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Knoedler S, Knoedler L, Boroumand S, Alfertshofer M, Diatta F, Sofo G, Huelsboemer L, Hansen FJ, Könneker S, Kim BS, Perozzo FAG, Ayyala H, Allam O, Pomahac B, Kauke-Navarro M. Surgical Management of Breast Capsular Contracture-A Multi-institutional Data Analysis of Risk Factors for Early Complications. Aesthetic Plast Surg 2024:10.1007/s00266-024-04203-x. [PMID: 38926252 DOI: 10.1007/s00266-024-04203-x] [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: 04/18/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Capsular contracture (CC) is a common complication following implant-based breast surgery, often requiring surgical intervention. Yet, little is known about risk factors and outcomes following CC surgery. METHODS We reviewed the American College of Surgeons National Surgical Quality Improvement Program database (2008-2021) to identify female patients diagnosed with CC and treated surgically. Outcomes of interest included the incidence of surgical and medical complications at 30-days, reoperations, and readmissions. Confounder-adjusted multivariable analyses were performed to establish risk factors. RESULTS 5,057 patients with CC were identified (mean age: 55 ± 12 years and mean body mass index [BMI]: 26 ± 6 kg/m2). While 2,841 (65%) women underwent capsulectomy, capsulotomy was performed in 742 patients (15%). Implant removal and replacement were recorded in 1,160 (23%) and 315 (6.2%) cases, respectively. 319 (6.3%) patients experienced postoperative complications, with 155 (3.1%) reoperations and 99 (2.0%) readmissions. While surgical adverse events were recorded in 139 (2.7%) cases, 86 (1.7%) medical complications occurred during the 30 day follow-up. In multivariate analyses, increased BMI (OR: 1.04; p = 0.009), preoperative diagnosis of hypertension (OR: 1.48; p = 0.004), and inpatient setting (OR: 4.15; p < 0.001) were identified as risk factors of complication occurrence. CONCLUSION Based on 14 years of multi-institutional data, we calculated a net 30 day complication rate of 6.3% after the surgical treatment of CC. We identified higher BMI, hypertension, and inpatient setting as independent risk factors of postoperative complications. Plastic surgeons may wish to integrate these findings into their perioperative workflows, thus optimizing patient counseling and determining candidates' eligibility for CC surgery. 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)
- Samuel Knoedler
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Leonard Knoedler
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Sam Boroumand
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Michael Alfertshofer
- Division of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - Fortunay Diatta
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Giuseppe Sofo
- Instituto Ivo Pitanguy, Hospital Santa Casa de Misericórdia Rio de Janeiro, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Lioba Huelsboemer
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Frederik J Hansen
- Department of General and Visceral Surgery, Friedrich-Alexander University Erlangen, Erlangen, Germany
| | - Sören Könneker
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Bong-Sung Kim
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Filippo A G Perozzo
- Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Haripriya Ayyala
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Omar Allam
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Bohdan Pomahac
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Martin Kauke-Navarro
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
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Segreto F, Carotti S, Marangi GF, Francesconi M, Calia E, Cagli B, Cimmino A, Rossi C, Morini S, Persichetti P. Cathelicidin LL-37 Expression in Human Breast Implant Capsules. Plast Reconstr Surg 2024; 153:1066-1073. [PMID: 37220260 DOI: 10.1097/prs.0000000000010733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Capsular contracture is the most common complication following breast implant placement. Cathelicidin LL-37 is a cationic peptide involved in innate immunity. Initially investigated for its antimicrobial role, it was found to have pleiotropic activities, such as immunomodulation, angiogenesis stimulation, and tissue healing. The aim of the study was to investigate the expression and localization of LL-37 in human breast implant capsules and its relationship with capsular formation, remodeling, and clinical outcomes. METHODS The study enrolled 28 women (29 implants) who underwent expander substitution with definitive implant. Contracture severity was evaluated. Specimens