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Scalise A, Pau A, Licini C, Brancorsini D, Mattioli Belmonte Cima M, Goteri G, Di Benedetto G. Use of Hydrosurgical Debridement System for Silicone Gel Removal after Breast Implant Rupture. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5862. [PMID: 38841532 PMCID: PMC11150029 DOI: 10.1097/gox.0000000000005862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 04/03/2024] [Indexed: 06/07/2024]
Abstract
Breast implant rupture is one of the most common complications in aesthetic and reconstructive surgery. Furthermore, this problem is closely linked to capsular contracture. It is therefore crucially important to effectively and promptly remove silicone leakage from breast pockets. Several techniques are described in the literature and have been typically used for this procedure. Hydrosurgical debridement (HD), which is usually applied in wound care to treat wounds, could be useful for the removal of the silicone leaked from prosthesis pockets after breast implant rupture. An entire periprosthetic capsule that contained a ruptured implant with silicone leakage was removed from a left breast. Half of the capsule was treated with HD, whereas the other half was left untreated as a control. Samples were processed by light microscopy and scanning electron microscopy for morphological analyses. light microscopy demonstrated that the nontreated tissues had a typical synovial-like structure with a middle layer of connective tissue in which there were numerous rounded empty spaces which contained silicone. In contrast, the superficial connective region of the treated tissues (T) had fewer and flattened spaces where the silicone was detected. Scanning electron microscopic analysis showed that in the T samples, the capsule thickness was compact compared with that of the nontreated tissues. Furthermore, the fibrous components appeared well organized with few and smaller silicone lacunae. HD is useful for the removal of silicone (ex vivo) from capsular surfaces after implant rupture. Because of its safety characteristics, this technique could be successfully used in vivo.
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Affiliation(s)
- Alessandro Scalise
- From the Clinic of Plastic and Reconstructive Surgery, Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Alberto Pau
- From the Clinic of Plastic and Reconstructive Surgery, Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Caterina Licini
- Histology, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Donatella Brancorsini
- Anatomic Pathology, Department of Biomedical Sciences and Public Health, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | | | - Gaia Goteri
- Anatomic Pathology, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Giovanni Di Benedetto
- From the Clinic of Plastic and Reconstructive Surgery, Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy
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Susini P, Marcaccini G, Giardino FR, Pozzi M, Volanti F, Nisi G, Cuomo R, Grimaldi L. Selective Capsulotomies and Partial Capsulectomy in Implant-Based Breast Reconstruction Revision Surgery. Breast J 2024; 2024:9097040. [PMID: 38444549 PMCID: PMC10914432 DOI: 10.1155/2024/9097040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 01/27/2024] [Accepted: 02/13/2024] [Indexed: 03/07/2024]
Abstract
Background Breast cancer with about 2.3 million diagnoses and 685,000 deaths globally is the most frequent malignancy in the female population. Continuous research has led to oncological and reconstructive advances in the management of breast cancer, thus improving outcomes and decreasing patient morbidity. Nowadays, the submuscular expander and prosthesis (E/P) implant-based breast reconstruction (IBR) accounts for 73% of all reconstructions. Despite its widely accepted efficacy, the technique is not free from complications and up to 28% of cases require revision surgery for mechanical complications such as capsular contracture, implant displacement/rotation, and implant rupture. With this study, the authors report their experience in the management of E/P IBR revision surgery through the technique of Selective Capsulotomies (SCs) and Partial Capsulectomy (PC). Methods A retrospective study was conducted on patients who had previously undergone E/P IBR and presented for revision reconstruction between January 2013 and May 2023 at the Department of Plastic Surgery of the University of Siena, Italy. Reasons for revision included capsular contracture, implant displacement/rotation, and implant rupture. Revision reconstructions involved SC and PC with implant replacement. Fat grafting was also considered. The complication rate was evaluated by analysis of patients' medical records. Patients' satisfaction with the treatment was assessed through a specific questionnaire. Results 32 patients underwent revision surgeries. No early complication occurred. Recurrence rate was assessed at 19% with average follow-up of 59 months (range: 13-114 months). The average time between revision surgery and recurrence was 3 years (range: 1-6 years). 23 patients answered the questionnaire and were overall satisfied with the treatments (8.29/10). Conclusions SC possibly associated to PC is a valuable option for E/P IBR revision surgery with minimal complications, reduced surgical trauma, short operating time, and relatively low recurrence risk. In addition, treated patients are overall satisfied with the results over time.
