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Swanson E. The Fallacy of a Bacterial Etiology for Capsular Contracture and BIA-ALCL and Assigning Blame to Noncertified Surgeons. Ann Plast Surg 2024; 93:405-408. [PMID: 39177949 DOI: 10.1097/sap.0000000000004073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Affiliation(s)
- Eric Swanson
- Dr Swanson is a plastic surgeon in private practice in Leawood, KS
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Park BC, Alving-Trinh AL, Prigmore HL, Harrell FE, Sarhane K, Joseph JT, Thomas H, Lupi AL, Perdikis G, Higdon KK. Impact of Tissue Expander Surface Texture on Two-Stage Breast Reconstruction Outcomes: A Combined Analysis. Plast Reconstr Surg 2024; 153:1053e-1062e. [PMID: 37252917 DOI: 10.1097/prs.0000000000010763] [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: 06/01/2023]
Abstract
BACKGROUND With ongoing investigations of the impact of device texturing on breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL), studies have begun comparing complication profiles of tissue expanders. However, there is a paucity of timing and severity data of complications. The aim of this study was to provide a comparative survival analysis of postoperative complications between smooth (STEs) and textured tissue expanders (TTEs) in breast reconstruction. METHODS A single-institution experience with tissue expander breast reconstruction was reviewed for complications up to 1 year after second-stage reconstruction from 2014 to 2020. Demographics, comorbidities, operation-related variables, and complications were evaluated. Kaplan-Meier curves, Cox proportional hazard models, and a consensus-based ordinal logistic regression model were used to compare complication profiles. RESULTS Of 919 total patients, 600 (65.3%) received TTEs and 319 (34.7%) received STEs. There was increased risk of infection ( P < 0.0001), seroma ( P = 0.046), expander malposition ( P < 0.0001), and wound dehiscence ( P = 0.019) in STEs compared with TTEs. However, there was also a decreased risk of capsular contracture ( P = 0.005) in STEs compared with TTEs. Failure of breast reconstruction ( P < 0.001) and wound dehiscence ( P = 0.018) occurred significantly earlier in STEs compared with TTEs. Predictors for significantly higher severity complications included the following: smooth tissue expander use ( P = 0.007), shorter time to complication ( P < 0.0001), higher body mass index ( P = 0.005), smoking history ( P = 0.025), and nipple-sparing mastectomy ( P = 0.012). CONCLUSIONS Differences in the timing and severity of complications contribute to the safety profiles of tissue expanders. STEs are associated with increased odds of higher severity and earlier complications. Therefore, tissue expander selection may depend on underlying risk factors and severity predictors. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
| | | | | | | | - Karim Sarhane
- Plastic Surgery, Vanderbilt University Medical Center
| | - Jeremy T Joseph
- Division of Plastic and Cosmetic Surgery, Eastern Virginia Medical School
| | | | | | | | - Kent K Higdon
- Plastic Surgery, Vanderbilt University Medical Center
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Karakas E, Ayhan MS, Karasu O, Kocak CO, Yalinay M. In Vivo Comparison of the Efficacy and Duration of Local Antibiotics on Smooth, Textured and Polyurethane Implant Surfaces. Aesthetic Plast Surg 2024:10.1007/s00266-024-04090-2. [PMID: 38806833 DOI: 10.1007/s00266-024-04090-2] [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: 10/03/2023] [Accepted: 04/15/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Capsular contracture is one of the most common complications after breast surgery involving silicone implants. The most likely cause of this condition is biofilm formation. In this study, the efficacy of local antibiotherapy against biofilm formation on implant surfaces was investigated. METHODS Thirty-six rats were divided into six groups. Three pockets were created on the dorsum of each rat, and 1 × 2 cm implant surface samples from smooth, polyurethane and textured implants were randomly placed into pockets. All samples were inoculated with staphylococcus epidermidis. In groups 1-2-3, inoculated samples were placed into the pockets and removed after 1, 6 and 24 h, respectively. In groups 4-5-6, inoculated samples immersed with rifamycin were placed and removed after 1, 6 and 24 h, respectively. Bacterial load was measured with plate count method. RESULTS Bacterial load was lower in groups 4-5-6 than in groups 1-2-3 (p < 0.05). In groups 4-5-6, bacterial load was lower for polyurethane than for textured surfaces at all time points (1, 6 and 24 h; p < 0.05). Again, in groups 4-5-6, bacterial load was lower for smooth than for textured surfaces at 24 h (p < 0.05). In groups 4-5-6, bacterial load was lower for polyurethane than for smooth surfaces at all time points, but difference was not statistically significant (1, 6 and 24 h; p < 0.05). CONCLUSION The results suggest that local antibiotic therapy was effective in reducing the bacterial load on all surfaces. The effectiveness of local rifamycin on the polyurethane surface was higher, and the duration of activity was longer than other surfaces. NO LEVEL ASSIGNED 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)
- Ebubekir Karakas
- Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - M Suhan Ayhan
- Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey.
| | - Oguzhan Karasu
- Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ceren Ozkul Kocak
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - Meltem Yalinay
- Department of Medical Microbiology, Faculty of Medicine, Gazi University, Ankara, Turkey
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Chow O, Hu H, Lajevardi SS, Deva AK, Atkinson RL. Preventing Bacterial Contamination of Breast Implants Using Infection Mitigation Techniques: An In Vitro Study. Aesthet Surg J 2024; 44:605-611. [PMID: 38290053 DOI: 10.1093/asj/sjae013] [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: 12/04/2023] [Revised: 01/15/2024] [Accepted: 01/19/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Bacterial contamination of implants has been linked to biofilm formation and subsequent infection, capsular contracture, and breast implant-associated anaplastic large cell lymphoma. Reducing contamination during implant insertion should therefore reduce biofilm formation disease sequelae. OBJECTIVES The aim of this study was to compare levels of contamination between preventative techniques. METHODS A model to simulate the passage of implants through a skin incision was designed that utilized a sterile textured polyvinyl plastic sheet contaminated with Staphylococcus epidermidis. In the first stage of the polyvinyl contamination model, implants were subject to infection-mitigation techniques and passed through the incision, then placed onto horse blood agar plates and incubated for 24 hours. In the second stage of the study the same contamination was applied to human abdominal wall specimens. A 5 cm incision was made through skin and fat, then implants were passed through and levels of contamination were measured as described. RESULTS Smooth implants grew a mean of 95 colony-forming units (CFUs; approximately 1 CFU/cm2) and textured implants grew 86 CFUs (also approximately 1 CFU/cm2). CFU counts were analyzed by the Mann-Whitney U-test which showed no significant difference between implant types (P < .05); independent-sample t-tests showed a significant difference. The dependent-variable techniques were then compared as groups by one-way analysis of variance, which also showed a significant reduction compared with the control group (P < .01). CONCLUSIONS This in vitro study has shown the effectiveness of antiseptic rinse and skin/implant barrier techniques for reducing bacterial contamination of breast implants at the time of insertion.
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Gryskiewicz J, Slavin BV, Slavin BR, Nayak VV, Pierrot RG, Taghioff SM, Alameddine KO, Singh D, Chopra K, Coelho PG. The Aesthetic Surgery Education and Research Foundation (ASERF): A 30-Year Retrospective Analysis. Aesthet Surg J 2024; 44:658-667. [PMID: 38195091 DOI: 10.1093/asj/sjae001] [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: 10/24/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/11/2024] Open
Abstract
Federal government research grants provide limited funding to plastic surgeon-scientists, with reconstructive research taking precedence over aesthetic research. The Aesthetic Surgery Education and Research Foundation (ASERF) is a nonprofit, 501(c)(3) organization that seeks to support innovative, diverse research endeavors within aesthetic surgery. A total of 130 ASERF-funded studies and 32 non-funded applications from 1992 to 2022 were reviewed. Kruskal Wallis, Fisher's exact, and chi-squared tests were utilized to assess the potential relationship between self-identified gender, practice setting, geographical location, and study type with individual grant amounts and grant funding decision. Although significant differences were observed between male and female grant recipient h-indices (P < .05), there were no differences in the amount of funding they received (P > .05). Grant amounts were also consistent between study types as well as principal investigator practice settings and geographical locations (P > .05). The subanalysis revealed that the practice setting of the primary investigator (PI) was the only variable to exhibit a significant association with the decision to award funding (P < .05). Further, of the 61 applicants between 2017 and 2022, only 2 PIs self-identified as female. ASERF serves as an excellent funding source for global aesthetic surgery. To promote further research diversification, increased emphasis should be placed on recruiting applicants from outside academia and those who identify as female or gender nonbinary.
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D’Orsi G, Giacalone M, Calicchia A, Gagliano E, Vannucchi L, Vanni G, Buonomo OC, Cervelli V, Longo B. BIA-ALCL and BIA-SCC: Updates on Clinical Features and Genetic Mutations for Latest Recommendations. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:793. [PMID: 38792976 PMCID: PMC11122735 DOI: 10.3390/medicina60050793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/03/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024]
Abstract
Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) and Breast Implant-Associated Squamous Cell Carcinoma (BIA-SCC) are emerging neoplastic complications related to breast implants. While BIA-ALCL is often linked to macrotextured implants, current evidence does not suggest an implant-type association for BIA-SCC. Chronic inflammation and genetics have been hypothesized as key pathogenetic players, although for both conditions, the exact mechanisms and specific risks related to breast implants are yet to be established. While the genetic alterations in BIA-SCC are still unknown, JAK-STAT pathway activation has been outlined as a dominant signature of BIA-ALCL. Recent genetic investigation has uncovered various molecular players, including MEK-ERK, PI3K/AKT, CDK4-6, and PDL1. The clinical presentation of BIA-ALCL and BIA-SCC overlaps, including most commonly late seroma and breast swelling, warranting ultrasound and cytological examinations, which are the first recommended steps as part of the diagnostic work-up. While the role of mammography is still limited, MRI and CT-PET are recommended according to the clinical presentation and for disease staging. To date, the mainstay of treatment for BIA-ALCL and BIA-SCC is implant removal with en-bloc capsulectomy. Chemotherapy and radiation therapy have also been used for advanced-stage BIA-ALCL and BIA-SCC. In-depth characterization of the tumor genetics is key for the development of novel therapeutic strategies, especially for advanced stage BIA-ALCL and BIA-SCC, which show a more aggressive course and poor prognosis.
