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Xu HH, Abi-Rafeh J, Davison P, Winocour S, Matros E, Vorstenbosch J. Complications of Aesthetic and Reconstructive Breast Implant Capsulectomy: An Analysis of 7486 Patients Using Nationwide Outcomes Data. Aesthet Surg J 2024; 44:936-945. [PMID: 38518757 PMCID: PMC11334206 DOI: 10.1093/asj/sjae068] [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: 01/19/2024] [Revised: 03/14/2024] [Accepted: 03/20/2024] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND Despite increasing demand for breast capsular surgery to treat various benign and malignant implant-related pathologies, high-quality evidence elucidating complication profiles of capsulectomy and capsulotomy is lacking. OBJECTIVES The aim of this study was to provide the largest-scale analysis of associated outcomes and complications using the Tracking Operations and Outcomes for Plastic Surgeons (TOPS) database, and to investigate clinical scenarios that may subject patients to increased risks for complications, most notably extent of capsular surgery (complete vs partial) and index indication of implantation (aesthetic vs reconstructive). METHODS An analysis of the TOPS database from 2008 to 2019 was performed. CPT codes were used to identify complete capsulectomy and partial capsulectomy/capsulotomy cases. Breast implant exchange procedures constituted procedural controls. RESULTS In total, 7486 patients (10,703 breasts) undergoing capsulectomy or capsulotomy were assessed. Relative to controls, capsulectomy (4.40% vs 5.79%), but not capsulotomy (4.40% vs 4.50%), demonstrated higher overall complication rates. Both capsulectomies (0.83% vs 0.23%) and capsulotomies (0.56% vs 0.23%) also had greater rates of seroma relative to controls. Subgroup analyses demonstrated that reconstructive patients, relative to aesthetic patients, experienced greater overall complications (6.76% vs 4.34%), and increased risks for seroma (1.06% vs 0.47%), dehiscence (0.46% vs 0.14%), surgical site infections (1.03% vs 0.23%), and implant loss (0.52% vs 0.23%). A detailed synthesis of 30-day outcomes, including all patient- and breast-specific complications, for both capsulectomy and capsulotomy, stratified according to all potential confounders, is presented herein. CONCLUSIONS Surgeries on the breast capsule are safe overall, although complete capsulectomies and reconstructive patients are associated with significantly increased operative risks. The present findings will enhance patient selection, counseling, and informed consent. LEVEL OF EVIDENCE: 3
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Affiliation(s)
| | | | | | | | | | - Joshua Vorstenbosch
- Corresponding Author: Dr Joshua Vorstenbosch, McGill University, Royal Victoria Hospital, 1001 Boul Decarie, Room D02.7007, Montreal, Quebec H4A 3J1, Canada. E-mail:
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Li X, Feng Y, Gong Y, Chen Y. Assessing the Reproducibility of Research Based on the Food and Drug Administration Manufacturer and User Facility Device Experience Data. J Patient Saf 2024; 20:e45-e58. [PMID: 38470959 DOI: 10.1097/pts.0000000000001220] [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: 03/14/2024]
Abstract
OBJECTIVE This article aims to assess the reproducibility of Manufacturer and User Facility Device Experience (MAUDE) data-driven studies by analyzing the data queries used in their research processes. METHODS Studies using MAUDE data were sourced from PubMed by searching for "MAUDE" or "Manufacturer and User Facility Device Experience" in titles or abstracts. We manually chose articles with executable queries. The reproducibility of each query was assessed by replicating it in the MAUDE Application Programming Interface. The reproducibility of a query is determined by a reproducibility coefficient that ranges from 0.95 to 1.05. This coefficient is calculated by comparing the number of medical device reports (MDRs) returned by the reproduced queries to the number of reported MDRs in the original studies. We also computed the reproducibility ratio, which is the fraction of reproducible queries in subgroups divided by the query complexity, the device category, and the presence of a data processing flow. RESULTS As of August 8, 2022, we identified 523 articles from which 336 contained queries, and 60 of these were executable. Among these, 14 queries were reproducible. Queries using a single field like product code, product class, or brand name showed higher reproducibility (50%, 33.3%, 31.3%) compared with other fields (8.3%, P = 0.037). Single-category device queries exhibited a higher reproducibility ratio than multicategory ones, but without statistical significance (27.1% versus 8.3%, P = 0.321). Studies including a data processing flow had a higher reproducibility ratio than those without, although this difference was not statistically significant (42.9% versus 17.4%, P = 0.107). CONCLUSIONS Our findings indicate that the reproducibility of queries in MAUDE data-driven studies is limited. Enhancing this requires the development of more effective MAUDE data query strategies and improved application programming interfaces.
