its Technical Variations

Munhoz, Alexandre Mendonça; Neto, Ary de Azevedo Marques; Maximiliano, João

doi:10.1007/s00266-021-02726-1

Cited by 4 publications

(14 citation statements)

References 78 publications

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“…Therefore, it is recommended to make the dissection of a very tight pocket to minimize inferior and lateral migration during surgery 26 . And also, specific surgical technique, composite reverse inferior muscle sling (CRIMS), helps the surgeon accurately place the silicone gel implant with more stability 27 , 28 .…”

Section: Discussionmentioning

confidence: 99%

Impact on capsule formation for three different types of implant surface tomography

Jeon

Kang

Lee

et al. 2022

Sci Rep

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Although capsular contracture remains one of the major problems following silicone breast implantation, the associated mechanism has yet to be determined. This study thus aimed to investigate capsule formation and capsular contracture using three types of implants with different surface topographies in vivo. Three types of implants (i.e., smooth, macrotexture, and nanotexture) with different surface topographies were inserted in a total of 48 Wistar rats. After 4 and 12 weeks, the samples were analyzed via histological, immunohistochemical, and Western blot examination. To identify implant movement, the degree to which implant position changed was measured. And the surface topography was characterized using scanning electron microscopy. Hematoxylin–eosin staining showed that the nanotexture type implant promoted significant decreases in capsule thickness at 12 weeks (P < 0.05), while Masson trichrome staining showed decreased collagen fiber density with the same implant type. Immunohistochemical and Western blot examination revealed reduced fibrosis markers (myofibroblast, and transforming growth factor beta-1) in the nanotexture surface implant. Meanwhile, implant location evaluation found that the nanotexture and smooth surface implants had significantly increased movement (P < 0.05). The nanotexture surface implant had been found to reduce capsule formation given that it minimizes the effects of factors related to foreign body reaction.

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Section: Discussionmentioning

confidence: 99%

Impact on capsule formation for three different types of implant surface tomography

Jeon

Kang

Lee

et al. 2022

Sci Rep

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“…Although AM has yielded satisfactory outcomes, it is a technically complex procedure that involves augmentation, suspension, and implant stabilization, [1][2][3][4][5][6][7][8][9][10][11][12][13][14] and techniques that use extra support structures are consequently attractive. [15][16][17][18][19][20][21][22][23][24] Despite the results, few series contain objective measurements of implant or breast position, 18,23,24 and there are no detailed descriptions of associating support from an inferior muscular sling support with fat grafting. Our first study included primary cases and no fat grafting, because the patients had adequate tissue coverage.…”

Section: Discussionmentioning

confidence: 99%

“…61–66 Because of this lack of tissue adhesion, the pocket must be carefully created and dimensioned to avoid expansion and implant displacement, 23,24 and we therefore advocate precise, tight pocket dissection to prevent implant migration. 23,24,39,41,43,63…”

Section: Discussionmentioning

confidence: 99%

“…Finally, because of the use of the muscle sling in this hybrid technique, there is still a risk of breast animation from muscular contraction; even so, no reoperation because of muscle animation was required in our sample. 23,24…”

Section: Discussionmentioning

confidence: 99%

“…Previously defined as type IIa in our algorithm for secondary AM, 24 autologous fat grafting is indicated in patients with lower pinch test results. As for cleavage zones, we can identify subareas of the upper pole: zone I (lower limit in contact with the implant pocket), and zone II (in contact with the subclavicular area) 40,41,43 [see Video 4 (online) and Fig.…”

Section: Discussionmentioning

confidence: 99%

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Hybrid Augmentation Mastopexy with New Generation of Smooth Surface Implants: Combining the Benefits of Fat Grafting, Inferior Muscle Support, and an L-Shaped Scar

Munhoz

Neto

Maximiliano

2023

Plastic &Amp; Reconstructive Surgery

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Background: Augmentation mastopexy (AM) is a challenging procedure. Complications include implant displacement and visibility, which can be addressed, but the stability of the smooth implant surface and poor soft-tissue coverage may present limitations. This article describes a surgical technique for AM using a composite reverse inferior muscle sling associated with autogenous fat grafting. Methods: Forty-five patients (90 breasts; mean age, 37.7 ± 7.2 years) underwent hybrid composite reverse inferior muscular sling AM. An upper/medial pole area between the implant and the clavicle region and parasternal area was marked to receive fat grafting and divided into three zones. Three-dimensional imaging was used to evaluate lower pole stretch and intermammary distance. Results: The average implant volume was 265 cc (range, 175 to 335 cc). The average fat volumes in zones I/II and III were 80.1 (range, 61.6 to 95.2 cc) and 39.3 (range, 25.2 to 47.3 cc), respectively. Five complications were observed in three patients (6.6%)—minor dehiscence in two (4.4%) and nipple-areola asymmetry in one (2.2%). The lower pole stretched 11.51% (9.9 mm) and 9.8% (8.5 mm) on the right and left sides, respectively (P < 0.0001), between 10 days and 1 year postoperatively. The intermammary distance was reduced, on average, 49.9% (25.1 mm) (P < 0.001) between the preoperative value and 1 year postoperatively. Conclusions: Hybrid composite reverse inferior muscular sling has led to improved aesthetic results for patients with breast ptosis and poor tissue coverage. Fat grafting and recognizing cleavage zones are still important to obtain satisfactory results. This procedure offers a good alternative for AM candidates, providing an adequate smooth surface for implant stabilization.

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Invited Response on: Soft Weight Hybrid (SWEH) Breast Augmentation Concept: The Benefits of the Association of Small Volume Silicone Implants and Fat Grafting

Munhoz

2022

Aesth Plast Surg

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Reoperative Augmentation Mammoplasty: An Algorithm to Optimize Soft-Tissue Support, Pocket Control, and Smooth Implant Stability with Composite Reverse Inferior Muscle Sling (CRIMS) and its Technical Variations

Cited by 4 publications

References 78 publications

Impact on capsule formation for three different types of implant surface tomography

Impact on capsule formation for three different types of implant surface tomography

Hybrid Augmentation Mastopexy with New Generation of Smooth Surface Implants: Combining the Benefits of Fat Grafting, Inferior Muscle Support, and an L-Shaped Scar

Invited Response on: Soft Weight Hybrid (SWEH) Breast Augmentation Concept: The Benefits of the Association of Small Volume Silicone Implants and Fat Grafting

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