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Kyriazidis I, Antoniou A, Demiri E, Pavlidis L, Papas A. Bilateral Hematoma Following Air Travel after Breast Augmentation: A Cautionary Tale and Literature Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5639. [PMID: 38435464 PMCID: PMC10906603 DOI: 10.1097/gox.0000000000005639] [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: 08/17/2023] [Accepted: 01/17/2024] [Indexed: 03/05/2024]
Abstract
In this study, we report a rare incidence of bilateral hematoma following air travel in a patient who had recently undergone breast augmentation surgery. The case underscores the potential risks associated with flying shortly after such procedures. Through a literature review, we aimed to explore the incidence rates and highlight the need for further research in this area. This case report aims to raise awareness among healthcare professionals and patients about the need for cautious post-surgical travel planning to mitigate the risk of similar complications.
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Affiliation(s)
- Ioannis Kyriazidis
- From the Department of Plastic Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Antonios Antoniou
- From the Department of Plastic Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Efterpi Demiri
- From the Department of Plastic Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Leonidas Pavlidis
- From the Department of Plastic Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Athanasios Papas
- From the Department of Plastic Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
- School of Medicine, European University Cyprus, Nicosia, Cyprus
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2
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Zeplin PH. Activin A and Follistatin Serum Concentrations in Breast Augmentation Patients. Plast Surg (Oakv) 2023; 31:377-382. [PMID: 37915344 PMCID: PMC10617457 DOI: 10.1177/22925503211051120] [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: 04/14/2021] [Revised: 08/17/2021] [Accepted: 08/28/2021] [Indexed: 11/03/2023] Open
Abstract
Background: Capsular contracture is caused by an excessive fibrotic reaction similar as observed in other progressive fibrotic disorders. For their pathogenesis, several studies confirmed the importance of activins and follistatin. The aim of this study was to determine and analyze serum levels of Activin A and follistatin in patients with capsular contracture after aesthetic breast augmentation. Methods: The study included 361 female patients who underwent primary aesthetic breast augmentation, came for control examination after breast augmentation or for revision operation because of capsular contracture. Blood samples were taken and using a specific ELISA to determine the serum concentration levels of Activin A and Follistatin. Results: Ninety-six patients (n = 96), who developed a capsular contracture Baker ≥°III and underwent revision surgery were collected (capsular fibrosis group). One-hundred and fourteen patients (n = 114) were asymptomatic for capsular fibrosis Baker ≥°III after primary breast augmentation and 33 (n = 33) of them had developed no capsular fibrosis after more than 10 years (long-term group). For control group, blood samples were taken from 167 patients (n = 167) before primary aesthetic breast augmentation. Serum Activin A levels were significantly higher in the long-term Group compared with those in the capsular fibrosis- and the control groups. Follistatin levels were significantly lower in the capsular fibrosis group compared to the control- and the long-term groups. A small amount of control group patients (n = 16) developed a capsular fibrosis within 2 years after primary breast augmentation with significant lower follistatin levels. Retrospectively, they showed significantly lower serum follistatin levels than the control group even before the onset of capsular contracture. Conclusions: Capsular fibrosis has no effect on Activin A serum levels. In contrast, follistatin serum levels are lower in patients with capsular fibrosis. These results show that besides many other factors, a dysregulation of the Activin-follistatin axis may have importance on the pathogenesis of capsular contracture.
