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Rossi M, Cammarata E, Cipolla C, Vieni S, Toia F, Cordova A. The "Octopus Head" Dermoglandular Flap: A Novel Technique for Breast Tissue Rearranging after Implant Removal. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5882. [PMID: 38868620 PMCID: PMC11167231 DOI: 10.1097/gox.0000000000005882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/15/2023] [Indexed: 06/14/2024]
Abstract
Background Patients with previous breast augmentation may need implant removal for mechanical complications or other causes. After prosthesis removal, the residual parenchyma can be reshaped through a mastopexy with rearrangement of breast tissue. Several techniques have been described in the literature, but none of them can be considered the gold standard. In this study, we present our preliminary experience in breast tissue rearranging after implant removal through a novel technique: the "octopus head" dermoglandular flap. Methods From January 2019 to October 2022, nine patients (18 breasts) underwent implant removal and simultaneous breast remodeling with the tissue obtained from the dermoglandular excess of the breast and shaped like an octopus head. Patient's demographic and clinical characteristics, postoperative complications, and patient-reported satisfaction were recorded. Results Mean age was 46.7 years. Body mass index ranged between 22.5 and 27.6 kg per m2. The majority of patients had moderate ptosis (67%). Breast implants were removed due to bilateral capsular contracture (n = 3), unilateral implant rupture with contralateral capsular contracture (n = 2), bilateral implant rupture (n = 3), and unilateral periprosthetic seroma (n = 1). We observed two minor complications: one postoperative hemorrhage with subsequent hematoma that was managed conservatively, and one nipple-areola complex malposition that underwent revision surgery. All patients were satisfied with the aesthetic and functional result. Conclusions The octopus head dermoglandular flap has proved to be a safe and reliable option for breast tissue rearranging after implant removal, providing a good and stable cosmetic result, a low complication rate, and high patient-reported satisfaction.
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Affiliation(s)
- Matteo Rossi
- From the Plastic and Reconstructive Surgery, Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.)., University of Palermo, Palermo, Italy
| | - Emanuele Cammarata
- From the Plastic and Reconstructive Surgery, Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.)., University of Palermo, Palermo, Italy
| | - Calogero Cipolla
- Oncological Surgery Unit, Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.)., University of Palermo, Palermo, Italy
| | - Salvatore Vieni
- Oncological Surgery Unit, Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.)., University of Palermo, Palermo, Italy
| | - Francesca Toia
- From the Plastic and Reconstructive Surgery, Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.)., University of Palermo, Palermo, Italy
| | - Adriana Cordova
- From the Plastic and Reconstructive Surgery, Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.)., University of Palermo, Palermo, Italy
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Su B, Chen L, Zhang B, Wang H, Zhou J, Du B. Major Clinical Adverse Events of Breast Implant in the Manufacturer and User Facility Device Experience Database. J Patient Saf 2024; 20:267-271. [PMID: 38635526 DOI: 10.1097/pts.0000000000001219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
OBJECTIVE Search the Manufacturer and User Facility Device Experience database to collect information on adverse events of breast implant. We analyzed the local complications and the breast implant illness (BII) of silicone breast implants, as well as saline breast implants separately, aim to provide a reference for women who want to breast augmentation. MATERIALS AND METHODS The Manufacturer and User Facility Device Experience database was queried for events reports related to the breast implant between July 1, 2012, and June 30, 2022. Event year and reporting year were summarized. Patient problem was collected and analyzed to distinguish between local complications and BII. RESULTS A total of 108,728 adverse events in the past 3 years were analyzed, silicone breast implants accounted for 62.1% and saline breast implants accounted for 37.9%. The most common local complication of women receiving silicone breast implants was "Capsular Contracture," accounting for 48.73%. However, the incidence of "capsular contracture" in women who received saline breast implants was only 17.49%. The most common BII was "fatigue/weakness" in both women receiving 2 different breast implants, 17.20% in women receiving silicone breast implants and 24.71% in women receiving saline breast implants. Of note, in all the reports, there was a wide variation in the timing of reporting as compared with the timing of the adverse event. CONCLUSIONS Although the adverse events of breast implant cannot completely be determined from this study, we provide a reference for women who want to get breast implants, so that they can choose breast implants more carefully. In addition, a better understanding of BII may allow them to think further about whether the benefits of breast implants outweigh the risks.
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Affiliation(s)
- Bing Su
- From the Nanfang Hospital, Southern Medical University, Guangzhou
| | - Lichuan Chen
- Pufeisheng Pharmaceutical Technology Co, Ltd, Nanjing
| | - Bohan Zhang
- Center for ADR Monitoring of Guangdong, Guangzhou, China
| | - Hong Wang
- Center for ADR Monitoring of Guangdong, Guangzhou, China
| | - Jie Zhou
- Pufeisheng Pharmaceutical Technology Co, Ltd, Nanjing
| | - Benjun Du
- From the Nanfang Hospital, Southern Medical University, Guangzhou
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3
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Borhani-Khomani K, Kalstrup J, Trøstrup H, Henriksen TF, Hölmich LR, Stellander AKL. Self-reported systemic symptoms among women with breast implants. Ugeskr Laeger 2024; 186:V12230801. [PMID: 38808767 DOI: 10.61409/v12230801] [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: 05/30/2024]
Abstract
Around 2,500 women receive a breast augmentation with silicone-based implants yearly in Denmark. A number of these women report various uncharacteristic systemic symptoms, which they attribute to the breast implants, including impaired cognition, joint pain, etc. This condition has been termed "breast implant illness" and is currently not a recognised diagnosis. The correlation between the patient's self-reported symptoms and breast implants has not been established and there is limited evidence that surgery has any effect. In this review, the current literature on the topic has been reviewed.
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Affiliation(s)
| | - Julie Kalstrup
- Afdeling for Plastikkirurgi, Københavns Universitetshospital, Herlev og Gentofte Hospital
| | - Hannah Trøstrup
- Plastik- og Brystkirurgisk Afdeling, Sjællands Universitetshospital, Roskilde
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Kabir R, Stanton E, Sorenson TJ, Hemal K, Boyd CJ, Karp NS, Choi M. Breast Implant Illness as a Clinical Entity: A Systematic Review of the Literature. Aesthet Surg J 2024:sjae095. [PMID: 38636098 DOI: 10.1093/asj/sjae095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/30/2024] [Accepted: 04/15/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Breast implant illness (BII) has become a contentious subject in recent years. While some studies have reported associations between breast implants and autoimmune diseases, others have failed to establish a definitive link. OBJECTIVES The objective of this study is to provide a comprehensive, up-to-date evaluation of the literature surrounding BII, with an emphasis on identifying patient-related factors that may be associated with BII. METHODS A systematic review was performed following PRISMA guidelines using Pubmed (MEDLINE), EMBASE, and Cochrane databases to search for relevant studies published in the last twenty years. RESULTS Thirty-one studies were included with a total of 39,505 implant patients and mean age of 44.2 ± 9.30 years. Fifteen studies reported implant explantation status with 72.4% patients choosing to remove their implants. Among these, nine studies reported symptom improvement in 83.5% patients. Fifty-three percent of patients undergoing explantation had total capsulectomy. Twenty-eight studies documented total numbers of patients experiencing symptoms related to BII, with 31.3% patients reporting such symptoms. Among these, sixteen studies of 4,109 BII patients distinguished whether the reason for implantation was cosmetic augmentation or reconstruction. When specified, more patients experiencing BII-related symptoms received implants for "cosmetic" versus "reconstructive" reasons (Cosmetic: 3,864/4,109; 94.0% vs. Reconstruction: 245/4,109; 5.96%, p < 0.001). CONCLUSIONS This review provides an overview of the current state of knowledge regarding BII. Our study highlights a potential relationship between BII and indication for implants (cosmetic vs. reconstructive) among other variables, offering valuable insight on factors associated with BII and directions for future research.
