What Exactly Was Wrong with the Trilucent Breast Implants? A Unifying Hypothesis

HISTORY OF BREAST IMPLANTS: BACK TO THE FUTURE

Modern breast implants are a staple of plastic surgery, finding uses in esthetic and reconstructive procedures. Their history began in the 1960s, with the first generation of smooth devices with thick silicone elastomer, thick silicone gel, and Dacron patches on the back. They presented hard consistency, high capsular contracture rates and the patches increased the risk of rupture. In the same decade, polyurethane coating of implants was implemented. A second generation was introduced in the 1970s with a thinner shell, less viscous gel filler and no patches, but increased silicone bleed-through and rupture rates. The third generation, in the early 1980s, featured implants with a thicker multilayered elastomer shell reinforced with silica to reduce rupture risk and prevent silicone bleed-through. A fourth generation from the late 1980s combined thick outer elastomer shells, more cohesive gel filler, and implemented for the first-time outer shell texturing. In the early 1990s, the fifth generation of devices pioneered an anatomical shape with highly cohesive form-stable gel filler and a rough outer shell surface. Surface texturing was hampered by the discovery of Breast Implant Associated-Anaplastic Large Cell Lymphoma and its link with textured devices. From the 2010s, we have the era of the sixth generation of implants, featuring innovations regarding the surface, with biomimetic surfaces, more resistant shells and variations in gel consistency. The road to innovation comprises setbacks such as the FDA moratorium in 1992, the PIP scandal, the Silimed CE mark temporary suspension and the FDA-requested voluntary recall of the Allergan BIOCELL implants.

The "Game of Implants": A Perspective on the Crisis-Prone History of Breast Implants

Since their introduction into the market, breast implants have been the subject of many controversies. It is timely to examine the forces that have shaped the breast implant industry to make it what it is today. This review will concentrate more on the use of implants in aesthetic surgery rather than their use in breast reconstruction, but some of the factors have relevance to both indications.

Chemical and Structural Characterization of Several Mid-Term Explanted Breast Prostheses

The recent scandal of poly implant prostheses (PIP), which were found in some cases to be made of non-medical grade silicone (as reported by the European Scientific Committee on Emerging and Newly Identified Health Risks), had a great social impact. Thousands of patients asked for implant removal with significant costs for public health care systems. We analysed, by a multidisciplinary approach, sixteen different breast implants after explantation by using several analytical and structural techniques, such as Fourier Transform infrared spectroscopy (FT-IR), mass spectrometry equipped by ion coupled plasma (ICP-MS), gas-chromatography (GC-MS), and tensile testing. Traces of organic (fatty acid) and inorganic (Fe, Cr, Pt, Na, and other metals) substances were found in all samples, and, even if these values are under danger threshold levels, our study results highlight the possibility of bioaccumulation and tissue contamination, implying the need for continuous medical surveillance and monitoring of material aging.

Objective Comparison of Commercially Available Breast Implant Devices

Breast implants are frequently used for both cosmetic breast augmentation and breast reconstruction after mastectomy. Three companies currently offer FDA-approved breast implants (Allergan, Mentor, and Sientra), but their product offerings-including permanent breast implants, breast tissue expanders, sizers, and post-operative warranty-can be difficult to compare because of brand names and company-specific jargon. The ability to have a brand-agnostic understanding of all available options is important for both the surgical trainee as well as the surgeon in clinical practice. After a brief review of the history of breast implant devices, this review utilizes a unique conceptual framework based on variables such as fill material, shape, relative dimensions, and surface coating to facilitate a better understanding of the similarities and differences between the different company's offerings. Specifically, we identify which types of devices are offered by all three companies, those that are offered by only one company, those that have very limited product offerings, and those combinations that are not available at all. Finally, clinical implications are drawn from this framework that can be used by both cosmetic and reconstructive surgeons to counsel patients about all available options. Importantly, this project is entirely independent of any company's funding, support, or input.

LEVEL OF EVIDENCE V

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 .

Screening criteria for breast cancer

Breast cancer screening constitutes an integral part of surgical practice for many surgeons and is an important tool in the war against breast cancer. Among many modalities, mammography plays a central role, with MRI now being increasingly used for women with high risk for breast cancer. Current guidelines for screening are in the process of evolution as more scientific knowledge is gained. The challenge lies in developing cost-effective methods to reach the maximum number of the population at risk.

Prospective Study on Trilucent Soybean Oil-Filled Breast Prosthesis

BACKGROUND

The use of Trilucent breast implants dates back to 1995. These implants were produced in an attempt to overcome the perceived shortcomings of other implants filled with saline and silicone gel. The filler material, which was derived from soybean oil, was said to be biodegradable and biocompatible. When this prosthesis was subsequently found to be prone to rapid aging and rupture of the silicone shell, the company that manufactured this implant decided to withdraw it from the market and offered to remove or replace all Trilucent prostheses.

METHODS

The authors present a clinical study of the Trilucent implant in which 36 patients received a total of 63 implants and 33 patients had 58 implants removed. The authors also examined the implant shell of the removed prostheses to investigate the possible cause of silicone implant aging and rupture.

RESULTS

Each of the implants removed was carefully inspected visually, and samples of the implant shell were analyzed by scanning electron microscopy. All the implants removed had a very bizarre appearance; they were variegated in color, with shades of yellow and brown, and were studded with whitish yellow nodules whose number grew in proportion to the time the prosthesis was implanted. Scanning electron microscopic analysis of the implant shell revealed a heterogeneous inner surface of the implant together with fissures and globoid deposits on the cut surface.

CONCLUSIONS

The authors' findings on Trilucent implants are similar to those reported in previously published studies for other types of breast implants for the first 2 years after implantation, after which a progressive, rapid deterioration was observed.