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Affiliation(s)
- Gennaro D’Orsi
- PhD School of Applied Medical-Surgical Sciences, Tor Vergata University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Martina Giacalone
- Plastic and Reconstructive Surgery at Department of Surgical Science, Tor Vergata University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Alessio Calicchia
- Plastic and Reconstructive Surgery at Department of Surgical Science, Tor Vergata University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Elettra Gagliano
- Plastic and Reconstructive Surgery at Department of Surgical Science, Tor Vergata University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Lisa Vannucchi
- Plastic and Reconstructive Surgery at Department of Surgical Science, Tor Vergata University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Gianluca Vanni
- Division of Breast Unit, Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Oreste Claudio Buonomo
- Division of Breast Unit, Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Valerio Cervelli
- Plastic and Reconstructive Surgery at Department of Surgical Science, Tor Vergata University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Benedetto Longo
- Plastic and Reconstructive Surgery at Department of Surgical Science, Tor Vergata University of Rome, Via Montpellier 1, 00133 Rome, Italy
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Nelson JA, Rubenstein RN, Vorstenbosch J, Haglich K, Poulton RT, McGriff D, Stern CS, Coriddi M, Cordeiro PG, McCarthy CM, Disa JJ, Mehrara BJ, Matros E. Textured versus Smooth Tissue Expanders: A Comparison of Complications in 3526 Breast Reconstructions. Plast Reconstr Surg 2024; 153:262e-272e. [PMID: 37104467 PMCID: PMC11275556 DOI: 10.1097/prs.0000000000010600] [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: 04/28/2023]
Abstract
BACKGROUND Increased understanding of breast implant-associated anaplastic large-cell lymphoma has led to a shift away from textured breast devices. A few small studies have compared the complication rates of textured and smooth tissue expanders (TEs). The aim of this study was to compare complication profiles in patients undergoing two-stage postmastectomy breast reconstruction with either textured or smooth TEs. METHODS The authors performed a retrospective review of female patients who underwent immediate breast reconstruction with textured or smooth TEs from 2018 to 2020 at their institution. Rates of seroma, infection/cellulitis, malposition/rotation, exposure, and TE loss were analyzed in the overall cohort and subgroups undergoing prepectoral and subpectoral TE placement. A propensity score-matched analysis was used to decrease the effects of confounders comparing textured and smooth TEs. RESULTS The authors analyzed 3526 TEs (1456 textured and 2070 smooth). More frequent use of acellular dermal matrix, SPY angiography, and prepectoral TE placement was noted in the smooth TE cohort ( P < 0.001). Univariate analysis suggested higher rates of infection/cellulitis, malposition/rotation, and exposure in smooth TEs (all P < 0.01). Rates of TE loss did not differ. After propensity matching, no differences were noted in infection or TE loss. Prepectoral smooth expanders had increased rates of malposition/rotation. CONCLUSIONS TE surface type did not affect rates of TE loss, although increased rates of expander malposition were noted in the smooth prepectoral cohort. Further research is needed to examine breast implant-associated anaplastic large-cell lymphoma risk with temporary textured TE exposure to improve decision-making. CLINICAL QUESTION/LEVEL OF EVIDENCW Therapeutic, III.
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Affiliation(s)
- Jonas A. Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robyn N. Rubenstein
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joshua Vorstenbosch
- Plastic and Reconstructive Surgery Service, Department of Surgery, McGill University, Royal Victoria Hospital, Montreal, Quebec
| | - Kathryn Haglich
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Richard T. Poulton
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - De’von McGriff
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Carrie S. Stern
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michelle Coriddi
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Peter G. Cordeiro
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Colleen M. McCarthy
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joseph J. Disa
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Babak J. Mehrara
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Evan Matros
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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Cho MJ, Farhadi RV, Nash DW, Kaleeny J, Povoski SP, Chao AH. The current use of tissue expanders in breast reconstruction: device design, features, and technical considerations. Expert Rev Med Devices 2024; 21:27-35. [PMID: 38032224 DOI: 10.1080/17434440.2023.2288911] [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: 08/15/2023] [Accepted: 11/24/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION The use of tissue expanders (TE) in post-mastectomy breast reconstruction is a widely accepted practice, especially in patients desiring implant-based breast reconstruction. It has become the standard of care to perform a two-staged breast reconstruction using tissue expanders for the past 50 years due to its reliability, safety, cost-effectiveness, and versatility. Due to its popularity, there are numerous types and features of breast tissue expanders and various surgical approaches available for plastic surgeons. AREAS COVERED In this article, we will review the role of tissue expanders in breast reconstruction, the types and features of breast tissue expanders, and technical considerations. EXPERT OPINION The use of tissue expanders in breast reconstruction offers significant advantages of preserving the breast skin envelope and reestablishing the breast mound. With evolving approaches to breast reconstruction, tissue expander design, and application underwent several refinements and modifications. Due to these advances, studies on its long-term efficacy and safety profile typically fall behind and more studies with higher levels of evidence are needed to better evaluate the efficacy and safety profile of tissue expanders. With increased understanding, reconstructive surgeons can minimize complications and maximize reconstructive, aesthetic outcomes with high patient satisfaction.
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Affiliation(s)
- Min-Jeong Cho
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Rana V Farhadi
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - David W Nash
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Joseph Kaleeny
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Stephen P Povoski
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Albert H Chao
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Swanson E. Breast Implant-Associated Anaplastic Large-Cell Lymphoma: Finding Fault Comes Full Circle. Ann Plast Surg 2023; 91:634-637. [PMID: 37651688 DOI: 10.1097/sap.0000000000003684] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Affiliation(s)
- Eric Swanson
- Dr Swanson is a plastic surgeon in private practice in Leawood, Kansas
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10
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Yeow M, Ching AH, Guillon C, Alperovich M. Breast implant capsule-associated squamous cell carcinoma: A systematic review and individual patient data meta-analysis. J Plast Reconstr Aesthet Surg 2023; 86:24-32. [PMID: 37666057 DOI: 10.1016/j.bjps.2023.08.002] [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: 04/05/2023] [Revised: 07/31/2023] [Accepted: 08/13/2023] [Indexed: 09/06/2023]
Abstract
INTRODUCTION New concerns have been raised by the US Food and Drug Administration regarding breast implant capsule-associated squamous cell carcinoma (BICA-SCC) but very little is known about this emerging topic. To gain a better understanding of the disease, a systematic review and individual patient data meta-analysis of patients with BICA-SCC were performed. METHODS PubMed, Embase, and Cochrane were searched from inception to 26th February 2023 for studies including patients with BICA-SCC. Individual patient data were extracted and pooled. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool. RESULTS A total of 16 studies reported 19 patients with BICA-SCC, commonly presented with swelling (84.2%), pain (73.7%), and erythema (21.1%). The median age at SCC diagnosis was 52.0 (interquartile range [IQR] 46.0-60.0) years. The median time from breast augmentation to SCC diagnosis was 20.0 (IQR 15.0-35.0) years. The majority of patients (68.4%) were found to have extracapsular spread at SCC diagnosis. All patients with breast implants in situ underwent implant removal with at least 60.0% of patients undergoing capsulectomy. The mean follow-up period was 17.6 months with 1-year overall survival of 80.8% and 1-year disease-free survival of 53.0%. CONCLUSION While rare, surgeons should counsel patients on the risks of malignancy including BICA-SCC before breast implantation and consider the possibility of BICA-SCC when treating patients with late-onset peri-implant changes. A centralized registry is needed to better understand and improve outcomes in patients with BICA-SCC.
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Affiliation(s)
- Marcus Yeow
- Department of Plastic, Reconstructive and Aesthetics Surgery, Singapore General Hospital, Singapore
| | | | - Christelle Guillon
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Hospital, Singapore
| | - Michael Alperovich
- Division of Plastic Surgery, Yale School of Medicine, New Haven, CT, USA.
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11
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Myckatyn TM, Duran Ramirez JM, Walker JN, Hanson BM. Management of Biofilm with Breast Implant Surgery. Plast Reconstr Surg 2023; 152:919e-942e. [PMID: 37871028 DOI: 10.1097/prs.0000000000010791] [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: 10/25/2023]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Understand how bacteria negatively impact aesthetic and reconstructive breast implants. 2. Understand how bacteria infect breast implants. 3. Understand the evidence associated with common implant infection-prevention strategies, and their limitations. 4. Understand why implementation of bacteria-mitigation strategies such as antibiotic administration or "no-touch" techniques may not indefinitely prevent breast implant infection. SUMMARY Bacterial infection of aesthetic and reconstructive breast implants is a common and expensive problem. Subacute infections or chronic capsular contractures leading to device explantation are the most commonly documented sequelae. Although bench and translational research underscores the complexities of implant-associated infection, high-quality studies with adequate power, control groups, and duration of follow-up are lacking. Common strategies to minimize infections use antibiotics-administered systemically, in the breast implant pocket, or by directly bathing the implant before insertion-to limit bacterial contamination. Limiting contact between the implant and skin or breast parenchyma represents an additional common strategy. The clinical prevention of breast implant infection is challenged by the clean-contaminated nature of breast parenchyma, and the variable behavior of not only specific bacterial species but also their strains. These factors impact bacterial virulence and antibiotic resistance.
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Affiliation(s)
- Terence M Myckatyn
- From the Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine
| | | | - Jennifer N Walker
- Department of Microbiology and Molecular Genetics
- Center for Infectious Diseases, Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston
| | - Blake M Hanson
- Center for Antimicrobial Resistance and Microbial Genomics, McGovern Medical School
- Center for Infectious Diseases, Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston
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12
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Gofstein-Hayuth D, Fliss E, Barnea Y, Legarda C, Bracha G, Lerner A, Lellouche J, Carmeli Y, Shani N, Arad E. Comparing the efficacy of antimicrobial pocket-irrigation protocols in an in vivo breast implant infection model. J Plast Reconstr Aesthet Surg 2023; 85:165-173. [PMID: 37499557 DOI: 10.1016/j.bjps.2023.06.062] [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: 03/29/2023] [Revised: 06/15/2023] [Accepted: 06/25/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Breast implant infection and biofilm formation are major concerns in reconstructive and esthetic breast surgery, with significant medical and economic consequences. Staphylococcus is the common pathogen, with rapidly increasing rates of methicillin-resistant Staphylococcus aureus (MRSA). There is no consensus on prevention practices. This study compares the effect of several pocket irrigation and antibiotic prophylaxis regimens on implant colonization and biofilm formation in an established rat model of MRSA-infected silicone breast implants. METHODS Silicone discs were inserted in a sub-pectoral pocket in 57 rats (114 implants). Implant infection was induced by injection of free planktonic MRSA into the surgical pocket. Rats were allocated to study groups treated by different antimicrobial protocols: pocket irrigation with vancomycin, povidone-iodine, or saline. Each group was divided into subgroups treated with or without additional peri-operative systemic vancomycin. Implant colonization or overt infection was assessed at post-operative day 14 both clinically and by cultures. RESULTS Pocket irrigation with vancomycin prevented contamination in 87% of implants. Irrigation and systemic vancomycin prevented contamination in 100% of implants with no difference between a single preoperative dose and a 48-h regimen. Systemic vancomycin alone or irrigation with povidone-iodine alone resulted in 100% contamination rates. CONCLUSIONS In this in vivo model, combination of systemic vancomycin with vancomycin pocket irrigation was the most effective regimen, preventing contamination in 100% of implants. Continuation of post-operative antibiotic treatment showed no added advantage.
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Affiliation(s)
- Dina Gofstein-Hayuth
- The Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Ehud Fliss
- The Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Yoav Barnea
- The Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Carolina Legarda
- The Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Gal Bracha
- The Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Anat Lerner
- The National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Jonathan Lellouche
- The National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Yehuda Carmeli
- The National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Nir Shani
- The Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Ehud Arad
- The Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel.