were stained with hematoxylin and eosin, Masson trichrome, immunohistochemistry, and immunofluorescence for LL-37, CD68, α-smooth muscle actin, collagen type I and type III, CD31, and Toll-like receptor-4. RESULTS LL-37 was expressed in macrophages and myofibroblasts of capsular tissue in 10 (34%) and nine (31%) of the specimens, respectively. In eight cases (27.5%), it was expressed by both macrophages and myofibroblasts of the same specimen. In infected capsules, expression by both cell types was found in all (100%) specimens. LL-37 expression by myofibroblasts positively correlated with its expression by macrophages ( P < 0.001). Moreover, LL-37 expression by macrophages of periexpander capsules negatively correlated with the severity of capsular contracture on definitive implants ( P = 0.04). CONCLUSIONS This study demonstrates the expression of LL-37 in macrophages and myofibroblasts of capsular tissue and its negative correlation with the severity of capsular contracture following permanent implant placement. Expression or up-regulation of LL-37 may be involved in myofibroblast and macrophage modulation, thus playing a role in the pathogenic fibrotic process underlying capsular contracture. CLINICAL RELEVANCE STATEMENT This is the first study to demonstrate LL37 expression in capsular tissue and to hypothesize its role in contracture and as a prognostic marker for contracture severity. If confirmed, medical strategies or implant coating could be implemented to reduce the risk of contracture for high-risk patients.
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Affiliation(s)
- Francesco Segreto
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery
| | - Simone Carotti
- Center for Integrated Biomedical Research, Laboratory of Microscopic and Ultrastructural Anatomy
| | | | - Maria Francesconi
- Center for Integrated Biomedical Research, Laboratory of Microscopic and Ultrastructural Anatomy
| | - Eleonora Calia
- Department of Obstetrics and Gynecology, Campus Bio-Medico of Rome University
| | - Barbara Cagli
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery
| | - Andrea Cimmino
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery
| | - Caterina Rossi
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery
| | - Sergio Morini
- Center for Integrated Biomedical Research, Laboratory of Microscopic and Ultrastructural Anatomy
| | - Paolo Persichetti
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery
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Kim J, Kang S, Choi MH, Park S, Nam SH, Park JU, Lee Y. Zwitterionic polymer on silicone implants inhibits the bacteria-driven pathogenic mechanism and progress of breast implant-associated anaplastic large cell lymphoma. Acta Biomater 2023; 171:378-391. [PMID: 37683967 DOI: 10.1016/j.actbio.2023.09.003] [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: 04/21/2023] [Revised: 08/22/2023] [Accepted: 09/03/2023] [Indexed: 09/10/2023]
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) occurs in the capsule surrounding breast implants. Malignant transformation of T cells by bacteria-driven chronic inflammation may be underlying BIA-ALCL mechanism. Here, we covalently grafted 2-methacryloyloxyethyl phosphorylcholine (MPC)-based polymers on a silicone surface and examined its effects against BIA-ALCL pathogenesis. MPC grafting strongly inhibited the adhesion of bacteria and bacteria-causing inflammation. Additionally, cancer T cell proliferation and capsule-derived fibroblast-cancer cell communication were effectively inhibited by MPC grafting. We further demonstrated the effect of MPC against the immune responses causing BIA-ALCL around human silicone implants in micro-pigs. Finally, we generated a xenograft anaplastic T cell lymphoma mouse model around the silicone implants and demonstrated that MPC grafting could effectively inhibit the lymphoma progression. This study is the first to show that bacteria-driven induction and progression of BIA-ALCL can be effectively inhibited by surface modification of implants. STATEMENT OF SIGNIFICANCE: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a major concern in the field of plastic and reconstructive surgery. In this study, we demonstrate strong inhibitory effect of zwitterionic polymer grafting on BIA-ALCL pathogenesis and progression, induced by bacterial infection and inflammation, both in vitro and in vivo. This study provides a molecular basis for the development of novel breast implants that can prevent various potential complications such as excessive capsular contracture, breast implant illness, and BIA-ALCL incidence, as well as for expanding the biomedical applications of zwitterionic polymers.
