1
|
Nepon H, Julien C, Petrecca S, Kalashnikov N, Safran T, Murphy A, Dionisopoulos T, Davison P, Vorstenbosch J. The cellular and molecular properties of capsule surrounding silicone implants in humans vary uniquely according to the tissue type adjacent to the implant. J Biomed Mater Res A 2024. [PMID: 38864257 DOI: 10.1002/jbm.a.37762] [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: 12/23/2023] [Revised: 04/15/2024] [Accepted: 05/29/2024] [Indexed: 06/13/2024]
Abstract
The foreign body reaction (FBR) to biomaterials results in fibrous encapsulation. Excessive capsule fibrosis (capsular contracture) is a major challenge to the long-term stability of implants. Clinical data suggests that the tissue type in contact with silicone breast implants alters susceptibility to developing capsular contracture; however, the tissue-specific inflammatory and fibrotic characteristics of capsule have not been well characterized at the cellular and molecular level. In this study, 60 breast implant capsule samples are collected from patients and stratified by the adjacent tissue type including subcutaneous tissue, glandular breast tissue, or muscle tissue. Capsule thickness, collagen organization, immune and fibrotic cellular populations, and expression of inflammatory and fibrotic markers is quantified with histological staining, immunohistochemistry, and real-time PCR. The findings suggest there are significant differences in M1-like macrophages, CD4+ T cells, CD26+ fibroblasts, and expression of IL-1β, IL-6, TGF-β, and collagen type 1 depending on the tissue type abutting the implant. Subglandular breast implant capsule displays a significant increase in inflammatory and fibrotic markers. These findings suggest that the tissue microenvironment contributes uniquely to the FBR. This data could provide new avenues for research and clinical applications to improve the site-specific biocompatibility and longevity of implantable devices.
Collapse
Affiliation(s)
- Hillary Nepon
- Division of Plastic & Reconstructive Surgery, McGill University, Montreal General Hospital, Quebec, Canada
- Division of Surgical and Interventional Sciences, McGill University, Montreal General Hospital, Quebec, Canada
| | - Cedric Julien
- McGill University Hospital Centre Research Institute, Montreal General Hospital, Quebec, Canada
| | - Sarah Petrecca
- Faculty of Medicine and Health Sciences, McGill University, Quebec, Canada
| | - Nikita Kalashnikov
- Division of Surgical and Interventional Sciences, McGill University, Montreal General Hospital, Quebec, Canada
- Faculty of Medicine and Health Sciences, McGill University, Quebec, Canada
| | - Tyler Safran
- Division of Plastic & Reconstructive Surgery, McGill University, Montreal General Hospital, Quebec, Canada
| | - Amanda Murphy
- Division of Plastic & Reconstructive Surgery, McGill University, Montreal General Hospital, Quebec, Canada
| | - Tassos Dionisopoulos
- Division of Plastic & Reconstructive Surgery, McGill University, Montreal General Hospital, Quebec, Canada
| | - Peter Davison
- Division of Plastic & Reconstructive Surgery, McGill University, Montreal General Hospital, Quebec, Canada
| | - Joshua Vorstenbosch
- Division of Plastic & Reconstructive Surgery, McGill University, Montreal General Hospital, Quebec, Canada
- McGill University Hospital Centre Research Institute, Montreal General Hospital, Quebec, Canada
| |
Collapse
|
2
|
