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Yuan Y, Du F, Xiao Y, Huang J, Long X. Severe capsular contracture in a patient with a history of multiple malignancies - Hematoma or neoplasm recurrence?: A case report. Medicine (Baltimore) 2024; 103:e39074. [PMID: 39093798 PMCID: PMC11296467 DOI: 10.1097/md.0000000000039074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 07/04/2024] [Indexed: 08/04/2024] Open
Abstract
RATIONALE Complications associated with breast implants pose a significant obstacle to improving the quality of life for patients undergoing implant-based breast reconstruction. Due to the intricate nature of their presentation, diagnosis often becomes challenging and perplexing. Herein, we present a case report detailing the diagnostic and therapeutic processes employed in managing implant-related complications in a patient with multiple malignancies who underwent immediate breast reconstruction following mastectomy. PATENT CONCERNS The patient, a 48-year-old woman, presented with severe pain and hardening in her left breast. She had previously undergone nipple-sparing mastectomy followed by immediate implant-based breast reconstruction 3 years ago. DIAGNOSES Upon admission, we suspected a simple diagnosis of capsular contracture. However, upon investigation, she had a medical history of colon cancer, breast cancer, and acute B-lymphoblastic leukemia. Furthermore, she recently experienced nipple hemorrhage. INTERVENTIONS Considering her clinical manifestations, we postulated the possibility of tumor recurrence along with potential presence of breast implant-associated anaplastic large cell lymphoma. The situation took a new turn, as diagnostic imaging techniques including breast MRI, and ultrasound revealed indications of potential prosthesis rupture and periprosthetic infection. OUTCOMES Ultimately, en bloc capsulectomy with implant removal was performed, revealing no evidence of implant rupture or infection but rather indicating delayed hematoma formation. LESSONS An accurate diagnosis of complications associated with breast prosthesis reconstruction is crucial for effective treatment. The examination and treatment processes employed in this case offer valuable insights toward achieving a more precise diagnosis of prosthesis-related complications, particularly in patients with complex medical histories.
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Affiliation(s)
- Yutong Yuan
- Division of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Beijing, China
- Department of Oncoplastic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fengzhou Du
- Division of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Yiding Xiao
- Division of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Jiuzuo Huang
- Division of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Xiao Long
- Division of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Beijing, China
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Spit KA, Azahaf S, de Blok CJ, Duvivier KM, Wiebenga OT, Nanayakkara PW. Ultrasound versus MRI for evaluation of silicone leakage from silicone breast implants. Heliyon 2024; 10:e33325. [PMID: 39022001 PMCID: PMC11253520 DOI: 10.1016/j.heliyon.2024.e33325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 06/19/2024] [Accepted: 06/19/2024] [Indexed: 07/20/2024] Open
Abstract
Background Implant ruptures and gel bleed are not uncommon among women with silicone breast implants. While magnetic resonance imaging (MRI) is traditionally considered the gold standard diagnostic modality, recent studies suggest ultrasound might be an acceptable alternative. This study compares the efficacy of ultrasound and MRI in assessing implant integrity. Methods Women with silicone breast implants underwent a breast and axillary ultrasound and MRI on the same day. All tests were assessed by experienced radiologists. The accuracy, sensitivity, and specificity of ultrasound and MRI for implant rupture detection and silicone depositions in axillary lymph nodes were evaluated. Findings A total of 104 women participated in the study. The accuracy, sensitivity, and specificity of ultrasound for detecting implant ruptures compared to MRI were 96 %, 95 %, and 96 %, respectively. MRI demonstrated significantly lower sensitivity (44 %) for detecting silicone depositions in axillary lymph nodes compared to ultrasound. A significant association was observed between the presence of enlarged axillary lymph nodes and/or axillary pain and the detection of silicone depositions in axillary lymph nodes on ultrasound (χ2 (1, N = 104) = 5·1, p = 0·024). Six women exhibited silicone depositions in axillary lymph nodes despite having intact first-pair implants, indicative of gel bleed. Interpretation Ultrasound is nearly as effective as MRI for detecting breast implant ruptures and is superior for detecting silicone depositions in axillary lymph nodes. We therefore recommend initiating radiological examination in women with breast implants with a breast and axillary ultrasound, proceeding to MRI only if the ultrasound is inconclusive. The prevalence of gel bleed is understudied and its potential adverse health effects might be underestimated. Further research is needed to explore its potential association with development of systemic symptoms.
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Affiliation(s)
- Karlinde A. Spit
- Section General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, location VUmc, Amsterdam, the Netherlands
| | - Siham Azahaf
- Section General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, location VUmc, Amsterdam, the Netherlands
| | - Christel J.M. de Blok
- Section General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, location VUmc, Amsterdam, the Netherlands
| | - Katya M. Duvivier
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres, location VUmc, Amsterdam, the Netherlands
| | - Oliver T. Wiebenga
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres, location VUmc, Amsterdam, the Netherlands
| | - Prabath W.B. Nanayakkara
- Section General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, location VUmc, Amsterdam, the Netherlands
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Larsen A, Timmermann AM, Kring M, Weltz TK, Ørholt M, Vester-Glowinski P, Elberg JJ, Trillingsgaard J, Mielke LV, Hölmich LR, Damsgaard TE, Roslind A, Herly M. A Histological Assessment Tool for Breast Implant Capsules Validated in 480 Patients with and Without Capsular Contracture. Aesthetic Plast Surg 2024:10.1007/s00266-024-04128-5. [PMID: 38849553 DOI: 10.1007/s00266-024-04128-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 05/09/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Understanding the impact of breast implants on the histological response in the surrounding fibrous capsule is important; however, consensus is lacking on how to analyze implant capsules histologically. We aimed to develop a standardized histological assessment tool to be used in research potentially improving diagnostic accuracy and treatment strategies for capsular contracture. METHODS Biopsies of breast implant capsules from 480 patients who had undergone breast augmentation or reconstruction were collected and stained with hematoxylin and eosin. Initially, biopsies from 100 patients were analyzed to select histological parameters demonstrating the highest relevance and reproducibility. Then, biopsies from the remaining 380 patients were used to determine intra- and interobserver agreements of two blinded observers and agreement with a pathologist. Finally, we tested the association between the parameters and capsular contracture. RESULTS The histological assessment tool included ten parameters assessing the inflammatory, fibrotic, and foreign-body reaction to breast implants, each graded on two-, three-, or four-point scales. Intra- and interobserver agreements were almost perfect (0.83 and 0.80), and agreement with the pathologist was substantial (0.67). Four parameters were significantly correlated with capsular contracture, namely chronic inflammation with lymphocyte infiltration (p < 0.01), thickness of the collagen layer (p < 0.0001), fiber organization (p < 0.01), and calcification (p < 0.001). CONCLUSIONS This is the first validated histological assessment tool for breast implant capsules. The validated tool not only advances our understanding of capsular contracture but also sets a new standard for histological evaluation in breast implant research and clinical diagnostics. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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)
- Andreas Larsen
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Adam Mandrup Timmermann
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Mikela Kring
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Tim Kongsmark Weltz
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Mathias Ørholt
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Peter Vester-Glowinski
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | | | | | | | - Lisbet Rosenkrantz Hölmich
- Department of Plastic and Reconstructive Surgery, Herlev and Gentofte, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Tine Engberg Damsgaard
- Department of Plastic and Reconstructive Surgery, Odense and Little Belt Hospital, Odense University Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Anne Roslind
- Department of Pathology, Herlev and Gentofte, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mikkel Herly
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
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Rosenthal A, Goldbart Nahmias A, Heller L, Hadad E. Silicone Lymphadenopathy Following Augmentation Mammoplasty With Silicone Implants. Aesthet Surg J 2024:sjae113. [PMID: 38762900 DOI: 10.1093/asj/sjae113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 05/05/2024] [Accepted: 05/09/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND Silicone implants claim the predominant share in global implant usage for breast augmentation. Despite technological advancements, complications persist, with silicone lymphadenopathy (siliconoma) being a noteworthy concern. This phenomenon has been inadequately addressed in the existing literature. OBJECTIVES To characterize axillary siliconomas and identify potential risk factors to help reduce their occurrence. METHODS The authors conducted a retrospective observational cross-sectional study spanning between 2011 to 2021 at the Shamir-Assaf Harofeh Medical Center. Preoperative ultrasound examination was conducted, categorizing patients into those with siliconomas and those without. RESULTS A total of 614 women (1209 breasts) met the inclusion criteria. The incidence of siliconomas was 13.6% (165 breasts). In univariate analysis, older age (age 47 years vs. 43 years, P < 0.001), older implant age (12.2 vs. 11 years, P = 0.026), ruptured implants (59.4% vs 17.7%, P < 0.001), subpectoral placement (P = 0.019), severe capsular contracture, and the use of Mentor implants (Irvine, CA; P = 0.007) and Poly Implant Prothèse implants (PIP; La Seyne-sur-Mer, France; P = 0.001) correlated significantly with the presence of siliconomas. In a multivariate analysis, implant rupture (OR = 6.342), and implant manufacturer - Mentor (OR = 3.047) and PIP (OR = 3.475), were identified as independent risk factors associated with a higher incidence of siliconomas. Severe capsular contracture was associated with higher incidence of siliconomas as well (OR = 1.65). CONCLUSIONS Surgeons should inform candidates about the potential risk of silicone migration. Patients with ruptured implants, significant capsular contracture, Mentor and PIP implants face an increased risk for developing siliconomas. Closer monitoring for the detection of siliconomas in the axilla for these patients is advisable, potential prophylactic replacement or removal of implants may be warranted to mitigate siliconoma risk.
