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Berger LE, Song DH. Discussion: Replacement of Shaped Textured Implants with Round Smooth Implants in Breast Reconstruction: Long-Term Outcomes. Plast Reconstr Surg 2024; 154:272-274. [PMID: 39046836 DOI: 10.1097/prs.0000000000011413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Affiliation(s)
- Lauren E Berger
- From the Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital
- Plastic and Reconstructive Surgery Division, Rutgers Robert Wood Johnson Medical School
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2
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Montemurro P, Pietruski P. Twelve Years and over 2400 Implants Later: Augmentation Mammoplasty Risk Factors Based on a Single Plastic Surgeon's Experience. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5720. [PMID: 38596589 PMCID: PMC11000759 DOI: 10.1097/gox.0000000000005720] [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: 12/11/2023] [Accepted: 02/15/2024] [Indexed: 04/11/2024]
Abstract
Background Breast augmentation is one of the most commonly performed aesthetic surgery procedures. Yet, few reports in the literature analyze individual surgeon experiences with a unified surgical method on a large group of patients. This study aimed to analyze a single surgeon's complications rate and experience with the Akademikliniken augmentation mammaplasty method from the beginning of his career. Methods A retrospective outcome analysis of all patients (n = 1646) who underwent breast augmentation between 2009 and 2021 performed by a single surgeon was conducted. Complications and reoperation rates were evaluated. In addition, correlations with the patient and implant characteristics and insertion-method-related risk factors were analyzed. Results In total, 1212 female patients (mean age, 31.47 years) were analyzed. The minimal follow-up for every patient was 6 months (mean follow-up, 18.35 months). The total complication rate was 7.1%, and the most common complication (2.64%) was capsular contracture (Baker scale III/IV). Implant insertion with a funnel significantly lowered the overall risk of complications (P = 0.009). Statistical analysis indicates that the single independent risk factors for primary breast augmentation are patient age younger than 27 years, initial breast size B and C, and tobacco smoking. Conclusions This study indicated that capsular contracture and implant rotation are the most common complications of analyzed primary augmentation mammoplasty. It also identifies various risk and protection factors, such as funnel usage, which should be considered by the surgeon when performing this type of procedure.
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Affiliation(s)
- Paolo Montemurro
- From Akademikliniken, Stockholm, Sweden
- Private Practice, Varese, Italy
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Jaeger M, Randquist C, Gahm J. Anatomical Breast Implant Assessment Using Ultrasound: A Case Series from the International Breast Implant Check Clinic. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5469. [PMID: 38111726 PMCID: PMC10727634 DOI: 10.1097/gox.0000000000005469] [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: 10/05/2023] [Accepted: 10/12/2023] [Indexed: 12/20/2023]
Abstract
Background Breast augmentation with anatomic implants can achieve a natural look, but over time, implant-related complications can occur. This includes a risk of potential rotation, which can cause a change in breast shape. Reported rates of rotation vary widely (0%-42%). Implant rotation is often detected by physical examination only or as a perioperative finding. Change in breast shape after augmentation requires clinical evaluation. In-office ultrasound allows for detailed assessment of implants for rotation and other complications. Methods Women with anatomical breast implants seeking follow-up at the International Breast Implant Check Clinic in Stockholm, Sweden, from April 2020 to July 2022 were included in the study. Using a standardized protocol, subjective symptoms were recorded, and a physical examination followed by an ultrasound assessment was performed by a single board-certified plastic surgeon (M.J.) trained in implant assessment via ultrasound. Rotation was defined as an implant rotated past 30 degrees off the breast midline at 6 o'clock. Results The study included 308 women (mean age 40.1, range 20-78) with bilateral anatomical implants. Overall, 40 women (13.0%) reported a change in breast shape; 35 had one or more implant-related complications, including five with rotation on ultrasound. Of the 308 women, 11 (3.6%) had rotations upon physical examination, and an additional 10 cases were identified using ultrasound. Conclusions Rotation is a potential complication of anatomical breast implants. However, in this study, change in breast shape was more commonly caused by other implant-related complications. Ultrasound is a valuable tool in evaluating causes of change in breast shape.
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Affiliation(s)
| | | | - Jessica Gahm
- From Victoriakliniken, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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4
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Rosas JM, Atkins DJ, Chau AL, Chen YT, Bae R, Cavanaugh MK, Lima RIE, Bordeos A, Bryant MG, Pitenis AA. In vitro models of soft tissue damage by implant-associated frictional shear stresses. PROCEEDINGS OF THE INSTITUTION OF MECHANICAL ENGINEERS. PART J, JOURNAL OF ENGINEERING TRIBOLOGY 2023; 237:1264-1271. [PMID: 38024847 PMCID: PMC10683933 DOI: 10.1177/13506501221132897] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Silicone elastomer medical implants are ubiquitous in medicine, particularly for breast augmentation. However, when these devices are placed within the body, disruption of the natural biological interfaces occurs, which significantly changes the native energy-dissipation mechanisms of living systems. These new interfaces can introduce non-physiological contact pressures and tribological conditions that provoke inflammation and soft tissue damage. Despite their significance, the biotribological properties of implant-tissue and implant-extracellular matrix (ECM) interfaces remain poorly understood. Here, we developed an in vitro model of soft tissue damage using a custom-built in situ biotribometer mounted onto a confocal microscope. Sections of commercially-available silicone breast implants with distinct and clinically relevant surface roughness (Ra = 0.2 ± 0.03 μm, 2.7 ± 0.6 μm, and 32 ± 7.0 μm) were mounted to spherically-capped hydrogel probes and slid against collagen-coated hydrogel surfaces as well as healthy breast epithelial (MCF10A) cell monolayers to model implant-ECM and implant-tissue interfaces. In contrast to the "smooth" silicone implants (Ra < 10 μm), we demonstrate that the "microtextured" silicone implant (10 < Ra < 50 μm) induced higher frictional shear stress (τ > 100 Pa), which led to greater collagen removal and cell rupture/delamination. Our studies may provide insights into post-implantation tribological interactions between silicone breast implants and soft tissues.