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Affiliation(s)
- Jungah Kim
- Department of Chemistry, College of Natural Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Sunah Kang
- Department of Chemistry, College of Natural Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Min-Ha Choi
- Department of Plastic and Reconstructive Surgery, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, 5 Gil 20, Boramae-ro, Dongjak-gu, Seoul 07061, Republic of Korea
| | - Sohyun Park
- Department of Chemistry, College of Natural Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - So Hee Nam
- College of Pharmacy, Dongduk Women's University, 60 Hwarang-ro 13-gil, Seongbuk-gu, Seoul 02748, Republic of Korea
| | - Ji-Ung Park
- Department of Plastic and Reconstructive Surgery, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, 5 Gil 20, Boramae-ro, Dongjak-gu, Seoul 07061, Republic of Korea; Institute of Medical and Biological Engineering, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Interdisciplinary Program in Bioengineering, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea.
| | - Yan Lee
- Department of Chemistry, College of Natural Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea.
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Lee S, Kim M, Kim M, Ryu W, Back S. Capsular Contracture Rate in Augmentation Mammoplasty With Motiva Breast Implant Insertion: A Single-Center Experience in Korea. Aesthet Surg J 2023; 43:1248-1255. [PMID: 37254824 DOI: 10.1093/asj/sjad166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/21/2023] [Accepted: 05/30/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Capsular contracture is the most common complication following breast implant surgery, and the implant shell characteristics are important in preventing this complication. OBJECTIVES The aim of this study was to evaluate the capsular contracture rate for SmoothSilk Motiva implants (Establishment Labs Holdings Inc., New York, NY) in females who underwent primary and revisional breast augmentation over a 3-year period. METHODS A total of 1324 cases that took place from 2017 to 2020 were retrospectively analyzed, with 1027 being primary surgeries and 297 being revisional surgeries. RESULTS In the 1324 cases of augmentation mammoplasty with SmoothSilk Motiva implants, the overall capsular contracture rate was 1.8% (n = 24). The capsular contracture rate in the 1027 primary surgery cases was 1.07% (n = 11), and the capsular contracture rate in the 297 revisional surgery cases was significantly different at 4.39% (n = 13, P = .0001). More specifically, the capsular contracture rate in 182 revisional surgery for cases without capsular contracture was 1.12% (n = 2), and it showed no statistically significant difference from the rate in primary surgery cases (P = .965). However, the rate in 115 revisional surgery for cases with capsular contracture was 9.57% (n = 11), and it showed a statistically significant difference from the rate in primary surgery cases (P = .000) and the rate in revisional surgery for cases without capsular contracture (P = .001). CONCLUSIONS Augmentation mammoplasty with SmoothSilk Motiva implants demonstrated a lower rate of capsular contracture than traditional smooth or textured implants. Revisional surgery for cases without capsular contracture showed a similar rate of capsular contracture to primary surgery cases, but the rates were higher in revisional surgery for cases with capsular contracture. LEVEL OF EVIDENCE: 4
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5
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Kalaaji A. Commentary on: Capsular Contracture Rate in Augmentation Mammoplasty With Motiva Breast Implant Insertion: A Single-Center Experience in Korea. Aesthet Surg J 2023; 43:1256-1257. [PMID: 37436824 DOI: 10.1093/asj/sjad223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/13/2023] Open
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6
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Biology and Regulation of Staphylococcal Biofilm. Int J Mol Sci 2023; 24:ijms24065218. [PMID: 36982293 PMCID: PMC10049468 DOI: 10.3390/ijms24065218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/15/2023] [Accepted: 03/03/2023] [Indexed: 03/11/2023] Open
Abstract
Despite continuing progress in medical and surgical procedures, staphylococci remain the major Gram-positive bacterial pathogens that cause a wide spectrum of diseases, especially in patients requiring the utilization of indwelling catheters and prosthetic devices implanted temporarily or for prolonged periods of time. Within the genus, if Staphylococcus aureus and S. epidermidis are prevalent species responsible for infections, several coagulase-negative species which are normal components of our microflora also constitute opportunistic pathogens that are able to infect patients. In such a clinical context, staphylococci producing biofilms show an increased resistance to antimicrobials and host immune defenses. Although the biochemical composition of the biofilm matrix has been extensively studied, the regulation of biofilm formation and the factors contributing to its stability and release are currently still being discovered. This review presents and discusses the composition and some regulation elements of biofilm development and describes its clinical importance. Finally, we summarize the numerous and various recent studies that address attempts to destroy an already-formed biofilm within the clinical context as a potential therapeutic strategy to avoid the removal of infected implant material, a critical event for patient convenience and health care costs.