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Affiliation(s)
- Pietro Susini
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico le Scotte, Via Bracci 16, Siena 53100, Italy
| | - Gianluca Marcaccini
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico le Scotte, Via Bracci 16, Siena 53100, Italy
| | - Francesco Ruben Giardino
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico le Scotte, Via Bracci 16, Siena 53100, Italy
| | - Mirco Pozzi
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico le Scotte, Via Bracci 16, Siena 53100, Italy
| | - Francesco Volanti
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico le Scotte, Via Bracci 16, Siena 53100, Italy
| | - Giuseppe Nisi
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico le Scotte, Via Bracci 16, Siena 53100, Italy
| | - Roberto Cuomo
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico le Scotte, Via Bracci 16, Siena 53100, Italy
| | - Luca Grimaldi
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico le Scotte, Via Bracci 16, Siena 53100, Italy
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Boyd CJ, Chiodo MV, Lisiecki JL, Wagner RD, Rohrich RJ. Systematic Review of Capsular Contracture Management following Breast Augmentation: An Update. Plast Reconstr Surg 2024; 153:303e-321e. [PMID: 36877620 DOI: 10.1097/prs.0000000000010358] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Capsular contracture is one of the most frequent indications for revision following breast augmentation. Management goals focus on restoring breast aesthetics and minimizing subsequent recurrence of capsular contracture. As new data emerge, close review of the data are merited to build evidence-based clinical guidelines to inform surgical practice and management of capsular contracture. METHODS A systematic review of the MEDLINE, Embase, and Cochrane Database of Systematic Reviews databases was conducted to characterize the surgical management of capsular contracture in revision breast augmentations. The primary endpoint was capsular contracture recurrence rate. RESULTS The review was conducted in November of 2021. Primary search revealed 14,163 results. Initial screening by title left 1223 articles. Abstract review left 90 articles for full-text review, of which 34 were ultimately included and were all observational in nature. CONCLUSIONS Capsular contracture management remains an important topic, with limited high-level evidence for establishing clear evidence-based treatment guidelines. Although more evidence is required to assess the effects of capsulectomy, implant exchange, and plane change, these appear to be useful mechanisms for reducing recurrent capsular contracture. There is more evidence regarding the use of acellular dermal matrix, although this still requires long-term follow-up studies. New developments regarding textured implants limit the revision breast augmentation surgeon to smooth devices.