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Affiliation(s)
- Philip H. Zeplin
- Schlosspark Klinik Ludwigsburg, Privatklinik für Plastische und Ästhetische Chirurgie, Ludwigsburg, Germany
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3
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Veletić M, Apu EH, Simić M, Bergsland J, Balasingham I, Contag CH, Ashammakhi N. Implants with Sensing Capabilities. Chem Rev 2022; 122:16329-16363. [PMID: 35981266 DOI: 10.1021/acs.chemrev.2c00005] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Because of the aging human population and increased numbers of surgical procedures being performed, there is a growing number of biomedical devices being implanted each year. Although the benefits of implants are significant, there are risks to having foreign materials in the body that may lead to complications that may remain undetectable until a time at which the damage done becomes irreversible. To address this challenge, advances in implantable sensors may enable early detection of even minor changes in the implants or the surrounding tissues and provide early cues for intervention. Therefore, integrating sensors with implants will enable real-time monitoring and lead to improvements in implant function. Sensor integration has been mostly applied to cardiovascular, neural, and orthopedic implants, and advances in combined implant-sensor devices have been significant, yet there are needs still to be addressed. Sensor-integrating implants are still in their infancy; however, some have already made it to the clinic. With an interdisciplinary approach, these sensor-integrating devices will become more efficient, providing clear paths to clinical translation in the future.
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Affiliation(s)
- Mladen Veletić
- Department of Electronic Systems, Norwegian University of Science and Technology, 7491 Trondheim, Norway.,The Intervention Centre, Technology and Innovation Clinic, Oslo University Hospital, 0372 Oslo, Norway
| | - Ehsanul Hoque Apu
- Institute for Quantitative Health Science and Engineering (IQ) and Department of Biomedical Engineering (BME), Michigan State University, East Lansing, Michigan 48824, United States.,Division of Hematology and Oncology, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan 48105, United States
| | - Mitar Simić
- Faculty of Electrical Engineering, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Jacob Bergsland
- The Intervention Centre, Technology and Innovation Clinic, Oslo University Hospital, 0372 Oslo, Norway
| | - Ilangko Balasingham
- Department of Electronic Systems, Norwegian University of Science and Technology, 7491 Trondheim, Norway.,The Intervention Centre, Technology and Innovation Clinic, Oslo University Hospital, 0372 Oslo, Norway
| | - Christopher H Contag
- Institute for Quantitative Health Science and Engineering (IQ) and Department of Biomedical Engineering (BME), Michigan State University, East Lansing, Michigan 48824, United States
| | - Nureddin Ashammakhi
- Institute for Quantitative Health Science and Engineering (IQ) and Department of Biomedical Engineering (BME), Michigan State University, East Lansing, Michigan 48824, United States.,Department of Bioengineering, University of California, Los Angeles, California 90095, United States
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4
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Guimier E, Carson L, David B, Lambert JM, Heery E, Malcolm RK. Pharmacological Approaches for the Prevention of Breast Implant Capsular Contracture. J Surg Res 2022; 280:129-150. [PMID: 35969932 DOI: 10.1016/j.jss.2022.06.073] [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: 11/02/2021] [Revised: 06/17/2022] [Accepted: 06/29/2022] [Indexed: 11/15/2022]
Abstract
Capsular contracture is a common complication associated with breast implants following reconstructive or aesthetic surgery in which a tight or constricting scar tissue capsule forms around the implant, often distorting the breast shape and resulting in chronic pain. Capsulectomy (involving full removal of the capsule surrounding the implant) and capsulotomy (where the capsule is released and/or partly removed to create more space for the implant) are the most common surgical procedures used to treat capsular contracture. Various structural modifications of the implant device (including use of textured implants, submuscular placement of the implant, and the use of polyurethane-coated implants) and surgical strategies (including pre-operative skin washing and irrigation of the implant pocket with antibiotics) have been and/or are currently used to help reduce the incidence of capsular contracture. In this article, we review the pharmacological approaches-both commonly practiced in the clinic and experimental-reported in the scientific and clinical literature aimed at either preventing or treating capsular contracture, including (i) pre- and post-operative intravenous administration of drug substances, (ii) systemic (usually oral) administration of drugs before and after surgery, (iii) modification of the implant surface with grafted drug substances, (iv) irrigation of the implant or peri-implant tissue with drugs prior to implantation, and (v) incorporation of drugs into the implant shell or filler prior to surgery followed by drug release in situ after implantation.
