1
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Gary CS, Kirloskar KM, Koh MJ, Abadeer AI, Wang JS, Del Corral G, Fan KL, Song DH. Intraoperative Evaluation of Textured Anatomical Implant Rotation: A Prospective Study. Plast Reconstr Surg 2024; 154:490-499. [PMID: 37734110 DOI: 10.1097/prs.0000000000011072] [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: 09/23/2023]
Abstract
BACKGROUND Textured implants were developed with the goal of reducing rates of capsular contracture and preventing implant malposition (eg, malrotation). Recent evidence has questioned whether textured implants are as resistant to malrotation as previously reported. METHODS Women presenting to a single health care system for removal of textured implants were prospectively enrolled in the study from September of 2019 to July of 2022. Patients who underwent removal of an anatomical, textured implant in the operating room were included in the study; whereas those who did not undergo implant removal, or were found to have a smooth implant, or a round, textured implant, were excluded. The degree of implant rotation on removal of the implant was measured intraoperatively. Information regarding implant-specific factors, patient demographics, clinical factors, and operative characteristics, was collected. RESULTS A total of 51 patients (80 implants) were included in the study; 45% of implants were malrotated (rotated >30 degrees), and the median degree of rotation was 30 degrees. Having more than one previous revision of the breast pocket was predictive of implant rotation (42 degrees) on multivariate linear regression analysis. Patients who presented with a complaint of "aesthetic dissatisfaction" had 2.89 increased odds of having an implant rotated greater than 30 degrees. CONCLUSION The authors' study found a high rate of malrotation of textured shaped implants on explantation. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Affiliation(s)
- Cyril S Gary
- From the Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital
| | | | | | - Andrew I Abadeer
- From the Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital
| | - Jessica S Wang
- From the Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital
| | | | - Kenneth L Fan
- From the Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital
| | - David H Song
- From the Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital
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2
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Swanson E. Breast Implant Pocket Antimicrobial Irrigation and the Importance of Reporting Contradictory Evidence. Ann Plast Surg 2024; 93:141-143. [PMID: 38319749 DOI: 10.1097/sap.0000000000003819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
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3
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Plotsker EL, Stern CS, Graziano FD, Rubenstein RN, Vingan PS, Haglich K, Monge J, Disa JJ, Mehrara BJ, Dayan JH, Allen R, Matros E, McCarthy C, Nelson JA. Surgical Management of Textured Breast Implants: Assessing Risk and Analyzing Patient-Reported Outcomes. Plast Reconstr Surg 2024; 154:39-52. [PMID: 37535711 PMCID: PMC10837321 DOI: 10.1097/prs.0000000000010957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
BACKGROUND Textured implants have been linked to breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL). Patients who undergo explantation have options for reconstruction, but data on safety and patient-reported outcomes (PROs) are limited. The purpose of this study was to classify complications and PROs in patients opting for surgical management of textured implants. METHODS Complication rates and BREAST-Q scores were compared between (1) asymptomatic patients who underwent conversion from textured to smooth implants ( n = 224), (2) symptomatic patients who underwent conversion from textured to smooth implants ( n = 83), (3) patients who underwent explantation without replacement ( n = 44), and (4) patients who underwent replacement with autologous reconstruction ( n = 33). Linear regression examined PROs controlling for clinical and surgical variables. RESULTS Overall complication rates in 384 patients (637 implants) differed across groups ( P = 0.034), with the highest rate (25%) in patients who underwent explantation without replacement. These patients were specifically more impacted by minor complications, notably seroma. Capsulectomy extent did not significantly impact complications. Asymptomatic and symptomatic smooth implant patients had improvements in Satisfaction with Breasts ( P < 0.05). Autologous reconstruction patients had significant improvements in Satisfaction with Breasts sustained after 3 months postoperatively ( P < 0.01) and Sexual Well-being sustained after 6-months postoperatively ( P < 0.05). Patients who underwent removal without replacement had lower Physical Well-being of the Chest scores at 1 year or more than the other groups. CONCLUSIONS Replacement of textured implants with smooth implants or flaps is safe and is associated with improved satisfaction with breasts and quality of life. The degree of capsulectomy does not appear to impact the incidence of perioperative complications. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