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Affiliation(s)
| | | | | | | | - Rachel Bae
- Department of Chemistry and Biochemistry
| | | | | | - Andrew Bordeos
- Surface Analysis Team, Keyence Microscopes, Keyence Corporation of America, El Segundo, California, United States
| | - Michael G. Bryant
- School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom
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5
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Breast Surgery with Smooth Anatomical Implants with Fixation System: A Review of the World's Largest Series of Cases. Plast Reconstr Surg 2023; 151:207e-213e. [PMID: 36696306 DOI: 10.1097/prs.0000000000009829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Anatomical implants continue to be a particularly useful tool in breast surgery, offering an excellent result for certain indications. However, to ensure fixation and prevent rotation, traditional alternatives have medium to high surface roughness and have been controversial in recent years. METHODS A retrospective assessment of 122 prosthetic augmentation and reconstruction patients over a period of 5 years was conducted. Patients were treated with tabbed anatomical implants with a smooth surface and followed up for a period of 12 months. Demographics, complications, and patient satisfaction were captured. A subgroup of 101 patients were assessed with chest radiographs at 1-year follow-up. Technical recommendations are discussed. RESULTS Primary breast augmentation, revision augmentation, augmentation-mastopexy, and breast reconstruction were the main indications for surgery. All implants were inserted through an inframammary incision and placed in the subpectoral space using dual-plane techniques, except in one mastectomy case. Rotation of the implants was radiographically observed in only two cases of revision augmentation. None of the 122 patients developed capsular contracture, seroma, rupture, infection, hematoma, or malposition following breast surgery. CONCLUSIONS Smooth anatomical implants with a fixation system offer reliable and satisfactory results for patients with various diagnoses and indications. The tab system and the fixation technique are essential to provide long-term stability, which was verified by radiographs because of the radiopaque lines present in the device for that purpose. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Nam SE, Lee S, Cho Y, Kim JH. A non-manufacturer-sponsored, retrospective study to assess 2-year safety outcomes of the BellaGel® SmoothFine as compared with its competitors in the context of the first Korean case of a medical device fraud. PLoS One 2023; 18:e0259825. [PMID: 36730227 PMCID: PMC9894413 DOI: 10.1371/journal.pone.0259825] [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: 06/19/2020] [Accepted: 10/27/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND We conducted this study to assess preliminary 2-year safety outcomes of an implant-based augmentation mammaplasty using the BellaGel® SmoothFine in the context of the first Korean case of a medical device fraud. METHODS Our clinical series of the patients (n = 579; 1,158 breasts) received augmentation using the BellaGel® SmoothFine, Naturgel™, Motiva Ergonomix™, Eurosilicone Round Collection™, Natrelle® INSPIRA™, Natrelle® 410, Mentor® MemoryGel Xtra or Microthane®. The patients were evaluated for incidences of postoperative complications and Kaplan-Meier survival and hazards. RESULTS Overall, there were a total of 101 cases (17.4%) of postoperative complications; these include 31 cases (5.4%) of shape deformity, 21 cases (3.6%) of CC, 18 cases (3.1%) of early seroma, 8 cases (1.4%) of infection, 5 cases (0.9%) of early hematoma, 1 case (0.2%) of delayed hematoma, 1 case (0.2%) of rupture and 1 case (0.2%) of ripping. Moreover, there were also 15 cases (2.6%) of other complications. There were significant differences in incidences of postoperative complications between the breast implants from different manufacturers (P = 0.034). The Natrelle® 410 showed the longest survival (333.3±268.2 [141.5-525.1] days). A subgroup analysis showed that there were no significant differences in incidences of postoperative complications between the breast implants (P = 0.831). Moreover, the Natrelle® INSPIRA™ showed the longest survival (223.7±107.1 [-42.3-489.6] days). CONCLUSIONS Here, we describe preliminary 2-year safety outcomes of an implant-based augmentation mammaplasty using the BellaGel® SmoothFine in the context of the first Korean case of a medical device fraud.