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Affiliation(s)
| | - Louise Carson
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - Benny David
- NuSil Technology LLC, Carpinteria, California
| | | | | | - R Karl Malcolm
- School of Pharmacy, Queen's University Belfast, Belfast, UK.
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5
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Oncoplastic and Reconstructive Surgery for Breast Cancer. Breast Cancer 2022. [DOI: 10.1007/978-981-16-4546-4_22] [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]
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6
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Evaluation of satisfaction and well being with Breast-Q© of aesthetic breast augmentations by implants using the "Dual Plane" technique: A serie of 191 cases. ANN CHIR PLAST ESTH 2020; 66:314-319. [PMID: 32800623 DOI: 10.1016/j.anplas.2020.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/03/2020] [Accepted: 07/20/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Dual Plane allows, according to J.B Tebbetts, to combine the advantages while reducing the drawbacks of the other implantation pockets. We assessed patient satisfaction using the Breast-Q © questionnaire after breast augmentation using the Dual Plane technique. MATERIAL AND METHODS Our study involved evaluating data from the Breast-Q © questionnaire from 191 patients retrospectively. Other secondary criteria were studied such as postoperative complications, the correlation between satisfaction and implant volume, satisfaction and operating time, satisfaction and age of the patient. RESULTS The Breast-Q © questionnaire allows us to assess the satisfaction of the patients in our series about their breasts, their implants, the information received and the outcome of the intervention. Physical, sexual and psychosocial well-being is also assessed. CONCLUSION Breast augmentation using a Dual Plane pocket according to Tebbetts achieves significant levels of satisfaction and well-being in patients. To our knowledge, this is the most important series devoted to the evaluation of these criteria after the use of the Dual Plane.
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7
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Kurakula M, Koteswara Rao G. Moving polyvinyl pyrrolidone electrospun nanofibers and bioprinted scaffolds toward multidisciplinary biomedical applications. Eur Polym J 2020. [DOI: 10.1016/j.eurpolymj.2020.109919] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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8
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Akyürek M, Orhan E, Aydın MŞ, Uysal Ö, Karşıdağ S. The effects of human amniotic membrane on silicone related capsule formation in rats. J Plast Surg Hand Surg 2020; 54:284-289. [PMID: 32427012 DOI: 10.1080/2000656x.2020.1766476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Silicone breast implants are commonly used materials in plastic surgery for breast augmentation and reconstruction and the most severe complication of silicone implants are capsule contraction which occurs in 40% of patients. The aim of our study is to evaluate how the amniotic membrane alters the capsule formation effects of silicone 24 wistar rats were used in the study. We placed a bare silicone block into the left side (Subgroup A) and single layer amniotic membrane coated silicone block into the right side (Subgroup B) of the rats back. The rats were then separated into three groups and in group 1 rats were euthanized after 3 weeks, in group 2 after 12 weeks and in group 3 after 24 weeks. Then capsule thickness, fibroblast and lymphocyte cell counts were evaluated for each sample. In Group 2 and group 3, the capsule thickness in Subgroup B was detected to be statistically significantly lower than that in Subgroup A. In Group 1, 2, and 3, the lymphocyte count in the capsule tissue taken from Subgroup B was lower than Subgroup A but the difference was not statistically significant. In Group 2 and 3, the fibrocyte count detected in the capsule tissue in Subgroup B was found to be statistically significantly lower than Subgroup A. the amniotic membrane was demonstrated to reduce capsule thickness by the antifibrinolytic effect in our study.