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Affiliation(s)
- Adaya Rosenthal
- Department of Plastic Surgery, Shamir Medical Center, Zerifin, Israel
| | | | - Lior Heller
- Department of Plastic Surgery, Shamir Medical Center, Zerifin, Israel
| | - Eran Hadad
- Department of Plastic Surgery, Shamir Medical Center, Zerifin, Israel
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Hamdi M, Kapila AK, Peters E, Ramaut L, Waked K, Giunta G, De Baerdemaeker R, Zeltzer A. Polyurethane Implants in Revisional Breast Augmentation: A Prospective 5-Year Study. Aesthet Surg J 2024; 44:NP379-NP390. [PMID: 38408194 DOI: 10.1093/asj/sjae047] [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: 11/21/2023] [Revised: 02/07/2024] [Accepted: 02/14/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Revisional surgery for aesthetic breast augmentation remains a challenging procedure. Polyurethane (PU) implants have been found to avoid capsular contracture recurrence as well as to prevent implant displacement by bio-integrating with the pocket. OBJECTIVES Our study aimed to assess the use of PU implants in breast revisional surgery and to provide an algorithm. METHODS Over a 5-year period, a prospective study was conducted involving consecutive patients undergoing implant revision. Patient demographics, previous breast procedures, and specific surgical details were documented. Postoperative outcomes were followed up. RESULTS Out of 92 patients (184 breasts), 78 (156 breasts) were included in the analysis. The average age was 47.5, with a BMI of 22.3 and a mean follow-up of 5 years. A majority (63%) represented secondary revisional cases, while 37% were tertiary cases. Implant size averaged 296 cc, with 53% placed in retropectoral position and 47% prepectoral. Significantly more implants in secondary cases were changed from prepectoral to retropectoral (P = .005), and in tertiary changed from retropectoral to prepectoral (P = .002). Complete capsulectomy was performed in 61.5% and partial in 25.6%. Additional lipofilling was performed in 32%, and concurrent mastopexy in 40%. Revisional surgery in our series had a 1.9% acute complication rate, 4.5% longer-term reoperation rate for corrections, 0.6% implant exchange rate, and no recurrent capsular contracture. CONCLUSIONS This is the first study to provide data on outcomes of revisional breast augmentation surgery with PU implants. It shows that polyurethane implants offer consistent stability and have low rates of recurrent capsular contracture in revisional surgery. LEVEL OF EVIDENCE: 3
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Vinsensia M, Schaub R, Meixner E, Hoegen P, Arians N, Forster T, Hoeltgen L, Köhler C, Uzun-Lang K, Batista V, König L, Zivanovic O, Hennigs A, Golatta M, Heil J, Debus J, Hörner-Rieber J. Incidence and Risk Assessment of Capsular Contracture in Breast Cancer Patients following Post-Mastectomy Radiotherapy and Implant-Based Reconstruction. Cancers (Basel) 2024; 16:265. [PMID: 38254756 PMCID: PMC10813520 DOI: 10.3390/cancers16020265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
Our study aims to identify the risk factors and dosimetry characteristics associated with capsular contracture. METHODS We retrospectively analyzed 118 women with breast cancer who underwent PMRT following an IBR between 2010 and 2022. Patients were treated with PMRT of 50.0-50.4 Gy in 25-28 fractions. Capsular contracture was categorized according to the Baker Classification for Reconstructed Breasts. RESULTS After a median follow-up of 22 months, the incidence of clinically relevant capsular contracture (Baker III-IV) was 22.9%. Overall, capsular contracture (Baker I-IV) occurred in 56 patients (47.5%) after a median of 9 months after PMRT. The rate of reconstruction failure/implant loss was 25.4%. In the univariate analysis, postoperative complications (prolonged pain, prolonged wound healing, seroma and swelling) and regional nodal involvement were associated with higher rates of capsular contracture (p = 0.017, OR: 2.5, 95% CI: 1.2-5.3 and p = 0.031, respectively). None of the analyzed dosimetric factors or the implant position were associated with a higher risk for capsular contracture. CONCLUSION Postoperative complications and regional nodal involvement were associated with an increased risk of capsular contracture following breast reconstruction and PMRT, while none of the analyzed dosimetric factors were linked to a higher incidence. Additional studies are needed to identify further potential risk factors.
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Affiliation(s)
- Maria Vinsensia
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Riccarda Schaub
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Eva Meixner
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Philipp Hoegen
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Nathalie Arians
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Tobias Forster
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Line Hoeltgen
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Clara Köhler
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Kristin Uzun-Lang
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Vania Batista
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Oliver Zivanovic
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Brustzentrum Heidelberg Klinik St. Elisabeth, 69121 Heidelberg, Germany
| | - Andre Hennigs
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Brustzentrum Heidelberg Klinik St. Elisabeth, 69121 Heidelberg, Germany
| | - Michael Golatta
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Brustzentrum Heidelberg Klinik St. Elisabeth, 69121 Heidelberg, Germany
| | - Jörg Heil
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Brustzentrum Heidelberg Klinik St. Elisabeth, 69121 Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg Ion Beam Therapy Center (HIT), Heidelberg University Hospital, 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Heidelberg, 69120 Heidelberg, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
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Hemmingsen MN, Bennedsen AK, Kullab RB, Norlin CB, Ørholt M, Larsen A, Bue M, Lichtenberg M, Hertz FB, Damsgaard TE, Vester-Glowinski P, Sørensen SJ, Bjarnsholt T, Herly M. Pharmacokinetics of Locally Applied Antibiotic Prophylaxis for Implant-Based Breast Reconstruction. JAMA Netw Open 2023; 6:e2348414. [PMID: 38113041 PMCID: PMC10731505 DOI: 10.1001/jamanetworkopen.2023.48414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 11/05/2023] [Indexed: 12/21/2023] Open
Abstract
Importance Antibiotic irrigation of breast implants is widely used internationally, but no clinical study has investigated the pharmacokinetics of antibiotic prophylaxis in the breast implant pocket. Objectives To evaluate how long locally applied gentamicin, cefazolin, and vancomycin concentrations in the implant pocket remain above the minimum inhibitory concentration (MIC) for the most common bacterial infections and to measure systemic uptake. Design, Setting, and Participants This prospective cohort study was performed at the Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen, Denmark, between October 25, 2021, and September 22, 2022, among 40 patients undergoing implant-based breast reconstruction who were part of the ongoing BREAST-AB trial (Prophylactic Treatment of Breast Implants With a Solution of Gentamicin, Vancomycin and Cefazolin Antibiotics for Women Undergoing Breast Reconstructive Surgery: a Randomized Controlled Trial). Patients were randomized to receive locally applied gentamicin, cefazolin, and vancomycin or placebo. Samples were obtained from the surgical breast drain and blood up to 10 days postoperatively. Exposures The breast implant and the implant pocket were irrigated with 160 μg/mL of gentamicin, 2000 μg/mL of cefazolin, and 2000 μg/mL of vancomycin in a 200-mL saline solution. Main Outcomes and Measures The primary outcome was the duration of antibiotic concentrations above the MIC breakpoint for Staphylococcus aureus according to the Clinical and Laboratory Standards Institute: gentamicin, 4 μg/mL; cefazolin, 2 μg/mL; and vancomycin, 2 μg/mL. Secondary outcomes included the time above the MIC for Pseudomonas aeruginosa and other relevant bacteria, as well as systemic uptake. Results The study included 40 patients (median age, 44.6 years [IQR, 38.3-51.4 years]; median body mass index, 23.9 [IQR, 21.7-25.9]) with a median number of 3 drain samples (range, 1-10 drain samples) and 2 blood samples (range, 0-6 blood samples). Vancomycin and cefazolin remained above the MIC for S aureus significantly longer than gentamicin (gentamicin, 0.9 days [95% CI, 0.5-1.2 days] for blood samples vs 6.9 days [95% CI, 2.9 to 10.9 days] for vancomycin [P = .02] vs 3.7 days [95% CI, 2.2-5.2 days] for cefazolin [P = .002]). The gentamicin level remained above the MIC for P aeruginosa for 1.3 days (95% CI, 1.0-1.5 days). Only cefazolin was detectable in blood samples, albeit in very low concentrations (median concentration, 0.04 μg/mL [range, 0.007-0.1 μg/mL]). Conclusions and Relevance This study suggests that patients treated with triple-antibiotic implant irrigation during breast reconstruction receive adequate prophylaxis for S aureus and other common implant-associated, gram-positive bacteria. However, the protection against P aeruginosa may be inadequate.