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Affiliation(s)
- Raeesa Kabir
- Medical student, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Eloise Stanton
- Medical student, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Thomas J Sorenson
- Hansjorg Wyss Department of Plastic Surgery, NYU-Langone Health, New York, NY, USA
| | - Kshipra Hemal
- Hansjorg Wyss Department of Plastic Surgery, NYU-Langone Health, New York, NY, USA
| | - Carter J Boyd
- Hansjorg Wyss Department of Plastic Surgery, NYU-Langone Health, New York, NY, USA
| | - Nolan S Karp
- Hansjorg Wyss Department of Plastic Surgery, NYU-Langone Health, New York, NY, USA
| | - Mihye Choi
- Hansjorg Wyss Department of Plastic Surgery, NYU-Langone Health, New York, NY, USA
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5
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Tanzella U, Ueberreiter K, Krapohl LF, Bell A, Krapohl BD. Results of a patient survey using an online questionnaire after implant removal for breast implant illness. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2024; 13:Doc04. [PMID: 38654894 PMCID: PMC11036085 DOI: 10.3205/iprs000186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
The use of silicone breast implants has a history of over 60 years. In recent years, specific health issues among implant wearers have repeatedly come into focus. The term "breast implant illness" has been circulating in scientific literature and on social media for several years. It describes a cluster of up to 60 different symptoms. The present results of an online survey conducted within a clinic's patient population of the last 8 years show, among other things, the evolution of 8 reported symptoms before and after breast implant removal. In the comparison before and after, there is a significant reduction in the intensity of symptoms after implant removal. A causal relationship with the removal of the implants is to be presumed.
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Affiliation(s)
| | | | | | - Armin Bell
- Park-Klinik Birkenwerder, Birkenwerder, Germany
| | - Björn Dirk Krapohl
- Department of Dento-maxillofacial, Reconstructive, and Plastic Surgery, Carl-Thiem Klinikum, Cottbus, Germany
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6
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Di Via Ioschpe A, Oleru OO, Brozynski M, Seyidova N, Henderson PW. Contextualizing the Impact of Pop Culture on Breast Implant Illness and its Medical Relevance. Aesthetic Plast Surg 2024; 48:1056-1065. [PMID: 37486364 PMCID: PMC11000431 DOI: 10.1007/s00266-023-03422-y] [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: 12/20/2022] [Accepted: 05/11/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION Despite a lack of data demonstrating causation, there is growing concern over breast implants and systemic illness. This study examines the impact of rising public interest in breast implant illness (BII) and its implications on breast implant removals (BIR). METHODS A Google Trends (GT) analysis of each year between 2010 and 2022 was performed globally, and then separately for the United States alone (US), using the search terms "capsular contracture," "breast implant illness," and "breast implant(s) removal". Linear regression was performed to determine significant correlations. Data on BII-related Facebook advocacy groups, relevant pop culture events, numbers of BIR surgeries, and number of BII-related publications were collected and analyzed alongside GT data to determine relevance. RESULTS For global GT, there was a significant relationship between "breast implant illness" and "breast implant(s) removal" in 2016 (R2=0.62, β =0.33, p<0.01), 2020 (R2=0.53, β =0.23, p=0.01), and 2022 (R2=0.60, β =0.44, p=0.01). In the US, 2016 (R2=0.53, β =1.75, p=0.01) 2018 (R2=0.61, β =1.93, p<0.01) and 2020 (R2=0.72, β=0.91, p<0.01) were significant. In 2020, "capsular contracture" and "breast implant(s) removal" was significant in the US (R2=0.58, β=0.4, p=0.01). In 2016, Facebook was the platform for the largest BII advocacy group and in 2020 YouTube was the platform for the first BII documentary and TEDx talk. From 2010 to 2020, PubMed publications containing "ASIA" and "BII" increased 24-fold and ASPS reports on BIR rose 70%. CONCLUSION This study suggests that BII is a topic of global concern and has implications on both academic medicine and clinical practice. 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)
- Anaïs Di Via Ioschpe
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 2L, New York, NY, 10003, USA
| | - Olachi O Oleru
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 2L, New York, NY, 10003, USA
| | - Martina Brozynski
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 2L, New York, NY, 10003, USA
| | - Nargiz Seyidova
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 2L, New York, NY, 10003, USA
| | - Peter W Henderson
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 2L, New York, NY, 10003, USA.
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7
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Suri K, Billick S. Breast Implant Illness Through a Psychiatric Lens. Aesthetic Plast Surg 2024; 48:559-567. [PMID: 37828367 DOI: 10.1007/s00266-023-03692-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/12/2023] [Indexed: 10/14/2023]
Abstract
Since their introduction in the 1960's, the safety of silicone breast implants has remained contentious due to concerns regarding carcinogenicity as well as a growing array of adverse psychiatric symptoms, which have now been termed 'Breast Implant Illness.' This article aims to explore the merits of a psychiatric approach to treating Breast Implant Illness by outlining how it is defined by psychiatric symptoms and categorized alongside other psychiatric illnesses. Furthermore, it is unclear whether the pathology of Breast Implant Illness is purely medical or psychiatric. However, the efficacy of the medical approach to treatment through a process called explantation, which involves removal of the implant and surrounding scar tissue, or capsule, is not strongly supported by existing data. A psychiatric approach to treatment, in conjunction with explanation, thus holds potential in remedying the novel and poorly understood Breast Implant Illness.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)
- Kashviya Suri
- The University of Pennsylvania, Philadelphia, PA, USA.
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8
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Liu HY, Alessandri Bonetti M, De Lorenzi F, Gimbel ML, Nguyen VT, Egro FM. Consulting the Digital Doctor: Google Versus ChatGPT as Sources of Information on Breast Implant-Associated Anaplastic Large Cell Lymphoma and Breast Implant Illness. Aesthetic Plast Surg 2024; 48:590-607. [PMID: 37903939 DOI: 10.1007/s00266-023-03713-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 10/10/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare complication associated with the use of breast implants. Breast implant illness (BII) is another potentially concerning issue related to breast implants. This study aims to assess the quality of ChatGPT as a potential source of patient education by comparing the answers to frequently asked questions on BIA-ALCL and BII provided by ChatGPT and Google. METHODS The Google and ChatGPT answers to the 10 most frequently asked questions on the search terms "breast implant associated anaplastic large cell lymphoma" and "breast implant illness" were recorded. Five blinded breast plastic surgeons were then asked to grade the quality of the answers according to the Global Quality Score (GQS). A Wilcoxon paired t-test was performed to evaluate the difference in GQS ratings for Google and ChatGPT answers. The sources provided by Google and ChatGPT were also categorized and assessed. RESULTS In a comparison of answers provided by Google and ChatGPT on BIA-ALCL and BII, ChatGPT significantly outperformed Google. For BIA-ALCL, Google's average score was 2.72 ± 1.44, whereas ChatGPT scored an average of 4.18 ± 1.04 (p < 0.01). For BII, Google's average score was 2.66 ± 1.24, while ChatGPT scored an average of 4.28 ± 0.97 (p < 0.01). The superiority of ChatGPT's responses was attributed to their comprehensive nature and recognition of existing knowledge gaps. However, some of ChatGPT's answers had inaccessible sources. CONCLUSION ChatGPT outperforms Google in providing high-quality answers to commonly asked questions on BIA-ALCL and BII, highlighting the potential of AI technologies in patient education. LEVEL OF EVIDENCE Level III, comparative study 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)
- Hilary Y Liu
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, G103, Pittsburgh, PA, 15219, USA
| | - Mario Alessandri Bonetti
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, G103, Pittsburgh, PA, 15219, USA
| | - Francesca De Lorenzi
- Department of Plastic Surgery, IRCCS European Institute of Oncology, Via Giuseppe Ripamonti 345, 20122, Milan, Italy
| | - Michael L Gimbel
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, G103, Pittsburgh, PA, 15219, USA
| | - Vu T Nguyen
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, G103, Pittsburgh, PA, 15219, USA
| | - Francesco M Egro
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, G103, Pittsburgh, PA, 15219, USA.
