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Introduction: Hyaluronic acid has come to represent the most widely used injectable cosmetic product in the world. Brought into being by the Swedish company Q-Med, in 2007 Macrolane™ was authorized for use in France, and the year after, it received official European approval as a means of breast augmentation. Since then, however, numerous controversies pertaining to its side effects have led to its withdrawal from the worldwide breast augmentation market. The objective of this article is to carry out a review of the literature providing updated information on Macrolane™ and its recent indications., Materials and Methods: We carried out a review of the literature on the PubMed and PubMed Central data bases through use of the keywords "Macrolane™", "NASHA", "hyaluronic acid" and "soft filler", and subsequently analyzed the levels of evidence and possible biases of the different publications. The official sites of the French, English, Spanish and American scholarly organizations of plastic surgery were likewise consulted. Perusal of the notifications and recommendations for use brought out by the Q-Med company completed our study., Results: A large majority of the available clinical series on Macrolane™ with regard to not only breast augmentation, but also its other indications, offer an insufficient level of evidence and present a number of conflicts of interest. Since April 2012 Macrolane™ has been temporarily withdrawn by its distributors from the worldwide breast augmentation market. In point of fact, Macrolane™ injections have been found to interfere with breast imaging and screening for breast cancer. As regards the latest indications for this controversial product, it is not yet possible to step back and take stock., Conclusions: Present-day scientific data fail to justify the market reappearance of Macrolane™ breast augmentation products. Q-Med has shown full awareness of the problem by imposing worldwide restrictions on products aimed at penis as well as breast enlargement. Larger cohorts of female patients are more necessary than ever, as is an approach based on stepping back and taking stock., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Study Purpose: The funnel chest or pectus excavatum (PE) is the most common congenital deformity. In women, it can be associated in some cases with breast asymmetry. It is the main cause of consultation in these patients. We report our management of this malformation by thoracic silicone prothesis modeled by computer-aided design., Materials and Methods: Two correction procedures are proposed: One-stage procedure including thoracic silicone prothesis or breast implants only, or two-stage procedure by the combination of the two techniques in two steps., Results: Between 1998 and 2011, 31 patients had a PE, within 26 patients were treated for breast asymmetry associated with a PE. The average age was 23.1 years (15-39). The median follow-up was 65 months (24-86). Type I Chin was found in five cases (19%), type II in two cases (7.7%) and type III Chin was found in 19 cases (73%). Of these 26 patients, in both cases a breast augmentation with asymmetric volumes of implants (7.7%) has adequately corrected the problem. Thoracic endoprothesis was performed in 24 patients to treat the initial breast asymmetry. Twenty-one patients (87.5%) were satisfied with the final symmetry and have not required a breast augmentation. Three patients (12.5%) underwent a second surgical procedure to correct the initial breast asymmetry., Conclusions: Breasts asymmetries associated with PE can be adequately corrected using an isolated thoracic endoprothesis. Whether it remains a lack of results, perform an unilaterally or bilaterally breast augmentation in a second time is always possible., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Authors present their personal and original experience in the use of computer to enhance the precision in the good choice of volumes and shapes in the field of mammary reconstruction and aesthetic augmentation (800 cases). Concerning funnel chest (163 cases) and Poland syndrome (12 cases), they use computer-assisted conception and custom-made implants, much more precise than traditional plaster cast., (Copyright © 2010. Published by Elsevier SAS.)

Too much a long time the manufacture of the breast implants does not have the object of a specific regulation. This lack led partly to the prohibition of the implants filled with silicone in 1995. It took 10 years for the European Union to create and to set up a standard EC specific to the breast prosthesis. It's the history of these steps as well on the level of Europe as has the French scale as we report you. Initially classified as implantable devices of IIb level, the breast implants were reclassified on level III in 1993, the highest level of requirement of CE marking. In accordance with the recommendations of the group of experts named by the Afssaps, the technical standard IN ISO 14630:1997, fixing the mechanical properties of the prosthesis, is in the course of revaluation since 2004. According to Council Directive 93/42/EEC of the June 14th 1993, the French government instituted a materiovigilance specific to the breast implants. All these evolutions allow, now a serene use of the breast implants.

