101
|
Malata CM, Feldberg L, Coleman DJ, Foo IT, Sharpe DT. Textured or smooth implants for breast augmentation? Three year follow-up of a prospective randomised controlled trial. BRITISH JOURNAL OF PLASTIC SURGERY 1997; 50:99-105. [PMID: 9135425 DOI: 10.1016/s0007-1226(97)91320-5] [Citation(s) in RCA: 96] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Silicone breast implant surface texturing has been shown to reduce the short-term incidence of adverse (Baker III/IV) capsular contracture in augmentation mammaplasty in double-blind randomised controlled trials. It is, however, undetermined whether the textured surface merely delays the onset of severe contracture or its effect on capsular contraction is persistent. The current study reviewed, after three years, 49 of the 53 patients who had undergone subglandular breast augmentation mammaplasty in a randomised double-blind study with textured or smooth silicone gel-filled implants in 1989. The incidence of adverse capsular contracture was 59% for smooth implants and 11% for textured ones (P = 0.001; chi 2 = 10.60). Eight patients (31%) with smooth prostheses underwent breast implant exchange for severe capsular contracture between the one and three year assessments, compared with a revisional surgery rate of only 7.4% (2/27 patients) for the textured group (P < 0.04). These adverse capsular contracture and revisional breast implant surgery rates clearly demonstrate that the effect of textured implants in reducing capsular contracture in augmentation mammaplasty found at one year is maintained at three years, and suggest that it may be long lasting.
Collapse
Affiliation(s)
- C M Malata
- Department of Plastic Surgery, Bradford Royal Infirmary, UK
| | | | | | | | | |
Collapse
|
102
|
Kraemer O, Andersen M, Siim E. Breast reconstruction and tissue expansion in irradiated versus not irradiated women after mastectomy. SCANDINAVIAN JOURNAL OF PLASTIC AND RECONSTRUCTIVE SURGERY AND HAND SURGERY 1996; 30:201-6. [PMID: 8885015 DOI: 10.3109/02844319609062815] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Thirty-five women whose breast cancer had been treated by radiation and 111 in whom it had not underwent unilateral breast reconstruction with the tissue expansion technique after modified radical mastectomy. Their records were reviewed and in a questionnaire the patients reported their own opinion on the results. The two groups differed significantly, because those patients who had been irradiated had a more painful course of expansion and a less over-expansion. Their reconstructed breasts were harder, had more deformities, and they required significantly more capsulotomies. The irradiated group also reported less satisfaction with the cosmetic results and more unfulfilled expectations. Tissue expansion cannot therefore be recommended as a routine procedure for breast reconstruction in patients after irradiation. However, our results do not show whether other methods are better for these patients.
Collapse
Affiliation(s)
- O Kraemer
- Department of Plastic and Reconstructive Surgery, Rigshospitalet, University of Copenhagen, Denmark
| | | | | |
Collapse
|
103
|
Camilleri IG, Malata CM, Stavrianos S, McLean NR. A review of 120 Becker permanent tissue expanders in reconstruction of the breast. BRITISH JOURNAL OF PLASTIC SURGERY 1996; 49:346-51. [PMID: 8881779 DOI: 10.1016/s0007-1226(96)90001-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In reconstructive breast surgery, the permanent tissue expander has become popular because it avoids expander-implant exchange and gives the patient some control over the final breast size. It may, however, be associated with a number of complications. We therefore analysed the clinical notes of 111 consecutive recipients of Becker breast expanders with respect to complications and their possible predisposing factors. 120 prostheses were inserted in 111 consecutive patients with a mean age of 42.6 years. Median follow-up was 12 months (range 8 to 22). The commonest indication was postmastectomy breast reconstruction (81%) followed by congenital hypoplasia (14%) and acquired breast asymmetry following repeated biopsies (3%). Overexpansion before size adjustment was achieved after an average of 8 expander inflations. Complications included capsular contracture (9%), local tumour recurrence (8%), wound dehiscence (8%), filling port failure (6%), infected prostheses (4.5%) and ruptured implants (1.6%). The significant predisposing factors to wound dehiscence/infection were heavy smoking and radiotherapy (P < or = 0.05, chi 2 test). Expansion rate was not a factor. 89% of patients expressed satisfaction with the final aesthetic result. Despite the excellent results obtained with this technique, caution must be exercised in heavy smokers and the previously irradiated.