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7
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The effect of human recombinant epidermal growth factor on capsule contraction in an irradiated rat model. EUROPEAN JOURNAL OF PLASTIC SURGERY 2023. [DOI: 10.1007/s00238-023-02055-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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8
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Diedrich CM, Verhorstert KWJ, Riool M, Schuster H, de Boer L, Kikhney J, Moter A, Zaat SAJ, Roovers JPWR. Transvaginal Mesh-related Complications and the Potential Role of Bacterial Colonization: An Exploratory Observational Study. J Minim Invasive Gynecol 2023; 30:205-215. [PMID: 36442754 DOI: 10.1016/j.jmig.2022.11.011] [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: 06/28/2022] [Revised: 10/12/2022] [Accepted: 11/19/2022] [Indexed: 11/27/2022]
Abstract
STUDY OBJECTIVE This study aimed to investigate the potential role of transvaginal mesh bacterial colonization in the development of mesh-related complications (MRCs). DESIGN An observational and exploratory study. SETTING Tertiary referral center (Amsterdam UMC, location AMC, Amsterdam, The Netherlands). PATIëNTS: 49 patients indicated for mesh removal and 20 women of whom vaginal tissue was retrieved during prolapse surgery as a reference cohort. INTERVENTIONS collection of mesh-tissue complex (patient cohort) or vaginal tissue (reference cohort) MEASUREMENTS AND MAIN RESULTS: Homogenized samples were used for quantitative microbiological culture. Inflammation and fibrosis were semiquantitatively histologically scored; Gram staining and fluorescence in situ hybridization were used to detect bacteria and bacterial biofilms. Of the 49 patients, 44 samples (90%) were culture positive, with a higher diversity of species and more Gram-negative bacteria and polymicrobial cultures in the MRC cohort than the reference cohort, with mostly staphylococci, streptococci, Actinomyces spp., Cutibacterium acnes, and Escherichia coli. Patients with clinical signs of infection or exposure had the highest bacterial counts. Histology demonstrated moderate to severe inflammation in most samples. Gram staining showed bacteria in 57% of culture-positive samples, and in selected samples, fluorescence in situ hybridization illustrated a polymicrobial biofilm. CONCLUSION In this study, we observed distinct differences in bacterial numbers and species between patients with MRCs and a reference cohort. Bacteria were observed at the mesh-tissue interface in a biofilm. These results strongly support the potential role of bacterial mesh colonization in the development of MRCs.
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Affiliation(s)
- Chantal M Diedrich
- Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 (Drs. Diedrich, Verhorstert, Schuster, and Roovers), Amsterdam, The Netherlands; Department of Medical Microbiology and Infection Prevention, Amsterdam institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 (Drs. Diedrich, Verhorstert, Riool, Zaa, and Schuster, Ms. de Boer), Amsterdam, The Netherlands.