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Affiliation(s)
- Mathilde Nejrup Hemmingsen
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Anne Karen Bennedsen
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Randa Bismark Kullab
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Caroline Barskov Norlin
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mathias Ørholt
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Andreas Larsen
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mats Bue
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mads Lichtenberg
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Frederik Boetius Hertz
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Tine Engberg Damsgaard
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Peter Vester-Glowinski
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Søren Johannes Sørensen
- Section of Microbiology, Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Bjarnsholt
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mikkel Herly
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
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8
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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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9
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Nichter LS, Hardesty RA, Zimmerman TJ. Ideal Implant Structured Breast Implants: Core Study Results through 10 Years. Plast Reconstr Surg 2023; 152:424e-432e. [PMID: 36827477 PMCID: PMC10461722 DOI: 10.1097/prs.0000000000010312] [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: 08/24/2021] [Accepted: 09/15/2022] [Indexed: 02/26/2023]
Abstract
BACKGROUND The Ideal Implant structured breast implant uses different technology than unstructured saline or silicone gel implants, making it a third type of implant. U.S. Food and Drug Administration (FDA) and Health Canada granted approval in November of 2014. This saline-filled implant has an internal structure consisting of a series of nested shells that support the upper pole when upright and control movement of the saline to provide a natural feel. Because women can look in the mirror to know their implants are intact, they have peace of mind. In contrast, most women are concerned about silicone gel implant ruptures, which are silent and require FDA-recommended magnetic resonance imaging or ultrasound scans for detection. METHODS This U.S. trial enrolled 502 women: 399 for primary and 103 for revision augmentation. Investigators were 45 American Board of Plastic Surgery-certified plastic surgeons at 35 sites. Of the 502 women enrolled, 426 (84.9%) completed 10-year follow-up visits, a higher percentage than all other FDA breast implant trials. RESULTS Through 10 years of follow-up, surgeon satisfaction was 94.8% for primary and 87.4% for revision augmentation; and patient satisfaction was 92.7% for primary and 82.3% for revision augmentation. Cumulative Kaplan-Meier risk rates for two major adverse events were lower than in the silicone gel implant trials: Baker class III and IV capsular contracture was 6.6% for primary and 11.5% for revision augmentation; and rupture/deflation was 3.7% for primary and 4.7% for revision augmentation. CONCLUSION Ten-year results from 426 women show the Ideal Implant has high patient and surgeon satisfaction, a low rate of capsular contracture, and a low rate of rupture/deflation. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Larry S. Nichter
- From the Pacific Center for Plastic Surgery, University of California, Irvine, and Mission Plasticos
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Paolini G, Firmani G, Briganti F, Macino M, Nigrelli S, Sorotos M, Santanelli di Pompeo F. Assessment of Risk Factors for Rupture in Breast Reconstruction Patients with Macrotextured Breast Implants. Aesthetic Plast Surg 2023; 47:517-530. [PMID: 36229658 PMCID: PMC10070228 DOI: 10.1007/s00266-022-03118-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/11/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Breast implants (BI) are widely used in plastic surgery, though they are not lifetime devices. Average life before rupture is reported to be around 10-15 years. No consensus exists regarding which factors are involved. OBJECTIVES Following FDA recommendations, this study aims at identifying potential risk factors by evaluating their effect on BI rupture cases. METHODS In this observational study, 763 BI patients were operated between 2003 and 2019, with a mean implant indwelling of 12.2 years. Patients that returned for follow-up were administered a questionnaire regarding postoperative lifestyle and habits. Implant rupture rate was 15.1%, while BI lifespan was 10.1 years. We obtained complete data from 191 breast implant patients (288 implants). Twenty-three potential risk factors were evaluated and divided in four categories: patient-related, surgery-related, postoperative complications/symptoms, and postoperative care/lifestyle habits. Odds Ratio (OR) for each factor was calculated. Linear regression analysis was calculated for those with a significant OR. RESULTS We report 120 patients (195 implants) with intact and 71 (93 implants) with ruptured devices. BIs were macrotextured in 95.1% of cases (86.8% Allergan BIOCELL). OR was significant for underwire bra use (OR: 2.708), car seat belts (OR: 3.066), mammographic imaging (OR: 2.196), weightlifting (OR: 0.407) and carry-on heavy purses and backpacks (OR: 0.347). CONCLUSION Wearing underwire bras, seat belts and undergoing mammography increases the risk of rupture. Weightlifting and carry heavy bags do not increase that risk. Implant rupture is directly linked with time of indwelling. Postoperative recommendations in BI patients should consider findings from our study, though larger multicenter studies should be encouraged. 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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Affiliation(s)
- Guido Paolini
- NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Faculty of Medicine and Psychology, Azienda Ospedaliera Sant'Andrea - U.O.D. Chirurgia Plastica, Sapienza University of Rome, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
| | - Guido Firmani
- Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - Francesca Briganti
- Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - Mattia Macino
- Department of Biomedicine and Prevention, Tor Vergata University, Via Montpellier, 1, 00133, Rome, Italy
| | - Simone Nigrelli
- Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - Michail Sorotos
- NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Faculty of Medicine and Psychology, Azienda Ospedaliera Sant'Andrea - U.O.D. Chirurgia Plastica, Sapienza University of Rome, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - Fabio Santanelli di Pompeo
- NESMOS Department, Faculty of Medicine and Psychology, Chair of Plastic Surgery - Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035-1039, 00189, Rome, Italy
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11
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Pacifico MD. Commentary on: Polydioxanone Monofilament Mesh: A Safety Net for Complex Breast Implant Revision Surgery. Aesthet Surg J 2023; 43:NP167-NP169. [PMID: 36376995 DOI: 10.1093/asj/sjac292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 11/17/2022] Open
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Ditlev M, Loentoft E, Hölmich LR. Breast augmentation under local anesthesia with intercostal blocks and light sedation. J Plast Surg Hand Surg 2023; 57:271-278. [PMID: 35510744 DOI: 10.1080/2000656x.2022.2069789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION This study of breast augmentations performed under local anesthesia with intercostal blocks and light sedation describes the outcomes and evaluates benefits and complications. METHOD From December 2005 until August 2019, 335 women consecutively underwent bilateral breast augmentation procedures. The anesthetic protocol consisted of an initial intravenous bolus of 1 mg midazolam and 0.25 mg alfentanil preoperatively. In 2017, this was changed to 2-4 mg midazolam intramuscularly, 1 mg midazolam intravenously, and 2.5 µg sufentanil intravenously. Intercostal blocks were injected at the midaxillary line into the intercostal spaces two to seven. The operating field was infiltrated with tumescent local anesthesia. Retrospective data extraction from patients' medical charts was done, registering demographics, dosage of anesthesia, surgical characteristics, complications, and reoperation rates. RESULTS Two hundred and eighty-one women underwent primary augmentation and 54 had implant replacement. The most common complications included suboptimal cosmetic results, asymmetry, and healing-related problems. The overall rate of reoperation was 16.1% within an average follow-up period of 2 years, ranging from 0 to 12.5 years. The majority of the reoperations were due to cosmetic reasons. The change in anesthetic regime was associated with a significantly (p < 0.0001) decreased need for supplementary medication with no increased risk of complications. CONCLUSION Breast augmentations in local anesthesia with intercostal blocks and light sedation can be performed safely and can serve as an alternative to procedures in general anesthesia.
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Affiliation(s)
- Martine Ditlev
- Plastic Surgery Clinic, Erik Loentoft, Odense, Denmark.,Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Erik Loentoft
- Plastic Surgery Clinic, Erik Loentoft, Odense, Denmark
| | - Lisbet R Hölmich
- Department of Plastic Surgery, Copenhagen University, Herlev and Gentofte, Copenhagen, Denmark
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Silicone Breast Implant Rupture is More Prevalent in the Dominant Limb Side, A Retrospective Cohort Study. J Plast Reconstr Aesthet Surg 2023; 80:126-132. [PMID: 37011442 DOI: 10.1016/j.bjps.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/12/2023] [Accepted: 02/13/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Breast implant rupture is associated with multiple risk factors such as implant age, manufacturer, and a history of trauma to the breast. However, the exact mechanism of breast implant rupture remains unclear. We hypothesize that repetitive minor mechanical forces on the implant collectively play a significant role in the cascade that eventually leads to its rupture. Therefore, we expect a more significant cumulative effect on the breast implant in the dominant upper limb side. Thus, we aim to ascertain whether laterality in silicone breast implant rupture is associated with the dominant upper limb. METHODS A retrospective cohort study was performed on patients with silicone breast implants who underwent an elective breast implant removal or exchange. All patients had breast augmentations for cosmetic reasons. We collected data on implant rupture laterality and limb dominance together with known risk factors like patient age, implant age, implant pocket, and implant volume. RESULTS A total of 154 patients with unilateral implant rupture were included in the study. Among patients with a dominant right limb (n = 133), an ipsilateral rupture was found in 77 patients (58%) (p = 0.036), while in patients with a left dominant limb (n = 21), an ipsilateral rupture was found in 14 patients (67%), (p = 0.036). CONCLUSIONS The dominant limb was a significant risk factor for ipsilateral breast implant rupture. The prevailing theory that cyclic envelope movement carries an increased rupture risk is reinforced in this study. Extensive prospective studies are needed to clarify risk factors for implant rupture further.
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Foroushani FT, Dzobo K, Khumalo NP, Mora VZ, de Mezerville R, Bayat A. Advances in surface modifications of the silicone breast implant and impact on its biocompatibility and biointegration. Biomater Res 2022; 26:80. [PMID: 36517896 PMCID: PMC9749192 DOI: 10.1186/s40824-022-00314-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/31/2022] [Indexed: 12/15/2022] Open
Abstract
Silicone breast implants are commonly used for cosmetic and oncologic surgical indications owing to their inertness and being nontoxic. However, complications including capsular contracture and anaplastic large cell lymphoma have been associated with certain breast implant surfaces over time. Novel implant surfaces and modifications of existing ones can directly impact cell-surface interactions and enhance biocompatibility and integration. The extent of foreign body response induced by breast implants influence implant success and integration into the body. This review highlights recent advances in breast implant surface technologies including modifications of implant surface topography and chemistry and effects on protein adsorption, and cell adhesion. A comprehensive online literature search was performed for relevant articles using the following keywords silicone breast implants, foreign body response, cell adhesion, protein adsorption, and cell-surface interaction. Properties of silicone breast implants impacting cell-material interactions including surface roughness, wettability, and stiffness, are discussed. Recent studies highlighting both silicone implant surface activation strategies and modifications to enhance biocompatibility in order to prevent capsular contracture formation and development of anaplastic large cell lymphoma are presented. Overall, breast implant surface modifications are being extensively investigated in order to improve implant biocompatibility to cater for increased demand for both cosmetic and oncologic surgeries.
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Affiliation(s)
- Fatemeh Tavakoli Foroushani
- Wound and Keloid Scarring Research Unit, Hair and Skin Research Laboratory, Division of Dermatology, Department of Medicine, The South African Medical Research Council, University of Cape Town, Cape Town, South Africa
| | - Kevin Dzobo
- Wound and Keloid Scarring Research Unit, Hair and Skin Research Laboratory, Division of Dermatology, Department of Medicine, The South African Medical Research Council, University of Cape Town, Cape Town, South Africa
| | - Nonhlanhla P Khumalo
- Wound and Keloid Scarring Research Unit, Hair and Skin Research Laboratory, Division of Dermatology, Department of Medicine, The South African Medical Research Council, University of Cape Town, Cape Town, South Africa
| | | | | | - Ardeshir Bayat
- Wound and Keloid Scarring Research Unit, Hair and Skin Research Laboratory, Division of Dermatology, Department of Medicine, The South African Medical Research Council, University of Cape Town, Cape Town, South Africa.
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15
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Mortality Rate in Breast Implant Surgery: Is an Additional Procedure Worthwhile to Mitigate BIA-ALCL Risk? Aesthetic Plast Surg 2022; 47:914-926. [DOI: 10.1007/s00266-022-03138-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/01/2022] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Because of poor knowledge of risks and benefits, prophylactic explantation of high BIA-ALCL risk breast implant (BI) is not indicated. Several surgical risks have been associated with BI surgery, with mortality being the most frightening. Primary aim of this study is to assess mortality rate in patients undergoing breast implant surgery for aesthetic or reconstructive indication.
Materials and Methods
In this retrospective observational cohort study, Breast Implant Surgery Mortality rate (BISM) was calculated as the perioperative mortality rate among 99,690 patients who underwent BI surgery for oncologic and non-oncologic indications. Mean age at first implant placement (A1P), implant lifespan (IL), and women’s life expectancy (WLE) were obtained from a literature review and population database.
Results
BISM rate was 0, and mean A1P was 34 years for breast augmentation, and 50 years for breast reconstruction. Regardless of indication, overall mean A1P can be presumed to be 39 years, while mean BIL was estimated as 9 years and WLE as 85 years.