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Min K, Kim EK, Han HH, Eom JS. The effect of intraoperative immersion solutions on acellular dermal matrix: Biofilm formation and mechanical property. J Plast Reconstr Aesthet Surg 2023; 84:191-202. [PMID: 37339544 DOI: 10.1016/j.bjps.2023.05.025] [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: 07/03/2022] [Accepted: 05/15/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Acellular dermal matrix (ADM) is generally used on implant-based breast operations; However, it can increase surgical site infection. Many immersion solutions are applied to ADM, however, the most effective solution is unknown. The purpose of this study is to determine the effect of different solutions on the biofilm formation and mechanical properties of ADM. METHODS Aseptic porcine-derived ADMs were immersed in 5 different solutions for 30 min; sterile normal saline, 10% povidone-iodine, 0.5% chlorhexidine, antibiotics (cefazolin, gentamicin, and vancomycin), and taurolidine. They are transferred to 10 ml suspension of methicillin-sensitive/resistant Staphylococcus aureus (MSSA/MRSA) or Staphylococcus epidermidis and an overnight culture was performed. After rinsing and sonication to obtain the biofilm on ADM, colony forming unit (CFU) was measured. In addition, the maximum load before ADM deformation and the elongation length of ADM at the start of the maximum load was determined. RESULTS Regardless of strains, povidone-iodine, chlorhexidine, and taurolidine group had lower CFUs than the saline group with statistical significance. Meanwhile, the antibiotics group did not show statistical difference from the saline group. Moreover, only taurolidine group showed higher tensile strength (MRSA, p = 0.0003; S. epidermidis, p = 0.0023) and elongation length (MSSA, p = 0.0015) than the saline group. The antibiotics and chlorhexidine group yielded lower tensile strength and elongation length than the povidone-iodine and taurolidine groups. CONCLUSIONS It was suggested that the 10% povidone-iodine or taurolidine solution is effective. In contrast, the antibiotics solution could be considered as an effective intraoperative solution.
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Affiliation(s)
- Kyunghyun Min
- Department of Plastic and Reconstructive Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Eun Key Kim
- Department of Plastic Surgery, Asan Medical Center, School of Medicine, University of Ulsan, Ulsan, Republic of Korea
| | - Hyun Ho Han
- Department of Plastic Surgery, Asan Medical Center, School of Medicine, University of Ulsan, Ulsan, Republic of Korea.
| | - Jin Sup Eom
- Department of Plastic Surgery, Asan Medical Center, School of Medicine, University of Ulsan, Ulsan, Republic of Korea.
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14
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Bletsis PP, van Veen MM, van der Lei B. The Influence of BIA-ALCL on the Use of Textured Breast Implant and its Placement: A Survey of Dutch Plastic Surgeons. Aesthet Surg J 2023; 43:NP595-NP601. [PMID: 36929763 PMCID: PMC10349646 DOI: 10.1093/asj/sjad067] [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: 02/21/2023] [Revised: 03/14/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) and its association with macrotextured breast implants may have induced plastic surgeons to change their breast augmentation and breast reconstruction practice. OBJECTIVES The aim of this study was to survey Dutch plastic surgeons about the effects of BIA-ALCL on their choice of breast implant texture and placement technique. METHODS An online questionnaire was distributed to all members of the Dutch Association of Plastic Surgeons. Descriptive data were presented as frequencies and percentages. Technique alterations were analyzed by the marginal homogeneity test for paired nominal data. RESULTS A total of 63 plastic surgeons completed the questionnaire. The majority of respondents altered their use of textured implants due to BIA-ALCL concerns for both breast augmentation and reconstruction (75.4% and 69.8%, respectively; both being statistically significant, P < .001). Microtextured and smooth/nanotextured breast implants are now most frequently used. BIA-ALCL did not influence the placement technique in breast augmentation and reconstruction (87.7% and 94.3%, respectively). Dual-plane breast implant placement is still the most favored technique for breast augmentation, and submuscular placement is still most favored for breast reconstruction. CONCLUSIONS BIA-ALCL has had a significant impact on the use of macrotextured breast implants by Dutch plastic surgeons in both aesthetic and reconstructive breast surgery. Breast implant placement technique has not been affected. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | | | - Berend van der Lei
- Corresponding Author: Dr Berend van der Lei, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30001, 9700 RB Groningen, the Netherlands. E-mail: ; Instagram: @bletje
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15
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Staphylococcus aureus Cell Wall Phenotypic Changes Associated with Biofilm Maturation and Water Availability: A Key Contributing Factor for Chlorine Resistance. Int J Mol Sci 2023; 24:ijms24054983. [PMID: 36902413 PMCID: PMC10003762 DOI: 10.3390/ijms24054983] [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: 02/06/2023] [Revised: 02/25/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
Staphylococcus aureus biofilms are resistant to both antibiotics and disinfectants. As Staphylococci cell walls are an important defence mechanism, we sought to examine changes to the bacterial cell wall under different growth conditions. Cell walls of S. aureus grown as 3-day hydrated biofilm, 12-day hydrated biofilm, and 12-day dry surface biofilm (DSB) were compared to cell walls of planktonic organisms. Additionally, proteomic analysis using high-throughput tandem mass tag-based mass spectrometry was performed. Proteins involved in cell wall synthesis in biofilms were upregulated in comparison to planktonic growth. Bacterial cell wall width (measured by transmission electron microscopy) and peptidoglycan production (detected using a silkworm larva plasma system) increased with biofilm culture duration (p < 0.001) and dehydration (p = 0.002). Similarly, disinfectant tolerance was greatest in DSB, followed by 12-day hydrated biofilm and then 3-day biofilm, and it was least in the planktonic bacteria--suggesting that changes to the cell wall may be a key factor for S. aureus biofilm biocide resistance. Our findings shed light on possible new targets to combat biofilm-related infections and hospital dry surface biofilms.
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16
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Akkad N, Kodgule R, Duncavage EJ, Mehta-Shah N, Spencer DH, Watkins M, Shirai C, Myckatyn TM. Evaluation of Breast Implant-Associated Anaplastic Large Cell Lymphoma With Whole Exome and Genome Sequencing. Aesthet Surg J 2023; 43:318-328. [PMID: 36351182 DOI: 10.1093/asj/sjac282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare malignancy originating from the periprosthetic capsule of a textured, most often macrotextured, breast implant. Identified in women whose indications for breast implants can be either aesthetic or reconstructive, the genomic underpinnings of this disease are only beginning to be elucidated. OBJECTIVES The aim of this study was to evaluate the exomes, and in some cases the entire genome, of patients with BIA-ALCL. Specific attention was paid to copy number alterations, chromosomal translocations, and other genomic abnormalities overrepresented in patients with BIA-ALCL. METHODS Whole-exome sequencing was performed on 6 patients, and whole-genome sequencing on 3 patients, with the Illumina NovaSeq 6000 sequencer. Data were analyzed with the Illumina DRAGEN Bio-IT Platform and the ChromoSeq pipeline. The Pathseq Genome Analysis Toolkit pipeline was used to detect the presence of microbial genomes in the sequenced samples. RESULTS Two cases with STAT3 mutations and 2 cases with NRAS mutations were noted. A critically deleted 7-Mb region was identified at the 11q22.3 region of chromosome 11, and multiple nonrecurrent chromosomal rearrangements were identified by whole-genome sequencing. Recurrent gene-level rearrangements, however, were not identified. None of the samples showed evidence of potential microbial pathogens. CONCLUSIONS Although no recurrent mutations were identified, this study identified mutations in genes not previously reported with BIA-ALCL or other forms of ALCL. Furthermore, not previously reported with BIA-ALCL, 11q22.3 deletions were consistent across whole-genome sequencing cases and present in some exomes. LEVEL OF EVIDENCE: 5
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Affiliation(s)
- Neha Akkad
- Resident of internal medicine, Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA
| | | | | | | | | | - Marcus Watkins
- Research coordinator of medical oncology, Department of Medicine, Division of Hematology and Oncology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Cara Shirai
- Instructor of pathology and immunology, Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Terence M Myckatyn
- Professor of plastic and reconstructive surgery, Division of Plastic and Reconstruction Surgery, Washington University School of Medicine, Saint Louis, MO, USA
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17
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Duran Ramirez JM, Gomez J, Hanson BM, Isa T, Myckatyn TM, Walker JN. Staphylococcus aureus Breast Implant Infection Isolates Display Recalcitrance To Antibiotic Pocket Irrigants. Microbiol Spectr 2023; 11:e0288422. [PMID: 36507629 PMCID: PMC9927092 DOI: 10.1128/spectrum.02884-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/08/2022] [Indexed: 12/15/2022] Open
Abstract
Breast implant-associated infections (BIAIs) are the primary complication following placement of breast prostheses in breast cancer reconstruction. Given the prevalence of breast cancer, reconstructive failure due to infection results in significant patient distress and health care expenditures. Thus, effective BIAI prevention strategies are urgently needed. This study tests the efficacy of one infection prevention strategy: the use of a triple antibiotic pocket irrigant (TAPI) against Staphylococcus aureus, the most common cause of BIAIs. TAPI, which consists of 50,000 U bacitracin, 1 g cefazolin, and 80 mg gentamicin diluted in 500 mL of saline, is used to irrigate the breast implant pocket during surgery. We used in vitro and in vivo assays to test the efficacy of each antibiotic in TAPI, as well as TAPI at the concentration used during surgery. We found that planktonically grown S. aureus BIAI isolates displayed susceptibility to gentamicin, cefazolin, and TAPI. However, TAPI treatment enhanced biofilm formation of BIAI strains. Furthermore, we compared TAPI treatment of a S. aureus reference strain (JE2) to a BIAI isolate (117) in a mouse BIAI model. TAPI significantly reduced infection of JE2 at 1 and 7 days postinfection (dpi). In contrast, BIAI strain 117 displayed high bacterial burdens in tissues and implants, which persisted to 14 dpi despite TAPI treatment. Lastly, we demonstrated that TAPI was effective against Pseudomonas aeruginosa reference (PAO1) and BIAI strains in vitro and in vivo. Together, these data suggest that S. aureus BIAI strains employ unique mechanisms to resist antibiotic prophylaxis treatment and promote chronic infection. IMPORTANCE The incidence of breast implant associated infections (BIAIs) following reconstructive surgery postmastectomy remains high, despite the use of prophylactic antibiotic strategies. Thus, surgeons have begun using additional antibiotic-based prevention strategies, including triple antibiotic pocket irrigants (TAPIs). However, these strategies fail to reduce BIAI rates for these patients. To understand why these therapies fail, we assessed the antimicrobial resistance patterns of Staphylococcus aureus strains, the most common cause of BIAI, to the antibiotics in TAPI (bacitracin, cefazolin, and gentamicin). We found that while clinically relevant BIAI isolates were more susceptible to the individual antibiotics compared to a reference strain, TAPI was effective at killing all the strains in vitro. However, in a mouse model, the BIAI isolates displayed recalcitrance to TAPI, which contrasted with the reference strain, which was susceptible. These data suggest that strains causing BIAI may encode specific recalcitrance mechanisms not present within reference strains.