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9
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Felis-Giemza A, Matusiewicz A, Wajda A, Olesińska M. Safety of esthetic procedures in rheumatic patients: single-center survey of patients. Rheumatol Int 2024; 44:357-362. [PMID: 37847387 PMCID: PMC10796409 DOI: 10.1007/s00296-023-05481-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 09/25/2023] [Indexed: 10/18/2023]
Abstract
The popularity of esthetic medicine is growing every year, also among patients with autoimmune inflammatory rheumatic diseases (AIRD). The objective of this study was to evaluate the safety of esthetic medicine (AM) procedures in patients with AIRD. A semi-structured, anonymous questionnaire regarding rheumatic and concomitant diseases and AM procedures was distributed among adult patients hospitalized in the rheumatology department or attending outpatient clinic in the National Institute of Geriatrics, Rheumatology, and Rehabilitation, Warsaw. The main outcome was the occurrence of an adverse event. A number of 512 patients took part in the survey and 15 were excluded (AM procedure preceded the diagnosis of AIRD). The study group consisted of 497 patients, of whom 47 had undergone AM procedures. The procedures performed included: tattooing (22 patients), piercing (16 patients), hyaluronic acid (7 patients), botulinum toxin (5 patients) injections, laser procedures (6 patients), plastic surgery (4 patients), mesotherapy (3 patients) and others. The vast majority of patients had these performed during remission or low disease activity. 70.2% of patients received treatment with disease-modifying antirheumatic drugs (DMARDs) during the AM procedure, with TNF-alfa inhibitors being the most common (63.6%). Adverse events occurred in 15% of patients. All were mild and transient site reactions. Most patients would like to repeat the AM procedure in the future. The use of esthetic medicine procedures in patients with AIRD, including those treated with biologic DMARDs, was associated with a risk of mild site reactions. Most of the patients expressed satisfaction with the results of the AM procedure.
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Affiliation(s)
- Anna Felis-Giemza
- Biologic Therapy Center, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Agata Matusiewicz
- Department of Connective Tissue Diseases, National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartańska 1, 02-637, Warsaw, Poland.
| | - Anna Wajda
- Department of Molecular Biology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Marzena Olesińska
- Department of Connective Tissue Diseases, National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartańska 1, 02-637, Warsaw, Poland
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10
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Tervaert JWC, Shoenfeld Y, Cruciani C, Scarpa C, Bassetto F. Breast implant illness: Is it causally related to breast implants? Autoimmun Rev 2024; 23:103448. [PMID: 37714420 DOI: 10.1016/j.autrev.2023.103448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/12/2023] [Indexed: 09/17/2023]
Abstract
Once believed to be completely inert implants, Silicon Breast Implants (SBIs) have been shown to be able to induce a chronic inflammatory response in the body which can lead to a variety of possible manifestations ranging from the most common capsular contraction to rarer conditions such as malignancies and autoimmune diseases. Among the latter, new syndromes have been consistently recognized: Breast Implant Illness (BII) and autoimmunity/autoinflammatory syndrome induced by adjuvants (ASIA syndrome/Shoenfeld's Syndrome). The pathophysiological mechanisms underlying such syndromes are not yet clear and the overlap they show with other common conditions have sparked an important debate in the scientific community regarding their existence and their cause-effect relationship with SBIs. In this article Professor Cohen Tervaert and Professor Bassetto, leading experts in the field, are going to present arguments in favor and against such causal relationship according to the latest scientific evidence. Professor Cohen Tervaert is going to demonstrate how the evidence available is enough to prove a causal relationship as defined by the Bradford Hill's criteria. Professor Bassetto is going to highlight how the many biases that afflict the available evidence prevent us from drawing such conclusions. Professor Shoenfeld is going to moderate the discussion with its insightful conclusions.
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Affiliation(s)
- Jan Willem Cohen Tervaert
- Division of Rheumatology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; School for Mental Health and Neurosciences (MHeNs), Maastricht University, Maastricht, the Netherlands
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Reichman University, Herzliya, Israel..
| | - Claudio Cruciani
- Division of Rheumatology, Department of Internal Medicine, Azienda Ospedaliera di Padova, University of Padova, Padova, Veneto, Italy
| | - Carlotta Scarpa
- Unit of Plastic and Reconstruction Surgery, Azienda Ospedaliera di Padova, University of Padova, Padova, Veneto, Italy
| | - Franco Bassetto
- Unit of Plastic and Reconstruction Surgery, Azienda Ospedaliera di Padova, University of Padova, Padova, Veneto, Italy
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11
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Meshkin DH, Firriolo JM, Karp NS, Salibian AA. Management of complications following implant-based breast reconstruction: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:416. [PMID: 38213810 PMCID: PMC10777227 DOI: 10.21037/atm-23-1384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 06/15/2023] [Indexed: 01/13/2024]
Abstract
Background and Objective Complications associated with implant-based reconstruction have a spectrum of severity with sequelae ranging from mild aesthetic deformities to additional surgery, reconstructive failure and systemic illness. The purpose of this narrative review of the literature is to provide updated evidence-based information on the management of complications in implant-based reconstruction. Methods A systematic search of PubMed, OVID MEDLINE and the Cochrane Library databases was performed to identify common complications associated with implant-based breast reconstruction, incidences of occurrence as well as preventative and management strategies. Key Content and Findings Pertinent short and long-term complications of implant-based breast reconstruction include hematoma, implant infection, seroma, skin envelope necrosis, capsular contracture, rupture, malposition, animation and contour deformities, implant-associated anaplastic large cell lymphoma, and breast implant illness. Important preventative measures for short term complications include meticulous sterile technique and antibiotic irrigation, adequate drainage and critical evaluation of mastectomy flaps. Management of short-term complications requires early recognition and aggressive treatment to prevent reconstructive failure as well as long-term complications such as capsular contracture. Important technological advances include dual-port expanders for seroma drainage, indocyanine green angiography for mastectomy flap perfusion evaluation, cohesive form-stable implants for treatment of rippling, and various biologic and synthetic mesh products for pocket control and correction. Conclusions Important principles in management of short-term complications in implant-based reconstruction include aggressive and early intervention to maximize the chance of reconstructive salvage. Contemporary technological advances have played an important role in both prevention and treatment of complications. Over-arching principles in management of implant-based reconstruction complications focus on preventative techniques and preoperative patient counseling on potential risks, their likelihood, and necessary treatments to allow for informed and shared decision-making.