| | | | - Francis D. Graziano
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Robyn N. Rubenstein
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Perri S. Vingan
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Kathryn Haglich
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Jasmine Monge
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Joseph J. Disa
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Babak J. Mehrara
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Joseph H. Dayan
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Robert Allen
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Evan Matros
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y
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4
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Azahaf S, Spit KA, de Blok CJM, Willging L, Rolfs H, Nanayakkara PWB. Breast implant iatrogenics: challenging the safety narrative. Front Glob Womens Health 2024; 5:1359106. [PMID: 38832108 PMCID: PMC11146578 DOI: 10.3389/fgwh.2024.1359106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/07/2024] [Indexed: 06/05/2024] Open
Affiliation(s)
- Siham Azahaf
- Section General Internal Medicine, Department of Internal Medicine, Amsterdam University Medical Centers, Location VUmc, Amsterdam, Netherlands
| | - Karlinde A. Spit
- Section General Internal Medicine, Department of Internal Medicine, Amsterdam University Medical Centers, Location VUmc, Amsterdam, Netherlands
| | - Christel J. M. de Blok
- Section General Internal Medicine, Department of Internal Medicine, Amsterdam University Medical Centers, Location VUmc, Amsterdam, Netherlands
| | - Laura Willging
- Board of Directors, Breast Implant Safety Alliance (BISA) non-Profit, Charleston, SC, United States
| | - Heidi Rolfs
- Board of Directors, Breast Implant Safety Alliance (BISA) non-Profit, Charleston, SC, United States
| | - Prabath W. B. Nanayakkara
- Section General Internal Medicine, Department of Internal Medicine, Amsterdam University Medical Centers, Location VUmc, Amsterdam, Netherlands
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5
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Flores T, Kerschbaumer C, Jaklin FJ, Rohrbacher A, Weber M, Luft M, Aspöck C, Ströbele B, Kitzwögerer M, Lumenta DB, Bergmeister KD, Schrögendorfer KF. Gram-Positive Bacteria Increase Breast Implant-Related Complications: Prospective Analysis of 100 Revised Implants. Plast Reconstr Surg 2024; 153:76-89. [PMID: 37036325 PMCID: PMC10729897 DOI: 10.1097/prs.0000000000010499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 11/08/2022] [Indexed: 04/11/2023]
Abstract
BACKGROUND Breast implant-related complications can be reduced by strict antiseptic precautions during insertion, but bacteria can often be found on implant surfaces on the occasion of revision surgery. The authors prospectively analyzed the association of bacteria found on breast implant surfaces with implant-related complications in breast implant revision cases. METHODS The authors analyzed a total of 100 breast implant revisions in 66 patients between August of 2018 and January of 2021. Capsular swabs and capsular samples were taken intraoperatively. Analyses on the occurrence of bacteria and the occurrence of implant-related complications were performed. In addition, correlations between bacteria-contaminated breast implant surfaces and implant-related complications were performed. RESULTS Implant-related complications (perforation, rupture, capsular contraction) were observed in 42 implant sites: eight unilateral and 34 bilateral cases. In total, 16 swabs showed positive bacterial growth, 10 of which were associated with a breast implant-related complication (χ 2 = x, y, and z; P = 0.006). The most common implant-based complication at contaminated prosthetics was implant rupture. The association of contaminated breast implants and implant rupture was statistically significant. CONCLUSIONS The authors identified a correlation between implant complications and Gram-positive bacteria found on breast implant surfaces. The most common implant-based complication seen at simultaneously positive samples was implant rupture in 50% of the authors' cases. No capsular contraction or other complications were seen. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Affiliation(s)
- Tonatiuh Flores
- From the Karl Landsteiner University of Health Sciences
- Clinical Department of Plastic, Aesthetic and Reconstructive Surgery
| | - Celina Kerschbaumer
- From the Karl Landsteiner University of Health Sciences
- Clinical Department of Plastic, Aesthetic and Reconstructive Surgery
| | - Florian J. Jaklin
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna
| | | | - Michael Weber
- From the Karl Landsteiner University of Health Sciences