Conclusion
This study first showed that the BISM risk is 0. This information, and the knowledge that BI patients will undergo one or more revisional procedures if not explantation during their lifetime, may help surgeons in the decision-making process of a pre-emptive substitution or explant in patients at high risk of BIA-ALCL. Our recommendation is that patients with existing macrotextured implants do have a relative indication for explantation and total capsulectomy. The final decision should be shared between patient and surgeon following an evaluation of benefits, surgical risks and comorbidities.
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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16
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Chiemi JA, Kelishadi SS. Polydioxanone Monofilament Mesh: A Safety Net for Complex Breast Implant Revision Surgery. Aesthet Surg J 2022; 43:NP155-NP166. [PMID: 36318791 PMCID: PMC9942435 DOI: 10.1093/asj/sjac278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Breast revision surgeries are complex cases requiring greater pocket control than primary surgeries. Intraoperative techniques to maximize pocket integrity are crucial to achieving an aesthetic result in revisions with implants. OBJECTIVES Uniform utilization of a polydioxanone (PDO) internal support matrix in a high volume of revision-augmentation cases has, to our knowledge, never before been described. METHODS A high-volume (n = 104) single-surgeon experience followed patient outcomes in consecutive cases from September 2020 to March 2022. Included in this cohort were patients undergoing revision-augmentations with vertical or wise-pattern mastopexies (n = 74), revision-augmentation without mastopexies (n = 25), and revision without implant exchange (n = 5). Each case employed at least 1 sheet of PDO mesh, with a small set (n = 4) receiving 2 sheets. Patients were followed up (range, 3-19 months), with 3 months minimum follow-up to assess outcomes. RESULTS The average length of follow-up was 8.8 months. Patients in this cohort had undergone an average of 1.6 prior breast surgeries (range, 1-7). A total 89.4% of patients received an increase in implant volume (average change, +165.2 Cc); 87.5% of patients had favourable aesthetic outcomes, and 12.5% of patients were reoperated on (including reoperations for complications and/or aesthetic reasons). There were 13 complications in the cohort, and no mesh-related complications. CONCLUSIONS PDO mesh is a safe and effective method of increasing pocket control in breast revision. Supplemental soft-tissue support allowed greater implant volumes to be employed, yielding high rates of patient satisfaction with breast shape, scarring, and long-term aesthetics. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | - S Sean Kelishadi
- Corresponding Author: Dr S. Sean Kelishadi, 500 Superior Avenue, Suite 340, Newport Beach, CA 92663, USA E-mail: Instagram and Twitter: @sskplasticsurg
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Hemmingsen MN, Larsen A, Weltz TK, Ørholt M, Wiberg S, Bennedsen AK, Bille C, Carstensen LF, Jensen LT, Bredgaard R, Koudahl V, Schmidt VJ, Vester-Glowinski P, Hölmich LR, Sørensen SJ, Bjarnsholt T, Damsgaard T, Herly M. Prophylactic treatment of breast implants with a solution of gentamicin, vancomycin and cefazolin antibiotics for women undergoing breast reconstructive surgery: protocol for a randomised, double-blind, placebo-controlled trial (The BREAST-AB trial). BMJ Open 2022; 12:e058697. [PMID: 36115667 PMCID: PMC9486197 DOI: 10.1136/bmjopen-2021-058697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 08/30/2022] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Periprosthetic infection is one of the most severe complications following implant-based breast reconstruction affecting 5%-10% of the women. Currently, many surgeons apply antibiotics locally on the breast implant to reduce the risk of postoperative infection, but no randomised, placebo-controlled trials have tested the treatment's efficacy. METHODS AND ANALYSIS The BREAST-AB trial (BREAST-AntiBiotics) is an investigator-initiated, multicentre, randomised, placebo-controlled, double-blind trial of local treatment with gentamicin, vancomycin and cefazolin on breast implants in women undergoing implant-based breast reconstruction. The trial drug consists of 80 mg gentamicin, 1 g vancomycin and 1 g cefazolin dissolved in 500 mL of isotonic saline. The placebo solution consists of 500 mL isotonic saline. The trial drug is used to wash the dissected tissue pocket and the breast implant prior to insertion. The primary outcome is all-cause explantation of the breast implant within 180 days after the breast reconstruction surgery. This excludes cases where the implant is replaced with a new permanent implant, for example, for cosmetic reasons. Key long-term outcomes include capsular contracture and quality of life. The trial started on 26 January 2021 and is currently recruiting. ETHICS AND DISSEMINATION The trial was approved by the Regional Ethics Committee of the Capital Region (H-20056592) on 1 January 2021 and the Danish Medicines Agency (2020070016) on 2 August 2020. The main paper will include the primary and secondary outcomes and will be submitted to an international peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT04731025.
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Affiliation(s)
- Mathilde Nejrup Hemmingsen
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Andreas Larsen
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tim K Weltz
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mathias Ørholt
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sebastian Wiberg
- Department of Anaesthesiology, Zealand University Hospital Koge, Køge, Denmark
| | - Anne Karen Bennedsen
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Camilla Bille
- Department of Plastic Reconstructive Surgery, Odense University Hospital, Odense, Denmark
| | | | - Lisa Toft Jensen
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rikke Bredgaard
- Department of Plastic Surgery and Burns Treatment, Herlev og Gentofte, Copenhagen University Hospital, Herlev, Denmark
| | - Vibeke Koudahl
- Department of Plastic Surgery, Lillebaelt Hospital, Vejle, Denmark
| | - Volker Jürgen Schmidt
- Department of Plastic and Breast Surgery, Zealand University Hospital Roskilde, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Peter Vester-Glowinski
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lisbet Rosenkrantz Hölmich
- Department of Plastic Surgery and Burns Treatment, Herlev og Gentofte, Copenhagen University Hospital, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Søren J Sørensen
- Department of Biology, Section of Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Bjarnsholt
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tine Damsgaard
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Herly
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
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Letter to the Editor Re: Discussion: MemoryGel Breast Implants: Final Safety and Efficacy Results after 10 Years of Follow-up (by Debra J. Johnson, M.D.). Plast Reconstr Surg 2022; 150:691e-692e. [PMID: 35819980 DOI: 10.1097/prs.0000000000009384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Santanelli di Pompeo F, Clemens MW, Atlan M, Botti G, Cordeiro PG, De Jong D, Di Napoli A, Hammond D, Haymaker CL, Horwitz SM, Hunt K, Lennox P, Mallucci P, Miranda RN, Munhoz AM, Swanson E, Turner SD, Firmani G, Sorotos M. 2022 Practice Recommendation Updates From the World Consensus Conference on BIA-ALCL. Aesthet Surg J 2022; 42:1262-1278. [PMID: 35639805 PMCID: PMC9924046 DOI: 10.1093/asj/sjac133] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Laboratory and clinical research on breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is rapidly evolving. Changes in standard of care and insights into best practice were recently presented at the 3rd World Consensus Conference on BIA-ALCL. OBJECTIVES The authors sought to provide practice recommendations from a consensus of experts, supplemented with a literature review regarding epidemiology, etiology, pathogenesis, diagnosis, treatment, socio-psychological aspects, and international authority guidance. METHODS A literature search of all manuscripts between 1997 and August 2021 for the above areas of BIA-ALCL was conducted with the PubMed database. Manuscripts in different languages, on non-human subjects, and/or discussing conditions separate from BIA-ALCL were excluded. The study was conducted employing the Delphi process, gathering 18 experts panelists and utilizing email-based questionnaires to record the level of agreement with each statement by applying a 5-point Likert Scale. Median response, interquartile range, and comments were employed to accept, reject, or revise each statement. RESULTS The literature search initially yielded 764 manuscripts, of which 405 were discarded. From the remaining 359, only 218 were included in the review and utilized to prepare 36 statements subdivided into 5 sections. After 1 round, panelists agreed on all criteria. CONCLUSIONS BIA-ALCL is uncommon and still largely underreported. Mandatory implant registries and actions by regulatory authorities are needed to better understand disease epidemiology and address initial lymphomagenesis and progression. Deviation from current diagnosis and treatment protocols can lead to disease recurrence, and research on breast implant risk factors provide insight to etiology. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Fabio Santanelli di Pompeo
- Corresponding Author: Prof Fabio Santanelli di Pompeo, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sant’Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy. E-mail: ; Instagram: @diepflap.it
| | - Mark W Clemens
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA and is a Breast Surgery section editor for Aesthetic Surgery Journal
| | - Michael Atlan
- Aesthetic Plastic Reconstructive Unit/CHU TENON PARIS—APHP, Université Pierre et Marie Curie, Paris, France
| | | | - Peter G Cordeiro
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Daphne De Jong
- Amsterdam UMC-Vrije Universiteit Amsterdam, Department of Pathology and Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Arianna Di Napoli
- Pathology Unit, Department of Clinical and Molecular Medicine, Sapienza University, Sant’Andrea Hospital, Rome, Italy
| | | | - Cara L Haymaker
- Department of Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven M Horwitz
- Lymphoma Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Kelly Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peter Lennox
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, BC, Canada and is a clinical editor for Aesthetic Surgery Journal
| | | | - Roberto N Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alexandre M Munhoz
- Plastic Surgery Department, Hospital Moriah, Hospital Sírio-Libanês, Higienópolis, São Paulo, Brazil
| | | | - Suzanne D Turner
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Guido Firmani
- Faculty of Medicine and Psychology, Sapienza University of Rome, Department of Plastic Surgery, Sant’Andrea Hospital, Rome, Italy
| | - Michail Sorotos
- Faculty of Medicine and Psychology, Sapienza University of Rome, Department NESMOS, Sant’Andrea Hospital, Rome, Italy
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Chiemi JA, Kelishadi SS. A Rationale for Micro-textured Breast Implant Augmentation. Aesthet Surg J Open Forum 2022; 4:ojac020. [PMID: 35601234 PMCID: PMC9117005 DOI: 10.1093/asjof/ojac020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Textured breast implants have been used in aesthetic breast surgery to decrease rates of malposition and capsular contracture. Recent concerns regarding breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)’s link to textured devices have prompted many physicians to re-evaluate their use.
Objectives
The authors aimed to create an algorithm for when to use smooth versus micro-textured breast implants and provide their rationale for when micro-textured implants may be more beneficial.
Methods
133 patients received primary augmentations performed by a single surgeon from January 2018–December 2020. 84 patients received smooth implants and 49 patients received micro-textured implants. All surgeries were performed in the dual-plane using an inframammary incision. Implant-related complications and scar malposition were recorded and compared between groups.
