Is Rotation a Concern with Anatomical Breast Implants? A Statistical Analysis of Factors Predisposing to Rotation
I agree with Montemurro et al.1 that more meticulous and precise surgery is needed to decrease the degree of rotation, but it is also advisable to use implants with a larger vertical length to limit the horizontal dissection of the pocket, provided that the measurements of the patient`s chest and the type of patient allow it.2 Other factors that help to reduce rotation are the use of macrotexture implants,3 careful hemostasis, a highly aseptic technique, and the use of suction drains.4–6 All of these actions prevent the formation of fluids and biofilm.
In my private practice from January of 2009 to June of 2017 with 438 patients with macrotexture anatomical implants (Nagor, Glasgow, United Kingdom), we had nine patients with unilateral rotation and one patient with bilateral rotation caused by bilateral seroma. The unilateral cases were resolved with surgery with capsulorrhaphy on two planes and nonabsorbable mono-nylon sutures; in the bilateral case, both implants were changed to round ones and their size was increased by 10 percent.
With our routine, we use the subfascial plane with the subareolar approach in most patients, and when the areola size does not allow us to use the submammary approach, we always place suction drainage for 3 to 4 days. Surgery is performed with sedation and the anesthetist using pectoral and intercostal block with ultrasound control. The surgery is ambulatory, and 4 hours later the patient is discharged to home and returns the next day.
I do not agree with the opinion of the authors of the discussion,7 who consider that there are many cases of clinically undetectable rotations that can be detected only with high-resolution ultrasound. All of our patients—in the postoperative period—are advised to undergo ultrasound control yearly, and from the age of 40 onward, annual mammographic and ultrasound examinations are recommended to prevent breast cancer.
I personally use anatomical implants in approximately 70 percent of primary breast augmentations, and I consider that there is a group of patients mostly older than 35 years who prefer this type of implant because of their more natural results. Unfortunately, many colleagues discredit these devices which, when well indicated and in patients who request them, yield exceptional results. In conclusion, a suitable selection of patients is very important, and a meticulous dissection of the pocket with an electric scalpel and use of suction drains are essential to avoid serous collections that cause rotation of the implant.