Kim N, Cho WK, Park W, Lee JE, Nam SJ, Kim SW, Yu J, Chae BJ, Lee SK, Ryu JM, Ko ES, Kim H. Outcomes of whole breast radiation therapy in Asian breast cancer patients with prior cosmetic implants. Breast Cancer 2024; 31:391-400. [PMID: 38368487 DOI: 10.1007/s12282-024-01547-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/16/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND As breast augmentation has become more popular, an increasing number of women with augmented breasts require treatment for breast cancer. This study aimed to assess the outcomes of postoperative whole breast radiation therapy (WB-RT) in Asian patients with breast cancer who underwent prior cosmetic breast implantation. METHODS We retrospectively reviewed the medical records of 61 patients with breast cancer who had prior cosmetic breast implants (prior-CBI) and underwent breast-conserving surgery (BCS) and WB-RT between 2015 and 2020. The median implant volume was 238.8 cc, with a median interval of 84.7 months between the prior-CBI and BCS. WB-RT was administered with either conventional fractionation (CF-RT) at 50 Gy in 25 fractions (N = 36) or hypofractionation (HF-RT) at 42.6 Gy in 16 fractions (N = 25). The incidences of implant-related complications (IRC) and their contributing factors were analyzed. RESULTS After a median follow-up of 43.5 months, the 3-year cumulative incidences of IRC and implant loss were 17.2% and 4.9%, respectively. Among the four (6.6%) patients who opted for implant removal after RT, three were potentially related to RT-related capsular contracture. There was no difference in the 3-year cumulative IRC rates following CF-RT and HF-RT (12.2% and 26.7%, respectively; p = 0.120). The risk factors for IRC included a larger implant size (> 260 cc) and a higher ratio of breast tissue to implant volume. CONCLUSIONS This study demonstrated a favorable safety profile of WB-RT for treatment of breast cancer in Asian women with prior-CBI. The integration of HF-RT following BCS was thought to be a feasible approach.
Collapse
Affiliation(s)
- Nalee Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Won Kyung Cho
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Jeong Eon Lee
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seok Jin Nam
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seok Won Kim
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jonghan Yu
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byung Joo Chae
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sei Kyung Lee
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jai-Min Ryu
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Sook Ko
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Haeyoung Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea.
| |
Collapse
|
3
|
Schoberleitner I, Faserl K, Tripp CH, Pechriggl EJ, Sigl S, Brunner A, Zelger B, Hermann-Kleiter N, Baier L, Steinkellner T, Sarg B, Egle D, Brunner C, Wolfram D. Silicone implant surface microtopography modulates inflammation and tissue repair in capsular fibrosis. Front Immunol 2024; 15:1342895. [PMID: 38566997 PMCID: PMC10985323 DOI: 10.3389/fimmu.2024.1342895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Excessive fibrous capsule formation around silicone mammary implants (SMI) involves immune reactions to silicone. Capsular fibrosis, a common SMI complication linked to host responses, worsens with specific implant topographies. Our study with 10 patients investigated intra- and inter-individually, reduced surface roughness effects on disease progression, wound responses, chronic inflammation, and capsular composition. The results illuminate the significant impact of surface roughness on acute inflammatory responses, fibrinogen accumulation, and the subsequent fibrotic cascade. The reduction of surface roughness to an average roughness of 4 μm emerges as a promising approach for mitigating detrimental immune reactions, promoting healthy wound healing, and curbing excessive fibrosis. The identified proteins adhering to rougher surfaces shed light on potential mediators of pro-inflammatory and pro-fibrotic processes, further emphasizing the need for meticulous consideration of surface design. The composition of the implant capsule and the discovery of intracapsular HSP60 expression highlight the intricate web of stress responses and immune activation that can impact long-term tissue outcomes.