Results
No significant difference in the prevalence of implant-related complications was found (3.57% for smooth devices and 2.04% for micro-textured devices [P-value 0.621257, 95% CI -0.06100–0.007467]). There were no cases of BIA-ALCL. Comparison of scar malposition rates between the smooth and micro-textured groups also revealed no statistically significant difference (15.4% for smooth devices and 8.16% for micro-textured devices [P-value 0.226156, 95% CI -0.1200–0.007467]). Patients in the micro-textured group proportionately had more anatomical risk factors for malposition.
Conclusions
Micro-textured breast implants continue to be a safe and effective choice for patients. Micro-textured implants show a trend towards decreased scar malposition, although not statistically significant. Patients at high risk for malposition with micro-textured breast implants give similar results to patients at average risk for malposition with smooth implants.
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Ahmad J, Austin RE, Lista F. Commentary on: Five-Year Safety and Satisfaction With the Lightweight Breast Implant. Aesthet Surg J 2022; 42:273-274. [PMID: 33780528 DOI: 10.1093/asj/sjab154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jamil Ahmad
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Frank Lista
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Montemurro P, Siri G, Clerico L. Safety and Performance of POLYTECH Mesmo Breast Implants: A 5-Year Post-market Surveillance Study on 919 Patients. Aesthet Surg J Open Forum 2022; 4:ojac011. [PMID: 35415603 PMCID: PMC8994747 DOI: 10.1093/asjof/ojac011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background In 2007, POLYTECH Health & Aesthetics (POLYTECH, Dieburg, Germany) established an ongoing patient survey to improve the post-market surveillance of silicone gel-filled breast implants based on patient-reported outcomes in the context of the pioneering "Implants of Excellence" (IoE) program. Objectives To disclose an update on safety and performance outcomes at 5 years for Mesmo breast implants. Methods Between January 2014 and October 2019, 919 patients (for a total of 1816 implants) who underwent breast augmentation and reconstruction with Mesmo implants were asked to participate in the IoE program. Data were collected by mean of 1320 questionnaires received. A survival analysis assessed the onset of different complications. Results Eight patients (0.9%) experienced capsular contracture Baker grade III or IV with a cumulative rate at 5 years of 1.2% (95% CI = 0.6-2.4). The proportion of revisional surgery was 0.5% with a 5-year rate of 0.6% (95% CI = 0.2-1.5). Additional adverse events such as hematoma, seroma, malposition, open wounds, and other complications were carefully monitored. Questionnaires showed that 93.9% (95% CI = 92.2-95.4) of the patients were satisfied or very satisfied with their aesthetic results with Mesmo implants. Conclusions Post-market clinical follow-up revealed that the overall complications rate reported was low. Data demonstrated an excellent safety property on a large cohort of patients. This result allows the rating of Mesmo breast implants as highly competitive and a very safe choice for both surgeons and patients. Level of Evidence 3
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Affiliation(s)
- Paolo Montemurro
- Corresponding Author: Dr Paolo Montemurro, Akademikliniken, Storängsvägen 10, 11542 Stockholm, Sweden. E-mail:
| | - Giacomo Siri
- Department of Mathematics, University of Genoa, Genoa, Italy
| | - Luana Clerico
- Clinical and Medical Affairs Department, Polytech Health & Aesthetics, Dieburg, Germany
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Assessing Long-Term Outcomes in Breast Implant Illness: The Missing Link? A Systematic Review. Plast Reconstr Surg 2022; 149:638e-645e. [PMID: 35103633 DOI: 10.1097/prs.0000000000009067] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY The purpose of this special topic article is to explore the current state of outcomes-based literature related to breast implant illness and summarize the key understandings that emerge from the summation of existing studies. While implanted silicone devices are some of the most ubiquitous products in modern medicine, the safety of silicone breast implants has long remained under scientific scrutiny. In the era of social media and with breast implants once again under public scrutiny with the recent connection of texture silicone implants to breast implant-associated anaplastic large-cell lymphoma, the borders between breast implant illness and other implant-related diseases are becoming clouded in the public eye. The surgical management options for breast implant illness range from simple implant explantation alone to complete en bloc capsulectomies, or even secondary exploratory operations for additional capsulectomy in persistently symptomatic patients. In this review of outcomes-based studies related to breast implant illness, the authors found that a subset of patients improves with surgical intervention but limited evidence to inform most current surgical management practices. Further, the nature of this illness renders it difficult to study. A carefully designed, large, prospective, outcomes-based study is still required if an evidence-based and sound treatment approach for this condition is to be established.
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Zhu L, Zhu J, Qian Y, Jiang H. Reduced capsular contracture with smooth and textured breast implants following submuscular mammoplasty: systematic literature review. Future Oncol 2021; 17:5177-5187. [PMID: 34730405 DOI: 10.2217/fon-2021-0510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Capsular contracture is common in breast augmentation and reconstruction surgery. The present systematic review discusses the safety of textured and smooth implants in the submuscular position. Methods: A literature search was conducted on PubMed and EMBASE from inception until June 2020. The primary outcome was reduction of capsular contracture (Baker grade); others included time of capsular contracture onset, implant position/rupture rate/surface, hematoma/seroma risk, surgeon assessment and patient satisfaction. A total of 7731 patients were included from six publications. Results: The overall risk rate for capsular contracture increased from 7.6 to 25% in 10 years. The capsular contracture rates in textured and smooth implants were 3-14% and 6-20%, respectively, and no significant difference between implants was observed when the implants were placed submuscularly. Submuscular placement and textured implants also reduced the incidence of other complications. Conclusion: This systematic review suggests that appropriate placement reduces capsular contracture rate, irrespective of implant surface.
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Affiliation(s)
- Lie Zhu
- Department of Plastic & Reconstructive Surgery, Second Affiliated Hospital of Naval Medical University, Shanghai 200003, China
| | - Jie Zhu
- Department of Plastic & Reconstructive Surgery, Second Affiliated Hospital of Naval Medical University, Shanghai 200003, China
| | - Yuxin Qian
- Department of Plastic & Reconstructive Surgery, Shanghai East Hospital, Tongji University, Shanghai 200120, China
| | - Hua Jiang
- Department of Plastic & Reconstructive Surgery, Second Affiliated Hospital of Naval Medical University, Shanghai 200003, China.,Department of Plastic & Reconstructive Surgery, Shanghai East Hospital, Tongji University, Shanghai 200120, China
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Valente DS, Zanella RK, Mulazzani CM, Valente SS. Risk Factors for Explantation of Breast Implants: A Cross-Sectional Study. Aesthet Surg J 2021; 41:923-928. [PMID: 33649754 DOI: 10.1093/asj/sjaa352] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Explantation of breast implant surgery (EBIS) is an emerging surgical field. Precise information about patients undergoing EBIS is important for preoperative planning of breast, augmentation, complications management, and to address any medicolegal issues. OBJECTIVES The aim of this study was to further extend current knowledge of EBIS risk factors. METHODS An analytic cross-sectional study was conducted involving patients who had previously undergone cosmetic breast augmentation and were seeking EBIS. RESULTS The study recruited 138 patients. The average time from implant placement and decision to explantation was 59.1 months. On average, each 1-year increase in age resulted in a 4% increase in the relative risk (RR) of explantation (confidence interval (CI), 1.07-1.21). Patients who were obese or overweight present a 1.5 times higher risk of EBIS (CI 95%, 1.03-2.29). On average, this RR was 40% lower (CI 95%, 0.33-0.91) in patients who never smoked compared with those with a history of tobacco use. Women with mastalgia had a 72% higher RR for EBIS (CI 95%, 1.11-2.65). The RR of EBIS was 5.6 times higher (CI 95%, 2.42-11.47) in patients presenting major Shoenfeld's criteria for autoimmune/inflammatory syndrome induced by adjuvants (ASIA). The RR of EBIS was 4.3 times higher (CI 95%, 1.96-8.63) in patients presenting minor Shoenfeld's criteria for ASIA. CONCLUSIONS EBIS poses a higher risk to patients who are overweight/obese, have a history of tobacco use, suffer from mastalgia, or present Shoenfeld's criteria for ASIA. It is important to assess properly these individuals before performing implant surgery for breast augmentation. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | | | | | - Sibelie Souto Valente
- Program in Medicine and Health Sciences, School of Medicine, PUCRS, Porto Alegre, Brazil
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Bachour Y. Capsular Contracture in Breast Implant Surgery: Where Are We Now and Where Are We Going? Aesthetic Plast Surg 2021; 45:1328-1337. [PMID: 33559094 DOI: 10.1007/s00266-021-02141-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/13/2021] [Indexed: 11/25/2022]
Abstract
Capsular contracture is the leading complication after surgery with breast implants. A lot of progress has been made investigating this complication over the years, and knowledge has been gained on this complication. Currently, the exact cause for capsular contracture is still unclear. It has been hypothesized that immunobiological factors (i.e., immunological and bacterial factors) and several risk factors play a central role in its development. In this paper, we give an overview of the known immunological factors that have been investigated in contracted and non-contracted capsules, as well as the role of bacterial formation around breast implants. We also report on risk factors that might increase the risk of capsular development. Lastly, it provides the latest research on this matter and discusses future perspectives as follow-up research is needed to unravel the pathogenic process leading to capsular contracture. This knowledge is of interest to establish medical therapies in order to prevent such side effects. Overall, capsular contracture seems to be a multifactorial condition consisting of several risk factors. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Yara Bachour
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC- location VUmc, De Boelelaan 1117, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
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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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Marchac A, El Haddad R, Boedec C, DE Greef C, Dubrulle F, Garcia Perez J, Rostane Renouard D, Sanchez Nebreda M, Morral S, Sanchez Lagarejo E, Moran Montepeque JL, Terezanov O, Fink V, DE Mortillet S, Gounot N, Bricout N. Three-Year Intermediate Results of a Prospective Multicenter Study Investigating the use of Smooth, Semi-Smooth, Microtextured and Macrotextured Implants from a Single Manufacturer in Breast Augmentation and Reconstruction Procedures. J Plast Reconstr Aesthet Surg 2021; 74:3150-3157. [PMID: 34088647 DOI: 10.1016/j.bjps.2021.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 11/11/2020] [Accepted: 01/24/2021] [Indexed: 11/19/2022]
Abstract
Silicone gel-filled implants exist in a wide range of shapes and textures, and yet there are relatively few long-term large-scale studies, particularly on recently developed "semi-smooth" implants. The present study fills this gap by presenting the 3-year findings from an ongoing 10-year multicenter prospective study on breast implants with four different surface types: smooth, semi-smooth, microtextured, and macrotextured. A total of 908 patients were recruited in 15 investigational sites across Europe and divided into three groups: 653 primary augmentations in Group 1, 144 revision augmentations in Group 2, and 111 reconstructions in Group 3. All 4 types of implant shells were manufactured by the same company using the same silicone material. Surgeons were free to choose their preferred technique and implant surface, but data were collected using a standardized software and included all complications, and satisfaction levels reported by the patients at each visit. The incidence of post-operative complications was estimated based on Kaplan-Meier risk rates, on a per patient basis. At 3 years post implantation, capsular contracture (Baker grade III/IV) was the most common complication, with a per-patient risk rate of 1.5% in Group 1. Interestingly, there was no capsular contracture in this group when semi-smooth implants were used. The risk of implant rupture in Group 1 was 0.2%. The preliminary findings of this 10-year prospective study indicate that, 3 years after the operation, the four types of silicone gel-filled implants investigated were safe, with a low complication rate in comparison with the most favorable results published in other similar studies.