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Affiliation(s)
- Dean H. Meshkin
- Division of Plastic and Reconstructive Surgery, University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Joseph M. Firriolo
- Division of Plastic and Reconstructive Surgery, University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Nolan S. Karp
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
| | - Ara A. Salibian
- Division of Plastic and Reconstructive Surgery, University of California, Davis School of Medicine, Sacramento, CA, USA
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12
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Marco E, Trépanier G, Chang E, Mauti E, Jones JM, Zhong T. Postmastectomy Functional Impairments. Curr Oncol Rep 2023; 25:1445-1453. [PMID: 37955831 PMCID: PMC10728246 DOI: 10.1007/s11912-023-01474-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE OF REVIEW This narrative review aims to offer a thorough summary of functional impairments commonly encountered by breast cancer survivors following mastectomy. Its objective is to discuss the factors influencing these impairments and explore diverse strategies for managing them. RECENT FINDINGS Postmastectomy functional impairments can be grouped into three categories: neuromuscular, musculoskeletal, and lymphovascular. Neuromuscular issues include postmastectomy pain syndrome (PMPS) and phantom breast syndrome (PBS). Musculoskeletal problems encompass myofascial pain syndrome and adhesive capsulitis. Lymphovascular dysfunctions include lymphedema and axillary web syndrome (AWS). Factors such as age, surgical techniques, and adjuvant therapies influence the development of these functional impairments. Managing functional impairments requires a comprehensive approach involving physical therapy, pharmacologic therapy, exercise, and surgical treatment when indicated. It is important to identify the risk factors associated with these conditions to tailor interventions accordingly. The impact of breast reconstruction on these impairments remains uncertain, with mixed results reported in the literature.
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Affiliation(s)
- Eden Marco
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | | | - Eugene Chang
- Department of Medicine, Division of Physical Medicine & Rehabilitation, University of Toronto, Toronto, ON, Canada
- Department of Supportive Care, Cancer Rehab & Survivorship Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Multisystem & Musculoskeletal Rehabilitation Program, Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Emma Mauti
- Department of Medicine, Division of Physical Medicine & Rehabilitation, University of Toronto, Toronto, ON, Canada
| | - Jennifer M Jones
- Cancer Rehabilitation and Survivorship Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Toni Zhong
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
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13
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Berben JA, Miseré RML, van der Hulst RRWJ. The influence of personality on patient-reported outcomes in women undergoing implant-based breast reconstruction. J Plast Reconstr Aesthet Surg 2023; 87:303-309. [PMID: 37925919 DOI: 10.1016/j.bjps.2023.10.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/15/2023] [Accepted: 10/07/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Despite the lack of hard evidence for causality, some women attribute their systemic complaints to their silicone breast implants. Personality and psychological distress are associated with the development of medically unexplained symptoms. It could be hypothesized that these psychological factors are related to the development of breast implant illness (BII). In a previous study, we found a relationship between personality traits and BII-related complaints in patients with cosmetic breast implants. This association may also exist in patients with implant-based breast reconstruction. OBJECTIVES This cross-sectional study evaluated the association between personality, self-reported health complaints, and health- and breast-related quality of life (QoL) in women with implant-based breast reconstruction. METHODS Women who underwent breast reconstruction between January 2015 and December 2018 in either the Maastricht University Medical Center or Zuyderland Medical Center were invited to participate in this study. Participants were asked to complete a physical complaint score form and the BREAST-Q, SF-36, and EPQ-RSS questionnaires through an online survey. The association between outcomes was analyzed with multivariate linear regression. RESULTS A total of 118 women completed the questionnaires. Social desirability and extroversion were predominant personality traits. Neuroticism levels were comparable with normative data. Neuroticism correlated significantly with health status and breast-related QoL. Health-related QoL had the strongest correlation with neuroticism (β = -2.93, β = -3.41, p < 0.001). CONCLUSION This study suggests that personality, and neuroticism in particular, may contribute to the development of medically unexplained complaints in women with implant-based reconstruction. The influence of personality on BII needs to be further investigated in large prospective studies.
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Affiliation(s)
- Juliënne A Berben
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands.
| | - Renée M L Miseré
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - René R W J van der Hulst
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
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14
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Takahashi H, Sato H, Tsunekawa Y, Fujioka U, Wanifuchi-Endo Y, Toyama T, Toriyama K. Ruptured breast implant removal because of patient anxiety in the absence of breast implant-associated anaplastic large cell lymphoma. NAGOYA JOURNAL OF MEDICAL SCIENCE 2023; 85:852-856. [PMID: 38155618 PMCID: PMC10751495 DOI: 10.18999/nagjms.85.4.852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/02/2023] [Indexed: 12/30/2023]
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) has been regarded as a long-term problem after silicone breast implantations. We report a case in which BIA-ALCL and breast cancer were not detected preoperatively, with subsequent removal of a ruptured breast implant. A 52-year-old woman had silicone breast implants on both sides for breast augmentation 15 years ago. Right axillary lymphadenopathy and intracapsular ruptures were noted by magnetic resonance imaging. Right axillary lymph node biopsy was performed at our department of breast surgery. Flow cytometry for BIA-ALCL was also performed using the exudate around the implant. The results were negative for breast cancer and BIA-ALCL. However, taking into consideration exacerbation of breast implant rupture and the patient's anxiety about BIA-ALCL, ruptured bilateral implants were removed by total capsulectomy. The postoperative course was uneventful 1 year after the operation, and her anxiety was dispelled despite her breast deformity. Appropriate explantation and periodic examination may be required to prevent excessive anxiety.
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Affiliation(s)
- Hitomi Takahashi
- Department of Plastic & Reconstructive Surgery, Nagoya City University Graduate School of Medical Sciences and Medical School, Nagoya, Japan
| | - Hideyoshi Sato
- Department of Plastic & Reconstructive Surgery, Nagoya City University Graduate School of Medical Sciences and Medical School, Nagoya, Japan
| | - Yukiyo Tsunekawa
- Department of Plastic & Reconstructive Surgery, Nagoya City University Graduate School of Medical Sciences and Medical School, Nagoya, Japan
| | - Urara Fujioka
- Department of Plastic & Reconstructive Surgery, Nagoya City University Graduate School of Medical Sciences and Medical School, Nagoya, Japan
| | - Yumi Wanifuchi-Endo
- Department of Breast Surgery, Nagoya City University Graduate School of Medical Sciences and Medical School, Nagoya, Japan
| | - Tatsuya Toyama
- Department of Breast Surgery, Nagoya City University Graduate School of Medical Sciences and Medical School, Nagoya, Japan
| | - Kazuhiro Toriyama
- Department of Plastic & Reconstructive Surgery, Nagoya City University Graduate School of Medical Sciences and Medical School, Nagoya, Japan
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15
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Talwar AA, Niu EF, Broach RB, Nelson JA, Fischer JP. Patient-reported outcomes: A primer for plastic surgeons. J Plast Reconstr Aesthet Surg 2023; 86:35-47. [PMID: 37688832 DOI: 10.1016/j.bjps.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/23/2023] [Accepted: 08/13/2023] [Indexed: 09/11/2023]
Abstract
Surgical care today is no longer evaluated only on clinical outcomes but also on holistic patient wellbeing. Patient-reported outcomes (PROs) are a representation of the patient's perspective on their results and wellbeing. The aim of this review is to establish PROs as the center of healthcare and plastic surgery, to delineate important PROs in plastic surgery practice and research, to discuss the future of PROs within our discipline, and to encourage surgeons to incorporate PROs into their practice. PROs are an important parallel of clinical outcomes in that they can use the patient's perspective to 1) support clinical findings, 2) detect differences in care when there are no clear clinical differences, 3) track progress longitudinally, and 4) support systemic improvements in healthcare. Plastic surgery as a field is naturally aligned with PROs because, as a discipline, we focus on patient form and function. The emerging forefronts of plastic surgery such as lymphedema care, gender-affirming care, peripheral nerve surgery, migraine surgery, and breast implant illness are critically dependent on PROs. In the next decade, we predict that there will be a continued proliferation of robust PRO measures and integration into healthcare delivery. Outcomes research in surgery should continue to evolve as surgeons provide increasingly more benefits to improve patient wellbeing. Plastic surgeons must continue to play a prominent role in the future of PROs.