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Affiliation(s)
- Sang Eun Nam
- Department of Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | | | - Younghye Cho
- Department of Pathology, Jangwon Medical Foundation, Seoul, Korea
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7
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Ferenz S, McGuire P, Glicksman C. The Efficacy and Associated Learning Curve of Office-Based High-Resolution Ultrasound to Detect Shell Failure in Breast Implants. Aesthet Surg J 2022; 43:657-661. [PMID: 36478200 DOI: 10.1093/asj/sjac330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/04/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND HRUS is widely used in plastic surgery practices to detect implant rupture prior to revision surgery. Published research has found a good overall accuracy to detect shell failure. The literature often references a learning curve associated with incorporating this imaging technique into a medical practice, but it is yet to be visualized or defined. OBJECTIVE This study calculated current test statistics for the use of HRUS to detect shell failure, as well as define the associated learning curve with respect to the predicted improvement for statistics of test and surgeon proficiency. METHODS A retrospective review of sequential in-office HRUS on patients with breast implants was conducted across two plastic surgery practices. Pre-operative ultrasound reports and intra-operative findings were compared. Test statistics were calculated for each group of ten subsequent patient and a regression analysis was performed to define the learning curve. RESULTS 480 implants were examined and averages for all test statistics were calculated. All were higher than most of the previously reported literature standards. The regression analysis showed a linear improvement for both sensitivity and specificity over time, with significant improvement in sensitivity. CONCLUSION The study shows a high efficacy of HRUS to detect shell failure in breast implants. There is also a calculable linear improvement for all test values of the HRUS over time. Surgeons were able to remain above literature standard for sensitivity after their 60th HRUS reading. This improvement shows that continued use and practice with the imaging technique allow for more accurate findings.
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Affiliation(s)
| | - Patricia McGuire
- Clinical Instructor of Surgery Washington University, St. Louis, MO
| | - Caroline Glicksman
- Assistant Clinical Professor Hackensack Meridien School of Medicine, Nutley, NJ
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8
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Lohmeyer JA, Shahmiri-Zimmermann S, Keck MK. [Reliable diagnosis of implant rotation in high-resolution ultrasound depending on the implant manufacturer]. HANDCHIR MIKROCHIR P 2022; 54:495-500. [PMID: 36513061 DOI: 10.1055/a-1957-6616] [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: 12/15/2022] Open
Abstract
Rotation of an anatomical breast implant may require revisional surgery. High-resolution ultrasound can help determine the exact implant alignment. However, the directional markings of anatomical implants are implemented very inconsistently by manufacturers. Therefore, a definite diagnosis is often not possible without precise knowledge of the expected imaging. The aim of this work is a differentiation of the imaging of common implant brands in high-resolution ultrasound. Methods To simulate an authentic imaging, anatomical implants were viewed through abdominal skin thinned to 1.5-2 cm, which was obtained during a classic abdominoplasty. Implants from the companies Allergan, Eurosilicone, Mentor, Motiva, Nagor, Polytech and Sebbin were compared. The marking positions and dimensions were documented by ultrasound. Results Based on placement and shape, a clear allocation between alignment and manufacturer is basically possible among the implants used. The base plate and caudal markers could be clearly visualised for all brands. In Polytech implants, however, the visible structural change is limited to a very small central area. The visualisation of directional marks, base plate and implant shell also allow conclusions to be drawn about the manufacturer. In high-resolution ultrasound, a fast and reliable diagnosis of implant alignment is possible for all implants examined. Also it was possible to make a clear allocation between implant and manufacturer in this context. Flip over of the implant can also be reliably depicted. The cataloguing of the markings summarised here can be used to determine the exact alignment of the implant and thus provide diagnostic certainty, especially if the brand is unknown.
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Affiliation(s)
- Jörn Andreas Lohmeyer
- Klinik für Plastische, Rekonstruktive und Ästhetische Chirurgie, Agaplesion Diakonieklinikum Hamburg gAG, Hamburg, Germany
- Klinik und Poliklinik für Plastische Chirurgie und Handchirurgie, Klinikum rechts der Isar der Technischen Universität München, Germany
| | - Shanly Shahmiri-Zimmermann
- Klinik für Plastische, Rekonstruktive und Ästhetische Chirurgie, Agaplesion Diakonieklinikum Hamburg gAG, Hamburg, Germany
| | - Maike Katharina Keck
- Klinik für Plastische, Rekonstruktive und Ästhetische Chirurgie, Agaplesion Diakonieklinikum Hamburg gAG, Hamburg, Germany
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9
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Kuruoglu D, Harless CA, Tran NV, Yan M, Martinez-Jorge J, Nguyen MDT. Implant Malposition in Prepectoral Breast Reconstruction: Experience with Natrelle® Cohesive Implants over 6.5 Years. J Plast Reconstr Aesthet Surg 2022; 75:2561-2568. [PMID: 35370117 DOI: 10.1016/j.bjps.2022.02.072] [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: 09/23/2021] [Revised: 01/17/2022] [Accepted: 02/22/2022] [Indexed: 11/15/2022]
Abstract
Implant malposition has been reported to be a common reason for revision surgery after implant-based breast reconstruction (IBR). With the recent increase in the use of smooth implants due to concerns for breast implant-associated anaplastic large-cell lymphoma with textured implants, we compared and reported the rates of malposition in prepectoral IBR and identified risk factors. A retrospective review of patients who underwent prepectoral IBR with Natrelle® (Allergan, Inc., Irvine, CA) implants at our institution between January 2014 and May 2020 was performed. Clinical characteristics, implant types, and the rate of malposition, defined as implant flipping or rotation, were recorded. Univariate and multivariable time-to-event analyses using the Cox proportional-hazards model were performed to identify predictors of malposition. Three hundred seventy-five patients (660 breasts) were included. Four hundred forty-one (66.8%) breasts had smooth round implants whereas 219 (33.2%) had textured anatomical devices. Malposition requiring either a manual correction or surgical intervention occurred in 26 (5.9%) smooth round implants versus 3 (1.4%) textured anatomical. Multivariable analysis showed that having a smooth round implant (aHR: 7.19, 95% CI: [2.04 - 25.4]) and an increase in implant volume (aHR: 1.003, 95% CI: [1.001 - 1.006]) were associated with having a malposition requiring intervention. Among smooth round implants; INSPIRA® Cohesive implants were more likely to result in a malposition requiring intervention (p<0.0001) compared to other smooth round implants. Overall, malposition requiring intervention occurred in 5.9% of smooth round implants and 1.4% of textured anatomical implants. Statistical analysis demonstrates that smooth round implants and an increase in implant volume both are associated with a malposition requiring intervention.
