Schedule Slot

Aesthetic breast augmentation (ABA) may be performed using subglandular (SG), subfascial (SF), submuscular (SM), or dual-plane (DP) implant placement, which differ in complication profiles. This study aimed to compare implant planes using a network meta-analysis (NMA).

A systematic search of Cochrane, Embase, PubMed/MEDLINE, Scopus, and Web of Science was conducted from inception through February 2026. Randomized and nonrandomized comparative studies including adult women undergoing ABA with implants placed in SG, SF, SM, or DP planes were eligible. Primary outcomes were capsular contracture (CC) and patient-reported satisfaction (PRS); secondary outcomes included infection and reintervention. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment. A random-effects frequentist NMA was conducted, reporting risk ratios (RR) with 95% confidence intervals (CI) and SUCRA-based treatment rankings (p < 0.05).

Sixty-five studies including 74,081 patients (148,162 breasts) were analyzed (SG: 21,592; SF: 3,240; SM: 45,262; DP: 18,967). PRS was assessed in a subset of studies using non-standardized instruments and was generally high across all implant planes, with no consistent differences observed; quantitative synthesis was not feasible due to substantial heterogeneity.
The NMA of CC included 26,453 patients (52,906 breasts) and demonstrated significantly lower rates with SM and DP compared with SG. Ranking analyses consistently favored DP and SM, while SG ranked least favorably.
The infection NMA included 23,071 patients (46,142 breasts). SF was associated with a significantly lower risk of infection compared with SM, whereas other comparisons were not statistically significant. Ranking probabilities favored SF and SG.
Reintervention NMA included 3,779 patients (7,558 breasts). DP and SF were associated with significantly lower reintervention rates compared with SG, and SF also showed lower rates than SM. SF ranked as the most favorable plane, while SG ranked least favorably.

Implant placement plane influences complication profiles after aABA. SM and DP were associated with lower capsular contracture rates, while SF showed favorable results for infection and reintervention, and SG consistently ranked least favorably. Patient satisfaction was generally high and comparable across planes.

For the past 25 years, we have been performing deep plane preservation facelifts using the instruments designed by Dr. Trepsat. These instruments allow for blunt, atraumatic dissection of the SMAS flap, preserving important structures of the facial anatomy. Since 2022, we have begun a series of cases using these same guides to perform preservation breast augmentation surgery, with satisfactory results when the indication is correct, using implants of less than 220cc and with pinch test coverage of 2cm or more.

In the presentation, we analyze the surgical technique and present clinical cases performed since 2022, involving 75 patients. The indications and technical details of the surgery are defined. Indications, surgical tricks, and correct selection of the expander and implant.

75 patients have undergone surgery in the last 4 years, all for bilateral breast augmentation, with a maximum volume of 220cc and a minimum of 105cc. The placement plane is subglandular, and complications and reoperations are less than 2%. The only case of REOPERATION was a unilateral capsular contracture in the first year that required replacement and capsulectomy. The patients who underwent surgery are very satisfied with the results, highlighting the absence of postoperative pain, the rapid return to daily activities, and the natural results without complications.

Breast preservation surgery in the subglandular plane is a therapeutic option with good results when the indication is correct. The surgical instruments used are Trepsat dissectors, the RENUVE round expander with remote valve, and round implants with a nanotextured Perle surface, mainly with a low or intermediate profile.

The breast implant market features several reputable, high-profile manufacturers. Many patients arrive at our clinic well-informed or with specific implant preferences based on their personal circles. A comprehensive consultation is conducted to provide full disclosure regarding implant shape, pocket selection, surgical approach, and technical differences. In our clinical practice, we frequently utilize the round Perle implant by GC Aesthetics and have performed an isolated statistical analysis of these procedures.

We collected data from all surgeries utilizing Perle implants over a 5-month period. During the observation window (october 2025 to february 2026), a total of 26 patients were treated with 52 Perle implants. The procedures were categorized into primary augmentations (17 patients), augmentation-mastopexy (6 patients) and implant exchange (3 patients).