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Affiliation(s)
- Mustafa Akyürek
- Department of Plastic Surgery, School of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Erkan Orhan
- Department of Plastic Surgery, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Mehmet Şerif Aydın
- Department of Histology and Embryology, School of Medicine, İstanbul Medipol University, İstanbul, Turkey
| | - Ömer Uysal
- Department of Biostatistics and Medicine Informatics, School of Medicine, Bezmialem Foundation University, İstanbul, Turkey
| | - Semra Karşıdağ
- Department of Plastic Surgery, School of Medicine, Sağlık Bilimleri University, İstanbul, Turkey
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9
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Chong H, Majerus SJ, Bogie KM, Zorman CA. Non‐hermetic packaging of biomedical microsystems from a materials perspective: A review. ACTA ACUST UNITED AC 2020. [DOI: 10.1002/mds3.10082] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Hao Chong
- Department of Electrical, Computer, and Systems Engineering Case Western Reserve University Cleveland OH USA
| | | | - Kath M. Bogie
- APT Center Louis Stokes VA Medical Center Cleveland OH USA
- Department of Orthopaedics Case Western Reserve University School of Medicine Cleveland OH USA
| | - Christian A. Zorman
- Department of Electrical, Computer, and Systems Engineering Case Western Reserve University Cleveland OH USA
- APT Center Louis Stokes VA Medical Center Cleveland OH USA
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10
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Abstract
This review discusses the historical development of smooth and textured silicone gel filled implants, and examines the reasoning behind product development and aspects of surgical technique from a surgeon's perspective.
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Affiliation(s)
- D Perry
- Anglia Ruskin University, Chelmsford, UK
| | - J D Frame
- Anglia Ruskin University, Chelmsford, UK
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11
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Chukwulobelu R, Seetharam S, Desai AJ, Ragoowansi R. 'The silicone siphon' - A safe and simple method of removing silicone implant and content from the breast. J Plast Reconstr Aesthet Surg 2018; 71:1362-1380. [PMID: 30007537 DOI: 10.1016/j.bjps.2018.05.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 05/28/2018] [Indexed: 11/26/2022]
Affiliation(s)
- R Chukwulobelu
- Department of Plastic Surgery, Royal London Hospital, Barts NHS Trust, Whitechapel Road, London E1 1BB, United Kingdom
| | - S Seetharam
- BMI Sloane hospital, Albemarle Road, Kent BR3 5HS, Beckenham, England
| | - A J Desai
- BMI Sloane hospital, Albemarle Road, Kent BR3 5HS, Beckenham, England
| | - R Ragoowansi
- Department of Plastic Surgery, Royal London Hospital, Barts NHS Trust, Whitechapel Road, London E1 1BB, United Kingdom.
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12
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Bogaert P, Perrot P, Duteille F. [Should we drain after pre-pectoral breast implants? Analysis of a cohort of 400 patients operated for breast augmentation with pre-pectoral silicone implants]. ANN CHIR PLAST ESTH 2014; 60:35-8. [PMID: 25442123 DOI: 10.1016/j.anplas.2014.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 08/27/2014] [Indexed: 01/09/2023]
Abstract
AIM OF THE STUDY During breast augmentation, surgical drainage remains a source of debate. The objective of the study was to determine the interest of the drainage after pre-pectoral breast implants pre, analyzing the risk of hematoma and capsular contracture. PATIENTS AND METHODS We retrospectively analyzed a cohort of 400 patients who underwent a first aesthetic breast augmentation by pre-pectoral silicone gel implants. Patients were followed with a maximum of nine years and a minimum of one year. RESULTS The mean age of patients was 37 years (18-64). Ninety-two percent (368 cases) had no drainage (patients "low risk of bleeding") and 8% (32 cases) underwent a bilateral drainage (patients "high risk of bleeding"). We recorded 1.75% hematoma (7 cases) and 2% of capsular contracture (8 cases). CONCLUSION We believe that the drainage should not be systematic for pre-pectoral breast implants. In patients at high risk of bleeding that we drained, it does not prevent the occurrence of a possible hematoma. In patients at low risk of bleeding that we have not drained, we do not observed more hematoma or capsular contracture than data published for drained patients.
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Affiliation(s)
- P Bogaert
- Service de chirurgie plastique et reconstructrice, centre des brûlés, hôpital Jean-Monnet, CHU de Nantes, 44093 Nantes cedex 01, France
| | - P Perrot
- Service de chirurgie plastique et reconstructrice, centre des brûlés, hôpital Jean-Monnet, CHU de Nantes, 44093 Nantes cedex 01, France
| | - F Duteille
- Service de chirurgie plastique et reconstructrice, centre des brûlés, hôpital Jean-Monnet, CHU de Nantes, 44093 Nantes cedex 01, France.