| | - Matthias Luft
- From the Karl Landsteiner University of Health Sciences
- Clinical Department of Plastic, Aesthetic and Reconstructive Surgery
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna
| | - Christoph Aspöck
- From the Karl Landsteiner University of Health Sciences
- Clinical Institute of Hygiene and Microbiology
| | - Barbara Ströbele
- From the Karl Landsteiner University of Health Sciences
- Clinical Institute of Hygiene and Microbiology
| | - Melitta Kitzwögerer
- From the Karl Landsteiner University of Health Sciences
- Clinical Institute for Pathology, University Clinic of St. Poelten
| | - David B. Lumenta
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz
| | - Konstantin D. Bergmeister
- From the Karl Landsteiner University of Health Sciences
- Clinical Department of Plastic, Aesthetic and Reconstructive Surgery
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna
| | - Klaus F. Schrögendorfer
- From the Karl Landsteiner University of Health Sciences
- Clinical Department of Plastic, Aesthetic and Reconstructive Surgery
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6
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Allam O, Dinis J, Almeida MN, Junn A, Mozaffari MA, Shah R, Chong L, Olawoyin O, Mehta S, Park KE, Avraham T, Alperovich M. Smooth versus Textured Tissue Expanders: Comparison of Outcomes and Complications in 536 Implants. Arch Plast Surg 2024; 51:42-51. [PMID: 38425846 PMCID: PMC10901592 DOI: 10.1055/s-0043-1775592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 07/27/2023] [Indexed: 03/02/2024] Open
Abstract
Background Increasing concerns regarding the safety of textured surface implants have resulted in surgeons transitioning from textured tissue expanders (TEs) to smooth TEs. Given this change has only recently occurred, this study evaluated outcomes between smooth and textured TEs. Methods Women who underwent two-stage breast reconstruction using TEs from 2013 to 2022 were included. TE-specific variables, perioperative information, pain scores, and complications were collected. Chi-squared, t -test, and linear regression analyses were performed. Results A total of 320 patients received a total of 384 textured and 152 smooth TEs. Note that 216 patients received bilateral reconstruction. TEs were removed in 9 cases. No significant differences existed between groups regarding comorbidities. Smooth TEs had a higher proportion of prepectoral placement ( p < 0.001). Smooth TEs had less fills (3 ± 1 vs. 4 ± 2, p < 0.001), shorter expansion periods (60 ± 44 vs. 90 ± 77 days, p < 0.001), smaller expander fill volumes (390 ± 168 vs. 478 ± 177 mL, p < 0.001), and shorter time to exchange (80 ± 43 vs. 104 ± 39 days, p < 0.001). Complication rates between textured and smooth TEs were comparable. Smooth TE had a greater proportion of TE replacements ( p = 0.030). On regression analysis, pain scores were more closely associated with age ( p = 0.018) and TE texture ( p = 0.046). Additional procedures at time of TE exchange ( p < 0.001) and textured TE ( p = 0.017) led to longer operative times. Conclusion As many surgeons have transitioned away from textured implants, our study shows that smooth TEs have similar outcomes to the textured alternatives.
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Affiliation(s)
- Omar Allam
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Jacob Dinis
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Mariana N. Almeida
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Alexandra Junn
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Mohammad Ali Mozaffari
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Rema Shah
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | | | - Olamide Olawoyin
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Sumarth Mehta
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Kitae Eric Park
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Tomer Avraham
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Michael Alperovich
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
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7
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Swanson E. The Case Against Betadine Irrigation of Breast Implant Pockets. Aesthetic Plast Surg 2023; 47:164-169. [PMID: 36195734 PMCID: PMC10439018 DOI: 10.1007/s00266-022-03123-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 09/12/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Eric Swanson
- Swanson Center, 11413 Ash St, Leawood, KS, 66211, USA.
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8
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Swanson E. BIA-ALCL: Comparing the Risk Profiles of Smooth and Textured Breast Implants. Aesthetic Plast Surg 2023; 47:245-250. [PMID: 36997735 PMCID: PMC10439047 DOI: 10.1007/s00266-023-03329-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/19/2023] [Indexed: 04/01/2023]
Affiliation(s)
- Eric Swanson
- Swanson Center, 11413 Ash St, Leawood, KS, 66211, USA.