Collapse
Affiliation(s)
- I G Camilleri
- Department of Plastic and Reconstructive Surgery, Newcastle General Hospital, Newcastle upon Tyne, UK
| | | | | | | |
Collapse
|
104
|
Abstract
A meniscus of serosanguineous fluid may persist for weeks at the inferior pole of the periprosthetic space after submuscular augmentation mammaplasty. Subsequent tissue accommodation may allow the prosthesis to become displaced into the space kept patent by the fluid meniscus. Implant malpositions of this etiology can be circumvented by the routine use of small suction drains.
Collapse
|
105
|
Abstract
Our surgical understanding and preference for an implant design suggests that location of the implant in the retromuscular plane gives an aesthetically better looking clinical result, there is less rippling when the chest wall is vertical, and the implant flattens when the patient is lying supine. An implant with a textured posterior wall and smooth anterior wall assists adherence of the implant at the desired level. It also induces a pseudo-bursa over its anterior surface which, being larger than the implant surface, allows it to flatten naturally when the patient is lying or raising the arm. A gel-filled implant gives the most natural quality to an implant and the contents displace less readily and therefore do not tend to cause rippling.
Collapse
|
106
|
Asplund O, Gylbert L, Jurell G, Ward C. Textured or smooth implants for submuscular breast augmentation: a controlled study. Plast Reconstr Surg 1996; 97:1200-6. [PMID: 8628802 DOI: 10.1097/00006534-199605000-00015] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Capsular contracture consistently has been the most frequently noted complication of submuscular and subglandular breast augmentation. The etiology of this complication is still unknown, although silicone bleed, hematoma, infection, foreign bodies, and surgical trauma have been implicated. In this prospective, double-blind study, 61 women undergoing submuscular breast augmentation were randomized between Dow Corning textured and smooth-walled silicone gel implants. Any consequent capsular contracture was assessed by an independent plastic surgeon and also by the patients themselves. Objective evaluation was made by applanation tonometry. It was found that depending on doctors, patients, and objective method used, 3 to 9 percent grade III and IV encapsulation followed submuscular augmentation with textured implants and 10 to 20 percent with smooth-walled implants after 1 year. The differences were significant according to both patient assessment and applanation tonometry but not according to the physicians' evaluations. There was no correlation of capsular contracture with the age of the patient, duration of the operation, or degree of blood loss. There was a small but inconclusive difference in capsular contracture rate that favored the placement of textured rather than smooth implants in the submuscular pocket.
Collapse
Affiliation(s)
- O Asplund
- Department of Plastic and Reconstructive Surgery, Charing Cross University Hospital, London, England
| | | | | | | |
Collapse
|
107
|
Hunter-Smith DJ, Laurie SW. Breast reconstruction using permanent tissue expanders. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1995; 65:492-5. [PMID: 7611969 DOI: 10.1111/j.1445-2197.1995.tb01792.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The breast is a variable organ and as such reconstructive surgeons need to use a variety of reconstructive techniques. Prosthetic reconstruction is a good technique for women who are either unsuitable for or not accepting of autogenous tissue reconstruction. We reviewed the last five years' experience at Monash Medical Centre with permanent tissue expander breast reconstruction. Forty patients underwent reconstruction of 54 breasts. Immediate reconstruction was performed in 70% with an overall average patient age of 45 years. The selection criteria, advantages, and disadvantages of this technique are discussed. Inflation of expanders took an average of 71 days and creation of breast mound (excluding nipple/areolar reconstruction) took an average of 2.3 operations. Overall aesthetic results have been judged to be good to excellent in 81%. Symmetry was more easily achieved in bilateral reconstructions. Capsular contracture rate was Baker Grade I or II in 83%. Minor complications occurred in 17% of patients. We believe that there still exists a significant number of women who are either unsuitable for or not accepting of autogenous tissue reconstruction. It is this group of women who, if well selected, can be reconstructed safely and efficiently by the use of permanent tissue expander breast prosthesis.