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Affiliation(s)
- Ankoor A Talwar
- Division of Plastic Surgery, University of Pennsylvania, United states
| | - Ellen F Niu
- Division of Plastic Surgery, University of Pennsylvania, United states
| | - Robyn B Broach
- Division of Plastic Surgery, University of Pennsylvania, United states
| | - Jonas A Nelson
- Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, United States
| | - John P Fischer
- Division of Plastic Surgery, University of Pennsylvania, United states.
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16
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Bascone CM, McGraw JR, Couto JA, Sulkar RS, Broach RB, Butler PD, Kovach SJ. Exploring Factors Associated with Implant Removal Satisfaction in Breast Implant Illness Patients: A PRO BREAST-Q Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5273. [PMID: 37753329 PMCID: PMC10519512 DOI: 10.1097/gox.0000000000005273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/31/2023] [Indexed: 09/28/2023]
Abstract
Background Breast implant illness (BII) is a poorly understood heterogeneous disorder treated with implant removal; however, patient-reported symptoms and outcomes after treatment remain unclear. Methods A retrospective review of patients undergoing bilateral breast implant removal related to BII by two surgeons at an academic medical center between 2018 and 2022 was conducted. Patients were surveyed using the BREAST-Q Reconstruction model with the American Society for Aesthetic Plastic Surgery BII survey extension. Outcomes were analyzed using multivariable logistic regression, adjusted for patient-associated factors. Results Forty-seven patients were surveyed with a response rate of 51% (n = 24). Of the 20 patients who completed the survey, the majority were White (85%), with 45% (n = 9) having a documented history of psychiatric illness. Six (30%) patients had capsular contracture and four (20%) had documented implant rupture. Most implant removal procedures (n = 12, 60%) were not covered by insurance. Fourteen (70%) patients reported a net improvement in their symptoms after implant removal, most commonly chest discomfort, muscle pain, fever, and headaches. Capsular contracture was predictive of reduced psychosocial, sexual, and breast satisfaction scores (P = 0.015). Self-pay was predictive of increased breast satisfaction scores (P = 0.009), but had no impact on symptomatic improvement. A reduced time to implant removal was predictive of fewer residual symptoms (P = 0.032). Psychiatric illness had no significant impact on the outcomes. Conclusions In the setting of suspected or diagnosed BII, a reduced time to implant removal may decrease the risk of residual symptoms and improve overall patient satisfaction. In patients with capsular contracture, preoperative counseling should emphasize that implant removal may only improve physical symptoms.
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Affiliation(s)
- Corey M. Bascone
- From the Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa
| | - J. Reed McGraw
- From the Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Javier A. Couto
- From the Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Reena S. Sulkar
- From the Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Robyn B. Broach
- From the Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Paris D. Butler
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
| | - Stephen J. Kovach
- From the Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa
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17
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Pompei B, Grufman V, Zoccali G, Farhadi J. Breast implant reverse surgery: A step-by-step approach. J Plast Reconstr Aesthet Surg 2023; 82:200-208. [PMID: 37186975 DOI: 10.1016/j.bjps.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 03/31/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023]
Abstract
The popularity of breast augmentation has seen a decrease in number in the recent years. Simultaneously, the request for breast implant removal has increased impressively. A total of 77 women undergoing breast implant removal with no exchange were divided into four groups depending on the type of "reverse surgery" following the explantation: simple implant removal, implant removal with lipofilling, implant removal with mastopexy, and implant removal with mastopexy and lipofilling. Following this, an algorithm was created to standardize the ideal "reverse" surgery. After surgery, all the patients were followed for at least 6 months to understand their level of satisfaction regarding the outcome of the surgery. The majority of patients were highly satisfied after explantation. Implant-related issues were found to be the main cause for explantation surgery. Capsulectomy was performed in the minority of cases, as the capsule was found to be an ideal layer for fat grafting. Grouping the patients into 4 categories allowed us to investigate a pattern behind the decision to undergo a certain type of secondary procedure and to create an algorithm with general rules that can be used as a guide for surgeons. The increased demand for this type of surgery underlines a new interesting trend in plastic surgery that, together with Breast Implant-Associated Anaplastic Large Cell Lymphoma advent, will probably have implications on the communication between surgeons and patients and most likely on the choice of choosing different ways of breast volume augmentation.
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Affiliation(s)
- Barbara Pompei
- Department of Plastic and Reconstructive Surgery, Ente Ospedaliero Cantonale, Lugano, Switzerland.
| | | | - Giovanni Zoccali
- Department of Plastic and Reconstructive Surgery-IRCCS, National Cancer Institute "Regina Elena", Italy
| | - Jian Farhadi
- Plastic Surgery Group, Zurich, Switzerland; University of Basel, Basel, Switzerland
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18
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Akpolat YT, Dryden MJ, Scoggins ME, Patel MM, Yalniz C, Hassid VJ, Whitman GJ. Imaging Features Following Breast Explant Surgery: A Pictorial Essay. Diagnostics (Basel) 2023; 13:2173. [PMID: 37443566 DOI: 10.3390/diagnostics13132173] [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: 04/10/2023] [Revised: 06/11/2023] [Accepted: 06/13/2023] [Indexed: 07/15/2023] Open
Abstract
Breast implants can be removed with breast explantation surgery (BES) for various reasons, including patient dissatisfaction, capsular contracture, implant infection or rupture, breast implant-associated anaplastic large cell lymphoma, and a recently emerging phenomenon called breast implant illness. There is very limited data on the imaging appearance after BES. A retrospective chart review was performed for patients with BES findings on imaging reports for the period between October 2016 and October 2021. When assessing BES techniques, a key element is determining whether the implant's fibrous capsule requires removal. The second important question is if the patient requires an additional aesthetic procedure after BES. BES techniques include capsulotomy, and partial, total, or en bloc capsulectomy. Adjunctive aesthetic or reconstructive procedures after BES include fat grafting, mastopexy, augmentation, and reconstruction with flaps. The majority of post-BES breast imaging findings are related to the surgical scar/bed, thereby confirming that the type of explantation surgery is important. Imaging findings after BES include focal and global asymmetries, architectural distortions, calcifications, calcified and non-calcified fat necrosis, masses, hematomas, seromas, capsular calcifications, and silicone granulomas. Most importantly, since these patients have residual breast tissue, paying attention to imaging features that are suspicious for breast cancer is necessary.
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Affiliation(s)
- Yusuf T Akpolat
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Mark J Dryden
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Marion E Scoggins
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Miral M Patel
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ceren Yalniz
- Department of Radiology Breast Imaging Section, The University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Victor J Hassid
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Gary J Whitman
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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19
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Chopra S, Khosla M, Vidya R. Innovations and Challenges in Breast Cancer Care: A Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050957. [PMID: 37241189 DOI: 10.3390/medicina59050957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023]
Abstract
Breast cancer care has seen tremendous advancements in recent years through various innovations to improve early detection, diagnosis, treatment, and survival. These innovations include advancements in imaging techniques, minimally invasive surgical techniques, targeted therapies and personalized medicine, radiation therapy, and multidisciplinary care. It is essential to recognize that challenges and limitations exist while significant advancements in breast cancer care exist. Continued research, advocacy, and efforts to address these challenges are necessary to make these innovations accessible to all patients while carefully considering and managing the ethical, social, and practical implications.
