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Rahman MA, Amirkhani A, Mempin M, Ahn SB, Deva AK, Baker MS, Vickery K, Hu H. The Low-Abundance Plasma Proteome Reveals Differentially Abundant Proteins Associated with Breast Implant Capsular Contracture: A Pilot Study. Proteomes 2024; 12:22. [PMID: 39189262 PMCID: PMC11348101 DOI: 10.3390/proteomes12030022] [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: 05/31/2024] [Revised: 08/02/2024] [Accepted: 08/04/2024] [Indexed: 08/28/2024] Open
Abstract
Capsular contracture (CC) is one of the most common postoperative complications associated with breast implant-associated infections. The mechanisms that lead to CC remain poorly understood. Plasma is an ideal biospecimen for early proteomics biomarker discovery. However, as high-abundance proteins mask signals from low-abundance proteins, identifying novel or specific proteins as biomarkers for a particular disease has been hampered. Here, we employed depletion of high-abundance plasma proteins followed by Tandem Mass Tag (TMT)-based quantitative proteomics to compare 10 healthy control patients against 10 breast implant CC patients. A total of 450 proteins were identified from these samples. Among them, 16 proteins were significantly differentially expressed in which 5 proteins were upregulated and 11 downregulated in breast implant CC patients compared to healthy controls. Gene Ontology enrichment analysis revealed that proteins related to cell, cellular processes and catalytic activity were highest in the cellular component, biological process, and molecular function categories, respectively. Further, pathway analysis revealed that inflammatory responses, focal adhesion, platelet activation, and complement and coagulation cascades were enriched pathways. The differentially abundant proteins from TMT-based quantitative proteomics have the potential to provide important information for future mechanistic studies and in the development of breast implant CC biomarkers.
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Affiliation(s)
- Md. Arifur Rahman
- Macquarie Medical School, Macquarie University, Sydney, NSW 2109, Australia (S.B.A.); (A.K.D.); (M.S.B.); (K.V.)
| | | | - Maria Mempin
- Macquarie Medical School, Macquarie University, Sydney, NSW 2109, Australia (S.B.A.); (A.K.D.); (M.S.B.); (K.V.)
| | - Seong Beom Ahn
- Macquarie Medical School, Macquarie University, Sydney, NSW 2109, Australia (S.B.A.); (A.K.D.); (M.S.B.); (K.V.)
| | - Anand K. Deva
- Macquarie Medical School, Macquarie University, Sydney, NSW 2109, Australia (S.B.A.); (A.K.D.); (M.S.B.); (K.V.)
| | - Mark S. Baker
- Macquarie Medical School, Macquarie University, Sydney, NSW 2109, Australia (S.B.A.); (A.K.D.); (M.S.B.); (K.V.)
| | - Karen Vickery
- Macquarie Medical School, Macquarie University, Sydney, NSW 2109, Australia (S.B.A.); (A.K.D.); (M.S.B.); (K.V.)
| | - Honghua Hu
- Macquarie Medical School, Macquarie University, Sydney, NSW 2109, Australia (S.B.A.); (A.K.D.); (M.S.B.); (K.V.)
- Jinhua Institute of Zhejiang University, Jinhua 321016, China
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2
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Karakas E, Ayhan MS, Karasu O, Kocak CO, Yalinay M. In Vivo Comparison of the Efficacy and Duration of Local Antibiotics on Smooth, Textured and Polyurethane Implant Surfaces. Aesthetic Plast Surg 2024:10.1007/s00266-024-04090-2. [PMID: 38806833 DOI: 10.1007/s00266-024-04090-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/15/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Capsular contracture is one of the most common complications after breast surgery involving silicone implants. The most likely cause of this condition is biofilm formation. In this study, the efficacy of local antibiotherapy against biofilm formation on implant surfaces was investigated. METHODS Thirty-six rats were divided into six groups. Three pockets were created on the dorsum of each rat, and 1 × 2 cm implant surface samples from smooth, polyurethane and textured implants were randomly placed into pockets. All samples were inoculated with staphylococcus epidermidis. In groups 1-2-3, inoculated samples were placed into the pockets and removed after 1, 6 and 24 h, respectively. In groups 4-5-6, inoculated samples immersed with rifamycin were placed and removed after 1, 6 and 24 h, respectively. Bacterial load was measured with plate count method. RESULTS Bacterial load was lower in groups 4-5-6 than in groups 1-2-3 (p < 0.05). In groups 4-5-6, bacterial load was lower for polyurethane than for textured surfaces at all time points (1, 6 and 24 h; p < 0.05). Again, in groups 4-5-6, bacterial load was lower for smooth than for textured surfaces at 24 h (p < 0.05). In groups 4-5-6, bacterial load was lower for polyurethane than for smooth surfaces at all time points, but difference was not statistically significant (1, 6 and 24 h; p < 0.05). CONCLUSION The results suggest that local antibiotic therapy was effective in reducing the bacterial load on all surfaces. The effectiveness of local rifamycin on the polyurethane surface was higher, and the duration of activity was longer than other surfaces. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Ebubekir Karakas
- Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - M Suhan Ayhan
- Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey.
| | - Oguzhan Karasu
- Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ceren Ozkul Kocak
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - Meltem Yalinay
- Department of Medical Microbiology, Faculty of Medicine, Gazi University, Ankara, Turkey
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3
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Chow O, Hu H, Lajevardi SS, Deva AK, Atkinson RL. Preventing Bacterial Contamination of Breast Implants Using Infection Mitigation Techniques: An In Vitro Study. Aesthet Surg J 2024; 44:605-611. [PMID: 38290053 DOI: 10.1093/asj/sjae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/15/2024] [Accepted: 01/19/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Bacterial contamination of implants has been linked to biofilm formation and subsequent infection, capsular contracture, and breast implant-associated anaplastic large cell lymphoma. Reducing contamination during implant insertion should therefore reduce biofilm formation disease sequelae. OBJECTIVES The aim of this study was to compare levels of contamination between preventative techniques. METHODS A model to simulate the passage of implants through a skin incision was designed that utilized a sterile textured polyvinyl plastic sheet contaminated with Staphylococcus epidermidis. In the first stage of the polyvinyl contamination model, implants were subject to infection-mitigation techniques and passed through the incision, then placed onto horse blood agar plates and incubated for 24 hours. In the second stage of the study the same contamination was applied to human abdominal wall specimens. A 5 cm incision was made through skin and fat, then implants were passed through and levels of contamination were measured as described. RESULTS Smooth implants grew a mean of 95 colony-forming units (CFUs; approximately 1 CFU/cm2) and textured implants grew 86 CFUs (also approximately 1 CFU/cm2). CFU counts were analyzed by the Mann-Whitney U-test which showed no significant difference between implant types (P < .05); independent-sample t-tests showed a significant difference. The dependent-variable techniques were then compared as groups by one-way analysis of variance, which also showed a significant reduction compared with the control group (P < .01). CONCLUSIONS This in vitro study has shown the effectiveness of antiseptic rinse and skin/implant barrier techniques for reducing bacterial contamination of breast implants at the time of insertion.
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Schoberleitner I, Faserl K, Tripp CH, Pechriggl EJ, Sigl S, Brunner A, Zelger B, Hermann-Kleiter N, Baier L, Steinkellner T, Sarg B, Egle D, Brunner C, Wolfram D. Silicone implant surface microtopography modulates inflammation and tissue repair in capsular fibrosis. Front Immunol 2024; 15:1342895. [PMID: 38566997 PMCID: PMC10985323 DOI: 10.3389/fimmu.2024.1342895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Excessive fibrous capsule formation around silicone mammary implants (SMI) involves immune reactions to silicone. Capsular fibrosis, a common SMI complication linked to host responses, worsens with specific implant topographies. Our study with 10 patients investigated intra- and inter-individually, reduced surface roughness effects on disease progression, wound responses, chronic inflammation, and capsular composition. The results illuminate the significant impact of surface roughness on acute inflammatory responses, fibrinogen accumulation, and the subsequent fibrotic cascade. The reduction of surface roughness to an average roughness of 4 μm emerges as a promising approach for mitigating detrimental immune reactions, promoting healthy wound healing, and curbing excessive fibrosis. The identified proteins adhering to rougher surfaces shed light on potential mediators of pro-inflammatory and pro-fibrotic processes, further emphasizing the need for meticulous consideration of surface design. The composition of the implant capsule and the discovery of intracapsular HSP60 expression highlight the intricate web of stress responses and immune activation that can impact long-term tissue outcomes.