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9
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Swanson E. The Value of an Opposing Perspective and the Importance of Evidence-Based Medicine in Plastic Surgery. Ann Plast Surg 2023; 90:395-397. [PMID: 36440909 PMCID: PMC10184799 DOI: 10.1097/sap.0000000000003329] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/01/2022] [Indexed: 11/29/2022]
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10
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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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11
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Atkins DJ, Chau AL, Rosas JM, Chen YT, Chan ST, Urueña JM, Pitenis AA. Silicone Implant Surface Roughness, Friction, and Wear. SURFACE TOPOGRAPHY : METROLOGY AND PROPERTIES 2023; 11:014010. [PMID: 37193116 PMCID: PMC10181813 DOI: 10.1088/2051-672x/ac9f5a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Textured silicone breast implants with high average surface roughness ("macrotextured") have been associated with a rare cancer of the immune system, Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). Silicone elastomer wear debris may lead to chronic inflammation, a key step in the development of this cancer. Here, we model the generation and release of silicone wear debris in the case of a folded implant-implant ("shell-shell") sliding interface for three different types of implants, characterized by their surface roughness. The "smooth" implant shell with the lowest average surface roughness tested (Ra = 2.7 ± 0.6 μm) resulted in average friction coefficients of μavg = 0.46 ± 0.11 across 1,000 mm of sliding distance and generated 1,304 particles with an average particle diameter of Davg = 8.3 ± 13.1 μm. The "microtextured" implant shell (Ra = 32 ± 7.0 μm) exhibited μavg = 1.20 ± 0.10 and generated 2,730 particles with Davg = 4.7 ± 9.1 μm. The "macrotextured" implant shell (Ra = 80 ± 10 μm) exhibited the highest friction coefficients, μavg = 2.82 ± 0.15 and the greatest number of wear debris particles, 11,699, with an average particle size of Davg = 5.3 ± 3.3 μm. Our data may provide guidance for the design of silicone breast implants with lower surface roughness, lower friction, and smaller quantities of wear debris.
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Affiliation(s)
- Dixon J Atkins
- Department of Biomolecular Science and Engineering, University of California, Santa Barbara
| | - Allison L Chau
- Materials Department, University of California, Santa Barbara
| | - Jonah M Rosas
- Department of Biomolecular Science and Engineering, University of California, Santa Barbara
| | - Yen-Tsung Chen
- Department of Chemical Engineering, University of California, Santa Barbara
| | - Samantha T Chan
- Molecular, Cellular, and Developmental Biology Department, University of California, Santa Barbara
| | - Juan Manuel Urueña
- NSF BioPACIFIC Materials Innovation Platform, University of California, Santa Barbara
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12
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Marmo AC, Grunlan MA. Biomedical Silicones: Leveraging Additive Strategies to Propel Modern Utility. ACS Macro Lett 2023; 12:172-182. [PMID: 36669481 PMCID: PMC10848296 DOI: 10.1021/acsmacrolett.2c00701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/18/2023] [Indexed: 01/21/2023]
Abstract
Silicones have a long history of use in biomedical devices, with unique properties stemming from the siloxane (Si-O-Si) backbone that feature a high degree of flexibility and chemical stability. However, surface, rheological, mechanical, and electrical properties of silicones can limit their utility. Successful modification of silicones to address these limitations could lead to superior and new biomedical devices. Toward improving such properties, recent additive strategies have been leveraged to modify biomedical silicones and are highlighted herein.
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Affiliation(s)
- Alec C. Marmo
- Department
of Materials Science and Engineering Texas
A&M University, College
Station, Texas 77843-3003, United States
| | - Melissa A. Grunlan
- Department
of Biomedical Engineering, Department of Materials Science and Engineering,
Department of Chemistry Texas A&M University, College Station, Texas 77843-3003, United
States
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13
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Naga HI, Mellia JA, Basta MN, Morris MP, Christopher AN, Campbell FM, Sommers K, Levinson H, Nelson JA, Fischer JP. Breast Implant-Associated Anaplastic Large-Cell Lymphoma: Updated Systematic Review and Analysis of Treatment Strategies. Plast Reconstr Surg 2022; 150:762-769. [PMID: 35862104 PMCID: PMC9551598 DOI: 10.1097/prs.0000000000009538] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although guidelines have been published on treatment of breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL), there has been no comprehensive analysis of BIA-ALCL treatment variation based on the available literature. The authors sought to assess current treatment strategies of BIA-ALCL relative to current guidelines. METHODS Database searches were conducted in June of 2020. Included articles were case reports and case series with patient-level data. Collected variables included clinicopathologic features, implant characteristics, diagnostic tests, ALCL characteristics, treatment, and details of follow-up and outcome. Treatment data from before and after 2017 were compared with National Cancer Center Network guidelines. RESULTS A total of 89 publications were included and 178 cases of BIA-ALCL were identified. Most patients presented with seroma ( n = 114, 70.4 percent), followed by a mass ( n = 14, 8.6 percent), or both ( n = 23, 14.2 percent). Treatment included en bloc capsulectomy of the affected implant in 122 out of 126 cases with treatment details provided (96.8 percent). Radiation therapy was given in 38 cases (30.2 percent) and chemotherapy was given in 71 cases (56.3 percent). Practitioners used less chemotherapy for local disease after treatment guideline publication in 2017 ( p < 0.001), whereas treatment for advanced disease remained unchanged ( p = 0.3). There were 10 recurrences and eight fatalities attributable to BIA-ALCL, which were associated with advanced presentation (29 versus 2.1 percent; OR, 19.4; 95 percent CI, 3.9 to 96.3; p < 0.001). CONCLUSIONS BIA-ALCL remains a morbid but treatable condition. Current guidelines focus treatment for local disease and reduce nonsurgical interventions with radiation or chemotherapy. Patients presenting with advanced BIA-ALCL experience higher rates of recurrence and mortality.