Perle implants are available in three distinct projections: Moderate (MR), high (HR), and extra high (EHR). In our clinic, patients can trial different sizes in front of a mirror and consult with the surgeon to select the ideal dimensions (diameter and projection). Moderate projection (MR) was associated with the smallest requested volumes (16 implants between 300cc and 390cc). High projection (HR): utilized for medium-sized volumes (28 implants between 300cc and 505cc). The extra high projection (EHR) was chosen by patients seeking the largest volumes (8 implants between 400cc and 575cc). Throughout the observation period, identical sizes were used for each bilateral procedure. All implants in this cohort were placed in the epipectoral (subglandular) pocket. In 2 out of 3 exchange cases, the pocket was converted to epipectoral to counteract a "waterfall" deformity. In our view, the submuscular plane is only recommended for specific indications. All implant exchanges involved a conversion from other manufacturers to Perle.

The Perle implant has proven to be a reliable "all-rounder" in our clinic. The available size range provided a suitable solution for every patient. Due to its soft consistency and ergonomic properties, we utilize this implant for all standard indications, including primary augmentations, augmentation-mastopexies, and complex revision cases. The epipectoral pocket remained the preferred placement. To date, no postoperative complications requiring surgical revision have occurred.

Polyurethane implants are breast implants featuring a silicone elastomer shell with a
polyurethane foam outer layer designed to adhere to tissue and potentially reduce capsular
contracture.

We have used POLYURETHANE coated silicone breast implants in 20 patients in past one year
and studied various complications and the results .
In another group of 20 patients we have used conventional silicone breast implants.
Age ,ethnicity and cup size of all the patients were almost similar in both the groups.
Group A-POLYURETHANE IMPLANTS
Group B-Silicone Implants

The final results were almost comparable in both groups but there had been no complication in
the group A whereas in group B there had been one episode of implant malposition and
another seroma.

In our study we feel Polyurethane implants are much safe than silicone implants .
The porous polyurethane foam helps the implant integrate with the surrounding tissue,
improving stability.
Aim to provide stable, natural-looking results due to the improved tissue integration and gel
characteristics.
A lower incidence of complications like capsular contracture may lead to fewer revision
surgeries.
PU implants have demonstrated a favorable safety profile in postmarket studies, with no
reported cases of breast implant-associated anaplastic large cell lymphoma

Haematoma and seroma formation are significant complications in cosmetic breast surgery that impact wound healing and can increase risks of capsular contracture in patients with breast implants. The use of tranexamic acid (TXA) in breast augmentation procedures and its role in haematoma and seroma prevention remains largely unexplored. This study looked at the clinical outcomes associated with the routine use of TXA (intravenous and topical) in cosmetic augmentation mammaplasty (AM).

Retrospective analysis of prospectively collected data of 226 patients and a total of 446 breasts, examining primary AM without mastopexy, re-augmentation mammaplasty (RAM) without mastopexy and AM with peri-areolar mastopexy (AM+PAM) between 2023-2025. All patients were operated on by the senior author. Patients were included from one private hospital in the United Kingdom. All patients received both intravenous (IV) and topical TXA intraoperatively. Drains were not used in any patient. We examined patient demographics, type of implant, placement of implant, length of hospital stay (LOS) and incidences of haematoma and seroma formation or thrombo-embolic events. Patients were followed up for these procedures for at least six months.

Within our cohort there were no occurrences of haematoma, seroma or thrombo-embolic events. All of these procedures were performed as day case procedures. 75% of patients had textured implants inserted.

This preliminary report of the routine use of TXA in AM has shown its use to be safe in these procedures. It could be an effective adjunct in breast augmentation procedures to reduce rates of haematoma and seroma formation, while acknowledging the limits of this study in its sample size and lack of a control group.

Surgical success in primary breast augmentation is commonly defined by aesthetic outcome and safety parameters. However, patient motivation often centers on psychosocial improvement, particularly enhancement of self-esteem and body confidence. This study retrospectively evaluates determinants of patient satisfaction, focusing on perceived natural breast feel, early return to daily life, and self-esteem. The primary endpoint was the association between natural breast feel and overall satisfaction. Secondary endpoints included functional recovery, self-esteem improvement, and implant volume.