Collapse
Affiliation(s)
- Ines Schoberleitner
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Klaus Faserl
- Protein Core Facility, Institute of Medical Chemistry, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph H. Tripp
- Department of Dermatology, Venereology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elisabeth Judith Pechriggl
- Department of Anatomy, Histology and Embryology, Institute of Clinical and Functional Anatomy, Medical University of Innsbruck, Innsbruck, Austria
| | - Stephan Sigl
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Andrea Brunner
- Institute of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, Innsbruck, Austria
- INNPATH GmbH, Tirol Kliniken, Innsbruck, Austria
| | - Bettina Zelger
- Institute of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, Innsbruck, Austria
| | - Natascha Hermann-Kleiter
- Institute of Cell Genetics, Department for Genetics and Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Leoni Baier
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Theresia Steinkellner
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Bettina Sarg
- Protein Core Facility, Institute of Medical Chemistry, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniel Egle
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christine Brunner
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Dolores Wolfram
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Ziegler-Rodriguez G, Garces-Ruiz M, De La Cruz-Ku G, Ziegler-Rodriguez O, Ziegler-Gutierrez O, Garces-Castre M, Montes-Gil J, Neira J, Taxa-Rojas L, Cebrian R, Chatterjee A. Prepectoral and Retropectoral Breast-implant-Associated Anaplastic Large-cell Lymphoma. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5520. [PMID: 38204871 PMCID: PMC10781137 DOI: 10.1097/gox.0000000000005520] [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: 08/27/2023] [Accepted: 11/08/2023] [Indexed: 01/12/2024]
Abstract
Breast-implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a non-Hodgkin lymphoma that arises in the space between the surface of a breast implant and the fibrous capsule that grows around the implant. Since its first description 20 years ago, almost 1000 cases of BIA-ALCL have been diagnosed worldwide. Nowadays, guidelines describe the diagnosis, staging, and treatment of this disease. We present the first two cases diagnosed and treated in Peru, demonstrating a wide range of aggressiveness of BIA-ALCL.
Collapse
Affiliation(s)
- Gonzalo Ziegler-Rodriguez
- From the Instituto Nacional de Enfermedades Neoplasicas (INEN), Lima, Peru
- Clinica Ziegler, Lima, Peru
- Universidad Peruana de Ciencias Aplicas (UPC), Lima, Peru
| | - Milko Garces-Ruiz
- From the Instituto Nacional de Enfermedades Neoplasicas (INEN), Lima, Peru
- Universidad Peruana de Ciencias Aplicas (UPC), Lima, Peru
| | - Gabriel De La Cruz-Ku
- University of Massachusetts Medical School, Worcester, Mass
- Universidad Cientifica del Sur, Lima, Peru
| | | | | | | | - Jaime Montes-Gil
- From the Instituto Nacional de Enfermedades Neoplasicas (INEN), Lima, Peru
| | - Jimena Neira
- From the Instituto Nacional de Enfermedades Neoplasicas (INEN), Lima, Peru
| | - Luis Taxa-Rojas
- From the Instituto Nacional de Enfermedades Neoplasicas (INEN), Lima, Peru
| | - Rosa Cebrian
- Department of Radiology, Clinical Ricardo Palma, Lima, Peru
| | - Abhishek Chatterjee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tufts Medical Center, Boston, Mass
| |
Collapse
|
6
|
Möllhoff N, Ehrl D, Fuchs B, Frank K, Alt V, Mayr D, Braig D, Giunta RE, Hagen C. [Breast implant-associated squamous cell carcinoma: a systematic literature review]. HANDCHIR MIKROCHIR P 2023; 55:268-277. [PMID: 37473774 DOI: 10.1055/a-2108-9111] [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: 07/22/2023] Open
Abstract
BACKGROUND Breast implant-associated squamous cell carcinoma (BIA-SCC) is being discussed as a distinct malignant tumour entity originating from the implant capsule. The FDA and the ASPS published a safety communication on BIA-SCC in 2022, with a first case report of BIA-SCC having been published in the 1990s. This manuscript summarises the current scientific data on this rare tumour entity. MATERIAL AND METHODS This systematic literature review from two independent databases includes all publications of cases with histopathologically confirmed BIA-SCC. Data extraction included study design, demographic data, implant information and details regarding diagnosis and treatment. RESULTS Nineteen cases of BIA-SCC with a mean age of 57±10 years were reported in 16 publications. In most cases, the indication was aesthetic augmentation (n=13). Both silicone (n=11) and saline (n=7) implants with different surfaces (smooth n=3, textured n=3, polyurethane n=1) were used. Symptoms such as unilateral swelling (n=18), pain (n=14) and erythema (n=5) occurred on an average of 23±9 years after implantation. Imaging showed fluid collection (n=8) or a tumour mass (n=4) around the breast implant. The most common surgical treatment was explantation with capsulectomy. Metastasis was described in 6 cases. CONCLUSIONS BIA-SCC is a malignant tumour entity associated with breast implant capsules. Based on current low-quality data (level of evidence class V), no definitive conclusion regarding correlation and causality of SCC in patients with breast implants can be drawn. There is an urgent need for national and international breast implant and breast cancer registries to obtain valid data on the incidence, pathogenesis and clinical presentation of rare tumour entities.