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Affiliation(s)
- Hani I. Naga
- Division of Plastic Surgery, Duke University, Durham, NC
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Joseph A. Mellia
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Marten N. Basta
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Martin P. Morris
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
| | | | - Frank M. Campbell
- Biomedical Library, Perelman School of Medicine, University of Pennsylvania, PA
| | | | - Howard Levinson
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
- Plastic Surgery Foundation, Arlington Heights, IL
| | - Jonas A. Nelson
- Plastic and Reconstructive Surgical Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - John P. Fischer
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
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14
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Singh D, Zhang R, Hori KH, Parsa FD. Is Iatrogenic Implant Contamination Preventable Using a 16-Step No-Touch Protocol? EPLASTY 2022; 22:e38. [PMID: 36160667 PMCID: PMC9490878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Intraoperative contamination of the surgical field during aesthetic breast augmentation may lead to implant infection with devastating consequences. This study covers a period of 30 years and is divided into 2 phases: a retrospective phase from 1992-2004 when a standard approach was used and a prospective phase from 2004-2022 when a no-touch approach was implemented to avoid contamination. METHODS Patients in the standard and no-touch groups underwent aesthetic breast augmentation by the same senior surgeon (FDP) in the same outpatient surgical facility during the 30-year period of the study. Patients are divided into 2 groups: from 1992-2004 and from the implementation of the no-touch protocol in 2004-2022. RESULTS Patients who underwent breast augmentation using the no-touch approach developed no infections, whereas the standard group had an infection rate of 3.54% (P = .017). The validity of this finding is discussed. CONCLUSIONS The no-touch approach as described in this article was effective in reducing implant infection rate when performing aesthetic breast augmentation by 1 surgeon at 1 surgical center during an 18-year observation period. Multicenter prospective cooperative studies are necessary to validate perioperative iatrogenic contamination as the cause of implant infection and to explore optimal approaches that could eliminate implant contamination.
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Affiliation(s)
- Dylan Singh
- University of Hawaii, John A Burns School of Medicine, Honolulu, HI
| | - Ruixue Zhang
- University of Hawaii, John A Burns School of Medicine, Honolulu, HI
| | | | - Fereydoun D Parsa
- Plastic Surgery Division, Department of Surgery, University of Hawaii, John A Burns School of Medicine. Honolulu, HI
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15
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Santanelli di Pompeo F, Clemens MW, Atlan M, Botti G, Cordeiro PG, De Jong D, Di Napoli A, Hammond D, Haymaker CL, Horwitz SM, Hunt K, Lennox P, Mallucci P, Miranda RN, Munhoz AM, Swanson E, Turner SD, Firmani G, Sorotos M. 2022 Practice Recommendation Updates From the World Consensus Conference on BIA-ALCL. Aesthet Surg J 2022; 42:1262-1278. [PMID: 35639805 PMCID: PMC9924046 DOI: 10.1093/asj/sjac133] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Laboratory and clinical research on breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is rapidly evolving. Changes in standard of care and insights into best practice were recently presented at the 3rd World Consensus Conference on BIA-ALCL. OBJECTIVES The authors sought to provide practice recommendations from a consensus of experts, supplemented with a literature review regarding epidemiology, etiology, pathogenesis, diagnosis, treatment, socio-psychological aspects, and international authority guidance. METHODS A literature search of all manuscripts between 1997 and August 2021 for the above areas of BIA-ALCL was conducted with the PubMed database. Manuscripts in different languages, on non-human subjects, and/or discussing conditions separate from BIA-ALCL were excluded. The study was conducted employing the Delphi process, gathering 18 experts panelists and utilizing email-based questionnaires to record the level of agreement with each statement by applying a 5-point Likert Scale. Median response, interquartile range, and comments were employed to accept, reject, or revise each statement. RESULTS The literature search initially yielded 764 manuscripts, of which 405 were discarded. From the remaining 359, only 218 were included in the review and utilized to prepare 36 statements subdivided into 5 sections. After 1 round, panelists agreed on all criteria. CONCLUSIONS BIA-ALCL is uncommon and still largely underreported. Mandatory implant registries and actions by regulatory authorities are needed to better understand disease epidemiology and address initial lymphomagenesis and progression. Deviation from current diagnosis and treatment protocols can lead to disease recurrence, and research on breast implant risk factors provide insight to etiology. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Fabio Santanelli di Pompeo