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Applying Principles of Breast Revision to Managing Aesthetic Patients with Textured Implants. Plast Reconstr Surg 2021; 147:24S-30S. [PMID: 33890877 DOI: 10.1097/prs.0000000000008042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY Textured breast implants have garnered increased attention recently because of their risk of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), an uncommon and treatable type of T-cell lymphoma. Treatment involves bilateral en bloc capsulectomy, which is curative in the majority of cases. At present, there is no defined management approach for aesthetic patients asymptomatic for BIA-ALCL requesting the removal of their textured implants, particularly as it relates to the management of the capsule. It is unclear if en bloc capsulectomy is necessary in these patients as it is in patients with BIA-ALCL. In the absence of clear guidance on the management of the capsule in asymptomatic patients, the basic principles of breast revision surgery can be applied to these patients.
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30
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A Comprehensive Outcome Review of Subfascial Breast Augmentation over a 10-Year Period. Plast Reconstr Surg 2021; 146:1249-1257. [PMID: 33234953 DOI: 10.1097/prs.0000000000007333] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Subfascial placement of breast implants has the advantages of subglandular and submuscular placement without the adverse outcomes. There are few large series with longitudinal follow-up and outcome measures. METHODS Seven hundred eighty-three patients underwent subfascial breast augmentation and were followed up for 10 years. Adverse outcomes, changes in breast morphometry, and patient satisfaction were outcome measures. RESULTS All morphometry increased except soft-tissue thickness at the lateral sternal margin. The distance from the nipple-areola complex to the inframammary crease increased by 40 percent, with a concomitant 6.2 percent increase in the distance from the suprasternal notch to the nipple-areola complex. The capsular contracture rate was 6.48 percent, and correlates with a lateral sternal margin of less than 20 mm (r = 0.57, p < 0.001). Ripples occurred in patients with less than 10 mm of soft tissue at the lateral sternal margin; 11.6 percent of patients would choose a larger implant and 2.7 percent would choose a smaller implant. CONCLUSIONS Subfascial placement of breast implants provides a reliable technique. It can be used in patients with at least 20 mm of soft tissue at the lateral sternal margin. Those with 10 to 20 mm should be counseled that ripples may occur if they lose body fat. The technique is unsuitable for individuals with less than 10 mm measurable at the lateral sternal margin. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Kaplan J, Rohrich R. Breast implant illness: a topic in review. Gland Surg 2021; 10:430-443. [PMID: 33634001 PMCID: PMC7882356 DOI: 10.21037/gs-20-231] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 07/23/2020] [Indexed: 01/22/2023]
Abstract
Recently, the term breast implant illness has become popularized in social media to describe a constellation of symptoms which have been attributed to a patient's breast implants. These symptoms include fatigue, chest pain, hair loss, headaches, chills, photosensitivity, rash, and chronic pain amongst others. While physicians aim to treat these physical symptoms, currently the evidence supports the safety of silicone breast implants. This article entitled "Breast implant illness: a topic in review" presents an up-to-date review focusing on the safety of silicone breast implants. Patients retain the right to decide to keep or remove their breast implants and for those who choose to pursue explantation, they should be advised to seek the care of a board-certified plastic surgeon. As a scientific community is our duty to continue to conduct well-designed scientific studies to gain more insight into the safety of breast implants as it related to cancer detection, autoimmune disease, and other health concerns to improve patient safety, awareness, and education. This review article aims to delineate both the content and timing of all research and evidence as it pertains to the newly coined phrase "breast implant illness". The authors of this study support that currently there have not been any concrete or evidence-based studies which support the formation of a new syndrome "silicone implant illness".
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Affiliation(s)
| | - Rod Rohrich
- Baylor College of Medicine, Houston, Texas, USA
- Dallas Plastic Surgery Institute, Dallas, TX, USA
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Loreti A, Siri G, De Carli M, Fanelli B, Arelli F, Spallone D, Abate O, La Pinta M, Manna E, Meli EZ, Costarelli L, Andrulli D, Broglia L, Scavina P, Fortunato L. Immediate Breast Reconstruction after mastectomy with polyurethane implants versus textured implants: A retrospective study with focus on capsular contracture. Breast 2020; 54:127-132. [PMID: 33010626 PMCID: PMC7529839 DOI: 10.1016/j.breast.2020.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/06/2020] [Accepted: 09/22/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Capsular contracture (CC) is the most common complication following Immediate Breast Reconstruction (IBR) with breast implants. Different implant surfaces were developed aiming to reduce the incidence of CC. We evaluated the incidence and degree of CC after Direct-to-Implant (DTI) IBR with insertion of textured (TE) or polyurethane (PU) covered implants. METHODS A retrospective review of consecutive patients treated at our Institution with mastectomy and one-stage IBR and implant reconstruction between 2013 and 2018, with or without post mastectomy radiation therapy (PMRT), was conducted. Immediate breast reconstruction was performed by implanting 186 PU covered implants and 172 TE implants. RESULTS Three-hundred-twelve women underwent 358 DTI IBR with PU or TE implants, were analyzed with a median follow-up time of 2.3 years (range 1.0-3.0). The overall rate of CC Baker grade III and IV was 11.8% (95%CI: 8.4-16.3), while, after PU and TE implant placement it was 8.1% (95% CI: 4.1-15.7) and 15.8% (95% CI: 4.1-15.7) [p = 0.009]), respectively. Irradiated breasts developed CC more frequently rather than non-irradiated breasts (HR = 12.5, p < 0.001), and the relative risk was higher in the TE group compared with the PU group (HR = 0.3, p = 0.003). CONCLUSIONS After mastectomy and one-stage IBR, the use of PU covered implants is associated with a lower incidence of CC compared to TE implants. This advantage is amplified several folds for patients who necessitate PMRT. Footnote: Capsular contracture (CC); Immediate Breast Reconstruction (IBR); Directto- Implant (DTI); Textured (TE); Polyurethane (PU); Post mastectomy radiation therapy (PMRT); Nipple Sparing mastectomy (NSM).
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Affiliation(s)
- Andrea Loreti
- Plastic and Reconstructive Surgery Division, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy.
| | - Giacomo Siri
- Department of Mathematics, University of Genoa, Genoa, Italy
| | - Matteo De Carli
- Plastic and Reconstructive Surgery Division, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
| | - Benedetta Fanelli
- Plastic and Reconstructive Surgery Division, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
| | - Floriana Arelli
- Plastic and Reconstructive Surgery Division, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
| | - Diana Spallone
- Plastic and Reconstructive Surgery Division, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
| | - Ornella Abate
- Plastic and Reconstructive Surgery Division, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
| | - Massimo La Pinta
- Breast Unit, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
| | - Elena Manna
- Breast Unit, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
| | - Emanuele Zarba Meli
- Breast Unit, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
| | - Leopoldo Costarelli
- Pathology Division, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
| | - Damiana Andrulli
- Radiation Oncology Division, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
| | - Laura Broglia
- Breast Radiology Division, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
| | - Paola Scavina
- Oncology Division, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
| | - Lucio Fortunato
- Breast Unit, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
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Abstract
BACKGROUND Capsular contracture following breast augmentation is prone to recurrence with conventional surgical therapy. Adding acellular dermal matrix improves results but significantly increases operating time and cost. This study tested a new treatment algorithm that uses acellular dermal matrix selectively to optimize success rates while minimizing its drawbacks. METHODS All patients surgically treated by the authors for Baker grade III/IV capsular contracture between 2007 and 2018 were included in this retrospective cohort study. Data were collected on patient, breast augmentation, capsular contracture, and surgical treatment characteristics, in addition to follow-up findings. Treatment success was defined as Baker grade II or better. RESULTS One hundred eighty patients underwent 217 surgical treatments for capsular contracture. Conventional treatment was used in 185 cases and acellular dermal matrix in 32. Twenty-six patients were treated for a second occurrence and four were treated for a third. The average follow-up was 2.4 years. Conventional treatment was successful in 72.5 percent of first occurrences, 62.5 percent of second occurrences, and 50.0 percent of third occurrences. Acellular dermal matrix was successful in 96.9 percent of cases. The odds of failure were increased by bilateral capsular contracture (3.9 times) and previous treatment failure (3.5 times). When acellular dermal matrix was used selectively for bilateral capsular contracture or in unilateral cases with a previous treatment failure, the overall treatment success rate improved to 85.6 percent compared with 64.2 percent when this algorithm was not followed (p < 0.001). CONCLUSION This study demonstrates that selective acellular dermal matrix use can increase success rate to over 85 percent in the overall treatment of capsular contracture, and to nearly 100 percent in individual cases.