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Affiliation(s)
- Ines Schoberleitner
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Klaus Faserl
- Protein Core Facility, Institute of Medical Chemistry, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph H. Tripp
- Department of Dermatology, Venereology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elisabeth Judith Pechriggl
- Department of Anatomy, Histology and Embryology, Institute of Clinical and Functional Anatomy, Medical University of Innsbruck, Innsbruck, Austria
| | - Stephan Sigl
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Andrea Brunner
- Institute of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, Innsbruck, Austria
- INNPATH GmbH, Tirol Kliniken, Innsbruck, Austria
| | - Bettina Zelger
- Institute of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, Innsbruck, Austria
| | - Natascha Hermann-Kleiter
- Institute of Cell Genetics, Department for Genetics and Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Leoni Baier
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Theresia Steinkellner
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Bettina Sarg
- Protein Core Facility, Institute of Medical Chemistry, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniel Egle
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christine Brunner
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Dolores Wolfram
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
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Flores T, Kerschbaumer C, Jaklin FJ, Rohrbacher A, Weber M, Luft M, Aspöck C, Ströbele B, Kitzwögerer M, Lumenta DB, Bergmeister KD, Schrögendorfer KF. Gram-Positive Bacteria Increase Breast Implant-Related Complications: Prospective Analysis of 100 Revised Implants. Plast Reconstr Surg 2024; 153:76-89. [PMID: 37036325 PMCID: PMC10729897 DOI: 10.1097/prs.0000000000010499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 11/08/2022] [Indexed: 04/11/2023]
Abstract
BACKGROUND Breast implant-related complications can be reduced by strict antiseptic precautions during insertion, but bacteria can often be found on implant surfaces on the occasion of revision surgery. The authors prospectively analyzed the association of bacteria found on breast implant surfaces with implant-related complications in breast implant revision cases. METHODS The authors analyzed a total of 100 breast implant revisions in 66 patients between August of 2018 and January of 2021. Capsular swabs and capsular samples were taken intraoperatively. Analyses on the occurrence of bacteria and the occurrence of implant-related complications were performed. In addition, correlations between bacteria-contaminated breast implant surfaces and implant-related complications were performed. RESULTS Implant-related complications (perforation, rupture, capsular contraction) were observed in 42 implant sites: eight unilateral and 34 bilateral cases. In total, 16 swabs showed positive bacterial growth, 10 of which were associated with a breast implant-related complication (χ 2 = x, y, and z; P = 0.006). The most common implant-based complication at contaminated prosthetics was implant rupture. The association of contaminated breast implants and implant rupture was statistically significant. CONCLUSIONS The authors identified a correlation between implant complications and Gram-positive bacteria found on breast implant surfaces. The most common implant-based complication seen at simultaneously positive samples was implant rupture in 50% of the authors' cases. No capsular contraction or other complications were seen. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Affiliation(s)
- Tonatiuh Flores
- From the Karl Landsteiner University of Health Sciences
- Clinical Department of Plastic, Aesthetic and Reconstructive Surgery
| | - Celina Kerschbaumer
- From the Karl Landsteiner University of Health Sciences
- Clinical Department of Plastic, Aesthetic and Reconstructive Surgery
| | - Florian J. Jaklin
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna
| | | | - Michael Weber
- From the Karl Landsteiner University of Health Sciences
| | - Matthias Luft
- From the Karl Landsteiner University of Health Sciences
- Clinical Department of Plastic, Aesthetic and Reconstructive Surgery
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna
| | - Christoph Aspöck
- From the Karl Landsteiner University of Health Sciences
- Clinical Institute of Hygiene and Microbiology
| | - Barbara Ströbele
- From the Karl Landsteiner University of Health Sciences
- Clinical Institute of Hygiene and Microbiology
| | - Melitta Kitzwögerer
- From the Karl Landsteiner University of Health Sciences
- Clinical Institute for Pathology, University Clinic of St. Poelten
| | - David B. Lumenta
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz
| | - Konstantin D. Bergmeister
- From the Karl Landsteiner University of Health Sciences
- Clinical Department of Plastic, Aesthetic and Reconstructive Surgery
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna
| | - Klaus F. Schrögendorfer
- From the Karl Landsteiner University of Health Sciences
- Clinical Department of Plastic, Aesthetic and Reconstructive Surgery
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6
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Jesmer AH, Marple AST, Wylie RG. Controlled swelling of biomaterial devices for improved antifouling polymer coatings. Sci Rep 2023; 13:19950. [PMID: 37968497 PMCID: PMC10651925 DOI: 10.1038/s41598-023-47192-8] [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: 08/22/2023] [Accepted: 11/10/2023] [Indexed: 11/17/2023] Open
Abstract
Nonspecific interactions between cells and implantable elastomers often leads to failure modes for devices such as catheters, cosmetic and reconstructive implants, and sensors. To reduce these interactions, device surfaces can be coated with hydrophilic polymers, where greater polymer density enhances antifouling properties. Although graft-from coating techniques result in higher density polymer films and lower fouling in controlled settings, simpler graft-to methods show similar results on complex implanted devices, despite limited density. To address the need for improved graft-to methods, we developed Graft then shrink (GtS) where elastomeric materials are temporarily swollen during polymer grafting. Herein, we demonstrate a graft-to based method for poly(oligo(ethylene glycol) methyl ether methacrylate) (pOEGMA) on swollen silicone, GtS, that enhances grafted polymer content and fouling resistance. Total grafted polymer content of pOEGMA on toluene swollen silicone increased over ~ 13 × compared to non-swollen controls, dependent on the degree of silicone swelling. Increases in total grafted polymer within the top 200 µm of the material led to bacterial and mammalian cell adhesion reductions of 75% and 91% respectively, compared to Shrink then Graft (StG) antifouling polymer coated controls. GtS allows for the simple 3D coating of swellable elastomers (e.g., silicone medical devices) with improved antifouling pOEGMA coatings.
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Affiliation(s)
- Alexander H Jesmer
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, ON, L8S 4M1, Canada
| | - April S T Marple
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, ON, L8S 4M1, Canada
| | - Ryan G Wylie
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, ON, L8S 4M1, Canada.
- School of Biomedical Engineering, McMaster University, Hamilton, ON, L8S 4M1, Canada.
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7
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Schoberleitner I, Augustin A, Egle D, Brunner C, Amort B, Zelger B, Brunner A, Wolfram D. Is It All about Surface Topography? An Intra-Individual Clinical Outcome Analysis of Two Different Implant Surfaces in Breast Reconstruction. J Clin Med 2023; 12:jcm12041315. [PMID: 36835850 PMCID: PMC9967160 DOI: 10.3390/jcm12041315] [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: 11/30/2022] [Revised: 01/23/2023] [Accepted: 02/04/2023] [Indexed: 02/10/2023] Open
Abstract
The most common long-term complication of silicone breast implants (SMI) remains capsular fibrosis. The etiology of this exaggerated implant encapsulation is multifactorial but primarily induced by the host response towards the foreign material silicone. Identified risk factors include specific implant topographies. Of note, breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) has only been observed in response to textured surface implants. We hypothesize that reduction of SMI surface roughness causes less host response and, hence, better cosmetic outcomes with fewer complications for the patient. A total of 7 patients received the routinely used CPX®4 breast expander (~60 µM Ra) and the novel SmoothSilk® (~4 µM Ra), fixed prepectoral with a titanized mesh pocket and randomized to the left or right breast after bilateral prophylactic NSME (nipple-sparing mastectomy). We aimed to compare the postoperative outcome regarding capsule thickness, seroma formation, rippling, implant dislocation as well as comfortability and practicability. Our analysis shows that surface roughness is an influential parameter in controlling fibrotic implant encapsulation. Compared intra-individually for the first time in patients, our data confirm an improved biocompatibility with minor capsule formation around SmoothSilk® implants with an average shell roughness of 4 µM and in addition an amplification of host response by titanized implant pockets.