Good selection of mammary implant volume is essential to satisfy patient's real desire of breast augmentation. The authors have developed a data processing called "Morphosein": it is an active press-i-book, allowing recording and exploitation of basic morphologic datas before and after operating procedure. They use Filemaker Pro as basic software and database, which is fed with personnal patients. This tool allows a comparative research on patients having a similar morphologic and on results obtained with different types of implants. These datas, store since 4 years, give to the authors' objective informations to help the patient's choice.

Breast augmentation offers a high rate of satisfaction but the local complications remain frequent. These are mainly capsular contracture, malpositions of implant, acute or infraclinical infections. The causes of these complications are multifactorials. The goal of this chapter is to determine the effect of the surgical technique on the result. We think that if no routine procedure can be proposed, a reflexion on the objectives of the breast augmentation and the adaptation of the surgical technique is necessary for each surgeon. We identify twelve aims and discuss them: rigorous preoperative planning, determination of the position of the implant, creation of an adapted implant pocket, as much atraumatic as possible dissection, no bacterial contamination, no foreign particles, respect of the implant, drainage or not, efficient suture, pain and discomfort control, need for contension and clear postoperative advices. These objectives being precised, we integrate them in a chronological surgical process under the form of questions. Each surgeon can then choose his answers by evaluating the arguments, which led to his choices.

The use is to oppose silicone and saline implants. Both are used in regular practice. What are the arguments to choose in between the two types? We separated three different criteria groups: prosthesis characteristics, surgical procedures and complications. For each criterion we made a review of literature looking for arguments in favour or against silicone or saline implants. The number of criteria to choose the correct type of prosthesis is very important. We conclude that surgeon experience; desires of the patient and evolution of prosthesis are the most important criteria.

The results of long-term follow-up of surgical site infection (SSI) after aesthetical breast surgery are reported. 205 consecutive patients operated from 1/2000 to 3/2002 were followed for at least one year. Postoperative incidents were observed in 26 (12.7%) patients, including SSI in six (2.9%) patients. After surgery, the mean time to SSI was 113 days, with only two cases in the first postoperative month. In all SSI cases, no antibiotic prophylaxis had been given. The causative role of infectious agents in breast implant capsule occurrence is under investigation.

Subject: The main mechanical side effect of saline or hydrogel filled implants is deflation. The aim of this study was to analyse the prosthetic deflation rate in the last 7 years in the plastic surgery unit of Toulouse., Patients and Methods: We tracked 650 patients operated on between july 1993 and july 2000 (representing 1117 primary implants) which we separated in two groups: the first group contained patients in need of breast reconstruction; the second group contained all the patients with implants placed for aesthetic or breast asymMetry reasons. For each of the two groups we determined the number and the type of implants, as well as the rate and the mean delay after which deflation occurred., Results: During this period, we've determined that: rate of deflation of group 1 (reconstruction) is highest than group 2 (aesthetic), despite sort of implant; rates of deflation of pre-filled hydrogel implants are highest than rates of deflation of pre-filled saline implants., Discussion: Only a few series concerning implants deflation have been described in the literature. We can find a large difference in results which vary from 2 to 76%. We were surprised by the result of our series with a rate of deflation up to 15% with a medium follow-up 5 years in both groups and a mean delay before the fourth year. Deflation's factors are numerous: type of sterilisation, rippling, texture, valve's incompetence, prosthetic patch, guarantee control and iatrogenic causes. Because the silicone gel implants (the one uncomplicated by deflation) were taken off the french market, the saline implants tried to supplant them but without satisfactory results., Conclusions: With the unacceptable rate deflation of implants in our study, the return in the french market of silicone gel implants seems us an acceptable alternative.