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Affiliation(s)
- Jesus M. Duran Ramirez
- Department of Microbiology and Molecular Genetics, McGovern Medical School, University of Texas Health Science Center, Houston, Texas, USA
- Department of Epidemiology, Human Genetics, and Environmental Sciences, Center for Infectious Diseases, School of Public Health, University of Texas Health Science Center, Houston, Texas, USA
| | - Jana Gomez
- Department of Microbiology and Molecular Genetics, McGovern Medical School, University of Texas Health Science Center, Houston, Texas, USA
| | - Blake M. Hanson
- Department of Epidemiology, Human Genetics, and Environmental Sciences, Center for Infectious Diseases, School of Public Health, University of Texas Health Science Center, Houston, Texas, USA
- Center for Antimicrobial Resistance and Microbial Genomics, McGovern Medical School, University of Texas Health Science Center, Houston, Texas, USA
| | - Taha Isa
- Department of Microbiology and Molecular Genetics, McGovern Medical School, University of Texas Health Science Center, Houston, Texas, USA
| | - Terence M. Myckatyn
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jennifer N. Walker
- Department of Microbiology and Molecular Genetics, McGovern Medical School, University of Texas Health Science Center, Houston, Texas, USA
- Department of Epidemiology, Human Genetics, and Environmental Sciences, Center for Infectious Diseases, School of Public Health, University of Texas Health Science Center, Houston, Texas, USA
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18
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The Role of Microorganisms in the Development of Breast Implant-Associated Anaplastic Large Cell Lymphoma. Pathogens 2023; 12:pathogens12020313. [PMID: 36839585 PMCID: PMC9961223 DOI: 10.3390/pathogens12020313] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/06/2023] [Accepted: 02/13/2023] [Indexed: 02/16/2023] Open
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a variant of anaplastic large cell lymphoma (ALCL) associated with textured-surface silicone breast implants. Since first being described in 1997, over 1100 cases have been currently reported worldwide. A causal relationship between BIA-ALCL and textured implants has been established in epidemiological studies, but a multifactorial process is likely to be involved in the pathogenesis of BIA-ALCL. However, pathophysiologic mechanisms remain unclear. One of the hypotheses that could explain the link between textured implants and BIA-ALCL consists in the greater tendency of bacterial biofilm in colonizing the surface of textured implants compared to smooth implants, and the resulting chronic inflammation which, in predisposed individuals, may lead to tumorigenesis. This review summarizes the existing evidence on the role of micro-organisms and rough surface implants in the development of BIA-ALCL. It also provides insights into the most updated clinical practice knowledge about BIA-ALCL, from clinical presentation and investigation to treatment and outcomes.
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19
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Breast Surgery with Smooth Anatomical Implants with Fixation System: A Review of the World's Largest Series of Cases. Plast Reconstr Surg 2023; 151:207e-213e. [PMID: 36696306 DOI: 10.1097/prs.0000000000009829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Anatomical implants continue to be a particularly useful tool in breast surgery, offering an excellent result for certain indications. However, to ensure fixation and prevent rotation, traditional alternatives have medium to high surface roughness and have been controversial in recent years. METHODS A retrospective assessment of 122 prosthetic augmentation and reconstruction patients over a period of 5 years was conducted. Patients were treated with tabbed anatomical implants with a smooth surface and followed up for a period of 12 months. Demographics, complications, and patient satisfaction were captured. A subgroup of 101 patients were assessed with chest radiographs at 1-year follow-up. Technical recommendations are discussed. RESULTS Primary breast augmentation, revision augmentation, augmentation-mastopexy, and breast reconstruction were the main indications for surgery. All implants were inserted through an inframammary incision and placed in the subpectoral space using dual-plane techniques, except in one mastectomy case. Rotation of the implants was radiographically observed in only two cases of revision augmentation. None of the 122 patients developed capsular contracture, seroma, rupture, infection, hematoma, or malposition following breast surgery. CONCLUSIONS Smooth anatomical implants with a fixation system offer reliable and satisfactory results for patients with various diagnoses and indications. The tab system and the fixation technique are essential to provide long-term stability, which was verified by radiographs because of the radiopaque lines present in the device for that purpose. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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20
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Barco I, Vallejo E, Muntañola A, García Fdez A, Vidal MC, Luizaga LA, Carrillo EM, Fraile M. ADVANCED-STAGE BREAST IMPLANT-ASSOCIATED LARGE CELL ANAPLASTIC LYMPHOMA. A RARE CASE OF MASS-LIKE BILATERAL DISEASE WITH AXILLARY INVOLVEMENT. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2022. [DOI: 10.1016/j.cpccr.2022.100211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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21
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Carmona-Torre F, Fernández-Ciriza L, Berniz C, Gomez-Martinez de Lecea C, Ramos A, Hontanilla B, del Pozo JL. An Experimental Murine Model to Assess Biofilm Persistence on Commercial Breast Implant Surfaces. Microorganisms 2022; 10:microorganisms10102004. [PMID: 36296280 PMCID: PMC9611056 DOI: 10.3390/microorganisms10102004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 09/29/2022] [Accepted: 10/08/2022] [Indexed: 11/16/2022] Open
Abstract
Capsular contracture is the most frequently associated complication following breast implant placement. Biofilm formation on the surface of such implants could significantly influence the pathogenesis of this complication. The objective of this study was to design an experimental model of breast implant infection that allowed us to compare the in vivo S. epidermidis ability to form and perpetuate biofilms on commonly used types of breast implants (i.e., macrotexturized, microtexturized, and smooth). A biofilm forming S. epidermidis strain (ATCC 35984) was used for all experiments. Three different implant surface types were tested: McGhan BIOCELL® (i.e., macrotexturized); Mentor Siltex® (i.e., microtexturized); and Allergan Natrelle Smooth® (i.e., smooth). Two different infection scenarios were simulated. The ability to form biofilm on capsules and implants over time was evaluated by quantitative post-sonication culture of implants and capsules biopsies. This experimental model allows the generation of a subclinical staphylococcal infection associated with a breast implant placed in the subcutaneous tissue of Wistar rats. The probability of generating an infection was different according to the type of implant studied and to the time from implantation to implant removal. Infection was achieved in 88.9% of macrotextured implants (i.e., McGhan), 37.0% of microtexturized implants (i.e., Mentor), and 18.5% of smooth implants (i.e., Allergan Smooth) in the short-term (p < 0.001). Infection was achieved in 47.2% of macrotextured implants, 2.8% of microtexturized implants, and 2.8% of smooth implants (i.e., Allergan Smooth) in the long-term (p < 0.001). There was a clear positive correlation between biofilm formation on any type of implant and capsule colonization/infection. Uniformly, the capsules formed around the macro- or microtexturized implants were consistently macroscopically thicker than those formed around the smooth implants regardless of the time at which they were removed (i.e., 1−2 weeks or 3−5 weeks). We have shown that there is a difference in the ability of S epidermidis to develop in vivo biofilms on macrotextured, microtextured, and smooth implants. Smooth implants clearly thwart bacterial adherence and, consequently, biofilm formation and persistence are hindered.
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Affiliation(s)
- Francisco Carmona-Torre
- Infectious Diseases Division, Clínica Universidad de Navarra, 31008 Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
| | | | - Carlos Berniz
- Department of Plastic Surgery, Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | | | - Ana Ramos
- Microbiology Department, Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | - Bernardo Hontanilla
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
- Department of Plastic Surgery, Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | - Jose L. del Pozo
- Infectious Diseases Division, Clínica Universidad de Navarra, 31008 Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
- Microbiology Department, Clínica Universidad de Navarra, 31008 Pamplona, Spain
- Correspondence: ; Tel.: +34-948-255-400
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22
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Li S, Ren L, Jia D, Yang D, Hao L. Effect of Carboxymethyl Chitin on Capsule Formation around Silicone Implants: An In Vivo and In Vitro Study. Plast Reconstr Surg 2022; 150:815-826. [PMID: 35895017 DOI: 10.1097/prs.0000000000009574] [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: 02/04/2023]
Abstract
BACKGROUND Capsular contracture is a serious complication that occurs after augmentation mammaplasty. The authors previously identified that carboxymethyl chitin had an inhibitory effect on capsule formation. This study was performed to elucidate the possible molecular mechanisms through which carboxymethyl chitin inhibits the formation of a capsule around silicone implants. METHODS In this study, the authors cultured human dermal fibroblasts and treated them with carboxymethyl chitin in vitro. The difference in proliferation between treated and untreated cells was analyzed through the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. Protein levels of transforming growth factor beta-1 and alpha smooth muscle actin (α-SMA) were examined by Western blot analysis. Expression levels of type I and type III collagen were checked by enzyme-linked immunosorbent assay. In vivo, silicone implants were placed under the pectoralis muscle in 12 female rabbits. The thickness of the capsule was measured by histologic analysis, and the effect of carboxymethyl chitin on α-SMA, collagen type I and III expression levels was evaluated by real-time polymerase chain reaction analysis, enzyme-linked immunosorbent assay, Western blot, and immunofluorescence analysis. RESULTS In the in vitro study, we confirmed that carboxymethyl chitin inhibited the proliferation of fibroblasts. The protein expression levels of collagen type I, transforming growth factor beta-1, and α-SMA were inhibited by carboxymethyl chitin treatment. In vivo, carboxymethyl chitin treatment reduced capsular thickness and the expression of α-SMA and collagen types I and III in capsules around silicone implants. CONCLUSION The authors' results showed that carboxymethyl chitin could influence capsule formation around silicone implants by inhibiting the fibroblast activity, interrupting fibroblast-to-myofibroblast differentiation, and decreasing collagen synthesis. CLINICAL RELEVANCE STATEMENT Carboxymethyl chitin influence capsule formation around silicone implants. Although more clinical studies are needed to verify the effect of carboxymethyl chitin on capsular contracture, the authors believe that it will play an effective role in the clinical application of reducing the occurrence of capsular contracture.
