Fitting the Final Implant

■ After removal of the sizer and after hemostasis has been carried out again, the implant, which has been immersed in betadine (Betaisadona), can be fitted. To do this the assistant holds the skin and gland tissue using a medium-sized Langenbeck retractor demonstrating the apex with strong traction in a cranial direction. The operating surgeon fixes the implant at the opening with his or her index finger and uses the other hand to prevent the implant from sliding out. Through alternating movements of both index fingers, the implant is introduced through the small opening. In doing this the correct position of the prosthesis must be checked, and it must not be allowed to unfold. The incorporated prosthesis is then smoothed out both above and below the implant using the finger.

■ In the center of the base, i. e., on the underside of the implant, there is a small nipple. After incorporation of the implant, this should be positioned approximately at the height of the actual nipple. The implant must be free over its whole base and without folds and ideally fill out the entire dissection boundaries, without causing impressions, particularly in the cranial and medial part (bulging); if this is the case, the dissection of the implant site has not been sufficient. In these circumstances a smaller implant must be used or the implant pocket must be enlarged.

This cannot happen if the shape and size of the implant have previously been correctly determined using the sizer.

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