| | - Kim W J Verhorstert
- Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 (Drs. Diedrich, Verhorstert, Schuster, and Roovers), Amsterdam, The Netherlands; Department of Medical Microbiology and Infection Prevention, Amsterdam institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 (Drs. Diedrich, Verhorstert, Riool, Zaa, and Schuster, Ms. de Boer), Amsterdam, The Netherlands
| | - Martijn Riool
- Department of Medical Microbiology and Infection Prevention, Amsterdam institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 (Drs. Diedrich, Verhorstert, Riool, Zaa, and Schuster, Ms. de Boer), Amsterdam, The Netherlands
| | - Heleen Schuster
- Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 (Drs. Diedrich, Verhorstert, Schuster, and Roovers), Amsterdam, The Netherlands; Department of Medical Microbiology and Infection Prevention, Amsterdam institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 (Drs. Diedrich, Verhorstert, Riool, Zaa, and Schuster, Ms. de Boer), Amsterdam, The Netherlands
| | - Leonie de Boer
- Department of Medical Microbiology and Infection Prevention, Amsterdam institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 (Drs. Diedrich, Verhorstert, Riool, Zaa, and Schuster, Ms. de Boer), Amsterdam, The Netherlands
| | - Judith Kikhney
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute for Microbiology, Infectious Diseases, and Immunology, Biofilmcenter, Hindenburgdamm 30 (Drs. Kikhney and Moter), 12203 Berlin, Germany; MoKi Analytics GmbH, Hindenburgdamm 30 (Drs. Kikhney and Moter) 12203 Berlin, Germany
| | - Annette Moter
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute for Microbiology, Infectious Diseases, and Immunology, Biofilmcenter, Hindenburgdamm 30 (Drs. Kikhney and Moter), 12203 Berlin, Germany; MoKi Analytics GmbH, Hindenburgdamm 30 (Drs. Kikhney and Moter) 12203 Berlin, Germany; Practice Moter Diagnostics (practice), Marienplatz 9 (Dr. Moter), 12207 Berlin, Germany
| | - Sebastian A J Zaat
- Department of Medical Microbiology and Infection Prevention, Amsterdam institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 (Drs. Diedrich, Verhorstert, Riool, Zaa, and Schuster, Ms. de Boer), Amsterdam, The Netherlands
| | - Jan-Paul W R Roovers
- Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 (Drs. Diedrich, Verhorstert, Schuster, and Roovers), Amsterdam, The Netherlands
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9
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Singh D, Zhang R, Hori KH, Parsa FD. Is Iatrogenic Implant Contamination Preventable Using a 16-Step No-Touch Protocol? EPLASTY 2022; 22:e38. [PMID: 36160667 PMCID: PMC9490878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Intraoperative contamination of the surgical field during aesthetic breast augmentation may lead to implant infection with devastating consequences. This study covers a period of 30 years and is divided into 2 phases: a retrospective phase from 1992-2004 when a standard approach was used and a prospective phase from 2004-2022 when a no-touch approach was implemented to avoid contamination. METHODS Patients in the standard and no-touch groups underwent aesthetic breast augmentation by the same senior surgeon (FDP) in the same outpatient surgical facility during the 30-year period of the study. Patients are divided into 2 groups: from 1992-2004 and from the implementation of the no-touch protocol in 2004-2022. RESULTS Patients who underwent breast augmentation using the no-touch approach developed no infections, whereas the standard group had an infection rate of 3.54% (P = .017). The validity of this finding is discussed. CONCLUSIONS The no-touch approach as described in this article was effective in reducing implant infection rate when performing aesthetic breast augmentation by 1 surgeon at 1 surgical center during an 18-year observation period. Multicenter prospective cooperative studies are necessary to validate perioperative iatrogenic contamination as the cause of implant infection and to explore optimal approaches that could eliminate implant contamination.
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Affiliation(s)
- Dylan Singh
- University of Hawaii, John A Burns School of Medicine, Honolulu, HI
| | - Ruixue Zhang
- University of Hawaii, John A Burns School of Medicine, Honolulu, HI
| | | | - Fereydoun D Parsa
- Plastic Surgery Division, Department of Surgery, University of Hawaii, John A Burns School of Medicine. Honolulu, HI
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10
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Jianu DM, Marin A. Invited Discussion on: Evaluation of Chlorhexidine Concentration on the Skin After Preoperative Surgical Site Preparation in Breast Surgery-A Randomized Controlled Trial. Aesthetic Plast Surg 2022; 46:1523-1524. [PMID: 35930040 DOI: 10.1007/s00266-022-03023-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 07/03/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Dana Mihaela Jianu
- Plastic surgery Department, ProEstetica Medical Center, Bucharest, Romania.