Collapse
Affiliation(s)
- Nicholas Möllhoff
- Abteilung für Hand-, Plastische- und Ästhetische Chirurgie, Klinikum der Universität München, LMU München, Deutschland
| | - Denis Ehrl
- Abteilung für Hand-, Plastische- und Ästhetische Chirurgie, Klinikum der Universität München, LMU München, Deutschland
| | - Benedikt Fuchs
- Abteilung für Hand-, Plastische- und Ästhetische Chirurgie, Klinikum der Universität München, LMU München, Deutschland
| | - Konstantin Frank
- Abteilung für Hand-, Plastische- und Ästhetische Chirurgie, Klinikum der Universität München, LMU München, Deutschland
- Ocean Clinic, Marbella, Spain
| | - Verena Alt
- Abteilung für Hand-, Plastische- und Ästhetische Chirurgie, Klinikum der Universität München, LMU München, Deutschland
| | - Doris Mayr
- Pathologisches Institut, Ludwig-Maximilians-Universität München, München, Deutschland
| | - David Braig
- Abteilung für Hand-, Plastische- und Ästhetische Chirurgie, Klinikum der Universität München, LMU München, Deutschland
- Klinik für Plastische und Handchirurgie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Deutschland
| | - Riccardo E Giunta
- Abteilung für Hand-, Plastische- und Ästhetische Chirurgie, Klinikum der Universität München, LMU München, Deutschland
| | - Christine Hagen
- Abteilung für Hand-, Plastische- und Ästhetische Chirurgie, Klinikum der Universität München, LMU München, Deutschland
| |
Collapse
|
7
|
Janszen G, Arnoldi M, Vinci V, Klinger M, Di Landro L. On the Safety of Implanted Breast Prostheses in Accidental Impacts. MATERIALS (BASEL, SWITZERLAND) 2023; 16:4807. [PMID: 37445121 DOI: 10.3390/ma16134807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/29/2023] [Accepted: 07/02/2023] [Indexed: 07/15/2023]
Abstract
The employment of breast silicone implants, both in aesthetic and reconstructive medicine, is widespread thanks to their recognized biocompatibility and durability. Some critical situations, for example, in the case of accidental impacts, may induce concerns by potential patients about their use. Dynamic tests reproducing frontal impacts at speeds up to 90 km/h, with anthropomorphic dummies carrying 330 cc prostheses and wearing safety belts, were conducted. Tests showed a significant probability of internal gel loss following implant damage at the highest speed. Moreover, considering that prostheses may remain implanted for many years, the effects of accelerated aging at 37 °C, 60 °C, 75 °C and 90 °C in physiological solution were also investigated. Tensile tests of the shell material and compressive tests of the full prosthesis showed evidence of variation in the prostheses' mechanical characteristics after aging, which affects their stiffness, deformability and strength. These results stress the importance of medical investigations for possible damages of the implanted prostheses in the case of an accident.