- Corresponding Author: Prof Fabio Santanelli di Pompeo, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sant’Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy. E-mail: ; Instagram: @diepflap.it
| | - Mark W Clemens
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA and is a Breast Surgery section editor for Aesthetic Surgery Journal
| | - Michael Atlan
- Aesthetic Plastic Reconstructive Unit/CHU TENON PARIS—APHP, Université Pierre et Marie Curie, Paris, France
| | | | - Peter G Cordeiro
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Daphne De Jong
- Amsterdam UMC-Vrije Universiteit Amsterdam, Department of Pathology and Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Arianna Di Napoli
- Pathology Unit, Department of Clinical and Molecular Medicine, Sapienza University, Sant’Andrea Hospital, Rome, Italy
| | | | - Cara L Haymaker
- Department of Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven M Horwitz
- Lymphoma Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Kelly Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peter Lennox
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, BC, Canada and is a clinical editor for Aesthetic Surgery Journal
| | | | - Roberto N Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alexandre M Munhoz
- Plastic Surgery Department, Hospital Moriah, Hospital Sírio-Libanês, Higienópolis, São Paulo, Brazil
| | | | - Suzanne D Turner
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Guido Firmani
- Faculty of Medicine and Psychology, Sapienza University of Rome, Department of Plastic Surgery, Sant’Andrea Hospital, Rome, Italy
| | - Michail Sorotos
- Faculty of Medicine and Psychology, Sapienza University of Rome, Department NESMOS, Sant’Andrea Hospital, Rome, Italy
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16
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Suh LJ, Khan I, Kelley-Patteson C, Mohan G, Hassanein AH, Sinha M. Breast Implant-Associated Immunological Disorders. J Immunol Res 2022; 2022:8536149. [PMID: 35571560 PMCID: PMC9095406 DOI: 10.1155/2022/8536149] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 04/05/2022] [Accepted: 04/16/2022] [Indexed: 11/18/2022] Open
Abstract
Background Breast implants are commonly placed postbreast cancer reconstruction, cosmetic augmentation, and gender-affirming surgery. Breast implant illness (BII) is a systemic complication associated with breast implants. Patients with BII may experience autoimmune symptoms including fatigue, difficulty concentrating, hair loss, weight change, and depression. BII is poorly understood, and the etiology is unknown. The purpose of this literature review is to characterize BII autoimmune disorders and determine possible causes for its etiology. Methods The PubMed, Google Scholar, Embase, Web of Science, and OVID databases were interrogated from 2010 to 2020 using a query strategy including search term combinations of "implants," "breast implant illness," "autoimmune," and "systemic illness." Results BII includes a spectrum of autoimmune symptoms such as fatigue, myalgias/arthralgias, dry eyes/mouth, and rash. A review of epidemiological studies in the past ten years exhibited evidence affirming an association between breast implants and autoimmune diseases. The most commonly recognized were Sjogren's syndrome, rheumatoid arthritis, systemic sclerosis, chronic fatigue syndrome, and Raynaud's syndrome. Explantation resulted in alleviation of symptoms in over 50% of patients, strengthening the hypothesis linking breast implants to BII. Studies have shown that silicone is a biologically inert material and unlikely to be the cause of these symptoms. This is supported by the fact that increased risk of autoimmune disease was also reported in patients with other implantable biomaterials such as orthopedic implants. Recent studies shed light on a possible role of bacterial biofilm and subsequent host-pathogen interactions as a confounding factor to this problem. Conclusion BII could be dependent on biofilm infection and the microenvironment around the implants. The true pathophysiology behind these complaints must be further investigated so that alternative treatment regimens other than explantation can be developed. Translational significance of these studies is not limited to breast implants but extends to other implants as well.