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13
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Pleural Damage During Capsulectomy and Exchange of Long-standing Breast Implants in Poland Syndrome. Ann Plast Surg 2012; 69:148-51. [DOI: 10.1097/sap.0b013e318226b4c4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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16
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Berry M, Davies D. Breast augmentation: Part I – a review of the silicone prosthesis. J Plast Reconstr Aesthet Surg 2010; 63:1761-8. [DOI: 10.1016/j.bjps.2009.07.047] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Revised: 07/27/2009] [Accepted: 07/31/2009] [Indexed: 10/20/2022]
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17
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San-Martín A, Dotor J, Martinez F, Hontanilla B. Effect of the inhibitor peptide of the transforming growth factor beta (p144) in a new silicone pericapsular fibrotic model in pigs. Aesthetic Plast Surg 2010; 34:430-7. [PMID: 20177678 DOI: 10.1007/s00266-010-9475-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Accepted: 01/14/2010] [Indexed: 01/27/2023]
Abstract
BACKGROUND Capsular contracture is the most common complication associated with silicone prostheses. It may take the form of anything from slight hardening to obvious deformity. The role of transforming growth factor beta (TGF-beta) in the scar physiopathology of any fibrotic process has been demonstrated. The effects of inhibition of TGF-beta have also been demonstrated in experimental models of fibrosis, which opens the way for new therapeutic alternatives in the treatment of capsular contracture. The aim of this study was to evaluate periprosthetic fibrosis with a newly synthesized TGF-beta peptide inhibitor (p144). METHODS Three experimental groups were formed: Group I, subcutaneous and submuscular textured silicone prostheses were left untreated; Group 2, the prostheses were left after being immersed in the vehicle; Group 3, the same protocol was followed as in Group 2, but the solution contained the vehicle with the inhibitor peptide of TGF-beta, p144 (15 mg/prosthesis). The animals were sacrificed 24 weeks after implantation, and the capsules were assessed both macroscopically and histologically. RESULTS The results obtained showed that the inhibition of capsular thickness and soluble collagen content in pericapsular fibrosis did not significantly decrease in the group of animals treated with the TGF-beta inhibitor peptide in comparison with control cases. CONCLUSIONS We detected no statistically significant reduction in fibrosis in the periprosthetic capsule after treating the implants with the inhibitor peptide p144, but we feel that the influence of trauma around the prosthesis is critical in impeding the antifibrotic activity of the inhibitor peptide.
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Affiliation(s)
- Andrea San-Martín
- Department of Plastic, Aesthetic and Reconstructive Surgery, Clínica Universidad de Navarra, University of Navarra, Pío XII 36, Pamplona, Spain
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Surface Modification of Silicone Breast Implants by Binding the Antifibrotic Drug Halofuginone Reduces Capsular Fibrosis. Plast Reconstr Surg 2010; 126:266-274. [DOI: 10.1097/prs.0b013e3181dbc313] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Effect of verapamil on reduction of peri-implant capsular thickness. Aesthetic Plast Surg 2009; 33:570-5. [PMID: 19101759 DOI: 10.1007/s00266-008-9288-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2008] [Accepted: 11/19/2008] [Indexed: 10/21/2022]
Abstract
Silicone is a material commonly used in reconstructive and aesthetic surgery, but capsular formation is a very frequent complication of silicone implants. This study aimed to investigate whether verapamil, a calcium-channel blocker, can reduce the thickness of the peri-implant capsule in rats when it is instilled into the subcutaneous pockets. For this study, 60 female Wistar albino rats were used, and cubes of silicone blocks (10 x 10 x 5 mm) were crafted. The rats were divided into five groups of 12 each, and the groups were distinguished according to the use of silicone and artificially created hematoma relevant to administration of a single dose of 5 mg verapamil (Isoptin). The control group was left without silicone. In two of the four silicone groups, hematoma was artificially created around the silicone by a 1-ml injection of blood. The implants were removed 6 months later, and capsulectomy was performed. Under light microscopic examination, no severe inflammation was observed in any of the capsule tissues. Additionally, the thickness of the capsule was measured and found to be significantly reduced statistically in all the verapamil-treated groups, including the groups with the artificially created hematoma. In conclusion, based on the statistically significant data obtained in this study, subcutaneous verapamil administration may be a useful adjunct for preventing formation of capsular contracture after silicone implantations. This preliminary work in rats should be confirmed with larger mammals before carefully controlled clinical trials are considered.