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Affiliation(s)
- Ines Schoberleitner
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Angela Augustin
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Daniel Egle
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Christine Brunner
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Birgit Amort
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Bettina Zelger
- Institute of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, Müllerstraße 44, A-6020 Innsbruck, Austria
| | - Andrea Brunner
- Institute of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, Müllerstraße 44, A-6020 Innsbruck, Austria
| | - Dolores Wolfram
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
- Correspondence: ; Tel.: +43-512-504-82050
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8
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Schoberleitner I, Faserl K, Sarg B, Egle D, Brunner C, Wolfram D. Quantitative Proteomic Characterization of Foreign Body Response towards Silicone Breast Implants Identifies Chronological Disease-Relevant Biomarker Dynamics. Biomolecules 2023; 13:biom13020305. [PMID: 36830674 PMCID: PMC9953687 DOI: 10.3390/biom13020305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/25/2023] [Accepted: 01/30/2023] [Indexed: 02/10/2023] Open
Abstract
The etiology of exaggerated fibrous capsule formation around silicone mammary implants (SMI) is multifactorial but primarily induced by immune mechanisms towards the foreign material silicone. The aim of this work was to understand the disease progression from implant insertion and immediate tissue damage response reflected in (a) the acute wound proteome and (b) the adsorption of chronic inflammatory wound proteins at implant surfaces. An intraindividual relative quantitation TMT-liquid chromatography-tandem mass spectrometry approach was applied to the profile wound proteome formed around SMI in the first five days post-implantation. Compared to plasma, the acute wound profile resembled a more complex composition comprising plasma-derived and locally differentially expressed proteins (DEPs). DEPs were subjected to a functional enrichment analysis, which revealed the dysregulation of signaling pathways mainly involved in immediate inflammation response and ECM turnover. Moreover, we found time-course variations in protein enrichment immediately post-implantation, which were adsorbed to SMI surfaces after 6-8 months. Characterization of the expander-adhesive proteome by a label-free approach uncovered a long-term adsorbed acute wound and the fibrosis-associated proteome. Our findings propose a wound biomarker panel for the early detection and diagnosis of excessive fibrosis that could potentially broaden insights into the characteristics of fibrotic implant encapsulation.
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Affiliation(s)
- Ines Schoberleitner
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Klaus Faserl
- Protein Core Facility, Biocenter, Institute of Medical Chemistry, Medical University of Innsbruck, Innrain 80-82, A-6020 Innsbruck, Austria
| | - Bettina Sarg
- Protein Core Facility, Biocenter, Institute of Medical Chemistry, Medical University of Innsbruck, Innrain 80-82, A-6020 Innsbruck, Austria
| | - Daniel Egle
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Christine Brunner
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Dolores Wolfram
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
- Correspondence: ; Tel.: +43-512-504-82050
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9
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Morkuzu S, Ozdemir M, Leach GA, Kanapathy M, Mosahebi A, Reid CM. Keller Funnel Efficacy in "No Touch" Breast Augmentation and Reconstruction: A Systematic Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4676. [PMID: 36448016 PMCID: PMC9699649 DOI: 10.1097/gox.0000000000004676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/29/2022] [Indexed: 01/25/2023]
Abstract
Breast augmentation is one of the most common aesthetic surgical procedures. Tissue expansion followed by permanent implants is the most frequent postmastectomy breast reconstruction method. Implant contamination remains a critical problem with these procedures' resulting in acute infection as well as capsular contracture. To reduce the risk of implant contamination, the "no-touch technique" utilizing the Keller funnel has been adopted by many surgeons. This systematic review aims to investigate the advantages of the Keller funnel method for breast augmentation-reconstruction. Methods A systematic review of PubMed, Embase, the Cochrane database, and Google Scholar was performed between 2005 and 2021. All clinical-based, retrospective and prospective studies utilizing the Keller funnel method for breast implant insertion were selected. Results Six studies were identified for evaluation: five were retrospective cohorts and one was a prospective trial. No randomized controlled trials were found. Outcomes reported included lower rates of capsular contracture (RR, 0.42; P = 0.0006; 95% CI, 0.25-0.69), shorter incision lengths (35.5 ± 2.1 mm), less insertion time (mean = 6 seconds), and decreased complications, and one paper reported ultimately greater patient satisfaction with outcomes (BREAST-Q Score: 92%). Conclusions This review suggests that the Keller funnel is a useful method for no-touch breast augmentation and reconstruction surgery. The Keller funnel reduces subsequent capsular contracture rate, surgical time, and incision length and allows for easier insertion. However, our findings support recommendation of a prospective randomized controlled clinical trial with larger population size and follow-up intervals.
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Affiliation(s)
- Suat Morkuzu
- From the Institute for Reconstructive Surgery, Houston Methodist Hospital, Houston, Tex
| | - Mehmet Ozdemir
- Department of Plastic and Reconstructive Surgery, Dicle University Hospital, Diyarbakir, Turkey
| | - Garrison A. Leach
- Division of Plastic Surgery, Department of Surgery, University of California, San Diego, San Diego, Calif
| | - Muholan Kanapathy
- Department of Plastic Surgery, Royal Free Hospital; and Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Afshin Mosahebi
- Department of Plastic Surgery, Royal Free Hospital; and Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Chris M. Reid
- Division of Plastic Surgery, Department of Surgery, University of California, San Diego, San Diego, Calif
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10
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Blum KM, Mirhaidari GJM, Zbinden JC, Breuer C, Barker JC. Tamoxifen reduces silicone implant capsule formation in a mouse model. FASEB Bioadv 2022; 4:638-647. [PMID: 36238364 PMCID: PMC9536088 DOI: 10.1096/fba.2022-00036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 05/19/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022] Open
Abstract
Capsular contracture as a result of the foreign body response (FBR) is a common issue after implant-based breast reconstruction, affecting up to 20% of patients. New evidence suggests that tamoxifen may mitigate the FBR. C57BL/6 female mice were treated with daily tamoxifen or control injections and implanted with bilateral silicone implants in the submammary glandular plane. Implants were removed en bloc after 2 weeks and the implant capsules were evaluated histologically. Tamoxifen treatment decreased capsule thickness, decreased the number of αSMA+ cells (477 ± 156 cells/mm control vs 295 ± 121 cells/mm tamoxifen, p = 0.005 unpaired t test), and decreased CD31+ cells (173.9 ± 96.1 cells/mm2 control vs 106.3 ± 51.8 cells/mm2 tamoxifen, p = 0.043 unpaired t test). There were similar amounts of pro- and anti-inflammatory macrophages (iNOS 336.1 ± 226.3 cells/mm control vs 290.6 ± 104.2 cells/mm tamoxifen, p > 0.999 Mann-Whitney test and CD163 136.6 ± 76.4 cells/mm control vs 94.1 ± 45.9 cells/mm tamoxifen, p = 0.108 unpaired t test). Tamoxifen treatment in the mouse silicone breast implant model decreased capsule formation through modulation of myofibroblasts, neovascularization, and collagen deposition. Tamoxifen may be useful for reducing or preventing capsule formation in clinical breast implantations.
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Affiliation(s)
- Kevin M. Blum
- Center for Regenerative Medicine, The Abigail Wexner Research InstituteNationwide Children's HospitalColumbusOhioUSA
- Department of Biomedical EngineeringThe Ohio State UniversityColumbusOhioUSA
| | - Gabriel J. M. Mirhaidari
- Center for Regenerative Medicine, The Abigail Wexner Research InstituteNationwide Children's HospitalColumbusOhioUSA
- Biological Sciences Graduate ProgramThe Ohio State UniversityColumbusOhioUSA
| | - Jacob C. Zbinden
- Center for Regenerative Medicine, The Abigail Wexner Research InstituteNationwide Children's HospitalColumbusOhioUSA
- Department of Biomedical EngineeringThe Ohio State UniversityColumbusOhioUSA
| | - Christopher K. Breuer
- Center for Regenerative Medicine, The Abigail Wexner Research InstituteNationwide Children's HospitalColumbusOhioUSA
| | - Jenny C. Barker
- Center for Regenerative Medicine, The Abigail Wexner Research InstituteNationwide Children's HospitalColumbusOhioUSA
- Department of Plastic and Reconstructive Surgery, Wexner Medical CenterThe Ohio State UniversityColumbusOhioUSA
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11
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Materazzo M, Vanni G, Rho M, Buonomo C, Morra E, Mori S. Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) in a young transgender woman: A case report. Int J Surg Case Rep 2022; 98:107520. [PMID: 36030763 PMCID: PMC9434022 DOI: 10.1016/j.ijscr.2022.107520] [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: 06/10/2022] [Revised: 07/26/2022] [Accepted: 08/12/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is a rare T-cell lymphoma occurring after breast implant procedures. As gender confirmation therapy (GCT) in male-to-female transgender (FT), up to 60–70 % of patients require breast augmentation and are at risk for BIA-ALCL. Hence, we report the youngest BIA-ALCL case in the Italian population and the first early-stage BIA-ALCL occurred in FT patients. Case presentation A 27-years-old FT was admitted to outpatients' clinics due to swollen left breast. The patient underwent GCT with a macrotextured implant four years before. Clinical examination revealed swollen left breast. Ultrasound and magnetic resonance imaging confirmed left breast periprosthetic effusion. Positron emission tomography-computed tomography scan did not reveal any focal pathological uptake. Fine needle aspiration cytology confirmed BIA-ALCL suspect. The patient underwent bilateral en bloc breast implant removal and periprosthetic capsulectomy. Due to the early stage, adjuvant chemotherapy was omitted. Postoperative follow-up was unremarkable. Clinical discussion BIA-ALCL is a rare, emergent clinical concern after breast implant surgery. GCT leads to improved body satisfaction and quality of life in FT individuals. As for non-trans patients undergoing breast reconstruction or breast augmentation, this clinical case once again demonstrates that FT patients undergoing breast implant surgery are at risk of BIA-ALCL. Conclusion Physicians should promote awareness among patients' GCT and tailored postoperative follow-up. Breast implants are associated with BIA-ALCL, a rare t-cell cell lymphoma. Cold seroma several years after breast implant surgery is the most common symptom. Up to 70 % of male-to-female transgender patients require breast augmentation. Clinicians should be aware of BIA-ALCL after breast implants in male-to-female transgender.