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Affiliation(s)
- Shasha Li
- From the Plastic and Cosmetic Center, The First Affiliated Hospital of Harbin Medical University; Department of Biochemistry, Qiqihar Medical University; and Teaching and Research Department of Biochemistry and Molecular Biology, Harbin Medical University
| | - Liwen Ren
- From the Plastic and Cosmetic Center, The First Affiliated Hospital of Harbin Medical University; Department of Biochemistry, Qiqihar Medical University; and Teaching and Research Department of Biochemistry and Molecular Biology, Harbin Medical University
| | - Di Jia
- From the Plastic and Cosmetic Center, The First Affiliated Hospital of Harbin Medical University; Department of Biochemistry, Qiqihar Medical University; and Teaching and Research Department of Biochemistry and Molecular Biology, Harbin Medical University
| | - Dan Yang
- From the Plastic and Cosmetic Center, The First Affiliated Hospital of Harbin Medical University; Department of Biochemistry, Qiqihar Medical University; and Teaching and Research Department of Biochemistry and Molecular Biology, Harbin Medical University
| | - Lijun Hao
- From the Plastic and Cosmetic Center, The First Affiliated Hospital of Harbin Medical University; Department of Biochemistry, Qiqihar Medical University; and Teaching and Research Department of Biochemistry and Molecular Biology, Harbin Medical University
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23
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Lee SW, Johnson EL, Chediak JA, Shin H, Wang Y, Phillips KS, Ren D. High-Throughput Biofilm Assay to Investigate Bacterial Interactions with Surface Topographies. ACS APPLIED BIO MATERIALS 2022; 5:3816-3825. [PMID: 35816421 PMCID: PMC9382637 DOI: 10.1021/acsabm.2c00367] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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The specific topography of biomaterials plays an important
role
in their biological interactions with cells and thus the safety of
medical implants. Antifouling materials can be engineered with topographic
features to repel microbes. Meanwhile, undesired topographies of implants
can cause complications such as breast implant-associated anaplastic
large cell lymphoma (BIA-ALCL). While the cause of BIA-ALCL is not
well understood, it is speculated that textured surfaces are prone
to bacterial biofilm formation as a contributing factor. To guide
the design of safer biomaterials and implants, quantitative screening
approaches are needed to assess bacterial adhesion to different topographic
surface features. Here we report the development of a high-throughput
microplate biofilm assay for such screening. The assay was used to
test a library of polydimethylsiloxane (PDMS) textures composed of
varying sizes of recessive features and distances between features
including those in the range of breast implant textures. Outliers
of patterns prone to bacterial adhesion were further studied using
real-time confocal fluorescence microscopy. The results from these
analyses revealed that surface area itself is a poor predictor for
adhesion, while the size and spacing of topographic features play
an important role. This high-throughput biofilm assay can be applied
to studying bacteria–material interactions and rational development
of materials that inhibit bacterial colonization.
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Affiliation(s)
- Sang Won Lee
- Department of Biomedical and Chemical Engineering, Syracuse University, Syracuse, New York 13244, United States.,Office of Medical Products and Tobacco, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Biology, Chemistry, and Materials Science, United States Food and Drug Administration, Silver Spring, Maryland 20993, United States
| | - Erick L Johnson
- Mechanical and Industrial Engineering, Montana State University, Bozeman, Montana 59717, United States
| | - J Alex Chediak
- Office of Medical Products and Tobacco, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Biology, Chemistry, and Materials Science, United States Food and Drug Administration, Silver Spring, Maryland 20993, United States.,Department of Mathematical Sciences, California Baptist University, Riverside, California 92504, United States
| | - Hainsworth Shin
- Office of Medical Products and Tobacco, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Biology, Chemistry, and Materials Science, United States Food and Drug Administration, Silver Spring, Maryland 20993, United States
| | - Yi Wang
- Office of Medical Products and Tobacco, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Biology, Chemistry, and Materials Science, United States Food and Drug Administration, Silver Spring, Maryland 20993, United States
| | - K Scott Phillips
- Office of Medical Products and Tobacco, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Biology, Chemistry, and Materials Science, United States Food and Drug Administration, Silver Spring, Maryland 20993, United States
| | - Dacheng Ren
- Department of Biomedical and Chemical Engineering, Syracuse University, Syracuse, New York 13244, United States.,Department of Civil and Environmental Engineering, Syracuse University, Syracuse, New York 13244, United States.,Department of Biology, Syracuse University, Syracuse, New York 13244, United States
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24
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Campolina AC, Maricevich JPBR, Silva RO, Santa-Cruz F, Coutinho LR, Maricevich M, Raj S, Ferraz ÁAB. Evaluation of Chlorhexidine Concentration on the Skin After Preoperative Surgical Site Preparation in Breast Surgery-A Randomized Controlled Trial. Aesthetic Plast Surg 2022; 46:1517-1522. [PMID: 35614158 DOI: 10.1007/s00266-022-02908-5] [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: 02/02/2022] [Accepted: 04/19/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Although there is a rationale supporting that preoperative showering with 2% or 4% chlorhexidine gluconate (CHG) would decrease skin bacterial colonization, there is no consensus that this practice reduces the risk of surgical site infection (SSI). OBJECTIVES Analyze the skin concentration of CHG after preoperative showering associated with the traditional skin preparation with CHG 4% for breast surgery. METHODS Randomized controlled trial that included 45 patients, all candidates for augmentation mammaplasty, allocated into three groups (A: no preoperative showering; B: one preoperative showering; C: two preoperative showering with CHG 4%) in a 1:1:1 ratio. Skin swabs collection was performed right before the surgical incision. The samples were, then, sent to spectrophotometry in order to determine the skin concentration of CHG at the beginning of surgery. RESULTS The age ranged from 18 to 61 years, with a mean of 37 years old. Group C had the lowest median concentration (0.057) followed by group B (0.060) and group A (0.072), however, with no statistical significance. The areola was the place with the lowest median concentration level (0.045), followed by the axilla (0.061) and the inframammary fold (IMF) (0.069). Still, when comparing the distribution of the sites, a statistically significant difference was found only between the axilla and the areola (p = 0.022). CONCLUSION Preoperative showering with CHG 4% did not increase the concentration of this agent on the skin surface right before the surgical incision. LEVEL OF EVIDENCE IV 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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McLaughlin C, Hughes AJ, Parham CS, Fritsche M, Potochny JD, Kunselman A, Ravnic DJ. Smooth Versus Textured Tissue Expander Breast Reconstruction: Complications and Efficacy. Ann Plast Surg 2022; 88:S288-S292. [PMID: 35513333 DOI: 10.1097/sap.0000000000003193] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Ongoing recognition of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and its link with textured devices has brought a paradigm shift in prosthetic-based breast reconstruction. Many institutions no longer offer textured expansion devices for staged reconstruction. However, there is a paucity of data regarding the efficacy of smooth tissue expanders (TE). We hypothesized that the time to final reconstruction and complication profile between smooth and textured TEs would be similar in breast reconstruction patients. METHODS A retrospective chart review was performed of all patients who underwent TE breast reconstruction during a 6-year period at the Penn State Hershey Medical Center. Rates of complications treated nonoperatively and those requiring reoperation were assessed. Mechanical complications, including expander malposition and rupture, were evaluated. Time to final breast reconstruction was quantified. Mixed-effects logistic regression and linear regression models, as appropriate, were used to compare textured to smooth TEs. Patient characteristics and anatomic plane placement were adjusted for in all analyses of outcomes. RESULTS Data were collected on 389 patients, encompassing 140 smooth and 604 textured TEs. Textured devices had an increased incidence of complications treated nonsurgically (16.7% vs 10.7%; P = 0.14). However, smooth TEs had an increased incidence of reoperation (12.1% vs 7.6%; P = 0.06). Most noteworthy was that although smooth TEs had a 40-fold increase in malposition (13.6% vs 0.3%; P < 0.001), no reoperation for this complication was warranted. Further, the time to final reconstruction was comparable between the 2 devices (textured expanders: 221 days and smooth expanders: 234 days; P = 0.15). CONCLUSIONS Staged, implant-based reconstruction is the most common surgical approach to recreate the breast mound following mastectomy. Textured TEs were the cornerstone to this approach. Unfortunately, the association between textured devices and BIA-ALCL now mandates an alternative. We postulated that smooth expanders would compare favorably for breast reconstruction. Although our study suggests that smooth TEs suffer more malposition, this has a negligible impact on the reconstructive timeline. Thus, smooth TEs may prove beneficial when considering the risk of BIA-ALCL associated with textured devices.
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Affiliation(s)
- Caroline McLaughlin
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, The Pennsylvania State University
| | | | | | | | - John D Potochny
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, The Pennsylvania State University
| | - Allen Kunselman
- Division of Biostatistics and Bioinformatics, Department of Public Health Sciences, The Pennsylvania State University, Hershey, PA
| | - Dino J Ravnic
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, The Pennsylvania State University
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Caldara M, Belgiovine C, Secchi E, Rusconi R. Environmental, Microbiological, and Immunological Features of Bacterial Biofilms Associated with Implanted Medical Devices. Clin Microbiol Rev 2022; 35:e0022120. [PMID: 35044203 PMCID: PMC8768833 DOI: 10.1128/cmr.00221-20] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The spread of biofilms on medical implants represents one of the principal triggers of persistent and chronic infections in clinical settings, and it has been the subject of many studies in the past few years, with most of them focused on prosthetic joint infections. We review here recent works on biofilm formation and microbial colonization on a large variety of indwelling devices, ranging from heart valves and pacemakers to urological and breast implants and from biliary stents and endoscopic tubes to contact lenses and neurosurgical implants. We focus on bacterial abundance and distribution across different devices and body sites and on the role of environmental features, such as the presence of fluid flow and properties of the implant surface, as well as on the interplay between bacterial colonization and the response of the human immune system.
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Affiliation(s)
- Marina Caldara
- Interdepartmental Center on Safety, Technologies, and Agri-food Innovation (SITEIA.PARMA), University of Parma, Parma, Italy
| | - Cristina Belgiovine
- IRCCS Humanitas Research Hospital, Rozzano–Milan, Italy
- Scuola di Specializzazione in Microbiologia e Virologia, Università degli Studi di Pavia, Pavia, Italy
| | - Eleonora Secchi
- Institute of Environmental Engineering, ETH Zürich, Zürich, Switzerland
| | - Roberto Rusconi
- IRCCS Humanitas Research Hospital, Rozzano–Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele–Milan, Italy
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Yoo H, Park JU, Chang H. Comprehensive Evaluation of the Current Knowledge on Breast Implant Associated-Anaplastic Large Cell Lymphoma. Arch Plast Surg 2022; 49:141-149. [PMID: 35832665 PMCID: PMC9045542 DOI: 10.1055/s-0042-1744422] [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: 11/08/2022] Open
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a recently spotlighted T-cell origin non-Hodgkin's lymphoma with an increasing incidence of over 800 cases and 33 deaths reported worldwide. Development of BIA-ALCL is likely a complex process involving many factors, such as the textured implant surface, bacterial biofilm growth, immune response, and patient genetics. As the incidence of BIA-ALCL is expected to increase, it is important for all surgeons and physicians to be aware of this disease entity and acquire thorough knowledge of current evidence-based guidelines and recommendations. Early detection, accurate diagnosis, and appropriate treatment are the foundations of current care.