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Rawlins JM, Austin O. Bony spur – a cause for concern following breast augmentation. J Plast Reconstr Aesthet Surg 2008; 61:1115-6. [DOI: 10.1016/j.bjps.2007.12.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2007] [Accepted: 12/26/2007] [Indexed: 11/26/2022]
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21
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Berry MG, Stanek JJ. Brachial plexus impingement: an unusual complication of bilateral breast augmentation. Aesthetic Plast Surg 2008; 32:381-2. [PMID: 18043961 DOI: 10.1007/s00266-007-9055-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Breast augmentation is one of the most commonly performed aesthetic procedures, with many studies documenting the early and long-term complications that might be expected. This report describes the case of an active young woman who experienced severe pain, particularly with movement. Surgical exploration showed the cause of this pain to be impingement of the patient's lower brachial plexus by the mammary prosthesis. Such a complication has not, to the authors' knowledge, been reported previously.
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22
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Gundeslioglu O, Altundag O, Altundag K. Nanobacteria and breast implant capsule contracture and calcification: a hypothesis. Aesthetic Plast Surg 2005; 29:582. [PMID: 16328629 DOI: 10.1007/s00266-005-0094-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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23
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Pajkos A, Deva AK, Vickery K, Cope C, Chang L, Cossart YE. Detection of subclinical infection in significant breast implant capsules. Plast Reconstr Surg 2003; 111:1605-11. [PMID: 12655204 DOI: 10.1097/01.prs.0000054768.14922.44] [Citation(s) in RCA: 262] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The pathogenesis of fibrous capsular contracture after augmentation mammaplasty is still debated. One hypothesis implicates low-grade bacterial infections as a cause. The presence of a staphylococcal biofilm in a patient with recurrent capsular contracture was previously reported. A comparative, prospective, blinded, clinical study of implants and capsules removed from patients with or without significant capsular contracture was conducted to investigate the association of biofilm contamination, breast implants, and capsular contracture. Capsule and implant samples obtained during explantation were tested by routine microbiological culture, sensitive broth culture (after maceration and sonication), and scanning electron microscopy. Clinical parameters were correlated with microbiological findings. A total of 48 implant and/or capsule samples were obtained from 27 breasts during a 22-month period. Of the 27 breasts, 19 exhibited significant contracture (Baker grade III/IV). The mean duration of implantation was 9.2 years (range, 0.4 to 26.0 years). Routine swab cultures obtained at the time of explantation were negative for bacterial growth for all samples. The sensitive broth culture technique yielded 24 positive samples (50 percent, n = 48). An analysis of capsules demonstrated that 17 of 19 samples obtained from patients with significant contracture were positive, compared with only one of eight samples obtained from patients with minimal or no contracture (p = 0.0006). Fourteen of the 17 positive cultures from significantly contracted breasts yielded coagulase-negative staphylococci, mainly, species of the Staphylococcus epidermidis group. The presence of coagulase-negative staphylococci was also significantly associated with capsular contracture (p = 0.01). There was no significant difference in the frequency of culture positivity for saline versus silicone implants (p = 0.885). Scanning electron microscopy confirmed the presence of extensive biofilm on implants and within capsules.Biofilm, in particular, S. epidermidis biofilm, was detected for a significant proportion of patients with capsular contracture. This implicates biofilm disease in the pathogenesis of contracture, and strategies for its prevention should be explored.