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Affiliation(s)
- Sharat Chopra
- Aneurin Bevan University Health Board, The Royal Gwent Hospital, Newport NP20 2UB, UK
| | - Muskaan Khosla
- The Royal Wolverhampton NHS Trust, Wolverhampton WV10 0QP, UK
| | - Raghavan Vidya
- The Royal Wolverhampton NHS Trust, Wolverhampton WV10 0QP, UK
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20
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Spoor J, Mureau MAM, Hommes J, Rakhorst H, Dassen AE, Oldenburg HSA, Vissers YLJ, Heuts EM, Koppert LB, Zaal LH, van der Hulst RRWJ, Vrancken Peeters MJTFD, Bleiker EMA, van Leeuwen FE. The Areola study: design and rationale of a cohort study on long-term health outcomes in women with implant-based breast reconstructions. Ann Epidemiol 2023; 82:16-25. [PMID: 37028614 DOI: 10.1016/j.annepidem.2023.04.001] [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: 07/21/2022] [Revised: 02/27/2023] [Accepted: 04/02/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Implant-based breast reconstructions contribute considerably to the quality of life of breast cancer patients. A knowledge gap exists concerning the potential role of silicone breast implants in the development of so called 'breast implant illness' and autoimmune diseases in breast cancer survivors with implant-based reconstructions. Breast implant illness (BII) is a constellation of non-specific symptoms reported by a small group of women with silicone breast implants. METHODS/DESIGN The Areola study is a multi-centre retrospective cohort study with prospective follow-up aiming to assess the risk of BII and autoimmune diseases in female breast cancer survivors with and without silicone breast implants. In this report, we set out the rationale, study design and methodology of this cohort study. The cohort consists of breast cancer survivors who received surgical treatment with implant-based reconstruction in six major hospitals across the Netherlands in the period between 2000 and 2015. As comparison group, a frequency-matched sample of breast cancer survivors without breast implants will be selected. An additional group of women who received breast augmentation surgery in the same years will be selected to compare their characteristics and health outcomes with those of breast cancer patients with implants. All women still alive will be invited to complete a web-based questionnaire covering health-related topics. The entire cohort including deceased women will be linked to population-based databases of Statistics Netherlands. These include a registry of hospital diagnostic codes, a medicines prescription registry and a cause-of-death registry, through which diagnoses of autoimmune diseases will be identified. Outcomes of interest are the prevalence and incidence of BII and autoimmune diseases. In addition, risk factors for the development of BII and autoimmune disorders will be assessed among women with implants. DISCUSSION The Areola study will contribute to the availability of reliable information on the risks of BII and autoimmune diseases in Dutch breast cancer survivors with silicone breast implants. This will inform breast cancer survivors and aid future breast cancer patients and their treating physicians to make informed decisions about reconstructive strategies after mastectomy. REGISTRATION This study is registered at ClinicalTrials.gov on June 2nd 2022 (NCT05400954).
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Affiliation(s)
- Jonathan Spoor
- Department of Epidemiology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Marc A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Juliëtte Hommes
- Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Plastic and Reconstructive Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Hinne Rakhorst
- Department of Plastic, Reconstructive and Hand Surgery, Ziekenhuis Groep Twente, Enschede, the Netherlands
| | - Anneriet E Dassen
- Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Hester S A Oldenburg
- Department of Surgical Oncology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Yvonne L J Vissers
- Department of Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Esther M Heuts
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Linetta B Koppert
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Laura H Zaal
- Department of Plastic Surgery, Velthuis kliniek, Hilversum, the Netherlands
| | - Rene R W J van der Hulst
- Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Plastic and Reconstructive Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
| | | | - Eveline M A Bleiker
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, the Netherlands; Family Cancer Clinic, Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Flora E van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
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21
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Bird GR, Niessen FB. The effect of explantation on systemic disease symptoms and quality of life in patients with breast implant illness: a prospective cohort study. Sci Rep 2022; 12:21073. [PMID: 36473891 PMCID: PMC9726875 DOI: 10.1038/s41598-022-25300-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
Silicone breast implants (SBIs) have been subject to scientific scrutiny since the 1960's because of their potential link with systemic disease symptoms. Breast implant illness (BII) is a cluster of over 56 (systemic) symptoms attributed by patients to their SBIs. BII remains an unofficial medical diagnosis, although its symptoms include but are not limited to the clinical manifestations of autoimmune/inflammatory syndrome induced by adjuvants (ASIA). The aim of this study was to prospectively analyse the effect of explantation on clinical manifestations of ASIA/BII symptoms, as well as to compare (breast-surgery specific) QoL in patients pre- and postoperatively while recording relevant perioperative/patient data. A prospective cohort study was conducted on 140 patients consulting a single surgeon for explantation of SBIs at a single clinic from 2019 to 2021 via their general practitioner, a medical specialist or self-referral. Of all patients, medical (implant) history, lifestyle factors and biometric data were obtained. Patients filled out a novel ASIA/BII symptom-survey termed the ASIA-scale, three domains of the SF-36 and the augmentation module of the BREAST-Q before and four months after the operation. A total of 109 patients completed both the pre- and postoperative survey with a mean follow-up duration of 205 days. There was a significant decrease in all individual symptom scores as well as ASIA-scale summary scores after explantation (p < .001). All SF-36 subdomains showed significant improvement postoperatively (p < .001). The BREAST-Q subdomain 'satisfaction with breasts' improved significantly after explantation (p = .036). No statistically significant association was found between any clinical parameters (such as age, capsulectomy, rupture etc.) and the recovery of symptom scores. This is the largest prospective cohort study on SBI explantation to date showing significant improvement of the most common systemic complaints in SBI patients as well as improvement of satisfaction with breasts and overall quality of life.
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Affiliation(s)
- G. R. Bird
- grid.509540.d0000 0004 6880 3010Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands ,MITTSU Institute, Amsterdam, The Netherlands
| | - F. B. Niessen
- grid.509540.d0000 0004 6880 3010Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands ,MITTSU Institute, Amsterdam, The Netherlands
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22
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Bird GR, Niessen FB. The effect of explantation on systemic disease symptoms and quality of life in patients with breast implant illness: a prospective cohort study. Sci Rep 2022; 12:21073. [PMID: 36473891 PMCID: PMC9726875 DOI: 10.1038/s41598-022-25300-4;pmid:36473891;pmcid:29pmc9726875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/28/2022] [Indexed: 06/10/2023] Open
Abstract
Silicone breast implants (SBIs) have been subject to scientific scrutiny since the 1960's because of their potential link with systemic disease symptoms. Breast implant illness (BII) is a cluster of over 56 (systemic) symptoms attributed by patients to their SBIs. BII remains an unofficial medical diagnosis, although its symptoms include but are not limited to the clinical manifestations of autoimmune/inflammatory syndrome induced by adjuvants (ASIA). The aim of this study was to prospectively analyse the effect of explantation on clinical manifestations of ASIA/BII symptoms, as well as to compare (breast-surgery specific) QoL in patients pre- and postoperatively while recording relevant perioperative/patient data. A prospective cohort study was conducted on 140 patients consulting a single surgeon for explantation of SBIs at a single clinic from 2019 to 2021 via their general practitioner, a medical specialist or self-referral. Of all patients, medical (implant) history, lifestyle factors and biometric data were obtained. Patients filled out a novel ASIA/BII symptom-survey termed the ASIA-scale, three domains of the SF-36 and the augmentation module of the BREAST-Q before and four months after the operation. A total of 109 patients completed both the pre- and postoperative survey with a mean follow-up duration of 205 days. There was a significant decrease in all individual symptom scores as well as ASIA-scale summary scores after explantation (p < .001). All SF-36 subdomains showed significant improvement postoperatively (p < .001). The BREAST-Q subdomain 'satisfaction with breasts' improved significantly after explantation (p = .036). No statistically significant association was found between any clinical parameters (such as age, capsulectomy, rupture etc.) and the recovery of symptom scores. This is the largest prospective cohort study on SBI explantation to date showing significant improvement of the most common systemic complaints in SBI patients as well as improvement of satisfaction with breasts and overall quality of life.