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Affiliation(s)
- Hyokyung Yoo
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji-Ung Park
- Department of Plastic and Reconstructive Surgery, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hak Chang
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Batiukov D, Podgaiski V, Ladutko D. Polyurethane Implants in the Era of BIA-ALCL: Suggested Improvements According to Risk Factors. Aesthetic Plast Surg 2022; 46:995-998. [PMID: 34462797 DOI: 10.1007/s00266-021-02545-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/15/2021] [Indexed: 11/28/2022]
Affiliation(s)
- D Batiukov
- Medical Center "Antes Med", Kozlova Lane 25-6, 220037, Minsk, Belarus.
| | - V Podgaiski
- Belorussian Medical Academy of Postgraduate Education, Brovki 3, b. 3, 220013, Minsk, Belarus
| | - D Ladutko
- Medical Center "Antes Med", Kozlova Lane 25-6, 220037, Minsk, Belarus
- Department of Microsurgery, Minsk Regional Hospital, 223040, Lesnoe, Minsk region, Belarus
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Patiniott P, Jacombs A, Kaul L, Hu H, Warner M, Klosterhalfen B, Karatassas A, Maddern G, Richter K. Are late hernia mesh complications linked to Staphylococci biofilms? Hernia 2022; 26:1293-1299. [PMID: 35286510 PMCID: PMC9525333 DOI: 10.1007/s10029-022-02583-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/09/2022] [Indexed: 11/27/2022]
Abstract
Purpose The purpose of this study was to investigate the link between bacterial biofilms and negative outcomes of hernia repair surgery. As biofilms are known to play a role in mesh-related infections, we investigated the presence of biofilms on hernia meshes, which had to be explanted due to mesh failure without showing signs of bacterial infection. Methods In this retrospective observational study, 20 paraffin-embedded tissue sections from explanted groin hernia meshes were analysed. Meshes have been removed due to chronic pain, hernia recurrence or mesh shrinkage. The presence and bacterial composition of biofilms were determined. First, specimens were stained with fluorescence in situ hybridisation (FISH) probes, specific for Staphylococcus aureus and coagulase-negative staphylococci, and visualised by confocal laser scanning microscopy. Second, DNA was extracted from tissue and identified by S. aureus and S. epidermidis specific PCR. Results Confocal microscopy showed evidence of bacterial biofilms on meshes in 15/20 (75.0%) samples, of which 3 were positive for S. aureus, 3 for coagulase-negative staphylococci and 9 for both species. PCR analysis identified biofilms in 17/20 (85.0%) samples, of which 4 were positive for S. aureus, 4 for S. epidermidis and 9 for both species. Combined results from FISH/microscopy and PCR identified staphylococci biofilms in 19/20 (95.0%) mesh samples. Only 1 (5.0%) mesh sample was negative for bacterial biofilm by both techniques. Conclusion Results suggest that staphylococci biofilms may be associated with hernia repair failure. A silent, undetected biofilm infection could contribute to mesh complications, chronic pain and exacerbation of disease.
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Affiliation(s)
- P Patiniott
- Surgery Department, The Queen Elizabeth Hospital and Basil Hetzel Institute for Translational Health Research, The University of Adelaide, Adelaide, Australia
| | - A Jacombs
- Macquarie University Hospital, Macquarie University, Sydney, Australia
| | - L Kaul
- Surgery Department, The Queen Elizabeth Hospital and Basil Hetzel Institute for Translational Health Research, The University of Adelaide, Adelaide, Australia.,Institute of Pharmaceutical Sciences, Department of Pharmaceutical Technology and Biopharmacy, University of Freiburg, Freiburg, Germany
| | - H Hu
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - M Warner
- Microbiology and Infectious Diseases Directorate, SA Pathology, Adelaide, Australia.,Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia.,Infectious Diseases Unit, Central Adelaide Local Health Network, Adelaide, Australia
| | - B Klosterhalfen
- MVZ für Histologie, Zytologie und Molekulare Diagnostik Düren GmbH, Düren, Germany
| | - A Karatassas
- Surgery Department, The Queen Elizabeth Hospital and Basil Hetzel Institute for Translational Health Research, The University of Adelaide, Adelaide, Australia.,Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - G Maddern
- Surgery Department, The Queen Elizabeth Hospital and Basil Hetzel Institute for Translational Health Research, The University of Adelaide, Adelaide, Australia.,Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - K Richter
- Surgery Department, The Queen Elizabeth Hospital and Basil Hetzel Institute for Translational Health Research, The University of Adelaide, Adelaide, Australia. .,Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia. .,Institute for Photonics and Advanced Sensing, The University of Adelaide, Adelaide, Australia.
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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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Wang Y, Zhang Q, Tan Y, Lv W, Zhao C, Xiong M, Hou K, Wu M, Ren Y, Zeng N, Wu Y. Current Progress in Breast Implant-Associated Anaplastic Large Cell Lymphoma. Front Oncol 2022; 11:785887. [PMID: 35070989 PMCID: PMC8770274 DOI: 10.3389/fonc.2021.785887] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is an uncommon type of T-cell lymphoma. Although with a low incidence, the epidemiological data raised the biosafety and health concerns of breast reconstruction and breast augmentation for BIA-ALCL. Emerging evidence confirms that genetic features, bacterial contamination, chronic inflammation, and textured breast implant are the relevant factors leading to the development of BIA-ALCL. Almost all reported cases with a medical history involve breast implants with a textured surface, which reflects the role of implant surface characteristics in BIA-ALCL. With this review, we expect to highlight the most significant features on etiology, pathogenesis, diagnosis, and therapy of BIA-ALCL, as well as we review the physical characteristics of breast implants and their potential pathogenic effect and hopefully provide a foundation for optimal choice of type of implant with minimal morbidity.
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Affiliation(s)
| | | | | | | | | | | | | | - Min Wu
- Department of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuping Ren
- Department of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ning Zeng
- Department of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yiping Wu
- *Correspondence: Yiping Wu, ; Min Wu, ; Yuping Ren, ; Ning Zeng,
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Lajevardi SS, Rastogi P, Isacson D, Deva AK. What are the likely causes of Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)? JPRAS Open 2022; 32:34-42. [PMID: 35242986 PMCID: PMC8867047 DOI: 10.1016/j.jpra.2021.11.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/18/2021] [Indexed: 11/30/2022] Open
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a CD30-positive, anaplastic lymphoma kinase-negative T-cell lymphoma. Where implant history is known, all confirmed cases to date have occurred in patients with exposure to textured implants. The etiopathogenesis of BIA-ALCL is likely to be multifactorial, with current evidence-based theories recognising the combination of chronic infection in setting of textured implants, gram-negative biofilm formation, chronic inflammation, host genetics (e.g. JAK/STAT, p53) and time in tumorigenesis. Proposed triggers for the development of malignancy are mechanical friction, silicone implant shell particulates, silicone leachables and bacteria. Of these, the bacterial hypothesis has received significant attention, supported by a plausible biological model. In this model, bacteria form an adherent biofilm in the favourable environment of the textured implant surface, producing a bacterial load that elicits a chronic inflammatory response. Bacterial antigens, primarily of gram-negative origin, may trigger innate immunity and induce T-cell proliferation with subsequent malignant transformation in genetically susceptible individuals. Future research, investigating BIA-ALCL genetic mutations and immunological modulation with Gram-negative biofilm in BIA-ALCL models is warranted to establish a unifying theory for the aetiology of BIA-ALCL.
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Affiliation(s)
| | | | | | - Anand K. Deva
- Corresponding author at: Suite 301, 2 Technology Place, Macquarie University, NSW 2109 Australia.
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Silicon breast implants’ texture affecting bacterial biofilm formation. SRP ARK CELOK LEK 2022. [DOI: 10.2298/sarh211012065m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction/Objective. The most important etiologic factors for both, capsular contracture (CC) and breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is subclinical infection, defined as a response of an organism on presence of biofilm on the implant surface. The aim of this research was to examine the possibility of biofilm formation of four different bacteria (Staphylococcus epidermidis, Staphylococcus aureus, Pseudomonas aeruginosa, and Ralstonia picketti) on three differently textured silicone breast implants (Siltex, Mentor, pore size 70?150 ?m; MESMORsensitive, Polytech, pore size 50?900 ?m; and SilkSurface, Motiva pores 13 ?m) in vitro. Methods. Samples of silicone breast implant capsules (sized 1 ? 1 cm) were divided into three groups according to texture. After sterilization, 30 samples in every group were contaminated with 100 ?l of examined bacterial broth, followed by incubation which led to biofilm formation. For testing the capability of biofilm formation, modified technique with microtitar plates described by Stepanovic? was used. Results. All four examined bacteria (Staphylococcus epidermidis, Staphylococcus aureus, Pseudomonas aeruginosa, and Ralstonia picketti) form more biofilm on implants with pore sizes 50?900 ?m compared to implants with pore size 70?150 ?m and those with 13 ?m. Statistical significance was found in biofilm formation on implants with pores 70?150 ?m compared to implants with pores 13 ?m. The only exception was P. aeuruginosa which did not show significant difference in biofilm formation on implants 70?150 ?m and 13 ?m. Conclusion. Silicone breast implants with micro and nanotexture should be chosen in order to prevent biofilm formation and possible consequent complications.
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Sato H, Ishihata H, Kameyama Y, Shimpo R, Komasa S. Professional Mechanical Tooth Cleaning Method for Dental Implant Surface by Agar Particle Blasting. MATERIALS 2021; 14:ma14226805. [PMID: 34832206 PMCID: PMC8622555 DOI: 10.3390/ma14226805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/17/2021] [Accepted: 11/05/2021] [Indexed: 11/29/2022]
Abstract
Oral dysfunction due to peri-implantitis and shortened life of implants has become a major concern. Self-care and removal of oral biofilms by professional mechanical tooth cleaning (PMTC) are indispensable for its prevention. However, if the surface roughness of the implant is increased, it may result in the adhesion of biofilm in the oral cavity. Therefore, the PMTC method can serve for long-term implant management. Calcium carbonate (CaCO3) has been used as a cleaning method for implant surfaces; however, there is concern that the implant surface roughness could increase due to particle collision. Therefore, in this study, to establish a blasting cleaning method that does not adversely affect the implant surface, a new blasting cleaning method using agar particles was devised and its practical application examined. When the simulated stains were blasted with white alumina (WA) abrasive grains and CaCO3 particles, the simulated stains were almost removed, the surface roughness changed to a satin-finished surface—which was thought to be due to fine scratches—and the surface roughness increased. Most of the simulated stains were removed on the surface of the sample blasted with glycine particles and agar particles. Conversely, the gloss of the sample surface was maintained after cleaning, and the increase in surface roughness was slight.
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Affiliation(s)
- Hideaki Sato
- Department of Mechanical Engineering, Faculty of Science and Engineering, Tokyo City University, 1-28-1 Tamadutsumi, Setagaya-ku, Tokyo 158-8557, Japan; (H.S.); (Y.K.); (R.S.)
| | - Hiroshi Ishihata
- Department of Periodontology and Endodontology, Graduate School of Dentistry, Tohoku University, 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan;
| | - Yutaka Kameyama
- Department of Mechanical Engineering, Faculty of Science and Engineering, Tokyo City University, 1-28-1 Tamadutsumi, Setagaya-ku, Tokyo 158-8557, Japan; (H.S.); (Y.K.); (R.S.)
| | - Ryokichi Shimpo
- Department of Mechanical Engineering, Faculty of Science and Engineering, Tokyo City University, 1-28-1 Tamadutsumi, Setagaya-ku, Tokyo 158-8557, Japan; (H.S.); (Y.K.); (R.S.)
| | - Satoshi Komasa
- Department of Removable Prosthodontics and Occlusion, Osaka Dental University, 8-1 Kuzuha-hanazono-cho, Hirakata-shi, Osaka 573-1121, Japan
- Correspondence: ; Tel.: +81-72-864-3084; Fax: +81-72-864-3184
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Gram-Negative Bacterial Lipopolysaccharide Promotes Tumor Cell Proliferation in Breast Implant-Associated Anaplastic Large-Cell Lymphoma. Cancers (Basel) 2021; 13:cancers13215298. [PMID: 34771464 PMCID: PMC8582399 DOI: 10.3390/cancers13215298] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/02/2021] [Accepted: 10/11/2021] [Indexed: 01/04/2023] Open
Abstract
Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a distinct malignancy associated with textured breast implants. We investigated whether bacteria could trigger the activation and multiplication of BIA-ALCL cells in vitro. BIA-ALCL patient-derived BIA-ALCL tumor cells, BIA-ALCL cell lines, cutaneous ALCL cell lines, an immortal T-cell line (MT-4), and peripheral blood mononuclear cells (PBMC) from BIA-ALCL, capsular contracture, and primary augmentation patients were studied. Cells were subjected to various mitogenic stimulation assays including plant phytohemagglutinin (PHA), Gram-negative bacterial lipopolysaccharide (LPS), Staphylococcal superantigens enterotoxin A (SEA), toxic shock syndrome toxin-1 (TSST-1), or sterilized implant shells. Patient-derived BIA-ALCL tumor cells and BIA-ALCL cell lines showed a unique response to LPS stimulation. This response was dampened significantly in the presence of a Toll-like receptor 4 (TLR4) inhibitor peptide. In contrast, cutaneous ALCL cells, MT-4, and PBMC cells from all patients responded significantly more to PHA, SEA, and TSST-1 than to LPS. Breast implant shells of all surface grades alone did not produce a proliferative response of BIA-ALCL cells, indicating the breast implant does not act as a pro-inflammatory stimulant. These findings indicate a possible novel pathway for LPS to promote BIA-ALCL cell proliferation via a TLR4 receptor-mediated bacterial transformation of T-cells into malignancy.