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Affiliation(s)
- Marco Materazzo
- Oncoplastic Interdepartmental Unit, Istituto Nazionale Tumori IRCCS, Fondazione Pascale, Via Mariano Semmola, 52, 80131 Napoli, Italy; Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Viale Oxford, 81, 00133 Rome, Italy
| | - Gianluca Vanni
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Viale Oxford, 81, 00133 Rome, Italy
| | - Maurizio Rho
- Oncoplastic Interdepartmental Unit, Istituto Nazionale Tumori IRCCS, Fondazione Pascale, Via Mariano Semmola, 52, 80131 Napoli, Italy; Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Viale Oxford, 81, 00133 Rome, Italy.
| | - Chiara Buonomo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Viale Oxford, 81, 00133 Rome, Italy
| | - Emanuela Morra
- Oncoplastic Interdepartmental Unit, Istituto Nazionale Tumori IRCCS, Fondazione Pascale, Via Mariano Semmola, 52, 80131 Napoli, Italy
| | - Stefano Mori
- Oncoplastic Interdepartmental Unit, Istituto Nazionale Tumori IRCCS, Fondazione Pascale, Via Mariano Semmola, 52, 80131 Napoli, Italy.
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12
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Guimier E, Carson L, David B, Lambert JM, Heery E, Malcolm RK. Pharmacological Approaches for the Prevention of Breast Implant Capsular Contracture. J Surg Res 2022; 280:129-150. [PMID: 35969932 DOI: 10.1016/j.jss.2022.06.073] [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: 11/02/2021] [Revised: 06/17/2022] [Accepted: 06/29/2022] [Indexed: 11/15/2022]
Abstract
Capsular contracture is a common complication associated with breast implants following reconstructive or aesthetic surgery in which a tight or constricting scar tissue capsule forms around the implant, often distorting the breast shape and resulting in chronic pain. Capsulectomy (involving full removal of the capsule surrounding the implant) and capsulotomy (where the capsule is released and/or partly removed to create more space for the implant) are the most common surgical procedures used to treat capsular contracture. Various structural modifications of the implant device (including use of textured implants, submuscular placement of the implant, and the use of polyurethane-coated implants) and surgical strategies (including pre-operative skin washing and irrigation of the implant pocket with antibiotics) have been and/or are currently used to help reduce the incidence of capsular contracture. In this article, we review the pharmacological approaches-both commonly practiced in the clinic and experimental-reported in the scientific and clinical literature aimed at either preventing or treating capsular contracture, including (i) pre- and post-operative intravenous administration of drug substances, (ii) systemic (usually oral) administration of drugs before and after surgery, (iii) modification of the implant surface with grafted drug substances, (iv) irrigation of the implant or peri-implant tissue with drugs prior to implantation, and (v) incorporation of drugs into the implant shell or filler prior to surgery followed by drug release in situ after implantation.
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Affiliation(s)
| | - Louise Carson
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - Benny David
- NuSil Technology LLC, Carpinteria, California
| | | | | | - R Karl Malcolm
- School of Pharmacy, Queen's University Belfast, Belfast, UK.
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13
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Jeon HJ, Kang M, Lee JS, Kang J, Kim EA, Jin HK, Bae JS, Yang JD. Impact on capsule formation for three different types of implant surface tomography. Sci Rep 2022; 12:13535. [PMID: 35941148 PMCID: PMC9360403 DOI: 10.1038/s41598-022-17320-x] [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: 11/02/2021] [Accepted: 07/25/2022] [Indexed: 11/09/2022] Open
Abstract
Although capsular contracture remains one of the major problems following silicone breast implantation, the associated mechanism has yet to be determined. This study thus aimed to investigate capsule formation and capsular contracture using three types of implants with different surface topographies in vivo. Three types of implants (i.e., smooth, macrotexture, and nanotexture) with different surface topographies were inserted in a total of 48 Wistar rats. After 4 and 12 weeks, the samples were analyzed via histological, immunohistochemical, and Western blot examination. To identify implant movement, the degree to which implant position changed was measured. And the surface topography was characterized using scanning electron microscopy. Hematoxylin–eosin staining showed that the nanotexture type implant promoted significant decreases in capsule thickness at 12 weeks (P < 0.05), while Masson trichrome staining showed decreased collagen fiber density with the same implant type. Immunohistochemical and Western blot examination revealed reduced fibrosis markers (myofibroblast, and transforming growth factor beta-1) in the nanotexture surface implant. Meanwhile, implant location evaluation found that the nanotexture and smooth surface implants had significantly increased movement (P < 0.05). The nanotexture surface implant had been found to reduce capsule formation given that it minimizes the effects of factors related to foreign body reaction.
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Affiliation(s)
- Hyeon Jun Jeon
- Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu, 700-421, Korea
| | - MyeongJae Kang
- Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu, 700-421, Korea
| | - Joon Seok Lee
- Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu, 700-421, Korea
| | - Jieun Kang
- Cell and Matrix Research Institute, Kyungpook National University School of Medicine, Daegu, Korea
| | - Eun A Kim
- Exosome Convergence Research Center, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hee Kyung Jin
- Department of Laboratory Animal Medicine, College of Veterinary Medicine, Kyungpook National University, Daegu, Korea
| | - Jae-Sung Bae
- Department of Physiology, Cell and Matrix Research Institute, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jung Dug Yang
- Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu, 700-421, Korea.
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14
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Rahman MA, Amirkhani A, Chowdhury D, Mempin M, Molloy MP, Deva AK, Vickery K, Hu H. Proteome of Staphylococcus aureus Biofilm Changes Significantly with Aging. Int J Mol Sci 2022; 23:6415. [PMID: 35742863 PMCID: PMC9223533 DOI: 10.3390/ijms23126415] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/30/2022] [Accepted: 06/06/2022] [Indexed: 01/15/2023] Open
Abstract
Staphylococcus aureus is a notorious biofilm-producing pathogen that is frequently isolated from implantable medical device infections. As biofilm ages, it becomes more tolerant to antimicrobial treatment leading to treatment failure and necessitating the costly removal of infected devices. In this study, we performed in-solution digestion followed by TMT-based high-throughput mass spectrometry and investigated what changes occur in the proteome of S. aureus biofilm grown for 3-days and 12-days in comparison with 24 h planktonic. It showed that proteins associated with biosynthetic processes, ABC transporter pathway, virulence proteins, and shikimate kinase pathway were significantly upregulated in a 3-day biofilm, while proteins associated with sugar transporter, degradation, and stress response were downregulated. Interestingly, in a 3-day biofilm, we observed numerous proteins involved in the central metabolism pathways which could lead to biofilm growth under diverse environments by providing an alternative metabolic route to utilize energy. In 12-day biofilms, proteins associated with peptidoglycan biosynthesis, sugar transporters, and stress responses were upregulated, whereas proteins associated with ABC transporters, DNA replication, and adhesion proteins were downregulated. Gene Ontology analysis revealed that more proteins are involved in metabolic processes in 3dwb compared with 12dwb. Furthermore, we observed significant variations in the formation of biofilms resulting from changes in the level of metabolic activity in the different growth modes of biofilms that could be a significant factor in S. aureus biofilm maturation and persistence. Collectively, potential marker proteins were identified and further characterized to understand their exact role in S. aureus biofilm development, which may shed light on possible new therapeutic regimes in the treatment of biofilm-related implant-associated infections.
