Spectrum® Mammary Implants - Mentor

0211024 Intl Spec Surg Guide 6/6/06 2:31 PM Page 1
Plane of pocket dissection
Augmentation
Results with a subglandular vs. a subpectoral
pocket plane ultimately depend on the
quality, quantity, thickness of the overlying
breast tissue, and implant soft tissue
dynamics. The best assessment of
adequate soft tissue to permit placement
of a subglandular implant is the superior
pole pinch. In a patient whose superior
pole pinch is greater than 2 cm, the subglandular
pocket may be considered with
tradeoffs vs. benefits discussed with the
patient. In a patient with a superior pole
pinch less than 2 cm, subpectoral implant
placement is recommended.
Pocket dissection
Augmentation
The submuscular pocket is dissected
initially using blunt finger dissection. An
intraoperative expander is then placed in
the pocket and overexpanded. Further
blunt finger dissection is then carried out.
Sit the patient upright to assess the
implant position.The best results will be
achieved with a blunt dissection of the
pocket. It is recommended that you use
a sizer and expand intraoperatively.
Use of drains
A drain is usually not necessary. In
patients with a loose breast envelope
(postpartum), a drain for 48 hours may be
beneficial. The ultimate use of a drain will
be at the discretion of the surgeon. It is
recommended that a postoperative drain
be used for all reconstructive patients.
Proper implant positioning
The implant must be placed in its proper
position prior to incision closure.The base
of the implant should be at the level of the
new inframammary fold. Sit the patient at
90º to assess the proper implant positioning.
Postoperative management
Assess the patient standing up the day
after surgery. If the implants appear too
low, place the breasts in a bra. If the
implants appear too high, place the
breasts in a superior strap.The implant
position should be checked daily and
external pressure adjusted until the
position is satisfactory. It is recommended
that postoperative expansion be started
2-3 days after surgery. Avoid excessive
tension too early postoperatively in the
reconstructive patient to prevent muscle
repair dehiscence.
AUGMENTATION
Spectrum® Mammary Implants
Patient before
surgery.
RECONSTRUCTION
The Spectrum implant
is placed in position.
Expansion of the
implant is achieved
by injecting saline
through the skin into
the injection dome
for up to 6 months.
Final volume is
achieved by adding
or aspirating saline
through the
injection dome.
When the final
volume is reached,
the fill tube is
removed and the
valve seals itself.
Final result is achieved.
Surgical Technique Guide
Patient before
surgery.
The Spectrum implant
is placed in position.
Expansion of the
implant is achieved by
injecting saline
through the skin into
the injection dome
for up to 6 months.
Final volume is
achieved by adding
or aspirating saline
through the
injection dome.
When the final
volume is reached,
the fill tube is
removed and the
valve seals itself.
The nipple is
reconstructed at the
time of injection dome
removal or in a separate
procedure. Final result is
achieved.
Not for distribution in USA
© January 2003 Mentor 0211024
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0211024 Intl Spec Surg Guide 6/6/06 2:31 PM Page 3
The following information
is a compilation of
research on the Mentor
Spectrum ® Mammary
Implants from multiple
sources including
the developer of
the Spectrum
Expander/Implant.
This monograph is
designed to provide
the surgeon using the
Spectrum implants with
the most current vital
technique information to
THE BREAST SURGERY MEASUREMENT TOOL
The Pre-Operative Evaluation Sheet is available in pads of 25 sheets.
This form is designed to facilitate the surgical plan.
Sample of form
LEGEND
FH = Family History
CA = Cancer
PA = Periareolar
TA = Transaxillary
AD = Areolar Diameter
Sn-N = Sternal Notch-Nipple
N-IMF = Nipple-
Inframammary Fold
SURGICAL TECHNIQUE
Augmentation
The key points for good results with the Spectrum include:
• liberal muscle release
• pocket dissection with blunt dissection and intraoperative expansion
• minimal initial lateral dissection
• proper implant positioning at the inframammary fold and adequate release of
muscle and fascia inferiorly
Reconstruction
The key points for good results with the Spectrum include:
• muscle release under direct fiber optic vision
• use of a coagulation cautery and an extension suction bovie
• complete submuscular pocket dissection beneath the pectoralis major and
serratus anterior
• pectoralis muscle release medially and inferiorly
• fixation of the IM Fold
Implant Selection
Augmentation
The width of the selected implant should be close to or equal to
the breast base. For augmentation, use a Spectrum placed 90% submuscular.
For revision augmentation, it is recommended that you select a Spectrum
placed submuscular.
optimize results.
Reconstruction
The Spectrum can be used for both immediate and delayed reconstruction.
It can be used as part of a two-stage reconstruction or as the long-term
implant in a single-stage procedure.
Incision Planning
Augmentation
The standard three incisions (IMF, periareolar, and transaxillary) can be used
with the Spectrum implants.
Corporate Headquarters
Santa Barbara, CA 93111 USA
www.mentorcorp.com
Customer Service
Tel: +1 805 879 6000
Manufacturer
Mentor
3041 Skyway Circle North
Irving, TX 75038 USA
PRE-OPERATIVE CONSULTATION
Consideration should be given to taking the following measurements during
the pre-operative consultation. These measurements will allow for optimal
pre-operative planning for the Spectrum expander/implant.
1. Nipple to IMF (taken on stretch). Allows pre-operative planning of
new inframammary fold level.
2. Breast base width. The implant base width should be equal to the breast
base width measured from the para-sternal region at the pectoralis major
origin to the lateral border of the breast. This will reduce the chances of
implant palpability as well as other complications.
3. Desired Volume. Implant volume can be determined by placing an
implant in the patient’s bra. The base diameter and desired volume are
both taken into consideration when assessing implant size.*
Injection Dome Placement
1. It is important to have a sufficient soft tissue tunnel between the
implant and the injection dome.
2. Place the dome close to the incision so that the dome can be
removed through the original incision. The dome should be
secured in a snug tunnel or sutured to prevent rotation.
3. Use a 23-gauge butterfly to fill, and allow to flush prior to filling.
4. Once volume adjustments are completed, remove the injection
dome under local anesthetic. Make a small incision close to
the dome. Grasp beyond the connector and remove the
tube before taking out the injection dome to avoid disruption
of the connector.
Injection dome placement sites
MENTOR
* Postoperative adjustability allows for compensation if there is a discrepancy
between base diameter and desired volume.
The technique described in this guide is the opinion of Hilton Becker, M.D.