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Affiliation(s)
- Carter J Boyd
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone
| | | | | | - Ryan D Wagner
- Division of Plastic Surgery, Baylor College of Medicine
| | - Rod J Rohrich
- Dallas Plastic Surgery Institute
- Division of Plastic Surgery, Baylor College of Medicine
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Susini P, Nisi G, Pierazzi DM, Giardino FR, Pozzi M, Grimaldi L, Cuomo R. Advances on Capsular Contracture-Prevention and Management Strategies: A Narrative Review of the Literature. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5034. [PMID: 37305202 PMCID: PMC10256414 DOI: 10.1097/gox.0000000000005034] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/06/2023] [Indexed: 06/13/2023]
Abstract
Capsular contracture (CC) is the most relevant complication of both aesthetic and reconstructive breast implant surgery. For many years, experimental and clinical trials have attempted to analyze CC risk factors, clinical features, and appropriate management strategies. It is commonly accepted that a multifactorial etiology promotes CC development. However, the heterogeneity in patients, implants and surgical techniques make it difficult to suitably compare or analyze specific factors. As a consequence, discordant data are present in literature, and a true systematic review is often limited in its conclusions. Hence, we decided to present a comprehensive review of current theories on prevention and management strategies, rather than a specific "solution" to this complication. Methods The PubMed database was searched for literature regarding CC prevention and management strategies. Pertinent articles in English, published before December 1, 2022, were compared with selection criteria and eventually included in this review. Results Through the initial search, 97 articles were identified, of which 38 were included in the final study. Several articles explored different medical and surgical preventive and therapeutic strategies, showing numerous controversies on appropriate CC management. Conclusions This review provides a clear overview of the complexity of CC. The wide variety of clinical situations in term of patients, implants, and surgical techniques prevent the standardization of CC management strategies. By contrast, a patient-customized approach should be preferred, and different strategies should be considered depending on the specific case. Further research is desirable to better ascertain evidence-based protocols with regard to CC prevention and treatment.
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Affiliation(s)
- Pietro Susini
- From the Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Giuseppe Nisi
- From the Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Diletta Maria Pierazzi
- From the Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Francesco Ruben Giardino
- From the Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Mirco Pozzi
- From the Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Luca Grimaldi
- From the Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Roberto Cuomo
- From the Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
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5
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Schoberleitner I, Augustin A, Egle D, Brunner C, Amort B, Zelger B, Brunner A, Wolfram D. Is It All about Surface Topography? An Intra-Individual Clinical Outcome Analysis of Two Different Implant Surfaces in Breast Reconstruction. J Clin Med 2023; 12:jcm12041315. [PMID: 36835850 PMCID: PMC9967160 DOI: 10.3390/jcm12041315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/23/2023] [Accepted: 02/04/2023] [Indexed: 02/10/2023] Open
Abstract
The most common long-term complication of silicone breast implants (SMI) remains capsular fibrosis. The etiology of this exaggerated implant encapsulation is multifactorial but primarily induced by the host response towards the foreign material silicone. Identified risk factors include specific implant topographies. Of note, breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) has only been observed in response to textured surface implants. We hypothesize that reduction of SMI surface roughness causes less host response and, hence, better cosmetic outcomes with fewer complications for the patient. A total of 7 patients received the routinely used CPX®4 breast expander (~60 µM Ra) and the novel SmoothSilk® (~4 µM Ra), fixed prepectoral with a titanized mesh pocket and randomized to the left or right breast after bilateral prophylactic NSME (nipple-sparing mastectomy). We aimed to compare the postoperative outcome regarding capsule thickness, seroma formation, rippling, implant dislocation as well as comfortability and practicability. Our analysis shows that surface roughness is an influential parameter in controlling fibrotic implant encapsulation. Compared intra-individually for the first time in patients, our data confirm an improved biocompatibility with minor capsule formation around SmoothSilk® implants with an average shell roughness of 4 µM and in addition an amplification of host response by titanized implant pockets.
