Breast implants have more shapes than before. The style 410 gummy bear implant is shaped anatomically like a breast. It is slightly firmer (requiring a slightly larger incision), and it is textured (so it doesn’t rotate- you wouldn’t want your shaped implant to be on its side or upside down.) The recommended placement is through the inframammary incision (under the breast), but many will put it through the other traditional breast augmentation incision sites (areola or armpit).
This study is from a group who does many of the style 410 through the armpit and areola. The thought is the axilla and periareolar incisions have higher complication rates (read all of my blogs about biofilm).
But is it really riskier? So they decided to use science, and they studied it.
Aesthetic Surgery Journal, January 2017. “Five Year Outcomes of Breast Augmentation with Form Stable Implants: Periareolar vs Transaxillary.” This was a retrospective study of 373 patients with a 5 year follow up.
- 81% had transaxillary incision
- 69% in front of muscle, 30% behind muscle
- 19% had periareolar incision
- 70% in front of muscle, 30% behind
- They picked in front of the muscle or behind the muscle depending on the pinch test- if greater than 2cm it was placed in front of the muscle.
- They were done under general anesthesia, prep was done with iodine, and IV antibiotics were given prior to incision. During the case they cleaned the nipple gland with iodine, the gloves were changed, and the implant was soaked in iodine. It appears they used a drain as well.
Findings:
- Reoperation was 11% for periareolar, 8% for axilla.
- Grade III – IV was reason for reoperation for most. (also implant rupture, seroma, infetion, malrotation)
Conclusion:
The rate of reoperation was in line for this type of implant. There was no statistically significant difference between the techniques, though the authors state the reoperation rate was “significantly higher when the periareolar incision was used and the implant was placed in front of the muscle.”
They did think the placement under the muscle was more associated with seroma and rupture, and under the breast (in front of the muscle) more with rotation, adherence, and capsular contracture.
My thoughts?
The most common incision is under the breast in the inframammary foldfor the style 410. The 410 is a textured implant, and as we know, texturing is associated with biofilm (which leads to capsular contracture.) Other studies have shown the IMF incision has the lowest rates of capsular contracture, and placement under the muscle has the lowest rates of capsular contracture.
This study had a large number of patients and showed their technique is viable.