Collapse
Affiliation(s)
- D J Hunter-Smith
- Department of Plastic and Reconstructive Surgery, Monash Medical Centre, Clayton, Victoria, Australia
| | | |
Collapse
|
108
|
Wickman M. Breast reconstruction--past achievements, current status and future goals. SCANDINAVIAN JOURNAL OF PLASTIC AND RECONSTRUCTIVE SURGERY AND HAND SURGERY 1995; 29:81-100. [PMID: 7569818 DOI: 10.3109/02844319509034325] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Breast cancer is the most common malignant tumour in women, and more than 5000 new cases are discovered each year in Sweden, this means that one woman in nine will be treated for breast cancer during her lifetime. For unknown reasons, the incidence increases by 1% each year. Partial mastectomy is the most common surgical treatment today, but a large number of women undergo mastectomy--that is, excision of all breast tissue including the nipple-areola complex with or without an axillary biopsy. Radical mastectomy--that is the Halsted mastectomy with excision of the pectoral muscles (51)--is almost never done today, so chest wall defects are smaller than in the early days of breast reconstruction. There is, however, still a demand from patients for good, natural-looking, and longlasting breast reconstructions, and reconstructive surgeons have to search for perfection both in existing methods and also in new methods of breast reconstruction. The purpose of this article is to review this complex subject.
Collapse
Affiliation(s)
- M Wickman
- Department of Plastic and Reconstructive Surgery, Karolinska Hospital, Stockholm, Sweden
| |
Collapse
|
109
|
Thuesen B, Siim E, Christensen L, Schrøder M. Capsular contracture after breast reconstruction with the tissue expansion technique. A comparison of smooth and textured silicone breast prostheses. SCANDINAVIAN JOURNAL OF PLASTIC AND RECONSTRUCTIVE SURGERY AND HAND SURGERY 1995; 29:9-13. [PMID: 7597397 DOI: 10.3109/02844319509048417] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Twenty consecutive breast reconstructions were done by the expansion technique. Either textured or smooth expander prostheses were used followed by silicone implants. Histological samples were taken from the capsule when the expander was removed and the implant inserted. The results show no difference in capsular formation between the groups, although the microscopic evaluations from the group with textured prostheses showed considerable numbers of silicone droplets. The patients were generally pleased with the results even though some reconstructed breasts were slightly firm when evaluated postoperatively.
Collapse
Affiliation(s)
- B Thuesen
- Department of Plastic & Reconstructive Surgery, Rigshospitalet, Copenhagen, Denmark
| | | | | | | |
Collapse
|
110
|
Breast Implants. Emerg Med Clin North Am 1994. [DOI: 10.1016/s0733-8627(20)30418-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
111
|
|
112
|
Coleman DJ, Sharpe DT, Naylor IL, Chander CL, Cross SE. The role of the contractile fibroblast in the capsules around tissue expanders and implants. BRITISH JOURNAL OF PLASTIC SURGERY 1993; 46:547-56. [PMID: 8252260 DOI: 10.1016/0007-1226(93)90104-j] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The occurrence, structure and contractility of myofibroblasts in the capsules around tissue expanders and static implants has been studied in the rat, pig and humans. The capsules showed a characteristic layered structure with myofibroblasts being the predominant cell type. Capsular strips contract in vitro in a manner characteristic of fibroblast contraction. The contractile ability decreased with the time since expander insertion; and increased with expander exposure, peri-expander infection and clinical evidence of adverse capsular contracture. An hypothesis is proposed that capsular contracture is analogous to wound contraction, and that intraimplant pressure usually inhibits capsular contraction. Evidence is shown from intraexpander pressure measurements to support this hypothesis. The clinical implications for tissue expansion and breast augmentation are discussed.
