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Mammography is indicated in patients over the age of 35 and if the findings are equivocal, bilateral biopsy can be carried out. In patients with extensive fibrocystic disease, the author prefers subcutaneous mastectomy followed by implantation of a prosthesis. Any evidence of nipple infection should be eradicated prior to surgery. 43 On the basis of discussion between the surgeon and the patient an implant of appropriate size is chosen. The patient should be informed that contracture of the capsule is a potential complication which is unpredictable.
Rise and Strictler (1951) also defended total glandular removal with preservation of the cutaneous envelope. In 1961 Freeman revised this procedure, suggesting simple removal of the glandular tissue and immediate or delayed implantation of a silicone prosthesis. The improved silicone prosthesis developed for breast augmentation by Cronin and Gerow in 1963 was subsequently used to replace the mammary parenchyma following subcutaneous mastectomy using the submammary approach. 4 Considerations of Surgical Technique Various surgical approaches to the breast have already been discussed in Sect.
The appearance of the breast was normal and the implant could be palpated. The author then broke the capsule over the opposite implant and the patient showed more surprise than pain as she instinctively touched her left breast and realized with a smile that it had become as soft as the right one. An inherent danger in the technique is, of course, rupture of the gel prosthesis itself, but with experience the technique can be applied to great advantage. Open Capsulotomy. This is suitable for cases (i) in which there has been prolonged capsular contraction, (ii) Fig.
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