the possible risk of increased leakage and a firmer feel. To assess the reality of this situation, the incidence of leakage and increased firmness was assessed for each patient. As shown by the data, only one patient in this study complained of excessive firmness. This patient, in fact, had capsular contracture and was being overexpanded in an attempt to correct the condition.
With regard to leakage rate, there was no evidence of increased leakage. In fact, the rate was lower than that of regular saline implants with diaphragm valves. This lower leakage rate is attributed to less fold floor failure due to overfilling as well as to decreased valvular leakage due to superior quality of the spectrum valve over the diaphragm valve.
For the reconstruction patient, it often is necessary to place the implant underfilled so as not to compromise the circulation to the skin flaps. We also found it beneficial to place implants underfilled to decrease postoperative pain. This is particularly beneficial for patients undergoing augmentation mastopexy to prevent wound problems and possible nipple necrosis.
Often, it is necessary to overexpand implants to iron out irregularities, to alter implant position, or to treat impending capsular contracture. In the treatment of capsular contracture after release of the capsule, overexpansion and splinting of the capsule have been found to be effective in reducing recurrence of contracture.
In the treatment of breast implant problems, it is extremely beneficial in many instances to deviate from the manufacturer’s recommended fill volume, especially in the treatment of symmastia. It is important to avoid tension on the repair site in the healing phase. Therefore, it has been advocated to keep implants underfilled until repair has taken place. Subsequently, 2 to 3 weeks later, the implant can be filled to the desired volume.
In treatment of the breast cancer patient, deflation of the opposite breast implant is sometimes necessary during irradiation to allow the radiation beam access to the target area. Based on our clinical experience, it appears that the risks involved with reoperation to replace an implant far