Plastic surgeons gathered in Manchester this week for a two-day advanced course in cosmetic breast surgery. The British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) hosted the event, which attracted speakers from the UK, Belgium, Germany, Holland, Brazil, USA and Canada.
Dr Elizabeth Hall-Findlay (Banff, Alberta) provided delegates with an insight into her views on how the breast base, or ‘footprint’, and the infra-mammary fold are affected by adding or removing weight to and from the breast during breast augmentation and breast reduction surgery respectively.
Some patients will have a low breast footprint while others are high-breasted; breast augmentation surgery, which aims to centralise the implant behind the nipple, does little to change the position of the breast footprint.
However, an implant should be chosen to fit the desired breast, rather than the existing breast base, by expanding the footprint in either horizontal or vertical vectors. Dr Hall-Findlay pointed out that the infra-mammary fold will inevitably be lowered following the insertion of an implant while the upper breast border, another important landmark in breast surgery, will be raised on average by about 2cm.
Delegates also heard that Dr Hall-Findlay currently uses smooth-shelled round implants almost exclusively in her breast augmentation practice, having experienced difficulties with late seromas and double-capsules in association with aggressively textured implants.
In contrast, most UK surgeons still prefer textured implants, which are likely to lead to reduced capsular contracture rates.
There was significant discussion about the role of anatomical-shaped implants (particularly within the context of the ptotic breast), dual plane and sub-fascial pockets, and the use of polyurethane-coated breast implants.
PU implants have found a role in revisional surgery where capsular contracture has been problematic. Additionally, tissue in-growth and adherence to the polyurethane foam coating makes displacement or rotation much less likely compared with implants incorporating a silicone shell.