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Nugent N. Commentary on: Secondary Composite Breast Augmentation: Concept and Outcomes, Introduction to a Layered Approach. Aesthet Surg J 2020; 40:987-988. [PMID: 32531045 DOI: 10.1093/asj/sjaa096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Nora Nugent
- Queen Victoria Hospital, East Grinstead and in private practice in Kent, UK
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Auclair E, Marchac A, Kerfant N. Secondary Composite Breast Augmentation: Concept and Outcomes, Introduction to a Layered Approach. Aesthet Surg J 2020; 40:981-986. [PMID: 32161951 DOI: 10.1093/asj/sjaa069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Secondary procedures following breast augmentation are often more difficult than primary cases because the soft-tissue envelope changes over time. OBJECTIVES This study was conducted to confirm the utility of a composite technique in breast revisional surgery. METHODS This was a 9-year retrospective chart and photographic data study of one surgeon's experience with the combined use of fat and implants in revisional cases. The 148 patients had a follow-up at least 1 year after surgery. Our approach consists of a detailed analysis of the different layers covering the implant and yields a treatment plan addressing all issues involving the secondary breast. RESULTS On average, revisional surgery was performed 8.66 years after the first augmentation. The mean age of the patients at revision surgery was 42 years (range, 22.2-70.7 years). The mean fat harvest was 600 mL (range, 100-3000 mL) and the mean volume of fat reinjected was 153 mL (range, 60-400 mL). The mean volume before and after revision was the same (288 mL vs 289 mL). At the original surgery, the breast implants were located in a subpectoral pocket in 78.7% of the patients and, at the revision surgery, in a subglandular pocket in 74.8% of the patients. Within the first 2 years, 13 patients (8.7%) underwent reoperation for additional fat grafting. Among 45 preoperative breast capsular contractures, there were 8 recurrences in the first 3 years resulting in 4 reoperations. CONCLUSIONS Secondary breast augmentation cannot rely solely on implant exchange. Because the soft-tissue envelope also ages over time, fat grafting is mandatory in the vast majority of secondary cases. A rigorous preoperative analysis enables breast defects to be treated appropriately. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | | | - Nathalie Kerfant
- Department of Plastic and Reconstructive Surgery, Brest University Hospital, Brest Cedex, France
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36
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Calvert JW, Rovelo MO, Orlando MV, Kwon E. Autologous Costal Cartilage Harvest for Rhinoplasty with Simultaneous Breast Surgery: A Safe and Efficient Technique. Aesthet Surg J 2020; 40:NP480-NP490. [PMID: 31957807 DOI: 10.1093/asj/sjaa016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Autologous costal cartilage is frequently required for revision rhinoplasties and for challenging primary rhinoplasties. Patients undergoing a concomitant breast surgery can have costal cartilage harvested through their breast surgery incisions, thereby obviating an additional rib harvest scar. The safety and efficacy of this approach has yet to be described. OBJECTIVES The aim of this study was to evaluate the outcomes, safety, and results of a new technique, described here, for harvesting costal cartilage during a concomitant breast operation. Specifically, the rates of capsular contracture and rhinoplasty revisions were of great interest. METHODS A retrospective review was performed evaluating the senior author's experience with this technique. Data collected included patient demographics, operations performed, operative time, perioperative morbidity, and postoperative complications. Rates of capsular contracture and rhinoplasty revisions were compared with national averages. RESULTS A total of 31 female patients were included. Ten (32.3%) breast complications occurred. There were 6 (19.4%) rhinoplasty complications, comprising 1 infection and 5 revisions. The capsular contracture rate was 6% and the rhinoplasty revision rate was 16%. Both of these rates are comparable to independent breast surgeries and rhinoplasties. There were no cases of perioperative mortality or major morbidity. CONCLUSIONS Combining breast surgery and rhinoplasty surgery allows for autologous rib harvest through the breast surgery incisions. This is a safe technique that results in outcomes similar to either procedure performed alone. In addition, the patient is spared an additional surgery and donor site scar. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Jay W Calvert
- Roxbury Clinic and Surgery Center, University of Southern California, Los Angeles, CA
| | - Millicent O Rovelo
- Roxbury Clinic and Surgery Center, University of Southern California, Los Angeles, CA
| | - Marc V Orlando
- Roxbury Clinic and Surgery Center, University of Southern California, Los Angeles, CA
| | - Edwin Kwon
- Roxbury Clinic and Surgery Center, University of Southern California, Los Angeles, CA
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Breast implant-associated anaplastic large cell lymphoma in an Asian patient: The first case report from Thailand. Arch Plast Surg 2020; 47:478-482. [PMID: 32713177 PMCID: PMC7520251 DOI: 10.5999/aps.2020.00108] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 05/07/2020] [Indexed: 12/17/2022] Open
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) has received increasing interest among plastic surgeons as a long-term complication of breast augmentation. Although the prognosis is usually good, mortality is a possible outcome. Most of the cases reported in the past two decades have been from the United States, Europe, and Australia, whereas cases of BIA-ALCL in Asia remain rare. Herein, we describe the first known case of BIA-ALCL in Thailand, in which a 32-year-old woman developed BIA-ALCL 3 years after breast augmentation using textured implants. The patient underwent bilateral removal of the implants and ipsilateral total capsulectomy. This case report-the first of its kind from Thailand-should increase awareness of BIA-ALCL among plastic surgeons in Asia. The true incidence of BIA-ALCL in Asia may be underreported.
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Danilla SV, Jara RP, Miranda F, Bencina F, Aguirre M, Troncoso E, Erazo CA, Andrades PR, Sepulveda SL, Albornoz CR. Is Banning Texturized Implants to Prevent Breast Implant-Associated Anaplastic Large Cell Lymphoma a Rational Decision? A Meta-Analysis and Cost-Effectiveness Study. Aesthet Surg J 2020; 40:721-731. [PMID: 31761953 DOI: 10.1093/asj/sjz343] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an emergent disease that threatens patients with texturized breast implants. Major concerns about the safety of these implants are leading to global changes to restrict the utilization of this product. The principal alternative is to perform breast augmentation utilizing smooth implants, given the lack of association with BIA-ALCL. The implications and costs of this intervention are unknown. OBJECTIVES The authors of this study determined the cost-effectiveness of smooth implants compared with texturized implants for breast augmentation surgery. METHODS A tree decision model was utilized to analyze the cost-effectiveness. Model input parameters were derived from published sources. The capsular contracture (CC) rate was calculated from a meta-analysis. Effectiveness measures were life years, avoided BIA-ALCL, avoided deaths, and avoided reoperations. A sensitivity analysis was performed to test the robustness of the model. RESULTS For avoided BIA-ALCL, the incremental cost was $18,562,003 for smooth implants over texturized implants. The incremental cost-effectiveness ratio was negative for life years, and avoided death and avoided reoperations were negative. The sensitivity analysis revealed that to avoid 1 case of BIA-ALCL, the utilization of smooth implants would be cost-effective for a risk of developing BIA-ALCL equal to or greater than 1:196, and there is a probability of CC with smooth implants equal to or less than 0.096. CONCLUSIONS The utilization of smooth implants to prevent BIA-ALCL is not cost-effective. Banning texturized implants to prevent BIA-ALCL may involve additional consequences, which should be considered in light of higher CC rates and more reoperations associated with smooth implants than with texturized implants.
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Affiliation(s)
- Stefan V Danilla
- Division of Plastic Surgery, Department of Surgery, University Hospital of Chile, Santiago, Chile
| | - Rocio P Jara
- Division of Plastic Surgery, Department of Surgery, University Hospital of Chile, Santiago, Chile
| | - Felipe Miranda
- Center of Medical Informatics and Telemedicine, University of Chile, Santiago, Chile
| | | | - Marcela Aguirre
- Center of Medical Informatics and Telemedicine, University of Chile, Santiago, Chile
| | - Ekaterina Troncoso
- Division of Plastic Surgery, Department of Surgery, University Hospital of Chile, Santiago, Chile
| | - Cristian A Erazo
- Division of Plastic Surgery, Department of Surgery, University Hospital of Chile, Santiago, Chile
| | - Patricio R Andrades
- Division of Plastic Surgery, Department of Surgery, University Hospital of Chile, Santiago, Chile
| | - Sergio L Sepulveda
- Division of Plastic Surgery, Department of Surgery, University Hospital of Chile, Santiago, Chile
| | - Claudia R Albornoz
- Division of Plastic Surgery, Department of Surgery, University Hospital of Chile, Santiago, Chile
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Serritzlev MS, Lorentzen AK, Matthiessen LW, Hölmich LR. Capsular contracture in patients with prior breast augmentation undergoing breast conserving therapy and irradiation. J Plast Surg Hand Surg 2020; 54:225-232. [PMID: 32375532 DOI: 10.1080/2000656x.2020.1755299] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Radiation is considered to be a risk factor for developing capsular contracture in augmented women, but the studies reporting on this subject show conflicting results. In this systematic review we sought to understand the risk of capsular contracture in augmented patients with breast cancer treated with breast conserving surgery and radiotherapy. A search was conducted through PubMed for studies reporting on breast cancer, breast augmentation and radiotherapy, with capsular contracture as our primary outcome. To determine if specific risk factors were significant predictors of the development of capsular contracture, we performed uni- and multivariate analysis. Our search revealed 136 articles, of which 12 were deemed eligible. A total of 237 patients were included in the analysis. Univariate analysis revealed that whole breast irradiation (WBI) was significantly associated with a higher risk of contracture (p < .001), compared to treatment with accelerated partial breast irradiation (APBI). A higher radiotherapy dose regimen was also significantly associated with a risk of capsular contracture (p < .001). When performing the multivariate analysis only the effect of increasing radiation dose remained significant (p < .05). Neither the implant location nor the age of the implant had any significant effect on the development of contracture. In conclusion this review shows that WBI is associated with a higher risk of contracture compared to treatment with APBI. Because of the limitations of the studies included, further studies with larger patient cohorts are needed to establish this correlation and evaluate other potential risk factors.