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Affiliation(s)
- G R Bird
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands.
- MITTSU Institute, Amsterdam, The Netherlands.
| | - F B Niessen
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
- MITTSU Institute, Amsterdam, The Netherlands
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23
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Breast Lift Algorithm for the Treatment of Breast Implant Illness Requiring Implant Removal. Aesthetic Plast Surg 2022; 47:934-943. [DOI: 10.1007/s00266-022-03178-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/06/2022] [Indexed: 11/24/2022]
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24
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Weitkunat A, Targosinski S, Bauer B, Grünert JG, Winsauer S. [The Emerging Interest in Breast Implant Illness and its impact on Patient Behavior]. HANDCHIR MIKROCHIR P 2022; 54:489-494. [PMID: 36343629 DOI: 10.1055/a-1901-9041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Breast implant illness (BII) is a loosely defined term for a collection of non-specific systemic symptoms that are hypothesised to be associated with breast implants. BII symptoms include fatigue, hair loss, rashes, chronic pain, and others. However, conclusive evidence for a causal relationship between silicone implants and BII remains lacking. In the light of recent findings that textured implants can, in rare cases, lead to breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), a potential link between breast implants and BII is conceivable and justifies further investigation. We observe a growing number of patients seeking consultation and treatment for systemic symptoms related to breast implants, which is reflected in increasing interest in literature and social media. The aim of this work was to investigate the growing interest in BII. We now describe the clinical features of a patient who suffers from symptoms that are consistent with BII and contextualise clinical presentation in a review of literature and google trend analysis.
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Affiliation(s)
- Adina Weitkunat
- Klinik für Hand-, Plastische und Wiederherstellungschirurgie, Kantonsspital St Gallen, Sankt Gallen, Switzerland
| | - Stefan Targosinski
- Klinik für Hand-, Plastische und Wiederherstellungschirurgie, Kantonsspital St Gallen, Sankt Gallen, Switzerland
| | - Benedikt Bauer
- Klinik für Hand-, Plastische und Wiederherstellungschirurgie, Kantonsspital St Gallen, Sankt Gallen, Switzerland
| | - Jörg G Grünert
- Klinik für Hand-, Plastische und Wiederherstellungschirurgie, Kantonsspital St Gallen, Sankt Gallen, Switzerland
| | - Stefan Winsauer
- Klinik für Hand-, Plastische und Wiederherstellungschirurgie, Kantonsspital St Gallen, Sankt Gallen, Switzerland
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Katsnelson JY, Goodman DA, Paterson CK, Buinewicz BR. Regional Pain Blocks and Perioperative Pain Control in Patients Undergoing Breast Implant Removal With Capsulectomy. Aesthet Surg J Open Forum 2022; 4:ojac079. [PMID: 36439052 PMCID: PMC9687820 DOI: 10.1093/asjof/ojac079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Demand for breast implant removal is on the rise, with more than 36,000 explants performed in 2020, an increase of 7.5% from previous years. Postoperative (PO) analgesia is an important consideration in this patient group due to scar tissue surrounding the implant and the potential for extensive dissection during capsulectomy. Objectives The authors sought to compare perioperative pain control between three different types of ultrasound (US)-guided regional anesthetic techniques in patients undergoing implant removal with capsulectomy. Methods The authors reviewed all patients who received an US-guided block and underwent breast implant removal with capsulectomy at their outpatient surgical center over a 2-year period. They compared intraoperative (IO), PO opioid requirement, and patient-reported pain on the first postoperative day (POD1) between 3 different block techniques using chi-square analysis. A P-value of <.05 was considered statistically significant. Results A total of 352 patients were included. Twenty-six patients (7.4%) underwent a serratus plane (SP) block, 13 (3.7%) underwent an erector spinae combined with pectointercostal fascial plane (ES + PIFP) block, and 313 (88.9%) underwent an erector spinae combined with pectoral nerve (ES + PECS1) block. ES + PECS1 was associated with less IO and PO opioid use compared with SP and ES + PIFP (1.9% vs 19.2% vs 61.5%, P < .001 for IO, 26.8% vs 34.6% vs 38.5% PO, P < .001). The ES + PECS1 block was associated with mild pain on POD1 compared with the other 2 regional block techniques (P = .001). Conclusions Regional pain blocks, and specifically the ES block, offer effective pain control for patients undergoing breast implant removal with capsulectomy, demonstrating high patient satisfaction in the PO period with low opioid requirements. Level of Evidence 3
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Affiliation(s)
- Jacob Y Katsnelson
- Corresponding Author: Dr Jacob Y. Katsnelson, Department of Surgery, Abington Memorial Hospital-Jefferson Health, 1200 Old York Road, Price Medical Office Building, Suite 604, Abington, PA 19001, USA. E-mail: ; Instagram: @jykatsmd
| | - David A Goodman
- Anesthesiologist, Department of Anesthesia, Abington Memorial Hospital-Jefferson Health, Abington, PA, USA
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BIA-ALCL-Horizon Scanning. JPRAS Open 2022; 34:245-251. [DOI: 10.1016/j.jpra.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/29/2022] [Indexed: 11/27/2022] Open
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Spoor J, de Jong D, de Boer M, Rakhorst H, van der Hulst RRJW, Vrancken Peeters MJTFD, Bleiker EMA, Mureau MAM, van Leeuwen FE. Bradford Hill and breast implant illness: no evidence for causal association with breast implants. Expert Rev Clin Immunol 2022; 18:773-775. [PMID: 35702986 DOI: 10.1080/1744666x.2022.2090339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Jonathan Spoor
- Department of Epidemiology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Daphne de Jong
- Department of Pathology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Mintsje de Boer
- Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Hinne Rakhorst
- Department of Plastic and Reconstructive Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Rene R J W van der Hulst
- Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Eveline M A Bleiker
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Marc A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Flora E van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, The Netherlands
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Spit K, Azahaf S, de Blok C, Nanayakkara P. Measuring Platinum Levels in Hair in Women with Silicone Breast Implants and Systemic Symptoms. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4373. [PMID: 35702355 PMCID: PMC9187172 DOI: 10.1097/gox.0000000000004373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/12/2022] [Indexed: 12/02/2022]
Abstract
It has been suggested that compounds present in silicone breast implants (eg, silicone particles or heavy metals such as platinum) migrate into the body and can cause systemic symptoms in susceptible women, causing what is known as breast implant illness. This pilot study investigates possible associations between hair platinum levels in patients with breast implants and breast implant illness, and evaluates its possible use for diagnostic purposes. Methods Patients were included from the silicone outpatient clinic at Amsterdam University Medical Centre. Platinum concentration in hair samples of 10 women with breast implants and systemic symptoms (group A) was compared with that in 10 women with breast implants but no symptoms (group B), and a control group of 10 women without implants or symptoms (group C), using laser ablation inductively coupled plasma mass spectrometry. Radiological imaging was used to assess implant ruptures or silicone leakage. Results A median platinum concentration of 0.09 μg per kg [IQR 0.04-0.15] was found in group A, 0.08 μg per kg [IQR 0.04-0.12] in group B, and 0.04 μg per kg [IQR 0.02-0.13] in group C, with no statistical significant difference between the groups (Kruskal-Wallis test, P = 0.43). No correlation between radiologically proven implant leakage and platinum level was found. Conclusions There was no statistically significant difference in hair platinum levels in women with or without silicone breast implants or breast implant illness. Therefore, based on this pilot study, we do not recommend this test for clinical use. Given the small sample size, more research is required to fully assess its possible use for diagnostic purposes.