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Affiliation(s)
- Xinyu Li
- From the Department of Computer Science, Vanderbilt University, Nashville, Tennessee
| | - Yubo Feng
- From the Department of Computer Science, Vanderbilt University, Nashville, Tennessee
| | - Yang Gong
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas
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3
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Ruffenach L, Heintz D, Villette C, Cosentino C, Funfschilling D, Bodin F, Bahlouli N, Chatelin S. Ultrasonic elastography for the prevention of breast implant rupture: Detection of an increase with stiffness over implantation time. J Biomech 2024; 163:111955. [PMID: 38266533 DOI: 10.1016/j.jbiomech.2024.111955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 01/10/2024] [Accepted: 01/15/2024] [Indexed: 01/26/2024]
Abstract
Breast implants are widely used after breast cancer resection and must be changed regularly to avoid a rupture. To date, there are no quantitative criteria to help this decision. The mechanical evolution of the gels and membranes of the implants is still underinvestigated, although it can lead to early rupture. In this study, 35 breast explants having been implanted in patients for up to 17 years were characterized by ex vivo measurements of their mechanical properties. Using Acoustic Radiation Force Impulse (ARFI) ultrasound elastography, an imaging method for non-destructive mechanical characterization, an increase in the stiffness of the explants has been observed. This increase was correlated with the implantation duration, primarily after 8 years of implantation. With an increase of the shear modulus of up to a factor of nearly 3, the loss of flexibility of the implants is likely to lead to a significant increase of their risk of rupture. A complementary analysis of the gel from the explants by mass spectrometry imaging (MSI) and liquid chromatography coupled to high resolution mass spectrometry (LC-HRMS) confirms the presence of metabolites of cholesterol originating from the breast tissues, which most likely crossed the membrane of the implants and most likely degrades the gel. By observing the consequences of the physical-chemical mechanisms at work within patients, this study shows that ultrasound elastography could be used in vivoas a quantitative indicator of the risk of breast implant rupture and help diagnose their replacement.
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Affiliation(s)
- Laetitia Ruffenach
- ICube, UMR 7357 CNRS, University of Strasbourg, Strasbourg, France; Service de chirurgie plastique esthétique et reconstructrice, Hautepierre hospital, CHRU Strasbourg, HUS, Strasbourg, France
| | - Dimitri Heintz
- Plant Imaging & Mass Spectrometry (PIMS), IBMP, UPR 2357 CNRS, University of Strasbourg, Strasbourg, France
| | - Claire Villette
- Plant Imaging & Mass Spectrometry (PIMS), IBMP, UPR 2357 CNRS, University of Strasbourg, Strasbourg, France
| | | | | | - Frédéric Bodin
- ICube, UMR 7357 CNRS, University of Strasbourg, Strasbourg, France; Service de chirurgie plastique esthétique et reconstructrice, Hautepierre hospital, CHRU Strasbourg, HUS, Strasbourg, France
| | - Nadia Bahlouli
- ICube, UMR 7357 CNRS, University of Strasbourg, Strasbourg, France
| | - Simon Chatelin
- ICube, UMR 7357 CNRS, University of Strasbourg, Strasbourg, France
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4
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McGuire PA, Glicksman C, McCarthy C, Spiegel A. Separating Myth from Reality in Breast Implants: An Overview of 30 Years of Experience. Plast Reconstr Surg 2023; 152:801e-807e. [PMID: 37010472 DOI: 10.1097/prs.0000000000010488] [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: 04/04/2023]
Abstract
SUMMARY The purpose of this article is to review the pivotal events in the history of breast implants in the United States, including the events leading to the U.S. Food and Drug Administration moratorium on the use of silicone gel implants and subsequent approval; the emergence of breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL); and persistent concerns about an association between breast implants, autoimmune disease, and systemic symptoms. This article reviews the medical literature to outline our current knowledge on BIA-ALCL; offers recommendations for diagnosis and management of symptomatic and asymptomatic patients with textured implants; and reviews the science of potential associations of implants with autoimmune and systemic symptoms. The authors hope to help patients separate myths from reality and make educated decisions on having breast implants placed or removed.