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Affiliation(s)
- Doga Kuruoglu
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Christin A Harless
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Nho V Tran
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Maria Yan
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jorys Martinez-Jorge
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Minh-Doan T Nguyen
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
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10
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Van Slyke AC, Roller JM, Alaghehbandan R, Carr NJ. Defining Double Capsules: A Clinical and Histological Study. Aesthet Surg J 2021; 41:NP1437-NP1444. [PMID: 33655295 DOI: 10.1093/asj/sjab045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Macrotextured breast implants are associated with double capsules. There is little agreement as to what defines double capsules, how they present, and whether different degrees of double capsule exist. OBJECTIVES This study aimed to define double capsules and report an association between double-capsule type and degree of tissue adherence. METHODS Consecutive aesthetic patients undergoing explantation of Biocell (Allergan, Inc., Irvine, CA) implants between May 2018 and November 2018 were included if they were found to have double capsules intraoperatively. Patient demographics, implant characteristics, explantation reason, implant adherence, and intraoperative findings were recorded. Both adherent and double capsules were histologically examined. Data were analyzed by descriptive statistics. RESULTS Eleven patients had 22 Biocell implants explanted during the study period. The average explantation time was 8.0 years. Sixteen implants were found to have some degree of nonadherence, and all areas of nonadherence were associated with double-capsule formation. Double capsules were either partial or complete. The architecture of the inner layer of double capsules varied between an organized capsular layer and a thin area of nascent capsule. Histologically, all capsular specimens demonstrated an overall hypocellular fibrous capsule with scattered chronic inflammatory infiltrates. Synovial metaplasia was present in all capsule types and spaces/cracks in the capsule were disproportionately represented in partially adherent capsules. CONCLUSIONS This is the first study to identify a clinical and pathological correlation between double capsules and failed tissue adherence. Double capsules represent a spectrum of inner capsule formation ranging between nascent capsular tissue to a mature inner capsular layer. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Aaron C Van Slyke
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Janine M Roller
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Reza Alaghehbandan
- Department of Pathology, Faculty of Medicine, University of British Columbia, Royal Columbian Hospital, New Westminster, BC, Canada
| | - Nicholas J Carr
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
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11
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Adams WP. Commentary on: Relation Between Post-Augmentation Parenchymal Atrophy and Local Tissue Pressure. Aesthet Surg J 2021; 41:NP1496-NP1497. [PMID: 34375390 DOI: 10.1093/asj/sjab313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- William P Adams
- Department of Plastic Surgery, UT Southwestern, University Park, TX, USA
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12
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Avvedimento S, Montemurro P, Cigna E, Guastafierro A, Cagli B, Santorelli A. Quantitative Analysis of Nipple to Inframammary Fold Distance Variation in Tuberous Breast Augmentation: Is there a Progressive Lower Pole Expansion? Aesthetic Plast Surg 2021; 45:2017-2024. [PMID: 34100102 DOI: 10.1007/s00266-021-02363-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/15/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION In patients with short nipple to inframammary fold (N-IMF) distance, as in tuberous breast, the cohesivity and gel distribution of shaped implants work as a controlled tissue expander, progressively adapting the tissues to the implant's shape. This phenomenon translates into a gradual increase of the N-IMF distance over time, but the true extent to which this occurs has not been quantified to date. This study aims to quantify the postoperative variation of the N-IMF distance in tuberous breast treated with shaped cohesive silicone breast implants. METHODS We did a retrospective review of a prospective maintained database of all consecutive patients with bilateral Groulleau I and II tuberous breasts who underwent primary breast augmentation between April 2017 and May 2018 at our institution. To quantify the lower mammary pole's morphological changes, we evaluated the N-IMF distance under maximal stretch as an endpoint. We recorded this value at time 0 (preoperative), immediate post-op (equivalent to the distance planned preoperatively) and at month 1, month 6 and 1-year post-op. Then we calculated the average N-IMF distance variation of our sample of patients with a 99% interval of confidence for each breast obtained. Comparisons were performed using the Sign test and the Mann-Whitney U test. RESULTS The average implant weight was 353g (range 290-450; SD ±46.147). Of the 54 breasts analyzed, the immediate post-op N-IMF distance was on average 2.43 cm longer than the preop IMF with a 99% confidence interval between 2.01 and 2.86 and SD of ±1.22. The mean difference between the preop N-IMF distance and after 1, 6 and 12 months was respectively 2.78 cm (SD,1.56) (99% CI, 2.24-3.34), 3.08 cm (SD, 1.57) (99% CI, 2.53-3.64), and 3.36 (1.55) (99% CI, 2.82-3.91) Comparing immediate postoperative nipple to inframammary fold distance (N-IMF) to the 1, 6 and 12 months N-IMF values, an average of 4.23% (CI 1.3-7.16), 7.74% (CI 4.25-11.23) and 10.84% (CI 7.21-14.49) of skin length, was gained respectively. According to implants' weight, subgroup analysis showed that implants > 400 g were associated with significantly higher N-IMF distance increase (p <0.05) compared to implants < 400 g. CONCLUSIONS Our findings suggest that a significant progressive postoperative increase in N-IMF distance should be expected in all cases of tuberous breast augmentation with anatomical implants over a 1 year period. This aspect may have an important implication on the IMF incision and the new fold position preoperative planning. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | | | - Emanuele Cigna
