Which is the best position for the remote injection dome using the adjustable expander/prosthesis in breast...

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Biomedical Engineering

Background:

• Breast reconstruction commonly uses mammary implants, with adjustable expanders requiring an injection dome for filling.
• Traditional injection dome placement in the lower lateral thoracic or axillary area can cause patient discomfort, pain, and kinking of the filling tube.
• Patient complaints prompted an investigation into alternative injection dome locations.

Purpose of the Study:

• To compare the parasternal position with the lower lateral thoracic position for the injection dome in breast reconstruction using adjustable implants.
• To evaluate patient-reported outcomes including pain, discomfort, ease of injection, and aesthetic appearance.
• To assess technical complications such as filling tube kinking and dome rotation.

Main Methods:

• A comparative study involving 260 patients undergoing breast reconstruction with Becker adjustable implants.
• Patients were divided into two groups: Group A (130 patients) with injection domes in the lower lateral thoracic area, and Group B (130 patients) with domes in the parasternal area.
• Data collected included pain, discomfort, ease of injection, pain during puncture, aesthetic appearance, and risk of kinking/rotation, with an average follow-up of 1.6 years.

Main Results:

• The parasternal position (Group B) showed a statistically significant improvement in aesthetic appearance compared to the lower lateral thoracic position (Group A) (p < 0.05).
• Patients in the parasternal group reported significantly less pain during puncture than those in the lower lateral thoracic group (p < 0.05).
• No significant differences were noted in overall discomfort or ease of injection between the two groups.

Conclusions:

• The parasternal placement of the injection microdome offers advantages in breast reconstruction, specifically reduced pain during puncture and enhanced aesthetic outcomes.
• This alternative positioning addresses patient discomfort and potential technical issues associated with the traditional lower lateral thoracic site.
• Further discussion on the advantages and disadvantages of both locations is warranted.