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Affiliation(s)
- Md. Arifur Rahman
- Surgical Infection Research Group, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney 2109, Australia; (D.C.); (M.M.); (A.K.D.); (K.V.)
| | - Ardeshir Amirkhani
- Australian Proteome Analysis Facility, Macquarie University, Sydney 2109, Australia; (A.A.); (M.P.M.)
| | - Durdana Chowdhury
- Surgical Infection Research Group, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney 2109, Australia; (D.C.); (M.M.); (A.K.D.); (K.V.)
| | - Maria Mempin
- Surgical Infection Research Group, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney 2109, Australia; (D.C.); (M.M.); (A.K.D.); (K.V.)
| | - Mark P. Molloy
- Australian Proteome Analysis Facility, Macquarie University, Sydney 2109, Australia; (A.A.); (M.P.M.)
| | - Anand Kumar Deva
- Surgical Infection Research Group, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney 2109, Australia; (D.C.); (M.M.); (A.K.D.); (K.V.)
| | - Karen Vickery
- Surgical Infection Research Group, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney 2109, Australia; (D.C.); (M.M.); (A.K.D.); (K.V.)
| | - Honghua Hu
- Surgical Infection Research Group, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney 2109, Australia; (D.C.); (M.M.); (A.K.D.); (K.V.)
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15
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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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16
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Liu X, Song YJ, Chen X, Huang MY, Zhao CX, Zhou X, Zhou X. Asiaticoside Combined With Carbon Ion Implantation to Improve the Biocompatibility of Silicone Rubber and to Reduce the Risk of Capsule Contracture. Front Bioeng Biotechnol 2022; 10:810244. [PMID: 35646845 PMCID: PMC9133697 DOI: 10.3389/fbioe.2022.810244] [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: 12/02/2021] [Accepted: 04/25/2022] [Indexed: 11/19/2022] Open
Abstract
Capsular contracture caused by silicone rubber is a critical issue in plastic surgery that urgently needs to be solved. Studies have shown that carbon ion implant in silicone rubber (carbon silicone rubber, C-SR) can significantly improve the capsular structure, but the effect of this improvement only appear 2months or later. In this study, asiaticoside combined with carbon silicone rubber was used to explore the changes in the capsule to provide a reference for the treatment of capsule contracture. Human fibroblasts (HFF-1) were used for in vitro experiments. The combined effect of asiaticoside and carbon silicone rubber on cell proliferation was determined by the CCK8 method, cell migration changes were measured by Transwell assays, cell cycle changes were measured by flow cytometry, and the expression levels of fibroblast transformation markers (vimentin and α-SMA), collagen (Col-1A1) and TGF-β/Smad signaling pathway-related proteins (TGF-β1, TβRI, TβRII and Smad2/3) were detected by immunofluorescence. In vivo experiments were carried out by subcutaneous implantation of the material in SD rats, and asiaticoside was oral administered simultaneously. WB and ELISA were used to detect changes in the expression of TGF-β/Smad signaling pathway-related proteins. TGF-β/Smad signaling pathway proteins were then detected and confirmed by HE, Masson and immunohistochemical staining. The results shown that asiaticoside combined with carbon ion implantation inhibited the viability, proliferation and migration of fibroblasts on silicone rubber. In vitro immunofluorescence showed that the secretion levels of α-SMA and Col-1A1 were significantly decreased, the transformation of fibroblasts into myofibroblasts was weakened, and the TGF-β/Smad signaling pathway was inhibited. In vivo experimental results showed that asiaticoside combined with carbon silicone rubber inhibited TGF-β1 secretion and inhibited the TGF-β/Smad signaling pathway, reducing the thickness of the capsule and collagen deposition. These results imply that carbon silicone rubber combined with asiaticoside can regulate the viability, proliferation and migration of fibroblasts by inhibiting the TGF-β/Smad signaling pathway and reduce capsule thickness and collagen deposition, which greatly reduces the incidence of capsule contracture.
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Affiliation(s)
- Xing Liu
- Department of Cosmetology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Ya-Jun Song
- Department of Urology, Xinqiao Hospital, The Army Medical University, Chongqing, China
| | - Xing Chen
- Department of Cosmetology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Meng-Ya Huang
- Department of Cosmetology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Chen-Xi Zhao
- Department of Cosmetology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Xun Zhou
- Department of Cosmetology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
- *Correspondence: Xun Zhou, ; Xin Zhou,
| | - Xin Zhou
- Department of Pathology, Bishan Hospital, The Chongqing Medical University, Chongqing, China
- *Correspondence: Xun Zhou, ; Xin Zhou,
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17
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Yoo H, Park JU, Chang H. Comprehensive Evaluation of the Current Knowledge on Breast Implant Associated-Anaplastic Large Cell Lymphoma. Arch Plast Surg 2022; 49:141-149. [PMID: 35832665 PMCID: PMC9045542 DOI: 10.1055/s-0042-1744422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a recently spotlighted T-cell origin non-Hodgkin's lymphoma with an increasing incidence of over 800 cases and 33 deaths reported worldwide. Development of BIA-ALCL is likely a complex process involving many factors, such as the textured implant surface, bacterial biofilm growth, immune response, and patient genetics. As the incidence of BIA-ALCL is expected to increase, it is important for all surgeons and physicians to be aware of this disease entity and acquire thorough knowledge of current evidence-based guidelines and recommendations. Early detection, accurate diagnosis, and appropriate treatment are the foundations of current care.
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Affiliation(s)
- Hyokyung Yoo
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji-Ung Park
- Department of Plastic and Reconstructive Surgery, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hak Chang
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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18
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A Preliminary Retrospective Study to Assess the Short-Term Safety of Traditional Smooth or Microtextured Silicone Gel-Filled Breast Implants in Korea. Medicina (B Aires) 2021; 57:medicina57121370. [PMID: 34946315 PMCID: PMC8705802 DOI: 10.3390/medicina57121370] [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: 11/24/2021] [Revised: 12/09/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022] Open
Abstract
Background and objectives: We conducted this preliminary retrospective study to assess the short-term safety of silicone gel-filled breast implants (SGBIs) that are commercially available in Korean women. Materials and methods :The current retrospective, observational study was conducted in a total of 2612 patients (n = 2612) who underwent augmentation mammaplasty using breast implants at our hospitals between 1 January 2017 and 31 August 2021. Results: Overall, there were a total of 248 cases (9.49%) of postoperative complications; these include 112 cases of early seroma, 52 cases of shape deformation, 32 cases of CC, 12 cases of early hematoma, 12 cases of rupture, 12 cases of infection, 12 cases of stretch deformities with skin excess and 4 cases of rippling. Overall complication-free survival of the breast implant was estimated at 1564.32 ± 75.52 days (95% CI 1416.39–1712.32). Then, the Motiva Ergonomix™ SilkSurface showed the longest survival (1528.00 ± 157.92 days [95% CI 1218.48–1837.56]), followed by the BellaGel® SmoothFine (1458.4 ± 65.76 days [95% CI 1329.56–1587.28]), the Sebbin® Sublimity (1322.00 ± 51.20 days [95% CI 1221.64–1422.32]), the BellaGel® Smooth (1138.72 ± 161.28 days [95% CI 822.6–1454.84), the Mentor® MemoryGel™ Xtra (698.4 ± 52.64 days [95% CI 595.28–801.52]) and the Natrelle® INSPIRA™ (380.00 ± 170.88 days [95% CI 45.04–714.96]) in the decreasing order. On subgroup analysis, both the Motiva ErgonomixTM and Mentor® MemoryGel™ Xtra showed no postoperative complications. However, the BellaGel® SmoothFine, Sebbin® Sublimity and BellaGel® Smooth showed incidences of 8.87%, 4.84% and 1.61%, respectively. A subgroup analysis also showed differences in incidences of postoperative complications between microtextured and smooth breast implants (15.18% vs. 16.67%). Conclusions: In conclusion, our results indicate that diverse types of an SGBI are commercially available and their safety profile varies according to the manufacturer. Plastic surgeons should consider the safety profile of each device in selecting the optimal types of the device for Korean women who are in need of an implant-based augmentation mammaplasty. However, this warrants a single-surgeon, single-center study with long periods of follow-up.
