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    Danish surgeon shares experiences with breast augmentation in Europe

    Decisions regarding choice of procedure, type of implant used and anesthesia protocols all impact the outcomes of breast augmentation surgery and set the stage for a smooth surgical experience, says one Danish surgeon well versed in the field.


    Dr. Saether
    Silicone and saline implants have remained the most popular choices, and advances in breast implant technology have made these options safer than ever, says Jan Saether, M.D., director of the Dan Clinic, Beder, Denmark, and past-president of the American Society of Cosmetic Breast Surgery.

    "Though there is a clear resurgence in the popularity of silicone implants, the majority of my patients still prefer saline implants. Many are more comfortable with the fact that saline is a natural substance, compared to silicone, which is often viewed by them a foreign body," Dr. Saether says.

    Saline implants conduct heat from the core of the body to the breast, Dr. Saether says, as opposed to silicone implants, which cannot conduct heat. Saline implants also look and move much more naturally. Natural appearance and movement, however, depend most on the surgical technique used.

    Dr. Saether says his technique involves creating a large subpectoral pocket leading up to the clavicle, regardless of the type of implant chosen. This larger pocket allows the implant to move up and down about 5 cm to 6 cm, he says, resulting in more natural movement of the breast. He says his patients always prefer smooth implants because they have lesser palpability than textured implants.

    "Capsular contracture most commonly occurs in the first few months following surgery. Early manual massage postop, preventing the created cavity to narrow, can help reduce the risk of capsular contracture and is best started the first day following surgery and should be continued for at least three to four weeks postop. This will help prevent the pocket from closing and keep the breast and implant free-moving," Dr. Saether says.

    VARYING TECHNIQUES Several approaches are used in breast implant surgery, including the submammary, periareolar, transumbilical and transaxillary techniques. Not all techniques are created equal, Dr. Saether says, and many surgeons often prefer one technique over another.

    "In my opinion, the transaxillary endoscopic approach is much gentler and more precise, and therefore my technique of choice. The magnification within the endoscope allows the surgeon to better visualize the tissues intraoperatively and do the dissection with more precise care. This improved vision throughout the surgery helps to reduce trauma to the tissues, resulting in minimal to no bleeding in the wound and reduced postoperative pain," Dr. Saether says.

    Interestingly, transaxillary endoscopic breast implant surgery is not popular in the United States, with only about 2 percent of surgeons using the technique, Dr. Saether says, adding that this may be due to the high investment cost of the device and the learning curve associated with the technique.

    "You have to adapt to the endoscopic technique and visually turn around everything you have learned. This can take time, and one may need to do 50 to 100 endoscopies to reach a good level of comfort with the technique," he says.

    IN-PATIENT VS. OUT Many breast augmentation procedures in the United States are performed in an outpatient setting. In contrast, Dr. Saether keeps his patients overnight for observation and to administer local anesthesia every four hours through the drain directly into the pockets created for the implants. The drains, which are typically pulled the next morning before discharge, also serve to remove any exudate from the pocket that accumulates within the first 18 hours postop and help reduce any visible bruising and reduce pain.

    "Using this technique, the patient can start doing manual massage approximately six to eight hours after the operation without any pain," he says. "When you start doing massage so early, you slowly stretch the muscle and the tissue, resulting in much less pain the following postop days and reducing the chances of capsular contracture formation."

    Dr. Saether says it is crucial to listen to patients' preferences regarding the many options available in breast augmentation surgery. According to him, 99 percent will opt for the transaxillary endoscopic approach with use of saline implants when given the choice.

    Disclosures:
    Dr. Saether reports no relevant financial interests.

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