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Affiliation(s)
- K.A. Spit
- From the Section General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Location VUmc, Amsterdam, the Netherlands
| | - S. Azahaf
- From the Section General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Location VUmc, Amsterdam, the Netherlands
| | - C.J.M. de Blok
- From the Section General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Location VUmc, Amsterdam, the Netherlands
| | - P.W.B. Nanayakkara
- From the 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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Breast Implant Illness: Surgical, Autoimmune, and Breast Reconstruction Associations. SURGERIES 2022. [DOI: 10.3390/surgeries3020013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Breast implant illness refers to a combination of different symptoms related to breast implant surgery, including fatigue, brain fog, and arthralgias. This malaise occurs after cosmetic and reconstructive breast surgeries, although it has not been proven to be a disease. Even recent studies have reported concluding statements of the etiology, diagnosis, and treatment as unclear and widely unknown. Therefore, this review aimed to determine the associations between the manifestations of breast implant illness in surgery and breast reconstruction, as well as the autoimmune responses involved. Complications associated with breast implants include breast pain, capsular contracture, infections, as well as other manifestations specific to breast reconstruction. Moreover, patients with implants may present with new-onset systemic sclerosis, Sjögren’s syndrome, and connective tissue diseases. However, the incidence of capsular contracture has steadily decreased with each generation of implants, particularly since the development of textured implants, as well as with the use of antibiotics and antiseptic pocket irrigation. However, the incidence of anaplastic large cell lymphoma has increased with the use of textured implants. Remarkably, the autoimmune response to these implants remains unclear. Therefore, close follow-up, careful observation of any symptom presentation, and evidence-based treatment decisions are necessary for patients with breast implants.
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Atiyeh B, Emsieh S. Breast Implant Illness (BII): Real Syndrome or a Social Media Phenomenon? A Narrative Review of the Literature. Aesthetic Plast Surg 2022; 46:43-57. [PMID: 34231017 DOI: 10.1007/s00266-021-02428-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 06/13/2021] [Indexed: 12/16/2022]
Abstract
Breast implant illness (BII) is a condition characterized by elusive diagnostic criteria and self-reported diverse disabling and distressing physical and psychological symptoms. With currently significant increase in public awareness, BII is perhaps becoming the most controversial subject in aesthetic and reconstructive breast surgery, generating heated debates between those who do not believe such a condition exists and those who demand its acceptance as a recognized diagnosis. Silicone incompatibility has been associated with "autoimmune/inflammatory syndrome induced by adjuvants" (ASIA syndrome) or Shoenfeld's syndrome. It is still unclear, however, whether BII symptoms would have occurred if no implants had been placed in the first place. The purpose of this literature review is to analyze critically the current state of scientific evidence related to this condition. Though the psychosomatic theory is most likely, the mechanism of BII symptoms is probably multifactorial. At present, BII being an underlying connective tissue disorder cannot be confirmed; moreover, whether improved aesthetic outcome and patient's overall satisfaction with the profile of their reconstructed or augmented breasts translate into decreased self-reported BII symptoms is still not well elucidated. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Bishara Atiyeh
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Saif Emsieh
- American University of Beirut Medical Center, Beirut, Lebanon.
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Pelc Z, Skórzewska M, Kurylcio A, Olko P, Dryka J, Machowiec P, Maksymowicz M, Rawicz-Pruszyński K, Polkowski W. Current Challenges in Breast Implantation. Medicina (B Aires) 2021; 57:medicina57111214. [PMID: 34833432 PMCID: PMC8625629 DOI: 10.3390/medicina57111214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/16/2021] [Accepted: 11/05/2021] [Indexed: 12/03/2022] Open
Abstract
Breast implantation (BI) is the most common plastic surgery worldwide performed among women. Generally, BI is performed both in aesthetic and oncoplastic procedures. Recently, the prevalence of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) or breast implant illness (BII) has aroused concerns. As a result, several countries, like Australia, Korea or the United Kingdom, introduced national registries dedicated to the safety and quality of BI surgeries. This narrative review aimed to focus on the clinical challenges, management and the current state of knowledge of BI. Both short and long-term outcomes of BI are determined by various alternatives and differences, which surgeons must consider during the planning and performing breast augmentation along with further complications or risk of reoperation. Proper preoperative decisions and aspects of surgical technique emerged to be equally important. The number of performed breast reconstructions is increasing, providing the finest aesthetic results and improving patient’s quality of life. Choice of prosthesis varies according to individual preferences and anatomical variables. A newly diagnosed cases of BIA-ALCL with lacking data on prevention, diagnosis, and treatment are placing it as a compelling medical challenge. Similarly, BII remains one of the most controversial subjects in reconstructive breast surgery due to unspecified diagnostic procedures, and recommendations.
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Parrish AJ, Markov NP, Michael Johnson R, Fox JP. Hospital length of stay and hospital readmission after immediate breast reconstruction in the United States: Implications for quality measurement. J Plast Reconstr Aesthet Surg 2021; 75:439-488. [PMID: 34742659 DOI: 10.1016/j.bjps.2021.09.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 04/08/2021] [Accepted: 09/27/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Andrew J Parrish
- Wright State Boonshoft School of Medicine, Department of Orthopaedic and Plastic Surgery, 30 E. Apple St., Suite 2200, Dayton, OH 45409 USA.
| | - Nickolay P Markov
- Plastic Surgery Element, Surgical Operations Squadron, 88th Medical Group, Wright Patterson Medical Center, Wright Patterson Air Force Base, Ohio USA
| | - R Michael Johnson
- Wright State Boonshoft School of Medicine, Department of Orthopaedic and Plastic Surgery, 30 E. Apple St., Suite 2200, Dayton, OH 45409 USA; Plastic Surgery Element, Surgical Operations Squadron, 88th Medical Group, Wright Patterson Medical Center, Wright Patterson Air Force Base, Ohio USA
| | - Justin P Fox
- Wright State Boonshoft School of Medicine, Department of Orthopaedic and Plastic Surgery, 30 E. Apple St., Suite 2200, Dayton, OH 45409 USA; Plastic Surgery Element, Surgical Operations Squadron, 88th Medical Group, Wright Patterson Medical Center, Wright Patterson Air Force Base, Ohio USA
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33
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Fleury EDFC. The contradiction of breast implant illness. Gland Surg 2021; 10:2081-2083. [PMID: 34268094 DOI: 10.21037/gs-21-135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/09/2021] [Indexed: 11/06/2022]
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