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, Università degli Studi di Pisa, Pisa, Italy
| | - Antonio Guastafierro
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Plastic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Barbara Cagli
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome", Rome, Italy
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13
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Applying Principles of Breast Revision to Managing Aesthetic Patients with Textured Implants. Plast Reconstr Surg 2021; 147:24S-30S. [PMID: 33890877 DOI: 10.1097/prs.0000000000008042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY Textured breast implants have garnered increased attention recently because of their risk of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), an uncommon and treatable type of T-cell lymphoma. Treatment involves bilateral en bloc capsulectomy, which is curative in the majority of cases. At present, there is no defined management approach for aesthetic patients asymptomatic for BIA-ALCL requesting the removal of their textured implants, particularly as it relates to the management of the capsule. It is unclear if en bloc capsulectomy is necessary in these patients as it is in patients with BIA-ALCL. In the absence of clear guidance on the management of the capsule in asymptomatic patients, the basic principles of breast revision surgery can be applied to these patients.
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14
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Lee J, Lee HC, Park SH, Jung SP, Yoon ES. Correction of malrotation in two-stage breast reconstruction: outcomes and risk-factor analysis. J Plast Surg Hand Surg 2021; 55:6-12. [PMID: 33467962 DOI: 10.1080/2000656x.2020.1817752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Although an anatomical implant is no longer recommended in practice, frequent use of the implants in the past decade left apprehension to surgeons, and malrotation is one of the concerns. However, a limited amount of literature has focused on malrotation to date, especially in breast reconstruction, and there also exists a lack of consensus regarding the correction of malrotation. Given that implant-based reconstruction has increased in frequency and there remain many potential patients who have used earlier models of anatomical implants, this study sought to analyze predisposing risk factors and approaches to correct implant malrotation. A total of 132 implants in 118 patients who underwent expander/implant reconstruction were identified and retrospectively reviewed. Seventeen (12.9%) implants showed malrotation. The results of multivariate logistic regression revealed that tissue expander malrotation in the first stage and capsular contracture were significant risk factors associated with malrotation in two-stage implant-based breast reconstruction (both p < 0.001). When a patient presents with malrotation, it is recommended that the implant be changed to a round type if a patient has multiple risk factors because malrotation tends to recur after correction. Also, even when using a round implant during two-stage breast reconstruction, additional care should be adopted for those who experienced rotation after expander insertion.
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Affiliation(s)
- Jaemin Lee
- Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Seoul, Korea
| | - Hyung Chul Lee
- Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Seoul, Korea
| | - Seung-Ha Park
- Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Seoul, Korea
| | - Seung Pil Jung
- Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Eul-Sik Yoon
- Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Seoul, Korea
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15
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Marcelli S, Aso J. Preliminary outcomes and comparison of polytech POLYtxt Ⓡ and MESMOsensitive Ⓡ breast implants with focus on late seroma: Single-surgeon, retrospective cohort study on 621 consecutive aesthetic breast surgery cases. J Plast Reconstr Aesthet Surg 2021; 74:2217-2226. [PMID: 33582050 DOI: 10.1016/j.bjps.2020.12.092] [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: 05/03/2020] [Revised: 11/29/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Recent history shows incomplete understanding of the long-term interaction between breast implants and biological tissues. Although complications of silicone-textured implants have been previously reported, conclusive data are still controversial due to the lack of reduced bias, long-term, comparative studies. We present our preliminary outcomes of 3 years aesthetic use of POLYTECH silicone POLYtxtⓇ and MESMO SensitiveⓇ implants. METHODS This article is a retrospective analysis of 621 patients who have undergone primary aesthetic breast surgery (breast augmentation (BA) or augmentation mastopexy). The surgeries were performed by a single surgeon using Polytech microtextured silicone implants (POLYtxt and MESMO). Complications, with main focus on late seroma, were assessed and compared based on texturization type. RESULTS From January 2015 to September 2018, 358 patients were treated with POLYtxt and 263 with MESMO-textured implants. Incidence of complications, such as hematoma, infection, early seroma, capsular contraction and malposition/rotation was comparable between the two groups. Incidence of late seroma was, respectively, 6.4% (POLYtxt) and 0% (MESMO) resulting in a statistically significant difference between the two groups. Overall complications and reinterventions were 12.5%-9.2% (POLYtxt) and 4.5%-3.8% (MESMO), respectively, showing a significantly lower occurrence in the MESMO group. CONCLUSIONS This reduced bias study shows an increased risk in overall complications and reoperations with POLYtxt surface implants compared with MESMO. Furthermore, we registered an exceptionally high rate of late seroma when the more "aggressive" POLYtxt texturization was used. Conversely, a significantly low incidence of adverse events was registered with the MESMO surface, which has turned this device in our first choice in daily practice.
