Augmentation Mammaplasty After Breast Enhancement With Hyaluronic Acid

BACKGROUND

Macrolane is a stabilized, hyaluronic acid-based gel that has been available since 2007 as a minimally invasive, nonpermanent option for breast enhancement. However, numerous controversies pertaining to its side effects have highlighted the need for studies involving larger groups of patients.

OBJECTIVES

The authors sought to determine complications of Macrolane injections for breast enhancement and performed surgical evacuation of cysts comprising collections of hyaluronic acid in patients who previously received Macrolane treatment and presented for augmentation mammaplasty.

METHODS

The authors reviewed a case series of 20 patients who were treated elsewhere with intramammary injection of Macrolane for cosmetic purposes and who presented at the authors' medical studio with multiple intramammary and intramuscular cysts. All patients underwent surgical evacuation of the hyaluronic acid-based cysts in association with augmentation mammaplasty.

RESULTS

Good aesthetic results were achieved in all patients. Three months after surgery, 15 of 20 (75%) patients rated themselves as very much improved; 4 patients (20%) rated themselves as moderately improved, and 1 patient (5%) rated herself as somewhat improved.

CONCLUSIONS

The authors suggest that Macrolane cannot be considered a valid alternative for breast augmentation at this time.

LEVEL OF EVIDENCE

4 Therapeutic.

Sentinel lymph node biopsy in breast cancer: the role of micrometastasis

Intraoperative sentinel lymph node biopsy is widely used in patients with early-stage breast cancer for staging the axilla. The conventional analysis of the SLN has classically been performed by frozen section or touch imprint with a rapid H&E (hematoxylin and eosin) staining. Because of the risk of false-negative results, it has been replaced by the one-step acid amplification (OSNA) assay, a molecular diagnostic assay for the detection of cytokeratin 19 mRNA expression. Due to the controversial for the use of OSNA to evaluate the SLN because of its cost-effective and the lack of consensus to perform or avoid a lymphadenectomy when there is micrometastasis, we analyze 410 patients subjected to SLN biopsy in Hospital Puerta de Hierro, Madrid (Spain). Of the total of nodes, 223 (54.4 %) were processed throughout frozen-section examination and imprint cytology and 187 (45.6 %) throughout OSNA. The specificity of the frozen-section histological examination was of 100 %, with a sensitivity of 83.33 % (95 % CI 73.07-93.60). Of the 40 patients with definitive micrometastasis in the SLN, axillary dissection was performed in 90 % of the patients, with subsequent positive affectation in four of them (11.11 %). Based on our result and taking into account that 10 % of the lymphadenectomy performed after micrometastasis are positive, we do not believe that lymphadenectomy should be avoided after N(mi+) is detected in a SLN.