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Affiliation(s)
| | | | - Colleen McCarthy
- the Department of Surgery, Memorial Sloan Kettering Cancer Center
| | - Aldona Spiegel
- The Center for Breast Restoration, Weill Cornell Medical School, Houston Methodist Academic Institute, and Division of Surgical Innovation, Houston Methodist Hospital
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Abstract
OBJECTIVE A retrospective cross-sectional analysis was conducted of the US Food and Drug Administration's MAUDE (Manufacturer and User Facility Device Experience) database, to evaluate the complication profile of cochlear implantation according to manufacturer. METHODS A review of the MAUDE database was conducted from 1 January 2010 to 31 December 2020. Complications, including infection, extrusion, facial nerve stimulation, meningitis and cerebrospinal fluid leak, were identified using key word searches. The categorised data were analysed using a chi-square test to determine a difference in global complication incidence between three major cochlear implant manufacturers: manufacturer A (Cochlear Limited), manufacturer B (Med-El) and manufacturer C (Advanced Bionics). RESULTS A total of 31 857 adverse events were analysed. Implants of manufacturer C were associated with a statistically higher rate of infection (0.97 per cent), cerebrospinal fluid leak (0.07 per cent), extrusion (0.44 per cent) and facial nerve stimulation (0.11 per cent). Implants of manufacturer B were associated with a statistically higher rate of meningitis (0.07 per cent). CONCLUSION Consideration of patient risk factors along with cochlear implant manufacturers can heighten awareness of cochlear implant complications pre-operatively, intra-operatively and post-operatively.
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Affiliation(s)
- S Jinka
- Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - S Wase
- Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - A Jeyakumar
- Northeast Ohio Medical University, Rootstown, Ohio, USA
- Department of Otolaryngology, Mercy Bon Secours, Youngstown, Ohio, USA
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Pirompanich P, Saisirivechakun P, Nithisatienchai C, Homvises B, Sapankaew T, Udomlap N, Warnnissorn N. Acute respiratory distress syndrome following breast augmentation managed by delayed veno-venous extracorporeal membrane oxygenation. Lung India 2023; 40:356-359. [PMID: 37417090 PMCID: PMC10401979 DOI: 10.4103/lungindia.lungindia_63_23] [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: 02/15/2023] [Revised: 04/11/2023] [Accepted: 04/26/2023] [Indexed: 07/08/2023] Open
Abstract
The initiation of veno-venous extracorporeal membrane oxygenation (VV-ECMO) has been opposed in late-phase acute respiratory distress syndrome (ARDS) due to an increase in mortality. Herewith an individual case of a 20-year-old female who survived severe ARDS after breast augmentation is reported, whose delayed transfer to our tertiary referral center led to a late initiation of VV-ECMO and multiple mechanical ventilation-associated complications. Nonetheless, her VV-ECMO was decannulated after 45 days of ARDS onset, considering an awake ECMO strategy possibly contributing to her positive outcome. We also provided spirometry results and chest radiography findings over the three years of follow-up. Intensive care specialists need to consider the potential use of ECMO in late-phase ARDS with selected patients.