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Affiliation(s)
- Ines Schoberleitner
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Angela Augustin
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Daniel Egle
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Christine Brunner
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Birgit Amort
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Bettina Zelger
- Institute of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, Müllerstraße 44, A-6020 Innsbruck, Austria
| | - Andrea Brunner
- Institute of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, Müllerstraße 44, A-6020 Innsbruck, Austria
| | - Dolores Wolfram
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
- Correspondence: ; Tel.: +43-512-504-82050
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Bassetto F, Pandis L, Azzena GP, De Antoni E, Crema A, Scortecci L, Brambullo T, Pavan C, Marini M, Facchin F, Vindigni V. Complete Implant Wrapping with Porcine-Derived Acellular Dermal Matrix for the Treatment of Capsular Contracture in Breast Reconstruction: A Case-Control Study. Aesthetic Plast Surg 2022; 46:1575-1584. [PMID: 35352159 PMCID: PMC9512749 DOI: 10.1007/s00266-022-02826-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/31/2022] [Indexed: 02/06/2023]
Abstract
Background Capsular contracture (CC) represents one of the most common complications in breast reconstruction surgery, impairing final result and patients’ well-being. The role of acellular dermal matrixes (ADM) has been widely described for the treatment and prevention of contracture. The aim of the study was to evaluate the efficacy and safety of complete implant coverage with porcine-derived ADM in preventing CC limiting complications. In addition, patients’ reported outcomes were evaluated in order to define the role of ADM in improving sexual, physical and psychosocial well-being and satisfaction. Methods 42 patients who underwent surgical treatment of 46 contracted reconstructed breasts from May 2018th to May 2019th were collected in the two groups (ADM group vs. Control group). Results The ADM group showed lower rate of CC recurrence and a higher rate of implant losses and minor complications. A significant difference was observed in red breast syndrome (27.3% in the ADM group vs. absent in control the group) and skin ulceration rates (18.2% in the ADM group vs. 4.18% in the control group). As for patients’ perceived outcomes, the ADM group showed a statistically significant higher postoperative Satisfaction of Breast Scale score compared to the control group. In addition, a significant difference was observed in the improvement of Physical Well-Being of the Chest Scale and the Satisfaction of Breast Scale after surgery, in favor to the ADM group. Conclusion Complete implant coverage with ADM may reduce the risk of CC recurrence in breast reconstruction. An accurate patient selection allows minimizing complications improving patient well-being and satisfaction. 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)
- Franco Bassetto
- Plastic and Reconstructive Surgery Unit, Neuroscience Department, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Laura Pandis
- Plastic and Reconstructive Surgery Unit, Neuroscience Department, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Gian Paolo Azzena
- Plastic and Reconstructive Surgery Unit, Neuroscience Department, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Eleonora De Antoni
- Plastic and Reconstructive Surgery Unit, Neuroscience Department, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Alberto Crema
- Plastic and Reconstructive Surgery Unit, Neuroscience Department, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Leonardo Scortecci
- Plastic and Reconstructive Surgery Unit, Neuroscience Department, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Tito Brambullo
- Plastic and Reconstructive Surgery Unit, Neuroscience Department, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Chiara Pavan
- Psychiatric Clinic, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Massimo Marini
- Psychiatric Clinic, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Federico Facchin
- Plastic and Reconstructive Surgery Unit, Neuroscience Department, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
- Plastic Surgery Unit, San Bortolo Hospital, Vicenza, Viale Rodolfi 37, 36100 Vicenza, Italy
| | - Vincenzo Vindigni
- Plastic and Reconstructive Surgery Unit, Neuroscience Department, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
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Larsen A, Rasmussen LE, Rasmussen LF, Weltz TK, Hemmingsen MN, Poulsen SS, Jacobsen JCB, Vester-Glowinski P, Herly M. Histological Analyses of Capsular Contracture and Associated Risk Factors: A Systematic Review. Aesthetic Plast Surg 2021; 45:2714-2728. [PMID: 34312696 DOI: 10.1007/s00266-021-02473-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Capsular contracture is a severe complication to breast surgery with implants. Previous studies suggest multiple risk factors are associated with capsular contracture, but the etiology is still unknown. We performed a literature review to investigate existing studies on histological analyses of breast implant capsules and how clinical risk factors impact the capsule morphology. METHODS The literature search was conducted in PubMed. Studies that performed histological analyses of breast implant capsules were included. Animal studies or studies with a study population of less than five patients were excluded. RESULTS Fifty-two studies were included. The histological analyses showed that the breast implant capsules were organized in multiple layers with an inner layer of synovial-like metaplasia which was reported to diminish in capsules with capsular contracture. The remaining layers of the capsule mostly consisted of collagen. The alignment of the collagen fibers differed between contracted and non-contracted capsules, and capsules with higher Baker grade were generally thickest and contained more tissue inflammation. Studies investigating capsules affected by radiotherapy found a more pronounced inflammatory response and the capsules were generally thicker and fibrotic compared with nonirradiated capsules. CONCLUSIONS The included studies offer valuable insights into the histological changes caused by capsular contracture and their relation to clinical risk factors. Further studies with larger sample sizes and more strict inclusion criteria are needed to further investigate implant capsules and the role of the synovial-like metaplasia for the development of capsular contracture. 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 https://www.springer.com/00266 .