Summary: Authors present their personal and original experience in the use of computer to enhance the precision in the good choice of volumes and shapes in the field of mammary reconstruction and aesthetic augmentation (800 cases). Concerning funnel chest (163 cases) and Poland syndrome (12 cases), they use computer-assisted conception and custom-made implants, much more precise than traditional plaster cast. [Copyright &y& Elsevier]

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Summary: Study purpose: The funnel chest or pectus excavatum (PE) is the most common congenital deformity. In women, it can be associated in some cases with breast asymmetry. It is the main cause of consultation in these patients. We report our management of this malformation by thoracic silicone prothesis modeled by computer-aided design. Materials and methods: Two correction procedures are proposed: One-stage procedure including thoracic silicone prothesis or breast implants only, or two-stage procedure by the combination of the two techniques in two steps. Results: Between 1998 and 2011, 31 patients had a PE, within 26 patients were treated for breast asymmetry associated with a PE. The average age was 23.1 years (15–39). The median follow-up was 65 months (24–86). Type I Chin was found in five cases (19%), type II in two cases (7.7%) and type III Chin was found in 19 cases (73%). Of these 26 patients, in both cases a breast augmentation with asymmetric volumes of implants (7.7%) has adequately corrected the problem. Thoracic endoprothesis was performed in 24 patients to treat the initial breast asymmetry. Twenty-one patients (87.5%) were satisfied with the final symmetry and have not required a breast augmentation. Three patients (12.5%) underwent a second surgical procedure to correct the initial breast asymmetry. Conclusions: Breasts asymmetries associated with PE can be adequately corrected using an isolated thoracic endoprothesis. Whether it remains a lack of results, perform an unilaterally or bilaterally breast augmentation in a second time is always possible. [Copyright &y& Elsevier]

Summary: Study Purpose: For ten years the market for resorbable fillers has seen a large increase. A CE mark is sufficient for its placing on the market, they do not require AMM because they are not considered drugs. The Macrolane® is a hyaluronic acid NASHA gel-based technology, available on the French market since 2007 as filler used in all areas of the body except face and breasts. It is highly crosslinked, which slows its resorption, leaving in place long-term waste. At end of 2008, Macrolane® received a CE mark for breast augmentation. The aim of this paper is to review current scientific knowledge on the Macrolane™ and list the many uncertainties regarding its recent breast indication. Materials and methods: We reviewed the PubMed literature and study levels of evidence on Macrolane®. All AFFSAPS communication and correspondence with the SOFCPRE on hyaluronic acids and particularly Macrolane™ were collected. Results: At the moment there is no scientific study of high level of evidence which has studied the effects of Macrolane® on breast parenchyma in terms of carcinogenesis or the disruption of radiological monitoring of the breast. The subglandular method of injection remains complex and uncertain especially about the risk of wrong passage. Conclusions: The Macrolane® is proposed as an alternative less invasive than breast implants. Nevertheless the lack of scientific data on this product led to its non approval by the Food and Drug Administration in the United States. Currently there remains too much uncertainty on this filler for reasonable use plebiscite. It would therefore be preferable to return to the manufacturer the burden of proof of Macrolane® safety and security and limit its use in clinical trials yet. [ABSTRACT FROM AUTHOR]

Abstract: Breast augmentation offers a high rate of satisfaction but the local complications remain frequent. These are mainly capsular contracture, malpositions of implant, acute or infraclinical infections. The causes of these complications are multifactorials. The goal of this chapter is to determine the effect of the surgical technique on the result. We think that if no routine procedure can be proposed, a reflexion on the objectives of the breast augmentation and the adaptation of the surgical technique is necessary for each surgeon. We identify twelve aims and discuss them: rigorous preoperative planning, determination of the position of the implant, creation of an adapted implant pocket, as much atraumatic as possible dissection, no bacterial contamination, no foreign particles, respect of the implant, drainage or not, efficient suture, pain and discomfort control, need for contension and clear postoperative advices. These objectives being precised, we integrate them in a chronological surgical process under the form of questions. Each surgeon can then choose his answers by evaluating the arguments, which led to his choices. [Copyright &y& Elsevier]