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19
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Lam M, Falentin-Daudré C. Implication of the Nature and Texturation of Silicone Surfaces on the Grafting of PolyNaSS, a Bioactive Polymer. Ing Rech Biomed 2021. [DOI: 10.1016/j.irbm.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Shi XH, Zhou X, Lei ZY, Tian Y, Chen Y, Zhang YM, Mao TC, Fan DL, Zhou SW. Novel silicone rubber with carboxyl grafted polyhedral oligomeric silsesquioxane (POSS-COOH) as a potential scaffold for soft tissue filling. INT J POLYM MATER PO 2021. [DOI: 10.1080/00914037.2021.1999951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Xiao-hua Shi
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Army Medical University, Chong Qing, China
- Base for Drug Clinical Trial, Xinqiao Hospital, The Army Medical University, Chong Qing, China
| | - Xin Zhou
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Army Medical University, Chong Qing, China
| | - Ze-yuan Lei
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Army Medical University, Chong Qing, China
| | - Yuan Tian
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Army Medical University, Chong Qing, China
| | - Yao Chen
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Army Medical University, Chong Qing, China
| | - Yi-ming Zhang
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Army Medical University, Chong Qing, China
| | - Tong-chun Mao
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Army Medical University, Chong Qing, China
| | - Dong-li Fan
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Army Medical University, Chong Qing, China
| | - Shi-wen Zhou
- Base for Drug Clinical Trial, Xinqiao Hospital, The Army Medical University, Chong Qing, China
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21
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Lee S, Jeong JP, Sung JY, Choi WS, Moon DS, Kim HC, Kim JH. High-Resolution Ultrasound-Assisted Assessment of Preliminary Short-term Safety Outcomes of an Implant-Based Augmentation Mammaplasty Using a Bioengineered, Cell-Friendly, Smooth-Surface Device in Korean Females. Aesthet Surg J Open Forum 2021; 4:ojab046. [PMID: 35072069 PMCID: PMC8781774 DOI: 10.1093/asjof/ojab046] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The Motiva Ergonomix Round SilkSurface (Establishment Labs Holdings Inc., Alajuela, Costa Rica) is one of the representative brands of the fifth generation of a silicone gel-filled breast implant with a microtextured surface. OBJECTIVES In this study, the authors describe preliminary short-term safety outcomes of an implant-based augmentation mammaplasty using the Motiva Ergonomix Round SilkSurface in Korean females. METHODS The authors performed a retrospective analysis of medical records in a total of 69 females (n = 69) receiving an implant-based augmentation mammaplasty using the Motiva Ergonomix Round SilkSurface between September 26, 2017, and December 31, 2020. The authors analyzed incidences of postoperative complications. RESULTS A total of 6 cases (8.7%) of postoperative complications occurred; these include 2 cases (2.9%) of early seroma, 1 case (1.4%) of capsular contracture, 2 cases (2.9%) of alterations in the shape, and 1 case (1.4%) of foreign body sensation. Time-to-events were estimated at 266.81 ± 273.17 days. CONCLUSIONS The authors describe our preliminary short-term safety outcomes of an implant-based augmentation mammaplasty using the Motiva Ergonomix Round SilkSurface in Korean females. But this deserves further large-scale studies with long periods of follow-up. LEVEL OF EVIDENCE 4
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Affiliation(s)
| | | | | | | | | | | | - Jae Hong Kim
- Corresponding Author: Dr Jae Hong Kim, 9F Kukdong B/D, 596 Gangnam-daero, Gangnam-gu, Seoul 06626, Korea. E-mail:
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22
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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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23
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The surface topography of silicone breast implants mediates the foreign body response in mice, rabbits and humans. Nat Biomed Eng 2021; 5:1115-1130. [PMID: 34155355 DOI: 10.1038/s41551-021-00739-4] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 04/28/2021] [Indexed: 02/07/2023]
Abstract
Silicone is widely used in chronic implants and is generally perceived to be safe. However, textured breast implants have been associated with immune-related complications, including malignancies. Here, by examining for up to one year the foreign body response and capsular fibrosis triggered by miniaturized or full-scale clinically approved breast implants with different surface topography (average roughness, 0-90 μm) placed in the mammary fat pads of mice or rabbits, respectively, we show that surface topography mediates immune responses to the implants. We also show that the surface surrounding human breast implants collected during revision surgeries also differentially alters the individual's immune responses to the implant. Moreover, miniaturized implants with an average roughness of 4 μm can largely suppress the foreign body response and fibrosis (but not in T-cell-deficient mice), and that tissue surrounding these implants displayed higher levels of immunosuppressive FOXP3+ regulatory T cells. Our findings suggest that, amongst the topographies investigated, implants with an average roughness of 4 μm provoke the least amount of inflammation and foreign body response.
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Rezende-Pereira G, Albuquerque JP, Souza MC, Nogueira BA, Silva MG, Hirata R, Mattos-Guaraldi AL, Duarte RS, Neves FPG. Biofilm Formation on Breast Implant Surfaces by Major Gram-Positive Bacterial Pathogens. Aesthet Surg J 2021; 41:1144-1151. [PMID: 33378420 DOI: 10.1093/asj/sjaa416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Bacterial biofilm on surfaces of mammary implants is a predisposing factor for several outcomes. Because Gram-positive bacteria are potential agents of biomaterial-associated infections (BAIs), their abilities to form biofilm on breast implants should be elucidated. OBJECTIVES The aim of this study was to evaluate biofilm formation on different mammary prosthesis surfaces by major Gram-positive bacterial pathogens involved in BAIs. METHODS We initially evaluated biofilm formation on polystyrene plates with and without fibrinogen or collagen for 1 reference strain and 1 clinical isolate of Enterococcus faecalis, Staphylococcus aureus, Staphylococcus epidermidis, and Streptococcus pyogenes. We also tested the ability of clinical isolates to form biofilm on 4 different implant surfaces: polyurethane foam and smooth, microtextured, and standard textured silicone. Biofilm structure and cell viability were observed by scanning electron microscopy and confocal laser scanning microscopy. RESULTS All strains showed strong biofilm formation on polystyrene. After fibrinogen or collagen treatment, biofilm formation varied. With fibrinogen, reference strains of S. aureus and S. pyogenes increased biofilm formation (P < 0.05). Reference strains of all species and the clinical isolate of S. pyogenes increased biofilm formation after collagen treatment (P < 0.05). In general, S. aureus showed higher capacity to produce biofilm. Scanning electron microscopy showed that biofilm attached to all surfaces tested, with the presence of extracellular polymeric substances and voids. Viable cells were more frequent for E. faecalis and S. pyogenes. CONCLUSIONS All species produced biofilm on all prosthesis surfaces and under different conditions. Micrographies indicated thicker bacterial biofilm formation on microtextured and/or standard textured silicone by all species, except E. faecalis.
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Affiliation(s)
| | | | - Monica C Souza
- Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Barbara A Nogueira
- Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Marlei G Silva
- Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Raphael Hirata
- Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Ana L Mattos-Guaraldi
- Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Rafael S Duarte
- Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Felipe P G Neves
- Instituto Biomédico, Universidade Federal Fluminense, Niterói, RJ, Brazil
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Zare M, Ghomi ER, Venkatraman PD, Ramakrishna S. Silicone‐based biomaterials for biomedical applications: Antimicrobial strategies and 3D printing technologies. J Appl Polym Sci 2021. [DOI: 10.1002/app.50969] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Mina Zare
- Center for Nanotechnology and Sustainability, Department of Mechanical Engineering National University of Singapore Singapore Singapore
| | - Erfan Rezvani Ghomi
- Center for Nanotechnology and Sustainability, Department of Mechanical Engineering National University of Singapore Singapore Singapore
| | | | - Seeram Ramakrishna
- Center for Nanotechnology and Sustainability, Department of Mechanical Engineering National University of Singapore Singapore Singapore
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Nai GA, Medina DAL, Martelli CAT, de Oliveira MSC, Portelinha MJS, Henriques BC, Caldeira ID, Almeida MDC, Eller LKW, de Oliveira Neto FV, Marques MEA. Does washing medical devices before and after use decrease bacterial contamination?: An in vitro study. Medicine (Baltimore) 2021; 100:e25285. [PMID: 33787613 PMCID: PMC8021368 DOI: 10.1097/md.0000000000025285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 02/01/2021] [Accepted: 03/08/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT Surface treatment of medical devices may be a way of avoiding the need for replacement of these devices and the comorbidities associated with infection. The aim of this study was to evaluate whether pre- and postcontamination washing of 2 prostheses with different textures can decrease bacterial contamination.The following microorganisms were evaluated: Staphylococcus aureus, Staphylococcus epidermidis, Proteus mirabilis and Enterococcus faecalis. Silicone and expanded polytetrafluoroethylene vascular prostheses were used and divided into 3 groups: prostheses contaminated; prostheses contaminated and treated before contamination; and prostheses contaminated and treated after contamination. Treatments were performed with antibiotic solution, chlorhexidine and lidocaine. After one week of incubation, the prostheses were sown in culture medium, which was incubated for 48 hours. The area of colony formation was evaluated by fractal dimension, an image analysis tool.The antibiotic solution inhibited the growth of S epidermidis and chlorhexidine decrease in 53% the colonization density for S aureus in for both prostheses in the pre-washing. In postcontamination washing, the antibiotic solution inhibited the growth of all bacteria evaluated; there was a 60% decrease in the colonization density of S aureus and absence of colonization for E faecalis with chlorhexidine; and lidocaine inhibited the growth of S aureus in both prostheses.Antibiotic solution showed the highest efficiency in inhibiting bacterial growth, especially for S epidermidis, in both washings. Lidocaine was able to reduce colonization by S aureus in post-contamination washing, showing that it can be used as an alternative adjuvant treatment in these cases.