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Affiliation(s)
- Aniko Pajkos
- Department of Infectious Diseases, University of Sydney, Australia
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24
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Bitar GJ, Nguyen DB, Knox LK, Dahman MI, Morgan RF, Rodeheaver GT. Shur-clens: an agent to remove silicone gel after breast implant rupture. Ann Plast Surg 2002; 48:148-53. [PMID: 11910219 DOI: 10.1097/00000637-200202000-00005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Removal of silicone gel from surrounding tissues after implant rupture is difficult. Local inflammation, infection, and silicone granulomas warrant thorough removal of the silicone gel. Shur-Clens (20% solution of the surfactant poloxamer 188), povidone-iodine, and saline are agents that are used to aid in the removal of silicone gel from tissue. The purpose of this study was to compare the efficacy of silicone gel removal by these three agents in vitro. Shur-Clens, povidone-iodine, and saline were compared as solvents for silicone gel. Four weight increments of silicone gel (0.02 g, 0.04 g, 0.06 g, and 0.08 g) were placed on glass slides. These slides were placed in separate beakers containing 40 ml test solution. The slides were soaked for 1 minute with gentle agitation. The slides were removed, rinsed gently with de-ionized water, and placed in a vacuum desiccator to dry. The slides were weighed to determine the amount of silicone removed after soaking in the solution. Analysis of variance was used to determine the significance between the three solvents. The percentages of silicone gel removed for the four weight increments (0.02 g, 0.04 g, 0.06 g, and 0.08 g) in saline were 5.6%, 2.9%, 2.1%, and 5.8%, respectively. In povidone-iodine solution, the percentages were 18.9%, 25.4%, 28.8%, and 51.9%. In Shur-Clens, the percentages were 31.3%, 43.0%, 63.5%, and 79.9%. The greater percentage of silicone gel removed by Shur-Clens was significant compared with the other solutions (p < or = 0.05). Shur-Clens was shown to be a more effective solvent for removal of silicone gel in vitro. This enhanced efficacy is a result of the fact that Shur-Clens contains 20% of the surfactant poloxamer 188. The authors' clinical experience with 7 patients who underwent ruptured silicone breast implant removal demonstrated the superiority of Shur-Clens. Shur-Clens is a surfactant cleanser that is widely available, is inexpensive, and has a good safety profile. They propose the use of Shur-Clens to clean silicone gel spillage to decrease local complications resulting from residual silicone gel.
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Affiliation(s)
- George J Bitar
- Department of Plastic Surgery, University of Virginia, Health System Charlottesville, 22908-1351, USA
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25
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Faulkner A, Kent J. Innovation and regulation in human implant technologies: developing comparative approaches. Soc Sci Med 2001; 53:895-913. [PMID: 11522136 DOI: 10.1016/s0277-9536(00)00389-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Human implant technologies are subject to continual innovation and proliferation, raising important issues for technology testing, healthcare sciences, clinical performance and risk assessment, and regulation. The regulatory environment of medical devices is being shaped by harmonisation of standards in the European Union. The aim of this paper is to compare the histories and current regulatory environment of two technologies, breast implants and artificial hips, and to consider the implications of this comparison for a sociological healthcare research agenda to investigate the issues raised. The main focus is upon developments in the United Kingdom. Major points of contrast between the two technologies include the institutional contexts in which clinical evidence has been marshalled for government attention; the relative importance of strategic alliances between clinicians and manufacturers in the innovation process; the degree of public controversy evident; the varying definitions of an 'adverse incident' within medical device vigilance systems; and in the UK the presence of a national register for breast implants but not for hip implants. Inter-national contrasts in these dimensions are noted. The analysis suggests that improved understanding is required of the institutional, organisational and professional processes involved in implant technology innovation and regulation. A comparative research agenda is proposed, focusing upon: innovativeness and proliferation; safety and technological standards; clinical and social outcomes; and consumer/user information and choice. It is concluded that research in these areas will enhance the 'evidence-base' for the evaluation of human implant technologies in the context of their innovatory and regulatory environments.