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Affiliation(s)
- Andreas Larsen
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Louise E Rasmussen
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Leonia F Rasmussen
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Tim K Weltz
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Mathilde N Hemmingsen
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Steen S Poulsen
- Department of Biomedical Sciences, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens C B Jacobsen
- Department of Biomedical Sciences, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Vester-Glowinski
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Mikkel Herly
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
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Marcasciano M, Kaciulyte J, Giuli RD, Marcasciano F, Torto FL, Guerra M, Prà GD, Barellini L, Mazzocchi M, Casella D, Ribuffo D. "Just Pulse it!" Introduction of a conservative implant salvage protocol to manage infection in pre-pectoral breast reconstruction: Case series and literature review. J Plast Reconstr Aesthet Surg 2021; 75:571-578. [PMID: 34794920 DOI: 10.1016/j.bjps.2021.09.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/25/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
Abstract
Post-operative implant infection is generally rare after breast augmentation, but it can occur in up to 35% of cases in post-mastectomy breast reconstruction. Standard treatment consists in the administration of antibiotics, implant removal, and delayed prosthesis replacement leading to multiple operations, with a negative impact on patient's clinical, economical, and psychological outcomes. There is little information published in the literature on the management of periprosthetic infection following pre-pectoral reconstructions. Capsule's removal from a pre-pectoral plane brings the risk of excessive tissue thinning and the compromise of skin flaps viability. In this preliminary multi-center case series, eight patients diagnosed with implant infection following oncological mastectomy and two-stage heterologous pre-pectoral breast reconstruction underwent the same protocol, consisting in tissue expander removal and conservative surgical revision supplemented by an antibiotate pulse lavage of the pocket surface. All patients achieved a successful infection resolution with immediate prosthesis replacement switching the temporary expander to definitive implant. No additional surgical revision was registered during follow-up. The intermittent irrigation is meant to disrupt the biofilm structure and restore antibiotic susceptibility. Moreover, pulse lavage allows the cleansing of the prosthetic capsule, thus avoiding the vascular stress associated with subcutaneous capsulectomy. To the best of our knowledge, this is the first series reporting on the use of Pulsavac in periprosthetic infection following pre-pectoral breast reconstruction, in an attempt to set the basis for an alternative conservative protocol to manage breast implant infection. A thorough literature review on pulse lavage in breast surgery was carried out.
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Affiliation(s)
- Marco Marcasciano
- Unità di Oncologia Chirurgica Ricostruttiva della Mammella, "Spedali Riuniti" di Livorno, "Breast Unit Integrata di Livorno, Cecina, Piombino, Elba, Azienda USL Toscana Nord Ovest", Livorno, Italy.
