Case 35 Breast Augmentation



Zachary Okhah and Richard Zienowicz

Case 35 Breast Augmentation

Case 35 (a, b) A 21-year-old female presents to your office to discuss breast augmentation.



35.1 Description




  • Hypomastia: Small A cup breasts with mild asymmetry



  • Right inframammary fold is slightly higher than the left side



  • Right nipple is slightly higher than the left nipple



35.2 Work-Up



35.2.1 History




  • Age, medical comorbidities, anticoagulant use, and smoking history



  • Pregnancy/breastfeeding history; plans for future childbearing



  • Personal history of breast disease and/or procedures, prior mammography or ultrasound



  • Family history of breast cancer



  • Current bra size and desired breast size



  • Motivation for surgery



35.2.2 Physical Examination




  • Evaluate breast shape, skin quality, and adequacy of tissue envelope (e.g., upper pole pinch thickness)



  • Identify any asymmetries (volume, nipple–areola complex, inframammary fold position) and thoracic wall abnormalities



  • Palpate for breast masses or axillary lymphadenopathy; identify skin dimpling or nipple discharge



35.2.3 Diagnostic Studies




  • American Cancer Society guidelines for clinical breast exam (CBE) and mammography should be followed




    • Clinical breast examination every 3 years for women aged 20 to 39 years



    • Breast examination annually for women aged 40 and older



    • Yearly mammograms for women aged 40 and older



  • Breast masses or lymphadenopathy discovered on physical examination should be evaluated before augmentation



35.3 Patient Counseling




  • An effective consultation establishes an accurate understanding of the patient’s goals from the surgeon’s perspective, and establishes realistic expectations of the final result from the patient’s perspective.



  • Informed consent must include management of patient expectations and thorough discussion of existing asymmetries, potential complications, rupture screening recommendations, rates of revisional surgery (approximately 20%), responsibility for cost of revisions, and eventual need for implant exchange or removal



  • Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)




    • All patients being evaluated for breast implants should be informed of the risks and common presentations of BIA-ALCL.



    • Clinical experience has shown that this process is generally well received and is not disruptive to patient interactions.



    • When counseling on implant options, patients should be informed that BIA-ALCL is a predominantly textured implant-associated disease, although it is premature to conclude at this point that it cannot occur in smooth implants.



    • Both silicone (57%) and saline (43%) implants have been linked to BIA-ALCL with no specific predilection.

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Jul 17, 2021 | Posted by in General Surgery | Comments Off on Case 35 Breast Augmentation
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