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Cerceo JR, Cai L, Yesantharao P, Thornton B, Nazerali R. Risk stratification in subpectoral to prepectoral pocket conversion to reduce post-reconstruction animation deformity. J Plast Reconstr Aesthet Surg 2023; 77:253-261. [PMID: 36592536 DOI: 10.1016/j.bjps.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/18/2022] [Accepted: 11/16/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Animation deformity is a morbid complication that impacts women undergoing subpectoral implant-based breast reconstruction. Transferring implants from the subpectoral to prepectoral space, pocket conversion, can be performed to minimize this issue. While prior literature has evaluated outcomes associated with this procedure, we investigated the risk factors most commonly associated with post-conversion complications. METHODS We performed a retrospective cohort investigation of women undergoing prepectoral pocket conversion. Pre-conversion clinical characteristics and surgical complications (major and minor) were collected. Predictors for postoperative complications were identified using univariate and multivariate logistic regression models. Odds ratios (OR) and adjusted odds ratios (aOR) are presented with 95% confidence intervals, and p-values were assessed at α = 0.05. RESULTS A total of 34 patients (63 breasts) were included. Pocket conversion relieved animation deformity in all breasts. The overall rates of major and minor complications were 14.3% (n = 9/63) and 34.9% (n = 22/63), respectively, by mean follow-up of 11.1 months. After adjusting for confounders, pre-conversion implant rupture (OR= 6.00, CI= 0.99-34.58; aOR= 12.8, CI= 1.15-170.32) and duration of implant placement (OR=1.35, CI= 1.07-1.78; aOR= 1.1, CI= 1.00-1.21) were found to be significant predictors of major postoperative complications. CONCLUSION With a fairly inclusive patient population, this series provides data for improved risk stratification of patients considering conversion to relieve animation deformity. Interestingly, traditional risk factors (namely, body mass index and smoking status) were not significant predictors for postoperative complications, suggesting that conversion may be safe in high-risk patients. Such data support more informed preoperative counseling and wider application of this procedure.
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Affiliation(s)
- Jaclyn Riana Cerceo
- Arrowhead Regional Medical Center/Kaiser Permanente, Department of General Surgery; Colton, CA, USA
| | - Lawrence Cai
- Stanford University, Division of Plastic Surgery; Stanford, California, USA
| | - Pooja Yesantharao
- Stanford University, Division of Plastic Surgery; Stanford, California, USA
| | | | - Rahim Nazerali
- Stanford University, Division of Plastic Surgery; Stanford, California, USA.
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Pelc Z, Skórzewska M, Kurylcio A, Olko P, Dryka J, Machowiec P, Maksymowicz M, Rawicz-Pruszyński K, Polkowski W. Current Challenges in Breast Implantation. Medicina (B Aires) 2021; 57:medicina57111214. [PMID: 34833432 PMCID: PMC8625629 DOI: 10.3390/medicina57111214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/16/2021] [Accepted: 11/05/2021] [Indexed: 12/03/2022] Open
Abstract
Breast implantation (BI) is the most common plastic surgery worldwide performed among women. Generally, BI is performed both in aesthetic and oncoplastic procedures. Recently, the prevalence of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) or breast implant illness (BII) has aroused concerns. As a result, several countries, like Australia, Korea or the United Kingdom, introduced national registries dedicated to the safety and quality of BI surgeries. This narrative review aimed to focus on the clinical challenges, management and the current state of knowledge of BI. Both short and long-term outcomes of BI are determined by various alternatives and differences, which surgeons must consider during the planning and performing breast augmentation along with further complications or risk of reoperation. Proper preoperative decisions and aspects of surgical technique emerged to be equally important. The number of performed breast reconstructions is increasing, providing the finest aesthetic results and improving patient’s quality of life. Choice of prosthesis varies according to individual preferences and anatomical variables. A newly diagnosed cases of BIA-ALCL with lacking data on prevention, diagnosis, and treatment are placing it as a compelling medical challenge. Similarly, BII remains one of the most controversial subjects in reconstructive breast surgery due to unspecified diagnostic procedures, and recommendations.