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Affiliation(s)
- Maja Schjølin Serritzlev
- Department of Plastic Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Anne Kathrine Lorentzen
- Department of Plastic Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
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Deva AK. Commentary on: Establishment and Characterization of Bacterial Infection of Breast Implants in a Murine Model. Aesthet Surg J 2020; 40:529-530. [PMID: 31605527 DOI: 10.1093/asj/sjz251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Anand K Deva
- Department of Plastic and Reconstructive Surgery, Macquarie University, Sydney, Australia
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Borrelli MR, Irizzary D, Patel RA, Nguyen D, Momeni A, Longaker MT, Wan DC. Pro-Fibrotic CD26-Positive Fibroblasts Are Present in Greater Abundance in Breast Capsule Tissue of Irradiated Breasts. Aesthet Surg J 2020; 40:369-379. [PMID: 30972420 PMCID: PMC7317086 DOI: 10.1093/asj/sjz109] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Breast capsular contracture is a major problem following implant-based breast reconstruction, particularly in the setting of radiation therapy. Recent work has identified a fibrogenic fibroblast subpopulation characterized by CD26 surface marker expression. OBJECTIVES This work aimed to investigate the role of CD26-positive fibroblasts in the formation of breast implant capsules following radiation therapy. METHODS Breast capsule specimens were obtained from irradiated and nonirradiated breasts of 10 patients following bilateral mastectomy and unilateral irradiation at the time of expander-implant exchange, under institutional review board approval. Specimens were processed for hematoxylin and eosin staining as well as for immunohistochemistry and fluorescence activated cell sorting for CD26-positive fibroblasts. Expression of fibrotic genes and production of collagen were compared between CD26-positive, CD26-negative, and unsorted fibroblasts. RESULTS Capsule specimens from irradiated breast tissue were thicker and had greater CD26-postive cells on immunofluorescence imaging and on fluorescence activated cell sorting analysis than did capsule specimens from the nonirradiated breast. Compared with CD26-negative fibroblasts, CD26-positive fibroblasts produced more collagen and had increased expression of the profibrotic genes IL8, TGF-β1, COL1A1, and TIMP4. CONCLUSIONS CD26-positive fibroblasts were found in a significantly greater abundance in capsules of irradiated compared with nonirradiated breasts and demonstrated greater fibrotic potential. This fibrogenic fibroblast subpopulation may play an important role in the development of capsular contracture following irradiation, and its targeted depletion or moderation may represent a potential therapeutic option. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- Mimi R Borrelli
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, Stanford, CA
| | - Dre Irizzary
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, Stanford, CA
| | - Ronak A Patel
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, Stanford, CA
| | - Dung Nguyen
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, Stanford, CA
| | - Arash Momeni
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, Stanford, CA
| | - Michael T Longaker
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, Stanford, CA
| | - Derrick C Wan
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, Stanford, CA
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Randquist C, Cohen R. Commentary on: Popcorn Capsulorrhaphy in Revision Aesthetic Breast Surgery. Aesthet Surg J 2020; 40:75-77. [PMID: 30980654 DOI: 10.1093/asj/sjz062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Robert Cohen
- private practice in Beverly Hills/West Hollywood, CA, and Paradise Valley, AZ
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Calobrace MB, Mays C, Wilson R, Wermeling R. Popcorn Capsulorrhaphy in Revision Aesthetic Breast Surgery. Aesthet Surg J 2020; 40:63-74. [PMID: 30544132 DOI: 10.1093/asj/sjy324] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 12/06/2018] [Accepted: 12/07/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Control of the pocket in revisional breast surgery can be technically challenging and unpredictable. A capsulorrhaphy technique has been utilized in altering capsules in secondary aesthetic breast surgery. OBJECTIVES The authors sought to determine the effectiveness of popcorn capsulorrhaphy in revisional breast surgery. METHODS A retrospective chart review of revisional breast cases utilizing popcorn capsulorrhaphy was conducted between September 2015 and August 2017. Only aesthetic breast cases were included. Data were collected for 149 patients. RESULTS One hundred forty-nine patients representing 266 breasts were operated on. The average patient age was 42 years and the mean body mass index was 24.2 kg/m2. The average time from their original surgery to the popcorn capsulorrhaphy secondary procedure was 9.3 years. Indications for capsulorrhaphy included malposition in 163 breasts (61.3%), implant positioning for breast ptosis in 34 breasts (12.8%), pocket adjustment for implant size change in 49 breasts (18.4%), and postexplantation pocket reduction in 20 breasts (7.5%). Of the 266 implants, 145 (54.5%) were smooth, 101 (38%) textured, and 20 (7.5%) were explanted. The average original implant size was 405 cc and the average size placed at the time of capsulorrhaphy was 422 cc. Two hundred thirty-six (88.7%) were in a submuscular pocket and 30 (11.3%) were subglandular. The total number of complications was 39 (14.7%), and 16 (6%) required some type of operative revision. CONCLUSIONS Popcorn capsulorrhaphy can provide pocket control and stability with low complication and revision rates. The addition of a mesh or biologic at the time of popcorn capsulorrhaphy can further lower the complication and revision rates. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- M Bradley Calobrace
- Division of Plastic Surgery, University of Louisville, Louisville, KY
- Division of Plastic Surgery, University of Kentucky, Lexington, KY
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Kaoutzanis C, Winocour J, Unger J, Gabriel A, Maxwell GP. The Evolution of Breast Implants. Semin Plast Surg 2019; 33:217-223. [PMID: 31632203 PMCID: PMC6797490 DOI: 10.1055/s-0039-1696985] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Breast augmentation remains one of the most commonly performed aesthetic procedures in the United States and worldwide. Throughout the last few decades, the implants used for this procedure have undergone significant advancements, which has allowed surgeons to provide safer and more aesthetically pleasing outcomes. This article discusses the history of breast implants since their invention in 1962. Particular emphasis is given to the evolution of silicone implants with its many challenges, which has resulted in the development of the currently used fourth- and fifth-generation devices. Knowledge of these advances will allow physicians to more critically evaluate their results, and also will encourage them to provide more up-to-date scientific data on these devices to further improve the clinical outcomes of their patients.
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Affiliation(s)
- Christodoulos Kaoutzanis
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Colorado, Aurora, Colorado
| | - Julian Winocour
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jacob Unger
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Allen Gabriel
- Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - G. Patrick Maxwell
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Abstract
The purpose of this Special Topic article is to present the current state of scientific evidence related to the safety of silicone breast implants. There is presently overwhelming evidence to support the safety of silicone breast implants. Ultimately, the decision to obtain, keep, or remove breast implants is the choice of the patient. If a patient chooses to have her breast implants removed, it is important to find a board-certified plastic surgeon with expertise in breast surgery. Ongoing studies are strongly encouraged in all areas, from cancer detection to autoimmune disease, as we strive for improved patient safety, patient awareness, and patient education. To the best of our body of scientific knowledge to date, there have not been any concrete or evidence-based studies or peer-reviewed data concerning the formation of a new syndrome: "silicone implant illness." Silicone breast implants are used in nearly 300,000 breast augmentation and 100,000 breast reconstruction operations annually in the United States. Silicone gel-filled implants were first approved by the U.S. Food and Drug Administration in 1962. Since that time, few medical devices have been studied as closely for their safety and associated adverse outcomes. Despite multiple generations of implant shells and gel fillers, the basic components remain as originally designed.
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Plastic Surgeons Defend Textured Breast Implants at 2019 U.S. Food and Drug Administration Hearing: Why It Is Time to Reconsider. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2410. [PMID: 31592028 PMCID: PMC6756678 DOI: 10.1097/gox.0000000000002410] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 06/26/2019] [Indexed: 11/25/2022]
Abstract
Textured breast implants were the subject of a U.S. Food and Drug Administration (FDA) hearing on March 25 and 26, 2019. Regulating agencies in other countries, including all of Europe and Canada, have already banned macrotextured implants. Patients affected by Breast Implant-Associated Anaplastic Large-Cell Lymphoma (BIA-ALCL) recounted their life-changing experiences, and requested a ban on textured devices. Plastic surgeons, many with industry ties, spoke in favor of keeping the devices available. The historical advantages of textured implants were presented, including a reduced capsular contracture rate. A 14-point plan to improve sterility at the time of implantation was promoted as an effective alternative to reduce both capsular contractures and BIA-ALCL risk. However, recent studies show that textured implants have not delivered on their early promise. Biocell implants perform worse, not better, than other implant types, and capsular contracture rates are not significantly reduced according to recent core studies. The only known risk factor for BIA-ALCL is textured implants. The lifetime risk for Biocell implants is at least 1:2, 200. There is no reliable evidence that surgical technique makes a difference in risk. This serious issue represents a case study of conflict of interest. In light of recent information, a re-analysis of the true risks and benefits of textured implants is justified. It is time for our professional societies to recognize that the device is the problem rather than surgical technique. On May 2, 2019, the FDA decided against a ban on textured breast implants.
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Li S, Mu D, Liu C, Xin M, Fu S, Xu B, Li Z, Qi J, Luan J. Complications Following Subpectoral Versus Prepectoral Breast Augmentation: A Meta-analysis. Aesthetic Plast Surg 2019; 43:890-898. [PMID: 31139912 DOI: 10.1007/s00266-019-01404-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/12/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Subpectoral and prepectoral planes have commonly been used in implant-based breast augmentation. The effect of implant plane on complication rate was still unclear. This meta-analysis demonstrated current evidence with regard to comparison of complication rates between subpectoral and prepectoral breast augmentation. METHODS Pubmed, EMBASE and Cochrane library were searched to December 2018. The results of selected studies were meta-analyzed to obtain a pooled odds ratio of the effect of subpectoral versus prepectoral breast augmentation on rates of complications. RESULTS There were significantly lower rates of capsular contracture and hematoma but higher rates of implant displacement and animation deformity in the subpectoral group compared with the prepectoral group. There was no significant difference with regard to rates of reoperation, seroma, rippling, infection and implant rupture between these two groups. CONCLUSIONS Subpectoral and subglandular breast augmentations both have their merits and demerits with regard to complications. The pros and cons of each procedure should be fully explained to patients and selection of implant plane should be considered more comprehensively. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Shangshan Li
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Dali Mu
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Chunjun Liu
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Minqiang Xin
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Su Fu
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Boyang Xu
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Zifei Li
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Jun Qi
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Jie Luan
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, China.
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Salibian AA, Frey JD, Bekisz JM, Choi M, Karp NS. Fat Grafting and Breast Augmentation: A Systematic Review of Primary Composite Augmentation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2340. [PMID: 31942362 PMCID: PMC6952123 DOI: 10.1097/gox.0000000000002340] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 05/07/2019] [Indexed: 11/25/2022]
Abstract
Fat grafting during primary breast augmentation has the ability to address the limitations of soft tissue coverage of breast implants. The purpose of this study was to evaluate the current evidence on patient selection, surgical techniques, and assessment of outcomes with composite breast augmentation.
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Affiliation(s)
- Ara A Salibian
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health; New York, N.Y
| | - Jordan D Frey
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health; New York, N.Y
| | - Jonathan M Bekisz
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health; New York, N.Y
| | - Mihye Choi
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health; New York, N.Y
| | - Nolan S Karp
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health; New York, N.Y
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