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Affiliation(s)
- S Marcelli
- Private Practice, Calle de Núñez de Balboa, 107, 28006, Madrid, Spain.
| | - J Aso
- Private Practice, Calle de Núñez de Balboa, 107, 28006; Madrid Spain. Department of Plastic Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain
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Fundamentals of High-Resolution Ultrasound in Breast Implant Screening for Plastic Surgeons. Clin Plast Surg 2020; 48:59-69. [PMID: 33220905 DOI: 10.1016/j.cps.2020.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This article introduces the plastic surgeon to the basics of high-resolution ultrasound (HRUS) for screening breast implants. It describes how HRUS has become an accepted alternative to MRI for screening and diagnosis, and how plastic surgeons should use this new technology for the benefit of their patients and their practices. Basic principles, technology, and nomenclature are presented. Key steps to obtaining diagnostic images of breast implants are reviewed, including typical artifacts and sources of error. Imaging examples are presented. The article ends with a review and a step-by-step guide for plastic surgeons looking to use the technology.
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Kim JH, Paik NS, Nam SY, Cho Y, Park HK. The Emerging Crisis of Stakeholders in Implant-based Augmentation Mammaplasty in Korea. J Korean Med Sci 2020; 35:e103. [PMID: 32301294 PMCID: PMC7167397 DOI: 10.3346/jkms.2020.35.e103] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 02/10/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Korea is no longer safe from the risk of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL); the first reported case was a Korean woman in her 40s who had a 7-year-history of receiving an implant-based augmentation mammaplasty using a textured implant. We conducted this study to discuss the emerging crisis of stakeholders in implant-based augmentation mammaplasty and to propose a multi-disciplinary approach to early detection of its complications. METHODS We analyzed medical examination data that was collected from patients who visited us between August 12 and September 27, 2019. We evaluated a total of 114 women (n = 114) in the current study. They were evaluated for whether they were in healthy condition. Moreover, their baseline characteristics were also examined; these included age, gender, height (cm), weight (kg), duration since surgery (years), possession of a breast implant card, the site of surgical incision, side of symptoms and reasons for outpatient visit. Furthermore, the patients were also evaluated for their subjective awareness of the manufacturer, surface and shape of the breast implant. Potential complications include malrotation, folding, seroma, capsule thickening, upside-down rotation, rupture, capsule mass and breast mass. RESULTS A majority of the patients had a past history of receiving textured implants. The corresponding percentage was 78.95% (90/114) and 85.09% (97/114) based on their subjective awareness of a breast implant and sonographic findings, respectively. That is, it was slightly increased with the use of a breast ultrasound. CONCLUSION Here, we propose the following approaches. First, patient data should be prospectively collected. By tracking outcomes and complications of an implant-based augmentation mammaplasty, both high-quality care and patient safety can be ensured. Second, stakeholders in implant-based augmentation mammaplasty should collaborate with customers and regulatory authorities. Third, surgeons should consider applying imaging modalities for early detection of postoperative complications.
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Affiliation(s)
| | - Nam Sun Paik
- Department of Surgery, Breast and Thyroid Cancer Center, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sang Yu Nam
- Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea
| | - Younghye Cho
- Department of Pathology, Jangwon Medical Foundation, Seoul, Korea
| | - Heung Kyu Park
- Department of Surgery, Breast Cancer Center, Gachon University Gil Medical Center, Incheon, Korea.
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Short-term Safety of Augmentation Mammaplasty Using the BellaGel Implants in Korean Women. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2566. [PMID: 32537308 PMCID: PMC7288882 DOI: 10.1097/gox.0000000000002566] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/16/2019] [Indexed: 01/09/2023]
Abstract
Supplemental Digital Content is available in the text. Asian women are stereotypically characterized by a slim body, smaller breasts and areolae, and larger nipples when compared with White women. They would therefore be vulnerable to displacement of a breast implant if they receive larger implants. They are also prone to hypertrophic and prolonged hyperemic scars. Surgeons should therefore be aware of Asian women’s breast anatomy, healing tendency, and preferences. We conducted this multicenter, retrospective study to assess the short-term safety of the BellaGel implants in Korean women.
