1. Mama e Face Licenciatura em Engenharia Biomédica Biomaterias II IST/FML Serviço de Cirurgia Plástica, Reconstrutiva e Maxilo-Facial Hospital de Santa Maria – Lisboa Manuel Caneira

2. Breast

4. Breast implants - History The first surgical breast augmentation procedure was introduced in 1890 The first surgical breast augmentation procedure was introduced in 1890 –Paraffin injections approach led to Infections Infections hardening of the breasts hardening of the breasts lump formations lump formations By 1920 the paraffin injection breast augmentation technique was totally abandoned. By 1920 the paraffin injection breast augmentation technique was totally abandoned.

5. Breast implants - History Fat transplants in the 1920s Fat transplants in the 1920s –Fatty tissue was surgically removed from the abdomen and buttock area and transferred into the breasts –unsuccessful because the body would quickly reabsorb the fat, leaving the breasts in a lumpy, asymmetrical condition. –The prominent scar that resulted at the removal site also made this breast augmentation approach undesirable –no longer performed by the 1940s.

6. Breast implants - History Japanese prostitutes began to use silicone shots during World War II for breast augmentation to supposedly lure American servicemen. Japanese prostitutes began to use silicone shots during World War II for breast augmentation to supposedly lure American servicemen. By the early 1960s this breast augmentation procedure had become popular amongst topless dancers in the Las Vegas and San Francisco area. By the early 1960s this breast augmentation procedure had become popular amongst topless dancers in the Las Vegas and San Francisco area. Soon after the surge of popularity with silicone shots came reports of serious complications in the mid-1960s. Soon after the surge of popularity with silicone shots came reports of serious complications in the mid-1960s. –chronic inflammation –infections that can necessitate mastectomy –organ damage due to silicone migration –tumor like lumps. –Since this type of breast augmentation complications surfaced the procedure has been eliminated from mainstream, though it continues to be performed in underground circles.

7. Breast implants - History In the 1950s, polyvinyl sponges began to be implanted into the breasts for breast augmentation In the 1950s, polyvinyl sponges began to be implanted into the breasts for breast augmentation Different types of synthetic sponges were also available Different types of synthetic sponges were also available –Initial satisfaction with this type of breast augmentation was very temporary –The breast implants were found to shrink and harden within a year –removal of the sponges disfigured some women and was impossible for others –Infections, inflamed tissue, and a link between this type of breast augmentation surgery and cancer began to surface.

8. Breast implants - History The first silicone breast implant was developed in 1961. The first silicone breast implant was developed in 1961. In 1963 this breast augmentation surgery began to be marketed and continual improvements were attempted for the thirty years that followed. In 1963 this breast augmentation surgery began to be marketed and continual improvements were attempted for the thirty years that followed.

9. Breast implants - History The complications with silicone breast implants included capsular contracture The complications with silicone breast implants included capsular contracture –solution to combat it was attempted by covering the implant with polyurethane foam in 1982 A decade later, after more than 100,000 U.S. women had gotten this type of breast augmentation A decade later, after more than 100,000 U.S. women had gotten this type of breast augmentation FDA released a report that showed polyurethane foam can break down into the body and form a carcinogen FDA released a report that showed polyurethane foam can break down into the body and form a carcinogen The manufacturer withdrew the implant The manufacturer withdrew the implant By the late 1980s the gel was found to lead out of the sac and into the body, raising safety concerns By the late 1980s the gel was found to lead out of the sac and into the body, raising safety concerns

10. Breast implants - History In 1995, Europe launched a trilucent breast implant, which was filled with fat from soybean oil. In 1995, Europe launched a trilucent breast implant, which was filled with fat from soybean oil. –This was seen as a natural approach to breast augmentation, and about 9,000 women worldwide received this procedure before the 1999 withdrawal. –This breast augmentation technique was found to contain filler that could become toxic in the body as it breaks down. –This type of breast augmentation surgery was never approved in the U.S.

11. Breast implants - History In 1988, Dow Corning, one of the silicone breast implants largest manufacturer settled a class action lawsuit for $3.2 billion for 170,000 women. In 1988, Dow Corning, one of the silicone breast implants largest manufacturer settled a class action lawsuit for $3.2 billion for 170,000 women. –In 1999, the Institute of Medicine issued a 400- page report that concluded the silicone breast implants do not cause major illnesses –The main concern with that type of breast augmentation surgery was the tendency for the implant to leak or rupture, leading to infections, hardening, and breast tissue scarring

12. Breast implants - History The FDA approved saline implants that had been on the market for years but had not yet received approval. The FDA approved saline implants that had been on the market for years but had not yet received approval. There was a warning issued by the FDA regarding the alarmingly high rate the saline implants break at, requiring additional breast augmentation surgeries. There was a warning issued by the FDA regarding the alarmingly high rate the saline implants break at, requiring additional breast augmentation surgeries.

13. Breast implants - History Most recently, in 2001, the Brava Breast Enhancement and Shaping System hit the market. Most recently, in 2001, the Brava Breast Enhancement and Shaping System hit the market. –This is a bra-like device with two hard plastic domes ringed with silicone that sucks the air out of the domes and creates a vacuum that is supposed to induce the breast tissue to grow about one cup size. –This new type of breast augmentation must be worn for 10 hours a day for months.