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Lam MC, Walgenbach-Brünagel G, Pryalukhin A, Vorhold J, Pech T, Kalff JC, Kristiansen G, Walgenbach KJ. Management of Capsular Contracture in Cases of Silicone Gel Breast Implant Rupture with Use of Pulse Lavage and Open Capsulotomy. Aesthetic Plast Surg 2019; 43:1173-1185. [PMID: 31367775 DOI: 10.1007/s00266-019-01463-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 07/15/2019] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Pulse lavage (PL) irrigation of prosthesis pockets has prior been described for breast implant salvages. However, PL for removal of leaked silicone from prosthesis pockets after implant ruptures has not been studied yet. Since open capsulotomies are regarded as equal treatment of capsular contracture (CC) than capsulectomies, this study analyzed the clinical outcome of PL for silicone removal and subsequent capsulotomy in cases of concurrent CC and breast implant rupture. METHODS Between 2012 and 2017, 55 patients (75 breasts) with suspected silicone implant rupture and CC (Baker grade III/IV), after primary breast augmentation or implant-based breast reconstruction, were included in a retrospective, observational study. Mean patient follow-up was 12.2 ± 3.6 months. RESULTS In all preoperatively suspected ruptured silicone breast implants, around a quarter were intact. In contrast to previously published data, implant exchanges in cases of implant ruptures did not lead to significantly higher CC recurrence rates (27.6% vs. 22.2% in cases of intact implants, p = 0.682), if the prosthesis pockets were treated with PL irrigation followed by open capsulotomy. PL reduced the amount of encapsulated silicone remnants histologically. The age of patients with CC after failed implant-based reconstruction was significant lower for salvage surgeries with flap reconstruction than for implant exchanges, p < 0.05. CONCLUSIONS PL irrigation of prosthesis pockets prior to open capsulotomy is a safe and effective treatment of CC with concurrent silicone leakage. Remaining silicone remnants in breast capsules may affect the development of a recurrent CC. To avoid CC recurrences, patients should consider conversion to autologous tissue. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Martin C Lam
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, D-53127 Bonn, Germany
| | - Gisela Walgenbach-Brünagel
- Department of Surgery, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, D-53127 Bonn, Germany
| | - Alexey Pryalukhin
- Institute of Pathology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, D-53127 Bonn, Germany
| | - Jens Vorhold
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, D-53127 Bonn, Germany
| | - Thomas Pech
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, D-53127 Bonn, Germany
| | - Jörg C Kalff
- Department of Surgery, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, D-53127 Bonn, Germany
| | - Glen Kristiansen
- Institute of Pathology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, D-53127 Bonn, Germany
| | - Klaus J Walgenbach
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, D-53127 Bonn, Germany.
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Maisel Lotan A, Retchkiman M, Tuchman I, Binenboym R, Gronovich Y. Analysis of 109 Consecutive Explanted Breast Implants: Correlation Between Suspected Implant Rupture and Surgical Findings. Aesthetic Plast Surg 2016; 40:739-44. [PMID: 27514822 DOI: 10.1007/s00266-016-0689-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 07/29/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The use of breast implants is on the rise due to increases in breast reconstructive and aesthetic surgery. Implant rupture is a possible complication. Among assessment modalities for implant rupture detection, MRI is considered the gold standard. METHODS We conducted a prospective analysis of 57 women after breast augmentation or postmastectomy reconstruction (109 implants), admitted to our department between 2010 and 2015 due to suspected implant rupture. We correlated surgical findings with symptoms, physical examination, imaging, and device specifications. RESULTS Seventy-four explanted implants were preoperatively suspected as ruptured. Over a third were intact and unjustifiably explanted. MRI evaluation was the most accurate modality. Interestingly, 61 % of ruptured implants were left-sided. Patient's age, comorbidities, smoking, medications, presenting symptoms, implant duration, and volume did not correlate with implant rupture. CONCLUSIONS Our study confirmed preexisting data regarding the importance of imaging diagnosis, with MRI being the most accurate modality in both diagnosing and ruling out implant rupture. Interestingly, our study showed that MRI was accurate in detecting all intact implants, unlike lower detection rates reported in previous studies, thus preventing unnecessary explantation. Another unique finding was that the left-sided implants were significantly prone for rupture. As iatrogenic damage is the most common cause of implant rupture, with most surgeons being right-handed, awareness during surgery must be augmented, with further investigation required for potential causes of this unexpected difference. Our study emphasizes the importance of understanding the causes of rupture and the need for evidence-based indications regarding imaging and replacement of implants. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Adi Maisel Lotan
- Department of Plastic & Reconstructive Surgery, Shaare Zedek Medical Center, POB 3235, 91031, Jerusalem, Israel.