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Affiliation(s)
- Gisele Alborghetti Nai
- Department of Pathology
- Graduate Program in Health Sciences
- Graduate Program in Animal Science
- School of Medicine
| | | | | | | | | | | | | | - Mércia de Carvalho Almeida
- School of Medicine
- Department of Microbiology, Universidade do Oeste Paulista (UNOESTE), Presidente Prudente, SP, Brazil
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Materazzo M, Vanni G, Pellicciaro M, Anemona L, Servadei F, Giacobbi E, Farinaccio A, Pistolese CA, Perretta T, Chiocchi M, Bruno V, Tacconi F, Sadri A, De Majo A, Di Pasquali C, Meucci R, Santori F, Cotesta M, Buonomo OC. Case Report: Early Breast Cancer Recurrence Mimicking BIA-ALCL in a Patient With Multiple Breast Procedures. Front Surg 2021; 8:606864. [PMID: 33768110 PMCID: PMC7985528 DOI: 10.3389/fsurg.2021.606864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 02/18/2021] [Indexed: 12/02/2022] Open
Abstract
Breast reconstruction plays a fundamental role in the therapeutic process of breast cancer treatment and breast implants represents the leading breast reconstruction strategy. Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL), locoregional recurrence in the skin flap, and skin flap necrosis are well-known complications following mastectomy and immediate breast reconstruction (IBR). We report a case of locoregional cancer recurrence in the mastectomy flap mimicking BIA-ALCL, in a patient who underwent 6 breast procedures in four facilities across 15 years including immediate breast reconstruction with macrotextured breast implants. Despite the rate and onset of the disease, clinicians should be aware of BIA-ALCL. Due to the risk of false negative results of fine needle aspiration, clinical suspicion of BIA-ALCL should drive clinicians' choices, aside from cytological results. In the present case, surgical capsulectomy of the abnormal periprosthesic tissue revealed locoregional recurrence.
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Affiliation(s)
- Marco Materazzo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Gianluca Vanni
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Marco Pellicciaro
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Lucia Anemona
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata University, Rome, Italy
| | - Francesca Servadei
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata University, Rome, Italy
| | - Erika Giacobbi
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata University, Rome, Italy
| | - Andrea Farinaccio
- Department of Cardiothoracic Anesthesia, Tor Vergata University Hospital, Rome, Italy
| | - Chiara Adriana Pistolese
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Tommaso Perretta
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Marcello Chiocchi
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Valentina Bruno
- Section of Gynecology and Obstetrics, Academic Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
| | - Federico Tacconi
- Division of Thoracic Surgery, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Amir Sadri
- Plastic Surgery, Great Hormond Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Adriano De Majo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Camilla Di Pasquali
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Rosaria Meucci
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Francesca Santori
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Maria Cotesta
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Oreste Claudio Buonomo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
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Montemurro P, Cheema M, Hedén P. In search for the 'perfect' breast implant: are textured implants still indicated in today's breast augmentation practice? J Plast Surg Hand Surg 2021; 55:302-308. [PMID: 33612069 DOI: 10.1080/2000656x.2021.1883630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The popularity of breast augmentation procedure has driven research and debate as to whether any given implant characteristic offers a functional advantage. One such debate exists about the role of surface texturing. In the aftermath of the recent withdrawal of aggressively textured surfaces we would like to summarize the first author's experience of nearly 1500 primary aesthetic breast augmentations with different surfaces and offer our thoughts on this topic. All consecutive primary breast augmentations operated by the first author from January 2010 to June 2019 were included. All patients had silicone implants inserted via inframammary incision. Of all the operated cases, 1029 consecutive female patients had at least 6 months' follow-up (mean 15.1 months). Their mean age was 31.2 years, mean BMI 20.8 kg/m2 and mean implant volume was 311 cc. 997(96.9%) patients had dual plane and 32(3.1%) had sub-glandular implant placement. In total 113 patients (11.0%) developed a complication. This represented 15.1% of those with round and 10.0% of anatomical shape (or 10.6% of textured and 14.5% of smooth surface implants). As clinicians, we like patients to receive all the advantages of an implant but not be exposed to any risks. However, in reality, such a 'perfect implant' still does not exist. New literature continues to shed light on this trade-off between an implant's perceived utility and its complications profile. We hope that the search for an alternative technology, with more beneficial surface characteristics and less drawbacks, continues.
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Affiliation(s)
| | - Mubashir Cheema
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Lam M, Migonney V, Falentin-Daudre C. Review of silicone surface modification techniques and coatings for antibacterial/antimicrobial applications to improve breast implant surfaces. Acta Biomater 2021; 121:68-88. [PMID: 33212233 DOI: 10.1016/j.actbio.2020.11.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/12/2020] [Accepted: 11/12/2020] [Indexed: 12/19/2022]
Abstract
Silicone implants are widely used in the medical field for plastic or reconstructive surgeries for the purpose of soft tissue issues. However, as with any implanted object, healthcare-associated infections are not completely avoidable. The material suffers from a lack of biocompatibility and is often subject to bacterial/microbial infections characterized by biofilm growth. Numerous strategies have been developed to either prevent, reduce, or fight bacterial adhesion by providing an antibacterial property. The present review summarizes the diverse approaches to deal with bacterial infections on silicone surfaces along with the different methods to activate/oxidize the surface before any surface modifications. It includes antibacterial coatings with antibiotics or nanoparticles, covalent attachment of active bacterial molecules like peptides or polymers. Regarding silicone surfaces, the activation step is essential to render the surface reactive for any further modifications using energy sources (plasma, UV, ozone) or chemicals (acid solutions, sol-gel strategies, chemical vapor deposition). Meanwhile, corresponding work on breast silicone prosthesis is discussed. The latter is currently in the line of sight for causing severe capsular contractures. Specifically, to that end, besides chemical modifications, the antibacterial effect can also be achieved by physical surface modifications by adjusting the surface roughness and topography for instance.
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Ganon S, Morinet S, Serror K, Mimoun M, Chaouat M, Boccara D. Epidemiology and Prevention of Breast Prosthesis Capsular Contracture Recurrence. Aesthetic Plast Surg 2021; 45:15-23. [PMID: 32696162 DOI: 10.1007/s00266-020-01876-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 07/05/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Baker grade III and IV breast prosthesis capsular contractures represent a major problem for patients undergoing mammoplasties. The risk factors involved in recurrence are debated, and the best surgical approach for their prevention is not established. The objective was to identify these. MATERIALS AND METHODS We carried out a retrospective study of patients operated on for capsular contracture at the Saint-Louis Hospital in Paris from 2012 to 2014. The characteristics at inclusion were compared so as to determine the risk factors of recurrence. The surgical approaches were compared between the patients with recurrence and those without at 5 years. RESULTS Of the 100 patients included, 24 had a recurrence. The minimal follow-up was 5 years. No risk factors of recurrence of capsular contracture were identified. The surgical approach associated with the lowest rate of recurrence was anterior capsulectomy [OR total capsulectomy = 2.36 (0.73; 8.037) OR capsulotomy = 4.33 (1.37; 14.81)] (p < 0.040) with alteration of the volume of the implant, whether greater or less than initially [OR greater volume = 0.30 (0.096; 0.83); OR smaller volume = 0.14 (0.008; 0.85)] (p < 0.018). CONCLUSION The occurrence of capsular contracture is a major problem with prosthetic breast surgery. The main risk factors identified to date are essentially in regard to the occurrence of a first episode. No significant risk factors for recurrence were identified. The best prevention appears to be an anterior capsulectomy with reducing the volume of the implant. 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 . IV.