| | - Juste Kaciulyte
- Sapienza University of Rome, Policlinico Umberto I, Department of Surgery "P. Valdoni", Unit of Plastic and Reconstructive Surgery, Roma, Italy; Unit of Plastic and Reconstructive Surgery, Department of Surgery, Ospedale Santa Maria Della, Misericordia, Perugia, Italy
| | - Riccardo Di Giuli
- Unit of Plastic and Reconstructive Surgery, Department of Surgery, Ospedale Santa Maria Della, Misericordia, Perugia, Italy
| | - Fabio Marcasciano
- UOC Chirurgia Plastica e Ricostruttiva, Azienda Ospedaliera San Camillo - Forlanini, Roma, Italy
| | - Federico Lo Torto
- Sapienza University of Rome, Policlinico Umberto I, Department of Surgery "P. Valdoni", Unit of Plastic and Reconstructive Surgery, Roma, Italy
| | - Maristella Guerra
- Unità di Chirurgia Plastica, Polo Ospedaliero Santo Spirito ASL/RME, Roma, Italy
| | - Giovanni Dal Prà
- Unità di Chirurgia Plastica, Polo Ospedaliero Santo Spirito ASL/RME, Roma, Italy
| | - Leonardo Barellini
- Unità di Oncologia Chirurgica Ricostruttiva della Mammella, "Spedali Riuniti" di Livorno, "Breast Unit Integrata di Livorno, Cecina, Piombino, Elba, Azienda USL Toscana Nord Ovest", Livorno, Italy
| | - Marco Mazzocchi
- Unit of Plastic and Reconstructive Surgery, Department of Surgery, Ospedale Santa Maria Della, Misericordia, Perugia, Italy
| | - Donato Casella
- UOC Chirurgia Oncologica della Mammella, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Diego Ribuffo
- Sapienza University of Rome, Policlinico Umberto I, Department of Surgery "P. Valdoni", Unit of Plastic and Reconstructive Surgery, Roma, Italy
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Evaluating the Necessity of Capsulectomy in Cases of Textured Breast Implant Replacement. Ann Plast Surg 2021; 85:691-698. [PMID: 32102001 DOI: 10.1097/sap.0000000000002301] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Capsulectomy has traditionally been recommended as a treatment for capsular contracture after breast augmentation. With the advent of breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL), and the Food and Drug Administration's decision to ban Biocell textured devices, this operation has taken on new importance. This review was undertaken to better inform clinical recommendations for women with textured devices. METHODS An electronic search was performed using PubMed to identify all the available literature on the subject of capsulectomy and open capsulotomy (the alternative treatment). RESULTS Fifty-seven articles on this topic were identified. Capsulectomy was widely recommended for treatment of capsular contracture, although many authors recommended leaving thin capsular tissue behind in the absence of symptoms. En bloc resection was recommended only for women with a diagnosis of BIA-ALCL. No information supported a prophylactic role for capsulectomy in asymptomatic women with textured breast implants who are concerned regarding their future risk of BIA-ALCL. Routine pathologic examination in asymptomatic patients was not supported. DISCUSSION Capsulectomy adds substantially to the surgical risk, discomfort, recovery time, and expense. Implant removal or replacement without a simultaneous capsulectomy is atraumatic and poses negligible risk. CONCLUSIONS Capsulectomy introduces additional morbidity and is not mandatory for asymptomatic patients. Implant removal or exchange for smooth implants without a capsulectomy may be an acceptable choice for many women who do not demonstrate capsular pathology. However, any symptoms or surgical findings suggesting pathology warrant a capsulectomy. En bloc resections are reserved for patients diagnosed with BIA-ALCL.