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11
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Functionalized Self-Assembled Monolayers: Versatile Strategies to Combat Bacterial Biofilm Formation. Pharmaceutics 2022; 14:pharmaceutics14081613. [PMID: 36015238 PMCID: PMC9415113 DOI: 10.3390/pharmaceutics14081613] [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: 06/30/2022] [Revised: 07/29/2022] [Accepted: 07/30/2022] [Indexed: 11/16/2022] Open
Abstract
Bacterial infections due to biofilms account for up to 80% of bacterial infections in humans. With the increased use of antibiotic treatments, indwelling medical devices, disinfectants, and longer hospital stays, antibiotic resistant infections are sharply increasing. Annual deaths are predicted to outpace cancer and diabetes combined by 2050. In the past two decades, both chemical and physical strategies have arisen to combat biofilm formation on surfaces. One such promising chemical strategy is the formation of a self-assembled monolayer (SAM), due to its small layer thickness, strong covalent bonds, typically facile synthesis, and versatility. With the goal of combating biofilm formation, the SAM could be used to tether an antibacterial agent such as a small-molecule antibiotic, nanoparticle, peptide, or polymer to the surface, and limit the agent’s release into its environment. This review focuses on the use of SAMs to inhibit biofilm formation, both on their own and by covalent grafting of a biocidal agent, with the potential to be used in indwelling medical devices. We conclude with our perspectives on ongoing challenges and future directions for this field.
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12
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Kuhn N, Homsy C. Rare Presentation of Breast Implant Infection and Breast Implant Illness Caused by Penicillium Species. EPLASTY 2022; 22:ic9. [PMID: 35873069 PMCID: PMC9275409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
What is breast implant illness? What is the proposed pathophysiology behind breast implant illness? What are the most common etiologies of fungal breast implant infections? What risks should patients undergoing breast augmentation be informed of?
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Affiliation(s)
- Natalie Kuhn
- Tufts University School of Medicine, Falmouth, ME
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13
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Liu X, Song YJ, Chen X, Huang MY, Zhao CX, Zhou X, Zhou X. Asiaticoside Combined With Carbon Ion Implantation to Improve the Biocompatibility of Silicone Rubber and to Reduce the Risk of Capsule Contracture. Front Bioeng Biotechnol 2022; 10:810244. [PMID: 35646845 PMCID: PMC9133697 DOI: 10.3389/fbioe.2022.810244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/25/2022] [Indexed: 11/19/2022] Open
Abstract
Capsular contracture caused by silicone rubber is a critical issue in plastic surgery that urgently needs to be solved. Studies have shown that carbon ion implant in silicone rubber (carbon silicone rubber, C-SR) can significantly improve the capsular structure, but the effect of this improvement only appear 2months or later. In this study, asiaticoside combined with carbon silicone rubber was used to explore the changes in the capsule to provide a reference for the treatment of capsule contracture. Human fibroblasts (HFF-1) were used for in vitro experiments. The combined effect of asiaticoside and carbon silicone rubber on cell proliferation was determined by the CCK8 method, cell migration changes were measured by Transwell assays, cell cycle changes were measured by flow cytometry, and the expression levels of fibroblast transformation markers (vimentin and α-SMA), collagen (Col-1A1) and TGF-β/Smad signaling pathway-related proteins (TGF-β1, TβRI, TβRII and Smad2/3) were detected by immunofluorescence. In vivo experiments were carried out by subcutaneous implantation of the material in SD rats, and asiaticoside was oral administered simultaneously. WB and ELISA were used to detect changes in the expression of TGF-β/Smad signaling pathway-related proteins. TGF-β/Smad signaling pathway proteins were then detected and confirmed by HE, Masson and immunohistochemical staining. The results shown that asiaticoside combined with carbon ion implantation inhibited the viability, proliferation and migration of fibroblasts on silicone rubber. In vitro immunofluorescence showed that the secretion levels of α-SMA and Col-1A1 were significantly decreased, the transformation of fibroblasts into myofibroblasts was weakened, and the TGF-β/Smad signaling pathway was inhibited. In vivo experimental results showed that asiaticoside combined with carbon silicone rubber inhibited TGF-β1 secretion and inhibited the TGF-β/Smad signaling pathway, reducing the thickness of the capsule and collagen deposition. These results imply that carbon silicone rubber combined with asiaticoside can regulate the viability, proliferation and migration of fibroblasts by inhibiting the TGF-β/Smad signaling pathway and reduce capsule thickness and collagen deposition, which greatly reduces the incidence of capsule contracture.