Collapse
Affiliation(s)
- Gerardus Janszen
- Department of Aerospace Science and Technology, Politecnico di Milano, 20156 Milano, Italy
| | - Michela Arnoldi
- Department of Aerospace Science and Technology, Politecnico di Milano, 20156 Milano, Italy
| | - Valeriano Vinci
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Marco Klinger
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, 20126 Milano, Italy
| | - Luca Di Landro
- Department of Aerospace Science and Technology, Politecnico di Milano, 20156 Milano, Italy
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Chen J, Zhu XM, Huynh MNQ, McRae M. Breastfeeding Outcome and Complications in Females With Breast Implants: A Systematic Review and Meta-Analysis. Aesthet Surg J 2023; 43:731-740. [PMID: 36752943 DOI: 10.1093/asj/sjad027] [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: 01/10/2023] [Revised: 02/03/2023] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
Breast augmentation is a commonly performed cosmetic procedure. We set out to determine whether there was any effect on breastfeeding in females after breast implants. The aim of this study was to perform a systematic review and meta-analysis of the current evidence on breastfeeding outcome and complications in females with breast augmentation. A systematic review was performed utilizing MEDLINE, EMBASE, and all evidence-based medicine reviews from their respective inception dates to November 7, 2022, to assess outcomes of breastfeeding in females with breast implants (PROSPERO ID: CRD42022357909). This review was in accordance with both the Cochrane Handbook for Systematic Review of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eleven studies (4 prospective and 7 retrospective) in total were included in the review. A total of 8197 out of 9965 (82.25%) patients were successfully able to breastfeed after breast implants. Of 5 studies that included a control group, 343,793 of 388,695 (88.45%) women without breast implants successfully breastfed. A meta-analysis of 5 comparative studies showed a significant reduction of breastfeeding in females with breast implants, n = 393,686, pooled odds ratio = 0.45 (95% CI, 0.38 to 0.53). Complications described included pain, mastitis, insufficient or excessive lactation, and nipple inversion. There may be impairment in ability to breastfeed for females who receive breast implants when compared with those without. Additional studies on the topic are needed to further clarify the relationship.
Collapse
|
10
|
A Spectrum of Disease: Breast Implant-Associated Anaplastic Large Cell Lymphoma, Atypicals, and Other Implant Associations. Clin Plast Surg 2023; 50:249-257. [PMID: 36813403 DOI: 10.1016/j.cps.2022.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon and emerging malignancy caused by textured breast implants. The most common patient presentation is delayed seromas, other presentations include breast asymmetry, overlying skin rashes, palpable masses, lymphadenopathy, and capsular contracture. Confirmed diagnoses should receive lymphoma oncology consultation, multidisciplinary evaluation, and PET-CT or CT scan evaluation prior to surgical treatment. Disease confined to the capsule is curable in the majority of patients with complete surgical resection. BIA-ALCL is now recognized as one disease among a spectrum of inflammatory mediated malignancies which include implant-associated squamous cell carcinoma and B cell lymphoma.
Collapse
|
11
|
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.
Collapse
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
| | | |
Collapse
|
12
|
Foroushani FT, Dzobo K, Khumalo NP, Mora VZ, de Mezerville R, Bayat A. Advances in surface modifications of the silicone breast implant and impact on its biocompatibility and biointegration. Biomater Res 2022; 26:80. [PMID: 36517896 PMCID: PMC9749192 DOI: 10.1186/s40824-022-00314-1] [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: 08/08/2022] [Accepted: 10/31/2022] [Indexed: 12/15/2022] Open
Abstract
Silicone breast implants are commonly used for cosmetic and oncologic surgical indications owing to their inertness and being nontoxic. However, complications including capsular contracture and anaplastic large cell lymphoma have been associated with certain breast implant surfaces over time. Novel implant surfaces and modifications of existing ones can directly impact cell-surface interactions and enhance biocompatibility and integration. The extent of foreign body response induced by breast implants influence implant success and integration into the body. This review highlights recent advances in breast implant surface technologies including modifications of implant surface topography and chemistry and effects on protein adsorption, and cell adhesion. A comprehensive online literature search was performed for relevant articles using the following keywords silicone breast implants, foreign body response, cell adhesion, protein adsorption, and cell-surface interaction. Properties of silicone breast implants impacting cell-material interactions including surface roughness, wettability, and stiffness, are discussed. Recent studies highlighting both silicone implant surface activation strategies and modifications to enhance biocompatibility in order to prevent capsular contracture formation and development of anaplastic large cell lymphoma are presented. Overall, breast implant surface modifications are being extensively investigated in order to improve implant biocompatibility to cater for increased demand for both cosmetic and oncologic surgeries.