This retrospective single-center study includes patients who underwent primary breast augmentation at our clinic, between January 2016 and December 2025. Participants completed a standardized questionnaire assessing preoperative expectations, return to daily activities, perceived naturalness of breast feel, psychosocial outcomes, and overall satisfaction. Associations were analyzed using Spearman correlation and logistic regression. Multivariate analysis adjusted for age, implant volume, and time since surgery. Statistical significance was defined as p < 0.05.

Preliminary data demonstrate a high overall satisfaction rate of 95%. Perceived natural breast feel was significantly associated with overall satisfaction (p < 0.05), particularly in patients with implant volumes ≤350 cc. Early return to daily life was rated as highly important and significantly correlated with satisfaction (p < 0.05). Self-esteem improved significantly postoperatively (p < 0.05) and was positively associated with satisfaction.

Patient satisfaction extends beyond aesthetic outcome. Improvement in self-esteem represents a central expectation. Perceived natural breast feel and early functional recovery significantly contribute to overall satisfaction. PROM-based evaluation may enhance patient-centered outcome assessment and preoperative counseling.

There is still no consensus regarding either the nomenclature or the underlying etiology of the so-called “double bubble” deformity in implant-based breast augmentation. The literature uses a variety of terms—including bottoming out, implant displacement, lower pole deformity, lower pole retraction, and lower pole double-contour deformity—often interchangeably. Available publications are limited and consist predominantly of case reports, reflecting the ongoing ambiguity surrounding this entity.

A thorough understanding of breast anatomy and implant–tissue interaction is essential to elucidate the pathogenesis of these deformities. Differentiating between distinct anatomical and biomechanical mechanisms is crucial for establishing a rational and reproducible treatment strategy.

In this presentation, the fundamental anatomical and surgical parameters contributing to lower pole deformities are analyzed based on established anatomical studies.

On this basis, a differentiated conceptual framework is proposed. Preventive intraoperative strategies are discussed, and corrective surgical approaches are outlined and illustrated through representative clinical cases.

The periprosthetic capsule remains central to long-term outcomes of breast implant
surgery, including capsular contracture, rupture, and the inflammatory pathways implicated in BIAALCL
and BIA-SCC. Preclinical evidence on host–implant interaction is abundant but fragmented, and
no integrated synthesis has linked the native foreign body response to the modulatory effect of
pharmacological and surface-coating interventions across implant surfaces.

Two PRISMA-guided systematic reviews of murine studies on miniaturised breast implants
were conducted. Searches across PubMed, Google Scholar, Cochrane and LILACS yielded 2,812
records. The first review (n = 25 studies) characterised the native response by surface, classified per
ISO 14607:2018. The second (n = 29 studies) assessed pharmacological agents, barriers, surface
coatings, and physical therapies. Outcomes included capsular thickness, collagen organisation,
inflammatory infiltrate, and neoangiogenesis.

The native response showed a clear gradient. Smooth implants developed the thinnest capsules
with parallel collagen and an M2 macrophage polarization profile, while polyurethane induced the
thickest, most cellular capsules with active multinucleated giant cells and marked neoangiogenesis.
Intervention efficacy proved surface-dependent. Zafirlukast consistently reduced capsular thickness,
vascularisation and myofibroblast counts around textured implants but had no significant effect on
smooth surfaces; cromolyn sodium showed the opposite pattern. Corticosteroids modulated capsule
architecture but raised wound-healing and immunosuppression concerns. Acellular dermal matrix
neutralised the surface effect, with sustained improvement at 52 weeks, the longest follow-up in the
included murine studies.

Surface-dependent efficacy is a translational principle relevant to any soft-tissue implant.
ADM and leukotriene receptor antagonists emerge as the most consistent modulators. Methodological
standardisation, including ARRIVE adherence, unified roughness reporting, and longer follow-up, is
the prerequisite for meaningful clinical translation.