14. Breast implants - History Breast augmentation has become one of the most frequently performed cosmetic plastic surgeries. Breast augmentation has become one of the most frequently performed cosmetic plastic surgeries. –In 2000 alone, over 200,000 U.S. women had a breast augmentation for purely cosmetic purposes.

15. Breast implants - History FDA estimates there have been more than 2 million breast augmentations in the U.SA. FDA estimates there have been more than 2 million breast augmentations in the U.SA. A telephone survey found that 19.4% of women respondents claimed they would alter their breast size first of any plastic surgery procedure. A telephone survey found that 19.4% of women respondents claimed they would alter their breast size first of any plastic surgery procedure. Twice as many women get breast augmentation as facelifts. Twice as many women get breast augmentation as facelifts. Breast augmentation has increased by 476% since 1992, the largest increase in plastic surgery procedures. Breast augmentation has increased by 476% since 1992, the largest increase in plastic surgery procedures.

16. Implants - Breast Reconstruction after mastectomy Reconstruction after mastectomy Breast augmentation Breast augmentation –Hypoplasy –After breast feeding –Insatisfation with breast Assimetry correction Assimetry correction Malformation Malformation Other corrections Other corrections

17. Implants - Breast Location Location –Subglanduar –Submuscular (Pectoralis Major) Surgical approach Surgical approach –Periareolar –Sub mammary –Axilar –Umbilicus –Others

18. Breast Implants External silicone shell External silicone shell Smooth, texturized Smooth, texturized Filled with different substances Filled with different substances –Silicone gel –Saline –Hidrogel (water, sugar, salt)

19. Breast implants Different shapes Different shapes Different filler concepts Different filler concepts

21. Age: 22, Height: 5'5", Weight: 124 lbs. Surgery: Breast Augmentation Breast Implant Placement: Subglandular, Approach:Transumbilical Breast Implant Type: Mentor smooth round saline Breast Implant Size: 415 cc Breast Size: 34B to 34D Trans-umbilical Breast Augmentation Before & After Photos Dr. Gerson - Lake Geneva, WI Dr. Gerson - Lake Geneva, WI Breast augmentation

22. 36 year old white female, Height: 5'4", Weight: 115 lbs. Surgery: Breast Augmentation Breast Implant Size: 330cc Breast Implant Type: round implants Breast Size: 34A to 34C Dr. Linderman - Indianapolis, IN Breast augmentation

23. 32 year old white female, Height: 5'4", Weight: 137 lbs. Surgery: Breast Augmentation Breast Implant Size: 600cc Breast Implant Type: round implants Breast Size: 34C to 34DD Dr. Linderman - Indianapolis, IN Breast augmentation

24. Prof. Manuel Caneira - Lisboa Breast augmentation

25. Mastectomy Without reconstruction Without reconstruction Autologous tissues Autologous tissues –TRAM –DIEAP –Latissimus dorsi –Gluteous Expander/implant Expander/implant Combination of different techniques Combination of different techniques

26. Breast reconstruction

30. Face

31. Facial implants Internal devices Internal devices External devices External devices Combined Combined

32. Facial implants Internal devices Internal devices –Osteossintesis (plates, screws) –Endoprotesis

33. Facial implants External devices External devices –External fixation Fractures Fractures Bone distraction Bone distraction –Eternal devices Ear Ear Ocular Ocular Nose Nose Other Other

34. Facial implants Mixed Mixed –P.e. Dental implants

35. Facial implants Different materials Different materials –Metal Steel Steel Titanium Titanium Other Other –Silicone –Synthetic polymers –Synthetic cements –Hidroxiapatitis –Ceramic –Reabsorbable polymers (p.e. poly-lactic acid, poly-glicolic acid) –Etc

36. Facial implants

42. Face – Implantes

43. Facial implants

47. FlapFix Cranial Flap

48. Facial implants Polimax resorbable fixation system

49. Facial implants Resorbable Orbital Floor Plate

50. Facial implants

51. Chronos – fosfato tricálcico beta

52. Facial implants

55. Injectable materials Injectable materials –Local deformations –Ritides

56. Facial implants Injectable materials Injectable materials –Collagen –Biodegradable polymers –Non-biodegradable materials P.e. microspheres P.e. microspheres Polymers Polymers

57. Facial implants Aquamid® Aquamid® –injectable implants are transparent, injectable hydrogel implant composed of 97.5% apyrogenic water bound to 2.5% cross-linked polyacrylamide

58. Facial implants expanded polytetrafluoroethylene (ePTFE)

59. Facial implants Grafts Grafts Bones Bones Cartilage Cartilage Dermis Dermis Dura matter Dura matter Fat Fat Fibroblasts after culture Fibroblasts after culture

60. Intra-oral tumor

61. Ortopantomography

62. TAC

63. Incision

64. Dissection

65. After hemimandibulectomy

66. After reconstruction plate

67. Ortopantomography

68. Pos op with reconstruction plate and tumor resection

69. Pos-operative control after tumor resection and reconstruction plate in place

70. Angiography PRÉ-OP (2 nd intervention)

71. Peroneal free flap

72. Reconstruction with peroneal free flap

73. Intra op view with reconstruction plate previously applied

74. Peroneal Free flap harvesting

75. Peroneal free flap inset

76. Venous and arterial microvascular anastomosis

77. Post operative radiology

79. CINTIGRAPHY Showing captation in both mandibular branches

80. Pos-operative control