Collapse
Affiliation(s)
- D J Coleman
- Plastic Surgery and Burns Research Unit, University of Bradford, UK
| | | | | | | | | |
Collapse
|
113
|
POSTER COMMUNICATIONS. Br J Pharmacol 1993; 110:81P-184P. [DOI: 10.1111/j.1476-5381.1993.tb16292.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
114
|
Park AJ, Black RJ, Watson AC. Silicone gel breast implants, breast cancer and connective tissue disorders. Br J Surg 1993; 80:1097-100. [PMID: 8402103 DOI: 10.1002/bjs.1800800907] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Recent worldwide media speculation that silicone gel-filled breast implants may be linked to an increased incidence of breast and other cancers, and connective tissue disease (particularly systemic sclerosis) has caused concern to the medical profession and public alike. Until carefully controlled studies have been performed to prove the safety of these implants, the US Food and Drug Administration has restricted their use to research and breast reconstruction. Research has so far failed to prove a causative relationship between silicone implants and cancer or connective tissue disorders.
Collapse
Affiliation(s)
- A J Park
- Department of Plastic Surgery, St John's Hospital, Livingston, UK
| | | | | |
Collapse
|
115
|
Abstract
The appearance of the breast after wide local excision for carcinoma may be unsatisfactory. In 59 patients undergoing wide local excision a silicone prosthesis was inserted into the cavity at the time of primary surgery. Assessment of the cosmetic result was performed after 12 months by questionnaire and clinical examination. Four prostheses were removed within 1 year because of infection (two patients), wound breakdown (one) and pain (one). Seven prostheses were subsequently removed because of severe capsular contraction. Capsular contraction was more common in patients who had received radiotherapy. Only 23 patients found the results of the implant acceptable or satisfactory. The immediate use of intramammary implants after wide local excision is currently associated with a poor cosmetic result, and the problem of the distorted breast after such excision requires continued attention.
Collapse
Affiliation(s)
- P R Thomas
- Breast Unit, St George's Hospital, London, UK
| | | | | |
Collapse
|
116
|
Laing JH, Sanders R. The Misti Gold bio-oncotic gel filled breast prosthesis: an acceptable alternative to silicone? BRITISH JOURNAL OF PLASTIC SURGERY 1993; 46:240-2. [PMID: 8490704 DOI: 10.1016/0007-1226(93)90175-b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Concern about the use of silicone gel as a filler for breast prostheses has stimulated interest in other materials. We have evaluated the Misti Gold prosthesis which contains a "bio-oncotic" gel of low molecular weight Polyvinylpyrrolidone (PLASDONE 24AUK). Our experience of its use in breast augmentation is that the aesthetic results obtained with retromammary placement are inferior to those obtained from a silicone gel filled prosthesis. Nonetheless there are theoretical advantages for its use which will need to be considered in the light of recent regulatory decisions.
Collapse
Affiliation(s)
- J H Laing
- RAFT Department of Research, Mount Vernon Hospital NHS Trust, Northwood, Middlesex, UK
| | | |
Collapse
|
117
|
Steinbach BG, Hardt NS, Abbitt PL. Mammography: breast implants--types, complications, and adjacent breast pathology. Curr Probl Diagn Radiol 1993; 22:39-86. [PMID: 8472590 DOI: 10.1016/0363-0188(93)90007-g] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Approximately 1.5 million women in the United States currently have breast implants. The majority were placed for cosmetic augmentation, but 20% were placed for reconstruction after the loss or deformity of a breast. The augmented breast is a challenge to the mammographer. Many of the palpable and mammographically detected abnormalities in these patients are related to the implant itself. Since, however, there is breast tissue present with cosmetic augmentation, the full range of fibrocystic and neoplastic conditions that can affect the breast may be seen. The presence of the implant makes imaging the breast more difficult because the implant obscures the nearby breast tissue. This paper reviews the history and evolution of various breast prostheses. The surgical approaches to placement of implants and complications associated with their use will be discussed. Examples of concomitant pathologies and a review of imaging strategies will be given.