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The Food and Drug Administration Bans Biocell Textured Breast Implants: Lessons for Plastic Surgeons. Ann Plast Surg 2019; 84:343-345. [PMID: 31688109 DOI: 10.1097/sap.0000000000002139] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Plastic Surgeons Defend Textured Breast Implants at 2019 U.S. Food and Drug Administration Hearing: Why It Is Time to Reconsider. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2410. [PMID: 31592028 PMCID: PMC6756678 DOI: 10.1097/gox.0000000000002410] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 06/26/2019] [Indexed: 11/25/2022]
Abstract
Textured breast implants were the subject of a U.S. Food and Drug Administration (FDA) hearing on March 25 and 26, 2019. Regulating agencies in other countries, including all of Europe and Canada, have already banned macrotextured implants. Patients affected by Breast Implant-Associated Anaplastic Large-Cell Lymphoma (BIA-ALCL) recounted their life-changing experiences, and requested a ban on textured devices. Plastic surgeons, many with industry ties, spoke in favor of keeping the devices available. The historical advantages of textured implants were presented, including a reduced capsular contracture rate. A 14-point plan to improve sterility at the time of implantation was promoted as an effective alternative to reduce both capsular contractures and BIA-ALCL risk. However, recent studies show that textured implants have not delivered on their early promise. Biocell implants perform worse, not better, than other implant types, and capsular contracture rates are not significantly reduced according to recent core studies. The only known risk factor for BIA-ALCL is textured implants. The lifetime risk for Biocell implants is at least 1:2, 200. There is no reliable evidence that surgical technique makes a difference in risk. This serious issue represents a case study of conflict of interest. In light of recent information, a re-analysis of the true risks and benefits of textured implants is justified. It is time for our professional societies to recognize that the device is the problem rather than surgical technique. On May 2, 2019, the FDA decided against a ban on textured breast implants.
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Swanson E. The Textured Breast Implant Crisis: A Call for Action. Ann Plast Surg 2019; 82:593-594. [PMID: 31082845 PMCID: PMC6530980 DOI: 10.1097/sap.0000000000001963] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 03/13/2019] [Indexed: 12/11/2022]
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Effects of Silicone Implants on the Mammary Gland: Ultrasonographic and 3D Study. Aesthetic Plast Surg 2019; 43:354-365. [PMID: 30311034 DOI: 10.1007/s00266-018-1253-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 10/02/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Breast implants may be responsible for secondary deformities produced by parenchymal atrophy. However, few studies in the literature have reported changes in breast tissue after augmentation surgery. In this study, the breast thickness of patients undergoing breast augmentation was monitored by ultrasound, and correlations with surface, volume and projection measurements were examined. METHODS We studied the parenchymal thickness at the lower pole of the breast with ultrasound in 36 women (72 breasts). In another group of 33 patients (66 breasts), we studied the thickness at the upper and lower poles along the meridian of each breast by ultrasound and measured the anthropometric metrics, volume and projection of the breast with a 3D camera. RESULTS Midline measurements close to the areola showed reduced thickness at the lower pole, with 31.8% at the midpoint of the lower pole and 42% at the infra-areolar level (p < 0.0001). At the upper pole, there was a decrease of 14.6% (p < 0.001), but the thickness was increased by 6% and 38% at more cranial levels. No correlations with volume were found. Anatomical implants produced more atrophy at the lower pole, and round implants at the upper pole. More atrophy was found with subfascial than submuscular augmentation. Compared with the expected values, the final volume was very similar, but the projection was 29% less. Surface measurements changed significantly up to 4 months postoperatively and remained stable thereafter. CONCLUSIONS Implants affect significatively the thickness of the glandular tissue. All changes occur very soon postoperatively but stabilize after 4 months. 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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Swanson E, Brown T. A Discussion of Conflicts of Interest in Plastic Surgery and Possible Remedies. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e2043. [PMID: 30656120 PMCID: PMC6326602 DOI: 10.1097/gox.0000000000002043] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 10/10/2018] [Indexed: 01/31/2023]
Affiliation(s)
| | - Tim Brown
- Private Practice, Berwick, Victoria, Australia
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The Expanding Role of Diagnostic Ultrasound in Plastic Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1911. [PMID: 30349786 PMCID: PMC6191221 DOI: 10.1097/gox.0000000000001911] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 07/02/2018] [Indexed: 12/13/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Ultrasound in plastic surgery is quickly finding new applications. Ultrasound surveillance may replace ineffective individual risk stratification and chemoprophylaxis for deep venous thromboses. Abdominal penetration can be a catastrophic complication of liposuction. Preoperative screening for fascial defects may reduce risk. Limiting buttock fat injections to the subcutaneous plane is critical for patient safety, but it is difficult to know one’s injection plane. Methods: The author’s use of diagnostic ultrasound was evaluated from May 2017 to May 2018. Ultrasound scans were used routinely to detect deep venous thromboses. Patients undergoing abdominal liposuction and/or abdominoplasty were scanned for possible hernias. Other common applications included the evaluation of breast implants, breast masses, and seroma management. The device was used in surgery in 3 patients to assess the plane of buttock fat injection. Results: One thousand ultrasound scans were performed during the 1-year study period. A distal deep venous thrombosis was detected in 2 patients. In both cases, the thrombosis resolved within 1 month, confirmed by follow-up ultrasound scans. A lateral (tangential) fat injection method was shown to safely deposit fat above the gluteus maximus fascia. Conclusions: Ultrasound scans are highly accurate, noninvasive, and well-tolerated by patients. Some of these applications are likely to improve patient safety. Early detection of deep venous thromboses is possible. Unnecessary anticoagulation may be avoided. Subclinical abdominal defects may be detected. Ultrasound may be used in the office to evaluate breast implants, masses, and seromas. In surgery, this device confirms the level of buttock fat injection.
