In July 2019, due to the possibility of developing Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), the use of textured anatomical implants and expanders that were covered by insurance was banned in Japan. As alternatives, smooth type round implants and expanders were newly covered by insurance in October of the same year. This time, I will present the current state of Japan and the points of breast reconstruction using new artificial materials.
　Natrelle® 133S tissue expander has 6 suture tabs around it and can be fixed to the chest wall. An expander is inserted through an incision in a breast cancer resection and is fixed suture tabs at several places, but the sutures may come off and rotate in a few months. Although it can be corrected when it is replaced to an implant, upward displacement should be avoided as much as possible.
　Since Natrelle® breast implant Inspira series is a round smooth type, it is difficult to reproduce the original bell shape of the breast, and especially it is difficult to reproduce the drooping breast. I believe that it is most important to create a solid inframammary fold for reconstruction of the ptotic breast. Therefore, the angles of the inframammary fold and the chest wall were classified into four types, and a new inframammary fold was created by the method according to each type. For large breasts and drooping breasts, it is possible to reproduce the shape similar to the original breast by firmly creating the inframammary fold. On the other hand, it was unavoidable that the breast shape was flattened in a small and thin breast. In this presentation, I will show you a lot of typical cases. However, this presentation is based on the short-term follow up, and it is necessary to carry out a long-term follow up in the future.

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