Collapse
Affiliation(s)
- Fatemeh Tavakoli Foroushani
- Wound and Keloid Scarring Research Unit, Hair and Skin Research Laboratory, Division of Dermatology, Department of Medicine, The South African Medical Research Council, University of Cape Town, Cape Town, South Africa
| | - Kevin Dzobo
- Wound and Keloid Scarring Research Unit, Hair and Skin Research Laboratory, Division of Dermatology, Department of Medicine, The South African Medical Research Council, University of Cape Town, Cape Town, South Africa
| | - Nonhlanhla P Khumalo
- Wound and Keloid Scarring Research Unit, Hair and Skin Research Laboratory, Division of Dermatology, Department of Medicine, The South African Medical Research Council, University of Cape Town, Cape Town, South Africa
| | | | | | - Ardeshir Bayat
- Wound and Keloid Scarring Research Unit, Hair and Skin Research Laboratory, Division of Dermatology, Department of Medicine, The South African Medical Research Council, University of Cape Town, Cape Town, South Africa.
| |
Collapse
|
13
|
Dickinson BP, Vu MB, Silverstein M, Prajapati KP, Lopez J, Li ED, Handel N. Preoperative MRI to Improve Aesthetic Outcomes in Secondary Mastopexy Augmentation: A Step-by-Step Approach. Aesthet Surg J Open Forum 2022; 4:ojac068. [PMID: 36483849 PMCID: PMC9724776 DOI: 10.1093/asjof/ojac068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Secondary mastopexy augmentation is challenging because of compromised blood supply to the nipple areola complex (NAC). The operating surgeon often relies on clinical judgment and may perform a more conservative elevation of the NAC to minimize the risk of nipple necrosis. Despite this, the danger of necrosis persists. In our experience, MRI with contrast has enhanced preoperative planning in both cosmetic and reconstructive cases. Objectives The goals of this article are to describe our use of preoperative MRI in identifying the blood supply to the NAC, evaluating dermo glandular thickness, decreasing surgical complications, and improving outcomes in secondary mastopexy augmentation. Methods A consecutive series of secondary mastopexy augmentation procedures performed in 2021 were reviewed. In each case, preoperative maximum intensity projection (MIP) and/or high-resolution T1-weighted contrast enhanced MRI imaging was reviewed to elucidate the blood supply to the NAC and quantify the dermo glandular thickness. The imaging was used to formulate the operative plan. Preoperative and postoperative photographs were compared. Results Eight cases were performed, four of which were selected to demonstrate our method using breast MRI with contrast in step-by-step approach. Patient satisfaction was high. The NAC survived in all cases. Conclusions Surgeons can utilize preoperative breast MRI for strategic operative planning when performing secondary mastopexy augmentation. Visualization of the blood supply to the NAC and dermo glandular flap thickness are vitally important when performing a more aggressive lift of the breast. Level of Evidence 3
Collapse
Affiliation(s)
- Brian P Dickinson
- Plastic and reconstructive surgeon in private practice, Newport Beach, CA, USA
| | | | | | | | - January Lopez
- Director of breast imaging, Hoag Hospital Newport Beach Breast Center, Newport Beach, CA 92663, USA
| | - Ellin D Li
- Physician assistant at a plastic surgery private practice, Newport Beach, CA, USA
| | - Neal Handel
- clinical professor, University of California Los Angeles Department of Plastic & Reconstructive Surgery, Beverly Hills, CA 90210, USA
| |
Collapse
|