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Affiliation(s)
- Pattarin Pirompanich
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | | | | | - Boonlawat Homvises
- Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Tunlanut Sapankaew
- Department of Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Natthawarang Udomlap
- Department of Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Naree Warnnissorn
- Department of Pathology and Forensic Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
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Abi-Rafeh J, Safran T, Winocour S, Dionisopoulos T, Davison P, Vorstenbosch J. Complications of Capsulectomies: An Analysis of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Database. AESTHETIC SURGERY JOURNAL OPEN FORUM 2022; 4:ojac025. [PMID: 35747463 PMCID: PMC9212085 DOI: 10.1093/asjof/ojac025] [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] [Indexed: 11/18/2022] Open
Abstract
Background Although plastic surgeons commonly perform capsulectomies for a variety of peri-prosthetic capsular conditions, the safety of capsulectomy remains unknown, and the literature lacks evidence describing its morbidity and complication rates for patients inquiring about its associated risks. Objectives The present study aims to identify and define the complication rates associated with capsulectomies. Methods An analysis of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was performed between the years 2015 and 2018. All information pertaining to demographics, patient-related information, surgical indications, procedure-related information, outcomes, and complications were assessed. Results The study identified 2231 cases of surgeon-reported capsulectomies; indications most commonly reported included capsular contracture (n = 638, 28.6%) and breast implant rupture (n = 403, 18.1%). In total, 141 patients (6.32%) were hospitalized for longer than 1 postoperative day (range, 2-28 days), while the overall complication rate was 3.0% (n = 67/2231 patients). Incidence of minor complications, representing superficial surgical site infections, was 0.8%, while the major complication rate was 2.24%. These included 7 cases of deep surgical site infections (0.3%), 19 organ space infections (0.9%), and 8 cases of wound dehiscence (0.4%). Eight patients developed sepsis (0.4%); 6 patients required transfusions (0.3%); 1 case of postoperative pneumonia and 1 myocardial infarction were also identified (n = 1 each, 0.0%). The overall reoperation and readmission rates were 2.0%, representing a readmission rate of 66% among patients with complications. Conclusions The present study provides the first estimate of the incidence of complications associated with capsulectomies. Although the NSQIP database contains significant limitations, the data presented herein describe a complication profile that plastic surgeons can share with their patients during informed consent. Level of Evidence: 4
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Affiliation(s)
- Jad Abi-Rafeh
- Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Tyler Safran
- Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Sebastian Winocour
- Division of Plastic and Reconstructive Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Tassos Dionisopoulos
- Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Peter Davison
- Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Joshua Vorstenbosch
- Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Quebec, Canada
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8
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Atiyeh B, Emsieh S. Breast Implant Illness (BII): Real Syndrome or a Social Media Phenomenon? A Narrative Review of the Literature. Aesthetic Plast Surg 2022; 46:43-57. [PMID: 34231017 DOI: 10.1007/s00266-021-02428-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 06/13/2021] [Indexed: 12/16/2022]
Abstract
Breast implant illness (BII) is a condition characterized by elusive diagnostic criteria and self-reported diverse disabling and distressing physical and psychological symptoms. With currently significant increase in public awareness, BII is perhaps becoming the most controversial subject in aesthetic and reconstructive breast surgery, generating heated debates between those who do not believe such a condition exists and those who demand its acceptance as a recognized diagnosis. Silicone incompatibility has been associated with "autoimmune/inflammatory syndrome induced by adjuvants" (ASIA syndrome) or Shoenfeld's syndrome. It is still unclear, however, whether BII symptoms would have occurred if no implants had been placed in the first place. The purpose of this literature review is to analyze critically the current state of scientific evidence related to this condition. Though the psychosomatic theory is most likely, the mechanism of BII symptoms is probably multifactorial. At present, BII being an underlying connective tissue disorder cannot be confirmed; moreover, whether improved aesthetic outcome and patient's overall satisfaction with the profile of their reconstructed or augmented breasts translate into decreased self-reported BII symptoms is still not well elucidated. 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 the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Bishara Atiyeh
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Saif Emsieh
- American University of Beirut Medical Center, Beirut, Lebanon.
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Clinical outcomes of patients after nipple-sparing mastectomy and reconstruction based on the expander/implant technique. Surg Today 2020; 51:862-871. [PMID: 33185799 PMCID: PMC8141482 DOI: 10.1007/s00595-020-02175-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/08/2020] [Indexed: 12/19/2022]
Abstract
Advances in multi-modality treatments incorporating systemic chemotherapy, endocrine therapy, and radiotherapy for the management of breast cancer have resulted in a surgical-management paradigm change toward less-aggressive surgery that combines the use of breast-conserving or -reconstruction therapy as a new standard of care with a higher emphasis on cosmesis. The implementation of skin-sparing and nipple-sparing mastectomies (SSM, NSM) has been shown to be oncologically safe, and breast reconstructive surgery is being performed increasingly for patients with breast cancer. NSM and breast reconstruction can also be performed as prophylactic or risk-reduction surgery for women with BRCA gene mutations. Compared with conventional breast construction followed by total mastectomy (TM), NSM preserving the nipple-areolar complex (NAC) with breast reconstruction provides psychosocial and aesthetic benefits, thereby improving patients' cosmetic appearance and body image. Implant-based breast reconstruction (IBBR) has been used worldwide following mastectomy as a safe and cost-effective method of breast reconstruction. We review the clinical evidence about immediate (one-stage) and delayed (two-stage) IBBR after NSM. Our results suggest that the postoperative complication rate may be higher after NSM followed by IBBR than after TM or SSM followed by IBBR.
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