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Affiliation(s)
- A Faulkner
- School of Social Sciences, University of Wales Cardiff, UK.
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26
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de Kleer N, Cohen M, Semple J, Simor A, Antonyshyn O. Nipple piercing may be contraindicated in male patients with chest implants. Ann Plast Surg 2001; 47:188-90. [PMID: 11506329 DOI: 10.1097/00000637-200108000-00014] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The authors present a man who underwent chest augmentation and nipple piercing. The patient developed chronic nipple infection, which led to unnecessary invasive diagnostic procedures, serious implant infection, and eventually urgent explantation. This unfavorable scenario illustrates the distinct features of the procedure in men, which includes close proximity of the nipple to the implant and reduced awareness by health care providers. Based on this case the authors recommend avoiding nipple piercing in men with chest implants.
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Affiliation(s)
- N de Kleer
- Department of Surgery, Sunnybrook and Women's College Health Science Centre, University of Toronto, Ontario, Canada
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27
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Rizkalla M, Duncan C, Matthews RN. Trilucent breast implants: a 3 year series. BRITISH JOURNAL OF PLASTIC SURGERY 2001; 54:125-7. [PMID: 11207121 DOI: 10.1054/bjps.2000.3490] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The use of Trilucent breast implants in the UK dates back to 1995 and their introduction coincided with the medium-term effects of the silicone-implant controversy. We present a review of 3 years' experience of the Trilucent implant (1996-1998) during which 29 patients with a mean age of 39.4 years had a total of 50 implants. The aim of the study was to analyse the results in these patients in terms of complications, reoperation rate and patient satisfaction. Using a combination of retrospective chart analysis and postal survey, we found an incidence of implant deflation of 10% (5/50). The overall reoperation rate was 20% (10/50). The postal survey yielded a mean satisfaction score of 7.1 (on a scale of 0-10) from the 20 respondents out of the 29 patients (68.9%). In view of the high complication rate, we discontinued the use of Trilucent implants in advance of their withdrawal by the Medical Devices Agency (MDA) in March 1999. However, these findings may now be considered of added interest, particularly with regard to patients who are opting to keep their Trilucent implants despite the recommendation of the MDA in June 2000 that such implants should be removed.
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Affiliation(s)
- M Rizkalla
- Department of Plastic Surgery, George Eliot Hospital, Nuneaton, UK
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Oliver DW, Walker MS, Walters AE, Chatrath P, Lamberty BG. Anti-silicone antibodies and silicone containing breast implants. BRITISH JOURNAL OF PLASTIC SURGERY 2000; 53:410-4. [PMID: 10876279 DOI: 10.1054/bjps.2000.3344] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The detection of anti-silicone antibodies in patients with silicone breast implants (SBI) has been undertaken principally in the USA. We undertook a study of 20 women with SBI from different manufacturers from 6 weeks to 20 years after surgery, including those with ruptured implants. They were compared with three control groups: 20 women without implants, 20 women with auto-immune disease and 20 anonymous blood donors. Potential anti-silicone antibodies (IgG) were tested against a variety of silicone polymer antigens using an enzyme linked immunosorbent assay (ELISA) technique which had previously detected positive results in an uncontrolled series. Silicone-free collecting tubes were used. No differences were found between the patients with SBI and controls. However, samples that had been stored for the longest time, or frozen and thawed several times, had the highest levels. These false positives appear to be due to an unknown but human specific IgG binding phenomenon. We conclude that there is no demonstrable anti-silicone antibody formation in these patients with SBI and we would caution that the effect of storage may have been an important factor in previously published assay methods. This study supports the safety of silicone containing breast implants.
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Affiliation(s)
- D W Oliver
- Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge, UK
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