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Affiliation(s)
- Lily J. Suh
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Imran Khan
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | | | - Ganesh Mohan
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Aladdin H. Hassanein
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Mithun Sinha
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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17
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Concerns Regarding Dishonesty in Reporting a Large Study of Patients Treated With Allergan Biocell Breast Implants. Ann Plast Surg 2022; 88:585-588. [PMID: 35443274 DOI: 10.1097/sap.0000000000003199] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Smooth versus Textured Implants and Their Association with the Frequency of Capsular Contracture in Primary Breast Augmentation. Plast Reconstr Surg 2022; 149:373-382. [PMID: 35077412 DOI: 10.1097/prs.0000000000008717] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Capsular contracture is the most frequent complication of breast implant augmentation. Although studies indicate that textured implants have a low incidence of contracture, they have been associated with anaplastic cell lymphoma, which influences the choice of surface. This study estimated and compared the annual capsular contracture rate of both smooth and textured implants in primary breast implants. METHODS Two hundred fifty-three patients (506 implants) were evaluated from January of 2017 to July of 2019; 42.2 percent of the implants were smooth and 57.8 percent were textured. The inframammary approach was used in the subfascial (55.3 percent) and submuscular (44.7 percent) pockets. The primary outcome was the appearance of capsular contracture (Baker grade II, III, and IV) within the first postoperative year. RESULTS Smooth implants had a higher capsular contracture rate at 1 year postoperatively compared with textured implants, although with borderline statistical significance (p = 0.06). Smooth surface breast implants in the subfascial plane had a 4-fold higher risk of contracture than those with a textured surface in the same plane (OR, 4.4; 95 percent confidence interval, 1.6 to 12.4). However, when placed in the submuscular plane, both textures had a similar contracture risk. The rate of contracture was similar after 2 years postoperatively (p = 0.21). CONCLUSIONS Using the inframammary approach and a standardized technique, there were no significant differences in the incidence of capsular contracture between the smooth and textured implants. In the subfascial plane, the contracture rate with smooth implants was higher than with textured implants. However, in the submuscular plane, there was no difference between the surfaces. CLINICAL QUESTION/LEVEL OF EVIDENCW Therapeutic, III.
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19
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Bellaire CP, Sayegh F, Janssen P, Rutland JW, Salzberg CA. Major Complications After Textured Versus Non-textured Breast Implants in Direct-to-Implant Breast Reconstruction: A Propensity Score Analysis. Aesthetic Plast Surg 2021; 45:2077-2085. [PMID: 34100107 DOI: 10.1007/s00266-021-02377-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/22/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND While the risks and benefits of smooth versus textured implants for breast reconstruction and primary breast augmentation are thoroughly supported in the literature, few studies have examined the relationship between implant shell texture and complications following direct-to-implant (DTI) breast reconstruction. OBJECTIVES The present study examines the relationship between implant shell texture and complications in patients receiving DTI breast reconstruction. METHODS Retrospective chart review of patients undergoing DTI breast reconstruction between 2011 and 2018 by a single surgeon was performed. A propensity score matching algorithm was used to eliminate unwanted bias stemming from clinical covariates. Chi-squared and Fisher's exact tests were used to examine the association between implant shell texture and the following major postoperative complications: capsular contracture, hematoma, seroma, necrosis, infection, and implant loss. RESULTS A total of 402 unique patients (751 breasts) were included. The majority received smooth implants compared with textured implants (80.3% vs. 19.7%, respectively); 444 breasts were included for comparative analysis after 2:1 propensity score matching (296 smooth implants, 148 textured implants). The only statistically significant difference in outcomes between the two groups was a higher incidence of hematoma in the textured group (2.0% vs 0.0%), Fisher's Exact Test p = 0.04. Additionally, the matched cohort revealed a very low overall rate of capsular contracture (1.0%) for smooth implants. CONCLUSIONS Our data demonstrated non-significant differences for most major complication rates or revision surgery rates for smooth versus textured implants after matching. DTI breast reconstruction with smooth implants remains a safe and effective reconstructive option for select patients. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Christopher P Bellaire
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Farah Sayegh
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA
| | - Pierce Janssen
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA
| | - John W Rutland
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA
| | - C Andrew Salzberg
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA