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Magnusson MR, Deva AK. Letter to Editor: Fleming D, Stone J, Tansley P. Spontaneous Regression and Resolution of Breast Implant-Associated Anaplastic Large Cell Lymphoma: Implications for Research, Diagnosis and Clinical Management, APS 2018. Aesthetic Plast Surg 2018; 42:1164-1166. [PMID: 29721840 DOI: 10.1007/s00266-018-1141-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 04/22/2018] [Indexed: 10/17/2022]
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Intentional Lower Pole Rotation of Anatomic Breast Implants in Chest Wall Deformities. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 5:e1605. [PMID: 29632783 PMCID: PMC5889469 DOI: 10.1097/gox.0000000000001605] [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: 09/20/2017] [Accepted: 10/24/2017] [Indexed: 11/27/2022]
Abstract
Several methods have been described for the correction of congenital thoracic wall deformities. Our aim was to investigate the feasibility and clinical results of using standard anatomic breast implants with modified anatomic positioning according to the defect in congenital thoracic wall deformities. Between 2014 and 2015, 5 patients diagnosed with pectus excavatum (PE, n = 4) or pectus carinatum (PC, n = 1) and breast asymmetry or hypoplasia were evaluated. In all patients, a submammary incision and dual-plane subpectoral placement of texturized, anatomic implants were performed. In patients with PE, the lower pole of the implant was positioned medially to compensate for the caved chest. In patients with PC, the lower pole of the anatomic implant was positioned laterally to compensate for the prominent sternum. Outcome measures were satisfaction, minor and major complications, and morbidity. The mean surgery time was 95 ± 14 minutes, and the mean implant volume was 287 ± 56 cm3 (273 ± 60 cm3 on the right side and 305 ± 60 cm3 on the left side). After a median follow-up of 25 months (range: 2-35), all patients healed uneventfully, and a satisfactory correction of the thoracic wall deformity was achieved. Thus, by adjusting the lower pole of anatomic breast implants in a horizontal plane according to the thoracic defect, we showed satisfactory results. Our technique has a low complication rate and can be recommended for the correction of mild to moderate PE or PC.
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Ahmad J, Lista F. Commentary on: Do Not Fear an Implant's Shape: A Single Surgeon's Experience of Over 1200 Round and Shaped Textured Implants in Primary Breast Augmentation. Aesthet Surg J 2018; 38:262-264. [PMID: 29145613 DOI: 10.1093/asj/sjx206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Jamil Ahmad
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario
| | - Frank Lista
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario
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Anger J, Elias PE, Moraes PDC, Hamerschlak N. A review of data in medical request and the patient questionnaire for magnetic resonance evaluation of silicone breast implants. ACTA ACUST UNITED AC 2017; 15:465-469. [PMID: 29267430 PMCID: PMC5875161 DOI: 10.1590/s1679-45082017ao4147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 08/15/2017] [Indexed: 11/22/2022]
Abstract
Objective To analyze the quality and quantity of data in the questionnaires and in request forms for magnetic resonance imaging. Methods This retrospective study was conducted with data from 300 medical records. The research used the following data from the questionnaires: patient age, reason for the magnetic resonance imaging, reason for placing the breast implant, report of any signs or symptoms, time elapsed since surgery to place the current breast implant, replacement implant surgery, chemotherapy, and/or radiation therapy treatments. From the magnetic resonance imaging request forms, information about the breast implant, the implant placement surgery, patient clinical information and ordering physician specialty were verified. Results The mean age of patients was 48.8 years, and the mean time elapsed since breast implant surgery was 5 years. A total of 60% of women in the sample were submitted to aesthetic surgery, while 23.7% were submitted to chemotherapy and/or radiation therapy. In the request forms, 23.7% of physicians added some piece of information about the patient, whereas 2.3% of them informed the type of implant and 5.2% informed about the surgery. Conclusion The amount of information in the magnetic resonance imaging request forms is very limited, and this may hinder quality of radiological reports. Institutional and technological measures should be implemented to encourage the requesting physicians and radiologists to share information.
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Affiliation(s)
- Jaime Anger
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Glicksman CA. Commentary on: Implementation of an Integrated Biodimensional Method of Breast Augmentation with Anatomic, Highly Cohesive Silicone Gel Implants: Short-Term Results With the First 620 Consecutive Cases. Aesthet Surg J 2017; 37:793-795. [PMID: 29025220 DOI: 10.1093/asj/sjx047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Caroline A Glicksman
- Dr Glicksman is a Plastic Surgeon, Jersey Shore University Medical Center, Neptune, NJ
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Discussion: Is Rotation a Concern with Anatomical Breast Implants? A Statistical Analysis of Factors Predisposing to Rotation. Plast Reconstr Surg 2017; 139:1379-1380. [PMID: 28538562 DOI: 10.1097/prs.0000000000003390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Bengtson BP. Commentary on: Clinical Evaluation of Shaped Gel Breast Implant Rotation Using High-Resolution Ultrasound. Aesthet Surg J 2017; 37:297-300. [PMID: 28199547 DOI: 10.1093/asj/sjw276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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