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Jewell ML, Bionda N, Moran AV, Bevels EJ, Jewell HL, Hariri S, Leung BK. In Vitro Evaluation of Common Antimicrobial Solutions Used for Breast Implant Soaking and Breast Pocket Irrigation-Part 2: Efficacy Against Biofilm-Associated Bacteria. Aesthet Surg J 2021; 41:1252-1262. [PMID: 33512424 PMCID: PMC8520026 DOI: 10.1093/asj/sjaa308] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Biofilm-associated bacteria have been observed in both breast implant revision and tissue expander-implant exchange surgeries. The utilization of antimicrobial solutions in breast surgery, especially those containing triple antibiotics (TAB) and/or 10% povidone-iodine (PI), may help reduce existing biofilm-associated bacteria, which is particularly important in a mature breast pocket that may contain residual bacteria from a previously colonized implant surface or, theoretically, bacteria that may arrive postoperatively through hematogenous spread. Objectives A series of in vitro assessments was performed to evaluate the antimicrobial utility of TAB and PI, either alone or in combination, against preformed biofilm-associated bacteria. Methods Preformed biofilm-associated gram-positive and gram-negative bacterial strains were exposed to TAB and PI ± TAB for up to 30 minutes in a bacterial time-kill assay. Efficacy of various dilutions of PI and the effects of serum protein on PI efficacy were also investigated. Results TAB was ineffective at the timeframes tested when utilized alone; when utilized in conjunction with PI, significant log reduction of all biofilm-associated bacterial species tested was achieved when treated for at least 5 minutes. PI alone at a concentration of 25% or higher was also effective, although its efficacy was negatively affected by increasing serum protein concentration only for Staphylococcus epidermidis. Conclusions Our data indicate that PI-containing solutions significantly reduce biofilm-associated bacteria, suggesting potential utility for breast pocket irrigation during revision or exchange surgeries. Care should be taken to minimize excessive dilution of PI to maintain efficacy.
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Affiliation(s)
| | | | | | | | | | | | - Braden K Leung
- Corresponding Author: Braden K. Leung, PhD, Allergan Aesthetics, an AbbVie company, 2525 Dupont Dr, M/S: RD2-2A, Irvine, CA 92612, USA. E-mail: ; Twitter: @BradenLeung
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Zingaretti N, Vittorini P, Savino V, Vittorini JC, De Francesco F, Riccio M, Parodi PC. Surgical Treatment of Capsular Contracture (CC): Literature Review and Outcomes Utilizing Implants in Revisionary Surgery. Aesthetic Plast Surg 2021; 45:2036-2047. [PMID: 33543344 DOI: 10.1007/s00266-021-02148-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/17/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The objective of this clinical review is to provide an overview of the use of breast implants after capsular contracture (CC) surgical treatment, with a focus on type of implants used. Furthermore, our experience in this field is also reviewed. METHODS MEDLINE, EMBASE, Web of Science, Scopus, the Cochrane Central, and Google Scholar databases were reviewed to identify literature related to surgical treatment of capsular contracture and implant replacement. Each article was reviewed by two independent reviewers to ensure all relevant publications were identified. The literature search identified 54 applicable articles. Of these, 26 were found to have a therapeutic level of evidence. The reference lists in each relevant paper were screened manually to include relevant papers not found through the initial search. RESULTS Only four articles report the replacement of implants after surgical treatment of capsular contracture. Six articles reported an implant exchange with only smooth silicone gel filled implants. Two reviews advice to use smooth implants in implant replacement. CONCLUSION With our expertise in the field and the results of this up-to-date literature review, it can be concluded that implant exchange is recommended in case of breast revision for capsular contracture, and the use of subpectoral smooth silicone gel breast implants is a good option after surgical treatment in patients with primary or recurrence Baker III-IV. 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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Abstract
SUMMARY The purpose of this special topic article is to present an evidence-based approach and provide recommendations for the management of both asymptomatic and symptomatic patients with textured surface breast implants. There are currently no scientific data to support complete removal of a benign capsule. When unnecessary capsulectomies are performed, the patient is at higher risk for developing postoperative complications. Ultimately, the decision to keep, exchange, or remove breast implants is the patient's decision and the procedure should be performed only by a qualified surgeon.
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Walker JN, Myckatyn T. Commentary on: Biofilm Formation on Breast Implant Surfaces by Major Gram-Positive Bacterial Pathogens. Aesthet Surg J 2021; 41:1152-1154. [PMID: 33580656 DOI: 10.1093/asj/sjaa400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jennifer N Walker
- Department of Microbiology and Molecular Genetics, McGovern Medical School, Houston, TX, USA
| | - Terence Myckatyn
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO, USA
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Rezende-Pereira G, Albuquerque JP, Souza MC, Nogueira BA, Silva MG, Hirata R, Mattos-Guaraldi AL, Duarte RS, Neves FPG. Biofilm Formation on Breast Implant Surfaces by Major Gram-Positive Bacterial Pathogens. Aesthet Surg J 2021; 41:1144-1151. [PMID: 33378420 DOI: 10.1093/asj/sjaa416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Bacterial biofilm on surfaces of mammary implants is a predisposing factor for several outcomes. Because Gram-positive bacteria are potential agents of biomaterial-associated infections (BAIs), their abilities to form biofilm on breast implants should be elucidated. OBJECTIVES The aim of this study was to evaluate biofilm formation on different mammary prosthesis surfaces by major Gram-positive bacterial pathogens involved in BAIs. METHODS We initially evaluated biofilm formation on polystyrene plates with and without fibrinogen or collagen for 1 reference strain and 1 clinical isolate of Enterococcus faecalis, Staphylococcus aureus, Staphylococcus epidermidis, and Streptococcus pyogenes. We also tested the ability of clinical isolates to form biofilm on 4 different implant surfaces: polyurethane foam and smooth, microtextured, and standard textured silicone. Biofilm structure and cell viability were observed by scanning electron microscopy and confocal laser scanning microscopy. RESULTS All strains showed strong biofilm formation on polystyrene. After fibrinogen or collagen treatment, biofilm formation varied. With fibrinogen, reference strains of S. aureus and S. pyogenes increased biofilm formation (P < 0.05). Reference strains of all species and the clinical isolate of S. pyogenes increased biofilm formation after collagen treatment (P < 0.05). In general, S. aureus showed higher capacity to produce biofilm. Scanning electron microscopy showed that biofilm attached to all surfaces tested, with the presence of extracellular polymeric substances and voids. Viable cells were more frequent for E. faecalis and S. pyogenes. CONCLUSIONS All species produced biofilm on all prosthesis surfaces and under different conditions. Micrographies indicated thicker bacterial biofilm formation on microtextured and/or standard textured silicone by all species, except E. faecalis.
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Affiliation(s)
| | | | - Monica C Souza
- Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Barbara A Nogueira
- Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Marlei G Silva
- Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Raphael Hirata
- Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Ana L Mattos-Guaraldi
- Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Rafael S Duarte
- Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Felipe P G Neves
- Instituto Biomédico, Universidade Federal Fluminense, Niterói, RJ, Brazil
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41
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Evaluating the Necessity of Capsulectomy in Cases of Textured Breast Implant Replacement. Ann Plast Surg 2021; 85:691-698. [PMID: 32102001 DOI: 10.1097/sap.0000000000002301] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Capsulectomy has traditionally been recommended as a treatment for capsular contracture after breast augmentation. With the advent of breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL), and the Food and Drug Administration's decision to ban Biocell textured devices, this operation has taken on new importance. This review was undertaken to better inform clinical recommendations for women with textured devices. METHODS An electronic search was performed using PubMed to identify all the available literature on the subject of capsulectomy and open capsulotomy (the alternative treatment). RESULTS Fifty-seven articles on this topic were identified. Capsulectomy was widely recommended for treatment of capsular contracture, although many authors recommended leaving thin capsular tissue behind in the absence of symptoms. En bloc resection was recommended only for women with a diagnosis of BIA-ALCL. No information supported a prophylactic role for capsulectomy in asymptomatic women with textured breast implants who are concerned regarding their future risk of BIA-ALCL. Routine pathologic examination in asymptomatic patients was not supported. DISCUSSION Capsulectomy adds substantially to the surgical risk, discomfort, recovery time, and expense. Implant removal or replacement without a simultaneous capsulectomy is atraumatic and poses negligible risk. CONCLUSIONS Capsulectomy introduces additional morbidity and is not mandatory for asymptomatic patients. Implant removal or exchange for smooth implants without a capsulectomy may be an acceptable choice for many women who do not demonstrate capsular pathology. However, any symptoms or surgical findings suggesting pathology warrant a capsulectomy. En bloc resections are reserved for patients diagnosed with BIA-ALCL.