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20
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Dissemination and Implementation Science in Plastic and Reconstructive Surgery: Perfecting, Protecting, and Promoting the Innovation That Defines Our Specialty. Plast Reconstr Surg 2021; 147:303e-313e. [PMID: 33009331 DOI: 10.1097/prs.0000000000007492] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
SUMMARY Plastic and reconstructive surgery has an illustrious history of innovation. The advancement, if not the survival, of the specialty depends on the continual development and improvement of procedures, practices, and technologies. It follows that the safe adoption of innovation into clinical practice is also paramount. Traditionally, adoption has relied on the diffusion of new knowledge, which is a consistent but slow and passive process. The emerging field of dissemination and implementation science promises to expedite the spread and adoption of evidence-based interventions into clinical practice. The field is increasingly recognized as an important function of academia and is a growing priority for major health-related funding institutions. The authors discuss the contemporary challenges of the safe implementation and dissemination of new innovations in plastic and reconstructive surgery, and call on their colleagues to engage in this growing field of dissemination and implementation science.
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21
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Kouwenberg CAE, Kranenburg LW, Busschbach JJ, Mureau MAM. Why Breast-Conserving Therapy Should be Considered Treatment of Choice in Early-Stage Breast Cancer Patients. Ann Surg Oncol 2021; 28:8017-8019. [PMID: 34173138 DOI: 10.1245/s10434-021-10203-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/08/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Casimir A E Kouwenberg
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands. .,Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - Leonieke W Kranenburg
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jan J Busschbach
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Marc A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
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22
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Cooter RD. Commentary on: Particulate Debris Released From Breast Implant Surfaces Is Highly Dependent on Implant Type. Aesthet Surg J 2021; 41:NP794-NP795. [PMID: 33765115 DOI: 10.1093/asj/sjab047] [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
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23
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Swanson E. A Rebuttal of Antibiotic Irrigation as a Method to Reduce Risk of Capsular Contracture and Breast Implant-Associated Anaplastic Large-Cell Lymphoma. Ann Plast Surg 2020; 85:461-463. [PMID: 31855865 PMCID: PMC7547873 DOI: 10.1097/sap.0000000000002230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/13/2019] [Indexed: 11/26/2022]
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24
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Swanson E, Hall-Findlay E. Banning Textured Implants Is a Rational Decision to Eliminate the Risk of Breast Implant-Associated Anaplastic Large-Cell Lymphoma (BIA-ALCL). Aesthet Surg J 2020; 40:NP474-NP477. [PMID: 32618333 DOI: 10.1093/asj/sjaa053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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25
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Turner SD. Commentary on: Breast Implant-Associated Anaplastic Large Cell Lymphoma in Australia: A Longitudinal Study of Implant and Other Related Risk Factors. Aesthet Surg J 2020; 40:847-849. [PMID: 32011676 DOI: 10.1093/asj/sjz371] [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)
- Suzanne D Turner
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge, UK
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26
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Lee JH, Kang SG. Letter to the Editor: Discussion of the Article "The Emerging Crisis of Stakeholders in Implant-based Augmentation Mammaplasty in Korea". J Korean Med Sci 2020; 35:e172. [PMID: 32383367 PMCID: PMC7211509 DOI: 10.3346/jkms.2020.35.e172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/14/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Jung Ho Lee
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Korean Academic Association of Aesthetic and Reconstructive Breast Surgery, Seoul, Korea
| | - Sang Gue Kang
- Korean Academic Association of Aesthetic and Reconstructive Breast Surgery, Seoul, Korea
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea.
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27
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Kim JH, Paik NS, Nam SY, Cho Y, Park HK. The Author's Response: The Emerging Crisis of Stakeholders in Implant-based Augmentation Mammaplasty in Korea. J Korean Med Sci 2020; 35:e173. [PMID: 32383369 DOI: 10.3346/jkms.2020.35.e173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/05/2020] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Nam Sun Paik
- Department of Surgery Ewha Womans University College of Medicine, Seoul, Korea
- Breast and Thyroid Cancer Center, Ewha Womans University College 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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28
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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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