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10
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Lam MC, Vorhold J, Pech T, Wefers N, Kalff JC, Walgenbach KJ. [Impact of breast dimension in one-stage augmentation mastopexies on implant selection: review of 103 consecutive breast augmentations with nanotextured silicone implants]. HANDCHIR MIKROCHIR P 2021; 53:130-143. [PMID: 33860491 DOI: 10.1055/a-1348-1481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION According to current studies, one-stage augmentation mastopexy (AM) is associated with only minor complications and a lower reoperation rate compared with a staged procedure. In AM, breast dimension can differ notably compared with those cases without simultaneous mastopexy. However, these differences have only been insufficiently investigated. This study aims to quantify the differences and then evaluate the effect of breast dimension on implant selection. In addition, it evaluates the influence of mastopexy on the outcome of augmentation mammoplasties with round nanotextured silicone gel implants. PATIENTS AND METHODS Over a two-year period, all patients with primary augmentation mammoplasties using nanotextured implants were included in the study. Patients' demographic data, breast measurements, specifications of the implants placed, and complications in the breast augmentation group without mastopexy were compared with those of the group with AM. The satisfaction of patients and surgeons was documented using Likert scales. RESULTS A total of 206 breast augmentations were performed in n = 103 patients. The mean follow-up was 24.0 ± 4.3 months. Compared with augmentations without an indication for simultaneous mastopexy, the AM group had wider breast bases and larger preoperative cup sizes; p < 0.001. As a result, implants selected for AM had greater diameters and lower volumes (p < 0.05) and were associated with smaller projections; p < 0.001. The total revision rates after augmentations without (n = 51) and with combined mastopexy (n = 52) were 5.9 % and 19.2 % (p < 0.05), respectively. AM increased tissue-related revisions from 2.0 % to 13.4 % (p < 0.05) without having an impact on implant-related revisions (3.9 % vs. 5.8 %, p = 0.663). The overall incidence of capsular contracture was 1.9 %. Satisfaction levels were approximately equal in both groups. CONCLUSION In comparison to augmentations without mastopexy, wider breast bases and larger breast volumes before surgery lead to the selection of significantly different implant dimensions in AM. Nanotextured silicone implants are associated with low complication rates, while an increased risk for tissue-related revisions of the combined procedure remains. Further studies are necessary in order to evaluate possible advantages and disadvantages over established implants.
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Affiliation(s)
- Martin C Lam
- Sektion für Plastische, Rekonstruktive und Ästhetische Chirurgie, Universitätsklinikum Bonn.,Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn
| | - Jens Vorhold
- Sektion für Plastische, Rekonstruktive und Ästhetische Chirurgie, Universitätsklinikum Bonn
| | - Thomas Pech
- Sektion für Plastische, Rekonstruktive und Ästhetische Chirurgie, Universitätsklinikum Bonn.,Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn
| | - Natalie Wefers
- Sektion für Plastische, Rekonstruktive und Ästhetische Chirurgie, Universitätsklinikum Bonn.,Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn
| | - Jörg C Kalff
- Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn
| | - Klaus J Walgenbach
- Sektion für Plastische, Rekonstruktive und Ästhetische Chirurgie, Universitätsklinikum Bonn.,Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn
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Ganon S, Morinet S, Serror K, Mimoun M, Chaouat M, Boccara D. Epidemiology and Prevention of Breast Prosthesis Capsular Contracture Recurrence. Aesthetic Plast Surg 2021; 45:15-23. [PMID: 32696162 DOI: 10.1007/s00266-020-01876-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 07/05/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Baker grade III and IV breast prosthesis capsular contractures represent a major problem for patients undergoing mammoplasties. The risk factors involved in recurrence are debated, and the best surgical approach for their prevention is not established. The objective was to identify these. MATERIALS AND METHODS We carried out a retrospective study of patients operated on for capsular contracture at the Saint-Louis Hospital in Paris from 2012 to 2014. The characteristics at inclusion were compared so as to determine the risk factors of recurrence. The surgical approaches were compared between the patients with recurrence and those without at 5 years. RESULTS Of the 100 patients included, 24 had a recurrence. The minimal follow-up was 5 years. No risk factors of recurrence of capsular contracture were identified. The surgical approach associated with the lowest rate of recurrence was anterior capsulectomy [OR total capsulectomy = 2.36 (0.73; 8.037) OR capsulotomy = 4.33 (1.37; 14.81)] (p < 0.040) with alteration of the volume of the implant, whether greater or less than initially [OR greater volume = 0.30 (0.096; 0.83); OR smaller volume = 0.14 (0.008; 0.85)] (p < 0.018). CONCLUSION The occurrence of capsular contracture is a major problem with prosthetic breast surgery. The main risk factors identified to date are essentially in regard to the occurrence of a first episode. No significant risk factors for recurrence were identified. The best prevention appears to be an anterior capsulectomy with reducing the volume of the implant. 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 . IV.
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