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Affiliation(s)
- Xing Liu
- Department of Cosmetology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Ya-Jun Song
- Department of Urology, Xinqiao Hospital, The Army Medical University, Chongqing, China
| | - Xing Chen
- Department of Cosmetology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Meng-Ya Huang
- Department of Cosmetology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Chen-Xi Zhao
- Department of Cosmetology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Xun Zhou
- Department of Cosmetology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
- *Correspondence: Xun Zhou, ; Xin Zhou,
| | - Xin Zhou
- Department of Pathology, Bishan Hospital, The Chongqing Medical University, Chongqing, China
- *Correspondence: Xun Zhou, ; Xin Zhou,
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14
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A Shakespearean Dilemma in Breast Augmentation: to Use Drains or not? a Systematic Review : Drains in Breast Augmentation. Aesthetic Plast Surg 2022; 46:1553-1566. [PMID: 35048149 DOI: 10.1007/s00266-021-02693-7] [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: 10/05/2021] [Accepted: 11/20/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Breast augmentation is one of the most commonly requested and performed plastic surgery procedures. In order to prevent early postoperative complications such as seroma or hematoma, surgical drains could be useful. The aim is to perform a systematic review of the literature on the use of surgical drains in primary breast augmentation. METHODS This review was performed following the PRISMA guidelines. PubMed, SCOPUS, Web of Science and Cochrane Library databases were queried in search of clinical studies describing the use of surgical drains in women undergoing primary breast augmentation with implants and documenting seroma and/or hematoma formation rate and/or infection rate. RESULTS Initial search identified 2596 studies, and 162 were found relevant. Full-text review and application of our inclusion criteria to all retrieved papers produced 38 articles that met inclusion criteria. Among the included studies, 16 papers reported the use of surgical drains in breast augmentation, while in the remaining 22 articles drains were not used. Only 5 studies specifically investigated the role and effectiveness of surgical drains in augmentation mammaplasty and its possible relationship with complication rate such as seroma, hematoma or infection. CONCLUSIONS Despite similar complication rates emerged from the analyzed articles, because of the heterogeneity of the studies, we were not able to demonstrate specifically whether drain use affects the rate of early postoperative complications such as seroma, hematoma and infection. Additional randomized controlled trials are strongly advocated in order to provide the necessary scientific evidence. 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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15
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Oliva A, Miele MC, Al Ismail D, Di Timoteo F, De Angelis M, Rosa L, Cutone A, Venditti M, Mascellino MT, Valenti P, Mastroianni CM. Challenges in the Microbiological Diagnosis of Implant-Associated Infections: A Summary of the Current Knowledge. Front Microbiol 2021; 12:750460. [PMID: 34777301 PMCID: PMC8586543 DOI: 10.3389/fmicb.2021.750460] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/04/2021] [Indexed: 12/14/2022] Open
Abstract
Implant-associated infections are characterized by microbial biofilm formation on implant surface, which renders the microbiological diagnosis challenging and requires, in the majority of cases, a complete device removal along with a prolonged antimicrobial therapy. Traditional cultures have shown unsatisfactory sensitivity and a significant advance in the field has been represented by both the application of the sonication technique for the detachment of live bacteria from biofilm and the implementation of metabolic and molecular assays. However, despite the recent progresses in the microbiological diagnosis have considerably reduced the rate of culture-negative infections, still their reported incidence is not negligible. Overall, several culture- and non-culture based methods have been developed for diagnosis optimization, which mostly relies on pre-operative and intra-operative (i.e., removed implants and surrounding tissues) samples. This review outlines the principal culture- and non-culture based methods for the diagnosis of the causative agents of implant-associated infections and gives an overview on their application in the clinical practice. Furthermore, advantages and disadvantages of each method are described.