| | - Meir Retchkiman
- Department of Plastic & Reconstructive Surgery, Shaare Zedek Medical Center, POB 3235, 91031, Jerusalem, Israel
| | - Izhak Tuchman
- Department of Plastic & Reconstructive Surgery, Shaare Zedek Medical Center, POB 3235, 91031, Jerusalem, Israel
| | - Rami Binenboym
- Department of Plastic & Reconstructive Surgery, Shaare Zedek Medical Center, POB 3235, 91031, Jerusalem, Israel
| | - Yoav Gronovich
- Department of Plastic & Reconstructive Surgery, Shaare Zedek Medical Center, POB 3235, 91031, Jerusalem, Israel
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Dinets A, Unukovych D, Khrapach V, Zakhartseva O, Sulik V, Kaminskyi E, Khrapach O, Meloyan A, Zakhartseva L, Mishalov V. An unusual case of a ruptured Poly Implant Prothèse breast implant associated with xanthoma. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2016; 3:11-5. [PMID: 27583262 PMCID: PMC4996062 DOI: 10.3109/23320885.2016.1153974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 02/10/2016] [Indexed: 11/13/2022]
Abstract
A suspicious breast mass was intra-operatively found in a female patient previously operated for breast augmentation with the Poly Implant Prothèse (PIP) implants. The neoplasm was verified as xanthoma and an asymptomatic microrupture of PIP was also detected. This report discusses possible association of breast xanthoma with PIP implant rupture.
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Affiliation(s)
- Andrii Dinets
- Department of Surgery #4, Bogomolets National Medical University, Kiev, Ukraine; Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Dmytro Unukovych
- Department of Surgery #4, Bogomolets National Medical University, Kiev, Ukraine; Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Vasyl Khrapach
- Department of Surgery #4, Bogomolets National Medical University , Kiev , Ukraine
| | - Olga Zakhartseva
- Department of Surgery #4, Bogomolets National Medical University , Kiev , Ukraine
| | - Volodymyr Sulik
- Department of Surgery #4, Bogomolets National Medical University , Kiev , Ukraine
| | - Edgar Kaminskyi
- Department of Plastic Surgery, Harmony Hospital , Kiev , Ukraine
| | - Olexandr Khrapach
- Department of Surgery #4, Bogomolets National Medical University , Kiev , Ukraine
| | - Ani Meloyan
- Department of Oncology-Pathology, Karolinska Institutet , Stockholm , Sweden
| | - Lubov Zakhartseva
- Department of Pathology, Kyiv City Teaching Oncology Center , Kiev , Ukraine
| | - Volodymyr Mishalov
- Department of Surgery #4, Bogomolets National Medical University , Kiev , Ukraine
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Park BY, Lee DH, Lim SY, Pyon JK, Mun GH, Oh KS, Bang SI. Is late seroma a phenomenon related to textured implants? A report of rare complications and a literature review. Aesthetic Plast Surg 2014; 38:139-145. [PMID: 24258224 DOI: 10.1007/s00266-013-0232-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 09/28/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Late seroma is an infrequent complication that manifests as fluid collection in the periprosthetic space at least 1 year after breast enlargement surgery. Interest in late seroma has grown with the potential connection between breast implants and anaplastic large cell lymphoma (ALCL), which presents with clinical symptoms similar to those of late seroma. This report presents a case of late seroma experienced by a patient with a history of multiple implant ruptures and a review of the relevant literature. METHODS Details are reported for a patient who presented with sudden swelling of an augmented breast that was initially suspected to be symptomatic of ALCL. A literature search of PubMed regarding this phenomenon also was conducted. RESULTS The literature review identified 14 articles on late seroma involving 60 patients, including the reported case. Analyses included epidemiology, etiology, and management strategy. Although a detailed statistical analysis was not performed, 55 cases (92 %) of late seroma occurred that involved patients with textured implants. No evidence-based guideline for the management of late seroma has been established, although the patients were managed successfully in all cases using various strategies. CONCLUSIONS The reported case and data from the literature provide evidence of a relationship between textured implant use and late seroma. Based on their review, the authors offer "sequential treatment steps," from conservative treatment to surgical management, which will be helpful for successful management of future late seroma cases. However, further study is needed to clarify the relationship, if any, between a particular type of textured implant and the development of late seroma. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Bo Young Park
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong 50, Gangnam-gu, Seoul, Korea
| | - Dong-Han Lee
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong 50, Gangnam-gu, Seoul, Korea
| | - So Young Lim
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong 50, Gangnam-gu, Seoul, Korea
| | - Jai-Kyong Pyon
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong 50, Gangnam-gu, Seoul, Korea
| | - Goo-Hyun Mun
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong 50, Gangnam-gu, Seoul, Korea
| | - Kap-Sung Oh
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong 50, Gangnam-gu, Seoul, Korea
| | - Sa-Ik Bang
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong 50, Gangnam-gu, Seoul, Korea.
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