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Chiu WK, Fracol M, Feld LN, Qiu CS, Kim JYS. Judging an Expander by Its Cover: A Propensity-Matched Analysis of the Impact of Tissue Expander Surface Texture on First-Stage Breast Reconstruction Outcomes. Plast Reconstr Surg 2021; 147:1e-6e. [PMID: 33002978 DOI: 10.1097/prs.0000000000007417] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is increased scrutiny of texturing on implants and a paucity of data looking at texturing on expanders. Because of the difficulty in controlling potential confounders with these comparative studies, the authors performed propensity matching between smooth and textured tissue expander cohorts to provide definitive insight into the impact of expander texture on breast reconstruction outcomes. METHODS A single-surgeon experience with immediate two-stage breast reconstruction was reviewed for 90-day postoperative complications after mastectomy and expander placement. Variables extracted included demographics, comorbidities, tissue expander texturing, mastectomy type, infection, seroma, skin flap necrosis, dehiscence, explantation, and overall complication rates. Subjects were 1:1 propensity matched using the nearest neighbor matching algorithm with caliper (maximum propensity score difference) of 0.2, and chi-square test was performed for statistical analysis. RESULTS After 1:1 propensity matching, 282 reconstructed breasts were analyzed (141 textured versus 141 smooth expanders). Textured expanders had higher minor infection rates than smooth expanders (5.0 percent versus 0 percent; p = 0.024). Smooth expanders had higher seroma rates than textured expanders (5.0 percent versus 0.7 percent; p = 0.031). Smooth expanders also had longer drain retention (20.4 days versus 16.8 days; p = 0.001). There was no difference in other complications, including major infection, explantation, or any complication, between textured and smooth expanders. CONCLUSIONS Textured expanders are associated with increased minor infection risk, whereas smooth expanders are associated with increased seroma formation. However, these differing complication profiles coalesce to equal explantation rates. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Wen-Kuan Chiu
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine
| | - Megan Fracol
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine
| | - Lauren N Feld
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine
| | - Cecil S Qiu
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine
| | - John Y S Kim
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine
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Cellular and Molecular Mechanisms of Breast Implant-Associated Anaplastic Large Cell Lymphoma. Plast Reconstr Surg 2021; 147:30e-41e. [PMID: 33370049 DOI: 10.1097/prs.0000000000007423] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
SUMMARY Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an emerging and highly treatable cancer of the immune system that can form around textured-surface breast implants. Although the underlying cause has yet to be elucidated, an emerging theme-linking pathogenesis to a chronic inflammatory state-continues to dominate the current literature. Specifically, the combination of increasing mutation burden and chronic inflammation leads to aberrant T-cell clonal expansion. However, the impetus remains largely unknown. Proposed mechanisms include a lipopolysaccharide endotoxin response, oncogenic transformation related to viral infection, associated trauma to the breast pocket, particulate matter digestion by capsular macrophages, chronic allergic inflammation, and genetic susceptibility. The Janus kinase-signal transducer and activator of transcription 3 (JAK-STAT3) pathway is a major signaling pathway that regulates a variety of intracellular growth and survival processes. Constitutive activation of JAK-STAT3 has been implicated in several malignancies, including lymphomas, and has recently been identified as a potential key mediator in BIA-ALCL. The purpose of this article is to review the cellular and molecular mechanisms of BIA-ALCL with a focus on the role of oncogenic JAK-STAT3 signaling in BIA-ALCL tumorigenesis and progression. Selected experimental work from the authors' group on aberrant JAK-STAT3 signaling in BIA-ALCL is also included. The authors discuss how an inflammatory microenvironment may facilitate malignant transformation through the JAK-STAT3 pathway-highlighting its potential mechanistic role. The authors' hope is that further investigation of this signaling pathway will reveal avenues for using JAK-STAT3 signaling as a prognostic indicator and novel therapeutic target in the case of advanced disease.
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Elective Implant Removal and Replacement in Asymptomatic Aesthetic Patients with Textured Devices. Plast Reconstr Surg 2021; 147:14S-23S. [PMID: 33890876 DOI: 10.1097/prs.0000000000008041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
SUMMARY The management of patients with breast implants requires secondary procedures through the life of the implant, sometimes in the early postoperative period and more commonly many years after the initial surgery. In performing revisional procedures, removal and replacement of the implants is often required for a variety of reasons. With growing concerns of implant safety, implant exchange or removal with or without a capsulectomy has been increasingly requested by patients. In particular, textured breast implants have been under increased scrutiny secondary to their association with breast implant-associated anaplastic large cell lymphoma. Unfortunately, to date, there are no data and very little guidance as to the appropriate management of patients currently with textured implants as well as patients with a history of having had textured implants placed in the past. The surgeon must not only consider the appropriate management of patients with uncomplicated, asymptomatic textured devices but also consider the appropriate management when faced with another indication for revisional surgery and the need determine the appropriate course of action. An algorithm for the management of the explantation patient in general will be introduced in this review with a focus on the rationale, planning, and management of patients with an uncomplicated, asymptomatic textured implants.
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Abstract
ABSTRACT Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a recently recognized malignancy of T-lymphocytes that is linked to certain types of textured breast implants. Although rare, the increasing awareness of the disease is resulting in more case reports and heightened anxiety in patients with textured breast implants. This review aims to summarize the available BIA-ALCL data, including the existing theories of etiopathogenesis, the diagnostic work-up for BIA-ALCL patients, BIA-ALCL treatment recommendations, the epidemiologic challenges, and the current opinions surrounding the use of textured breast implants.
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Affiliation(s)
- Alyson Skelly
- From the Tufts University School of Medicine, Boston
| | - Lifei Guo
- Division of Plastic Surgery, Lahey Hospital & Medical Center, Burlington, MA
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46
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Bachour Y. Response to "Bacterial Adhesion and Biofilm Formation on Textured Breast Implant Shell Materials". Aesthetic Plast Surg 2021; 45:353. [PMID: 30547190 DOI: 10.1007/s00266-018-1289-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 12/01/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Yara Bachour
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
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47
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Lam M, Migonney V, Falentin-Daudre C. Review of silicone surface modification techniques and coatings for antibacterial/antimicrobial applications to improve breast implant surfaces. Acta Biomater 2021; 121:68-88. [PMID: 33212233 DOI: 10.1016/j.actbio.2020.11.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/12/2020] [Accepted: 11/12/2020] [Indexed: 12/19/2022]
Abstract
Silicone implants are widely used in the medical field for plastic or reconstructive surgeries for the purpose of soft tissue issues. However, as with any implanted object, healthcare-associated infections are not completely avoidable. The material suffers from a lack of biocompatibility and is often subject to bacterial/microbial infections characterized by biofilm growth. Numerous strategies have been developed to either prevent, reduce, or fight bacterial adhesion by providing an antibacterial property. The present review summarizes the diverse approaches to deal with bacterial infections on silicone surfaces along with the different methods to activate/oxidize the surface before any surface modifications. It includes antibacterial coatings with antibiotics or nanoparticles, covalent attachment of active bacterial molecules like peptides or polymers. Regarding silicone surfaces, the activation step is essential to render the surface reactive for any further modifications using energy sources (plasma, UV, ozone) or chemicals (acid solutions, sol-gel strategies, chemical vapor deposition). Meanwhile, corresponding work on breast silicone prosthesis is discussed. The latter is currently in the line of sight for causing severe capsular contractures. Specifically, to that end, besides chemical modifications, the antibacterial effect can also be achieved by physical surface modifications by adjusting the surface roughness and topography for instance.
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Han SE, Lee KT, Bang S. Comprehensive Comparison Between Shaped Versus Round Implants for Breast Reconstruction: A Systematic Review and Meta-Analysis. Aesthet Surg J 2021; 41:34-44. [PMID: 32449906 DOI: 10.1093/asj/sjaa128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Prosthetic breast reconstruction has been gaining popularity and a variety of implant options are currently available. Therefore, it is important to evaluate the safety and efficacy of newly developed shaped implants compared with those of conventional round implants. To date, few studies have investigated the outcomes of breast reconstruction with shaped versus round implants. OBJECTIVES The present study aimed to comprehensively compare, via meta-analytic methodology, shaped and round breast implant reconstruction in terms of complication profiles and aesthetic satisfaction. METHODS PubMed/MEDLINE, Ovid, and Cochrane databases were searched to identify relevant studies presenting the complication rates for shaped and round implant groups. The relative risks of the following complications between the groups were calculated: infection, seroma, capsular contracture, rupture, rippling, reconstruction failure, and implant exchange or removal. Outcomes of aesthetic satisfaction included aesthetic results and patient-reported outcomes. RESULTS Meta-analysis of 8 retrospective cohort studies, representing 2490 cases of implant-based breast reconstruction, was performed. There were no significant differences in the risks of infection, seroma, capsular contracture, and reconstruction failure between the 2 groups. The risks of implant rupture and rippling were significantly reduced with shaped implants. In a subgroup analysis of shaped/textured and round/smooth implants, the risk of infection was significantly enhanced in the former, whereas incidences of other complications, including capsular contracture and reconstruction failure, were similar. Aesthetic satisfaction analysis of the 2 groups demonstrated similar outcome scores with favorable overall results. CONCLUSIONS Our results suggest that both shaped and round implants might provide favorable breast reconstruction outcomes with similarly low complication rates and aesthetic results. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- So-Eun Han
- Department of Plastic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyang, South Korea
| | - Kyeong-Tae Lee
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, South Korea
| | - Saik Bang
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, South Korea
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49
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Parham CS, Hanson SE, Butler CE, Calobrace MB, Hollrah R, Macgregor T, Clemens MW. Advising patients about breast implant associated anaplastic large cell lymphoma. Gland Surg 2021; 10:417-429. [PMID: 33634000 PMCID: PMC7882310 DOI: 10.21037/gs.2020.03.06] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 02/28/2020] [Indexed: 11/06/2022]
Abstract
The United States Food and Drug Administration (FDA) recently recognized the necessity for improved patient education and public awareness of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). BIA-ALCL is an uncommon T-cell lymphoma that can arise years after placement of a textured breast implant or tissue expander. Patients and providers would greatly benefit from a broader awareness of BIA-ALCL and how it presents with both common and rare symptoms. Disease awareness can be improved with specific steps moving forward. This includes improved counseling about annual recommendations from the FDA, standard of care guidelines, current estimates of disease prevalence, and manufacturer-specific risk for developing the malignancy. Informed consent for implant-based breast surgery should include a discussion of BIA-ALCL, symptoms, inherent risks and alternatives. Consideration should be given for reasonable efforts to retroactively contact patients with textured implants to inform them of recent regulatory actions as well as the risk of developing the disease and the signs and symptoms to watch for. Where risk can be reduced, all steps should be taken to ensure patient safety. In keeping with our commitment to patient safety, the strategies moving forward for implant-based breast surgery should be marked by patient awareness, physician vigilance, and defined by evidence-based diagnosis and treatment.
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Affiliation(s)
- Christopher S. Parham
- Department of Surgery, Division of Plastic Surgery, Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Summer E. Hanson
- Department of Plastic Surgery, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Charles E. Butler
- Department of Plastic Surgery, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - M. Bradley Calobrace
- CaloAesthetics Plastic Surgery Center; Clinical Faculty Member, Divisions of Plastic Surgery, University of Louisville and University of Kentucky, Louisville and Lexington, KY, USA
| | | | | | - Mark W. Clemens
- Department of Plastic Surgery, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
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50
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Moon DJ, Deva AK. Adverse Events Associated with Breast Implants: The Role of Bacterial Infection and Biofilm. Clin Plast Surg 2021; 48:101-108. [PMID: 33220897 DOI: 10.1016/j.cps.2020.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- David J Moon
- Department of Plastic and Reconstructive Surgery, Macquarie University, Suite 301, Level 3, 2 Technology place, New South Wales 2109, Australia
| | - Anand K Deva
- Department of Plastic and Reconstructive Surgery, Macquarie University, Suite 301, Level 3, 2 Technology place, New South Wales 2109, Australia; Integrated Specialist Healthcare Education and Research Foundation, Miranda, New South Wales, 2228, Australia.
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