Unusual masses found within ruptured silicone gel breast prostheses

Rupture of an expander prosthesis mimics axillary cancer recurrence

Regional silicone gel migration from a ruptured breast implant has been reported at different locations including the upper extremity, chest wall muscles, axilla and back. We report a patient who presented with an axillary mass that mimicked a regional recurrence 5 years after breast cancer reconstruction with a latissimus dorsi musculocutaneous flap and silicon gel expander-prosthesis. Surgical exploration revealed that the mass contained silicone gel around the port of the breast expander that had ruptured. The mass was confluent with an intracapsular silicone leak through a tract along the tube of the expander port.

Post acne scarring: a review

Historically, post acne scarring has not been well treated. New techniques have been added and older ones modified to manage this hitherto refractory problem. The patient, his or her expectations and overall appearance as well as the morphology of each scar must be assessed and treatment designed accordingly. Upon reaching an understanding of what the pathology of the scar is and where it resides in the skin, the most pertinent treatment for that scar may be devised. Post acne scars are polymorphous and include superficial macules, dermal troughs, ice picks, multi-channelled fistulous tracts and subcutaneous atrophy. The wide variety of new methods includes the latest resurfacing tools such as CO(2) and erbium infrared lasers, dermasanding and possibly some future techniques such as non-ablative and radiofrequency resurfacing. Dermal and subcutaneous augmentation with autologous (including fat and blood transfer) and non-autologous tissue augmentation and the advent of tissue undermining has greatly improved the treatment of atrophic scars. Use of punch techniques for sharply marginated scars (such as ice picks) is necessary if this scar morphology is to be treated well. One should attempt to match each scar against an available treatment as far as possible. Many of these techniques may be performed in a single treatment session but repeat treatments are often necessary. The treatment of hypertrophic acne scarring remains difficult, but silastic sheeting, vascular laser and intralesional cytotoxics are interesting developments. Most often occurring extra-facially and in males, these distressing scars often require multiple treatments and modalities before adequate improvement is achieved.

Blood transfer: the use of autologous blood as a chromophore and tissue augmentation agent

BACKGROUND

Atrophic scars, whether traumatic, postsurgical, or postacne, are distressing and difficult to treat. A freely available autologous agent that provides medium- to long-term correction of this problem would be welcome. There are very few endogenous chromophores in the skin for laser or light energy to target. A benign exogenous pigment implanted in superficial scars may be useful in presenting such a target for light energy, allowing selective injury to these scars and the possibility of new collagen formation.

OBJECTIVE

To report five representative case reports that describe elements of two new techniques that may be useful in the management of atrophic acne scarring.

METHODS

After drawing blood from the patient, this was immediately reinjected into premarked areas of atrophic scars. If there was substantial tissue deficit, this was either followed by repeated injections of whole blood at monthly intervals on three occasions or until adequate correction was attained and oral antifibrinolysis medication dispensed in addition to the blood transfer (hematogenous augmentation of tissue or the HAT technique). In the other circumstance, where the deficit was superficial, blood was implanted high in the tissue and used as a target for vascular laser or intense pulsed light in a technique termed the blood augmentation (with or without) stimulation of tissues by irradiation with light or laser energy or the Bastille technique. This is again repeated as required.

RESULTS

Reasonable short- to medium-term correction has been attained in all five cases and there seemed to be a progressive improvement with each injection session. With the Bastille technique case there seemed to be progressive improvement with time, with the result at 4 weeks being substantially better than that at 2 weeks or at baseline.

CONCLUSION

These case reports suggest that blood may be a worthwhile augmentation agent and chromophore. Both these techniques deserve further investigation to determine the optimum parameters. They are so simple in their concept and technique that should they help to provide a medium- to long-term correction for atrophic scars and other depressions, such as expression lines and wrinkles, they would be worthwhile additions to existing dermatologic techniques.