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Affiliation(s)
- Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Maria Claudia Miele
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Dania Al Ismail
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Federica Di Timoteo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Massimiliano De Angelis
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Luigi Rosa
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Antimo Cutone
- Department of Biosciences and Territory, University of Molise, Pesche, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Maria Teresa Mascellino
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Piera Valenti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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16
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Shi XH, Zhou X, Lei ZY, Tian Y, Chen Y, Zhang YM, Mao TC, Fan DL, Zhou SW. Novel silicone rubber with carboxyl grafted polyhedral oligomeric silsesquioxane (POSS-COOH) as a potential scaffold for soft tissue filling. INT J POLYM MATER PO 2021. [DOI: 10.1080/00914037.2021.1999951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Xiao-hua Shi
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Army Medical University, Chong Qing, China
- Base for Drug Clinical Trial, Xinqiao Hospital, The Army Medical University, Chong Qing, China
| | - Xin Zhou
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Army Medical University, Chong Qing, China
| | - Ze-yuan Lei
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Army Medical University, Chong Qing, China
| | - Yuan Tian
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Army Medical University, Chong Qing, China
| | - Yao Chen
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Army Medical University, Chong Qing, China
| | - Yi-ming Zhang
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Army Medical University, Chong Qing, China
| | - Tong-chun Mao
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Army Medical University, Chong Qing, China
| | - Dong-li Fan
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Army Medical University, Chong Qing, China
| | - Shi-wen Zhou
- Base for Drug Clinical Trial, Xinqiao Hospital, The Army Medical University, Chong Qing, China
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17
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Successful salvage of an infected breast prothesis by changing from continuous to intermittent suction under continuous irrigation. Int J Surg Case Rep 2021; 82:105860. [PMID: 33838484 PMCID: PMC8045035 DOI: 10.1016/j.ijscr.2021.105860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 11/23/2022] Open
Abstract
Continuous irrigation does not always salvage infected breast implants. It is unclear whether continuous or intermittent suction is more effective. We salvaged a breast implant by changing from continuous to intermittent suction. Intermittent suction worked well in this patient and it is worthy of further studies.
Introduction Implant-based breast reconstruction is a widely performed procedure. However, prostheses are susceptible to infection and there are currently no established guidelines on treatment. In the present case, a prosthesis was salvaged by changing from continuous irrigation and suction to continuous irrigation and intermittent suction. This case report has been reported in line with the SCARE criteria [1]. Presentation of case A 50-year-old female patient underwent implant-based breast reconstruction following surgery for breast cancer. One month later, the left breast prosthesis was infected with abscesses. Surgical treatment and continuous irrigation were performed as postoperative therapy. However, recurrent infection was detected a few days after surgery. Continuous irrigation was changed to continuous irrigation with intermittent aspiration, which successfully controlled the infection. Discussion Factors that limit the effectiveness of continuous irrigation and aspiration have not yet been identified. Inflow/discharge shunt routes may be established in continuous aspiration, and, thus, sufficient cleaning may not be possible. On the other hand, the storage of water throughout the wound in intermittent aspiration may facilitate cleaning. Conclusion Intermittent suction worked well in this patient and, thus, warrants further study.
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