Collapse
Affiliation(s)
- B G Steinbach
- Department of Radiology, University of Florida College of Medicine, Gainesville
| | | | | |
Collapse
|
118
|
McCARTHY EJANE, MERKATZ RUTHB, BAGLEY GRANTP. A Descriptive Analysis of Physical Complaints From Women With Silicone Breast Implants. J Womens Health (Larchmt) 1993. [DOI: 10.1089/jwh.1993.2.111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
119
|
Wickman M, Johansson O, Olenius M, Forslind B. A comparison of the capsules around smooth and textured silicone prostheses used for breast reconstruction. A light and electron microscopic study. SCANDINAVIAN JOURNAL OF PLASTIC AND RECONSTRUCTIVE SURGERY AND HAND SURGERY 1993; 27:15-22. [PMID: 8493479 DOI: 10.3109/02844319309080286] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A total of 18 women who had undergone modified radical mastectomy and tissue expansion for breast reconstruction were studied. When the expanders were replaced, nine patients had received smooth, gel-filled permanent prostheses and nine had received textured, gel-filled permanent prostheses. For medical reasons, e.g. capsular contraction, incorrectly placed or sized implant, an additional operation was performed, and then biopsy specimens from the capsules around the prostheses were taken and subsequently examined with the aid of the light and transmission electron microscope (TEM). A histologist was able to classify blindly 11 capsules out of 13 which were investigated by light microscopy in the correct groups and several differences between the capsules were found. Capsules around the smooth implants had a clear line of separation between the inner surface and the prosthesis, and formed a single collageneous layer. They were sparse in fibroblasts, which were long and thin. Capsules around textured implants consisted of two layers, the outer layer being compact with long, slender fibroblasts, and the inner one looking rugged with wavy bundles of collagen often splitting from each other, and with shorter and more rounded fibroblasts. The overall thickness seemed greater compared to the capsules around the smooth prostheses, which, on the other hand, showed a greater variation in thickness. To analyze collagen fibril diameters, sample sections were photographed at magnification 22,000 x in the TEM. The fibril diameters were measured with an interactive image analysis system (IBAS). The mean diameter of the collagen fibrils was 47.2 nm in the capsules around the smooth prostheses and 51.7 nm in the capsules around the textured prostheses.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- M Wickman
- Department of Plastic and Reconstructive Surgery, Karolinska Hospital, Stockholm, Sweden
| | | | | | | |
Collapse
|
120
|
|
121
|
Foo IT, Coleman DJ, Holmes JD, Palmer JH, Sharpe DT. Delay between expansion and expander/implant exchange in breast reconstruction--a prospective study. BRITISH JOURNAL OF PLASTIC SURGERY 1992; 45:279-83. [PMID: 1623343 DOI: 10.1016/0007-1226(92)90052-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
It has been suggested that delay between expansion and insertion of the definitive prosthesis in breast reconstruction reduces the incidence of adverse capsular contracture. We have carried out a prospective trial to examine this hypothesis. 65 patients were randomly allocated into two groups; in one, insertion of the definitive prosthesis was 2 weeks following expansion ("immediate") and in the other, 6 months ("delayed"). The incidence of adverse capsular contracture assessed both by the Baker Scale and a linear analogue scale showed no difference between the two groups. A new objective method for measuring ptosis using a specially designed template is described. The degree of ptosis was not affected by the delay.
Collapse
Affiliation(s)
- I T Foo
- Plastic Surgery and Burns Research Unit, University of Bradford
| | | | | | | | | |
Collapse
|
122
|
Dunn KW, Hall PN, Khoo CT. Breast implant materials: sense and safety. BRITISH JOURNAL OF PLASTIC SURGERY 1992; 45:315-21. [PMID: 1294075 DOI: 10.1016/0007-1226(92)90060-b] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Cosmetic breast augmentation, and post-mastectomy breast reconstruction surgery using synthetic implants, have become established in surgical practice over more than 20 years. The operative technique for implant placement have changed somewhat during this time, as many different implant presentations have become available, but the same basic materials have remained in use. We have reviewed the present state of knowledge about breast implant materials with particular reference to the possible connection between polydimethylsiloxane and polyurethane to the so-called "Human Adjuvant Disease", and to carcinogenesis. Problems related to capsular contracture and mammography are also discussed.
Collapse
Affiliation(s)
- K W Dunn
- Department of Plastic Surgery, Wexham Park Hospital, Stourbridge, UK
| | | | | |
Collapse
|