Management of breast implant malposition. Literature review

Abstract

Breast augmentation mammoplasty (BAM) remains the most common surgical procedure for women. According to ISAPS data, 1685471 women underwent BAM in 2021. At the same time, there is a high percentage of reoperations after primary breast augmentation, including breast implant malpositions (BIM): 4.7%‑5.2% after primary BAM and approximately 10% after revision BAM. These statistics refer only to severe BIM, which causes significant changes in the shape and contour of the breast and makes it look ugly. If all degrees of BIM severity are taken into account, its incidence may be much higher. The tendency of a foreign body to dislocate is a common medical problem. Implants are no exception, especially since their fixation cannot be recognized as absolute. Therefore, BIM is, to some extent, an expected complication. This literature review is devoted to one of the controversial problems of aesthetic surgery: the management of breast implant malposition (BIM) after augmentation mammoplasty. The review provides a critical analysis of the data on the classification, etiology, pathogenesis, diagnosis of ВIM, and assessment of its severity. The methods of treatment of ВIM, including the use of own tissues and additional materials, are comprehensively covered, with an emphasis on controversial aspects. The approaches to the prevention of ВIM are outlined. According to the literature, the frequency of ВIM is not known for certain since no quantitative or even qualitative assessment of its degree has been developed so far. This also limits the ability to compare the results of different treatments for ВIM in terms of the frequency and severity of malposition. Risk factors are not sufficiently assessed, and as a result, there are no generally accepted algorithms for their prevention and treatment. There is a lack of comparative studies of implant malposition treatment methods. Most studies include different revision surgeries, different anatomical implant placement planes, different implant styles, and different follow‑up durations for postoperative patients. Because of this and the lack of standardization in research, it is unclear which procedures achieve the best results. Further research is needed on the prevention and treatment of MIMS.