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3D Printing and NIR Fluorescence Imaging Techniques for the Fabrication of Implants. MATERIALS 2020; 13:ma13214819. [PMID: 33126650 PMCID: PMC7662749 DOI: 10.3390/ma13214819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/19/2020] [Accepted: 10/27/2020] [Indexed: 12/17/2022]
Abstract
Three-dimensional (3D) printing technology holds great potential to fabricate complex constructs in the field of regenerative medicine. Researchers in the surgical fields have used 3D printing techniques and their associated biomaterials for education, training, consultation, organ transplantation, plastic surgery, surgical planning, dentures, and more. In addition, the universal utilization of 3D printing techniques enables researchers to exploit different types of hardware and software in, for example, the surgical fields. To realize the 3D-printed structures to implant them in the body and tissue regeneration, it is important to understand 3D printing technology and its enabling technologies. This paper concisely reviews 3D printing techniques in terms of hardware, software, and materials with a focus on surgery. In addition, it reviews bioprinting technology and a non-invasive monitoring method using near-infrared (NIR) fluorescence, with special attention to the 3D-bioprinted tissue constructs. NIR fluorescence imaging applied to 3D printing technology can play a significant role in monitoring the therapeutic efficacy of 3D structures for clinical implants. Consequently, these techniques can provide individually customized products and improve the treatment outcome of surgeries.
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Perry L, Radzevich J, Kelter D, Gott M, Slotman G, Kulkarni N, Gundlapalli V. Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). Am Surg 2020; 88:2065-2067. [PMID: 32931319 DOI: 10.1177/0003134820951422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Luke Perry
- 375822 Department of Surgery, Inspira Health Network, Vineland, NJ, USA
| | - Joseph Radzevich
- 375822 Department of Surgery, Inspira Health Network, Vineland, NJ, USA
| | - David Kelter
- 375822 Department of Surgery, Inspira Health Network, Vineland, NJ, USA
| | - Melissa Gott
- 375822 Department of Surgery, Inspira Health Network, Vineland, NJ, USA
| | - Gus Slotman
- 375822 Department of Surgery, Inspira Health Network, Vineland, NJ, USA
| | - Nandini Kulkarni
- 375822 Department of Surgery, Inspira Health Network, Vineland, NJ, USA
| | - Vinay Gundlapalli
- 375822 Department of Surgery, Inspira Health Network, Vineland, NJ, USA
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Public Perceptions on Breast Implant–Associated Anaplastic Large Cell Lymphoma. Plast Reconstr Surg 2020; 146:30-37. [DOI: 10.1097/prs.0000000000006889] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Surface Texturization of Breast Implants Impacts Extracellular Matrix and Inflammatory Gene Expression in Asymptomatic Capsules. Plast Reconstr Surg 2020; 145:542e-551e. [PMID: 32097311 DOI: 10.1097/prs.0000000000006606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Texturing processes have been designed to improve biocompatibility and mechanical anchoring of breast implants. However, a high degree of texturing has been associated with severe abnormalities. In this study, the authors aimed to determine whether implant surface topography could also affect physiology of asymptomatic capsules. METHODS The authors collected topographic measurements from 17 different breast implant devices by interferometry and radiographic microtomography. Morphologic structures were analyzed statistically to obtain a robust breast implant surface classification. The authors obtained three topographic categories of textured implants (i.e., "peak and valleys," "open cavities," and "semiopened cavities") based on the cross-sectional aspects. The authors simultaneously collected 31 Baker grade I capsules, sorted them according to the new classification, established their molecular profile, and examined the tissue organization. RESULTS Each of the categories showed distinct expression patterns of genes associated with the extracellular matrix (Timp and Mmp members) and inflammatory response (Saa1, Tnsf11, and Il8), despite originating from healthy capsules. In addition, slight variations were observed in the organization of capsular tissues at the histologic level. CONCLUSIONS The authors combined a novel surface implant classification system and gene profiling analysis to show that implant surface topography is a bioactive cue that can trigger gene expression changes in surrounding tissue, even in Baker grade I capsules. The authors' new classification system avoids confusion regarding the word "texture," and could be transposed to implant ranges of every manufacturer. This new classification could prove useful in studies on potential links between specific texturizations and the incidence of certain breast-implant associated complications.
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Manahan MA. What Surgeons Should Know About Breast Reconstruction for Oncology Patients. CURRENT SURGERY REPORTS 2020. [DOI: 10.1007/s40137-020-00260-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Breast Implant Illness: A Biofilm Hypothesis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2755. [PMID: 32440423 PMCID: PMC7209857 DOI: 10.1097/gox.0000000000002755] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/11/2020] [Indexed: 12/28/2022]
Abstract
Background "Breast implant illness" (BII) is a poorly defined cluster of nonspecific symptoms, attributed by patients as being caused by their breast implants. These symptoms can include joint pain, skin and hair changes, concentration, and fatigue. Many patients complaining of BII symptoms are dismissed as psychosomatic. There are currently over 10,000 peer-reviewed articles on breast implants, but at the time of commencing this study, only 2 articles discussed this entity. At the same time, mainstream media and social media are exploding with nonscientific discussion about BII. Methods We have prospectively followed 50 consecutive patients, self-referring for explantation due to BII. We analyzed their preoperative symptoms and followed up each patient with a Patient-Reported Outcome Questionnaire. All implants and capsules were, if possible, removed en bloc. Explanted implants were photographed. Implant shell and capsule sent for histology and microbiological culture. Results BII symptoms were not shown to correlate with any particular implant type, surface, or fill. There was no significant finding as to duration of implant or location of original surgery. Chronic infection was found in 36% of cases with Propionibacterium acnes the most common finding. Histologically, synoviocyte metaplasia was found in a significantly greater incidence than a matched cohort that had no BII symptoms (P = 0.0164). Eighty-four percent of patients reported partial or complete resolution of BII symptoms on Patient-Reported Outcome Questionnaire. None of the 50 patients would consider having breast implants again. Conclusion The authors believe BII to be a genuine entity worthy of further study. We have identified microbiological and histological abnormalities in a significant number of patients identifying as having BII. A large proportion of these patients have reported resolution or improvement of their symptoms in patient-reported outcomes. Improved microbiology culture techniques may identify a larger proportion of chronic infection, and further investigation of immune phenotypes and toxicology may also be warranted in this group.
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Lam M, Moris V, Humblot V, Migonney V, Falentin-Daudre C. A simple way to graft a bioactive polymer – Polystyrene sodium sulfonate on silicone surfaces. Eur Polym J 2020. [DOI: 10.1016/j.eurpolymj.2020.109608] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Breast implant-associated anaplastic large-cell lymphoma: first case detected in a Japanese breast cancer patient. Breast Cancer 2020; 27:499-504. [PMID: 32095988 PMCID: PMC7196092 DOI: 10.1007/s12282-020-01064-5] [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: 09/10/2019] [Accepted: 02/10/2020] [Indexed: 02/07/2023]
Abstract
This paper details the first breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) case detected in Japan. The patient, a 67-year-old Japanese woman, was diagnosed with left unilateral breast cancer 17 years ago. Induration and redness presented in the left breast, which had undergone immediate breast reconstructive surgery using a tissue expander, later replaced by a silicone breast implant (SBI). Breast ultrasound showed fluid collection around the SBI. Surgery was performed to remove the left breast implant and the fragmented capsule surrounding the implant. Postoperative pathological findings did not indicate malignancy. Nine months later, a contralateral axillary lymphadenopathy was observed, and an excisional biopsy of the axillary lymph node was performed. The patient was diagnosed with BIA-ALCL and successfully underwent adjuvant CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) chemotherapy.
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Comparison of round smooth and shaped micro-textured implants in terms of quality of life and aesthetic outcomes in women undergoing breast reconstruction: a single-centre prospective study. Updates Surg 2020; 72:537-546. [PMID: 32062785 DOI: 10.1007/s13304-020-00721-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 02/05/2020] [Indexed: 02/06/2023]
Abstract
Breast cancer (BC) is the most frequent cancer among women, impacting 2.1 million women each year and having caused 627,000 deaths in 2018. In Italy, BC represents the first cancer diagnosis with 53,000 new cases in 2019 and the first cause of mortality for cancer among the female population. Breast implants represent the first reconstructive choice after mastectomy: in Italy, 411,000 prostheses have been implanted since 2010 and more than 95% of them are macro-texturized. The attempt to reduce complications such as capsular contracture, rotation and rupture of the prosthesis and the most recent BIA-ALCL association with macro-texturized implants have led to the development of new materials and the refinement of implants' coating techniques. We carried out a 1-year prospective single-centre study to evaluate patient-reported quality of life (QoL) and aesthetic outcomes after breast reconstructive surgery using two different prostheses: shaped micro-textured implants and round smooth implants. We treated 62 patients with radical or conservative mastectomy followed by reconstructive surgery performed with 44 shaped implants and 48 round implants. Quality of life evaluated through the Breast-Q®-questionnaire showed high scores of psycho-social well being in both groups, as well as pre- and post-operative aesthetic satisfaction and physical well being. Round smooth implants appear to be better in terms of softness, volume and less association with rippling, whereas shaped micro-textured implants prove to be better in the profile delineation. This study confirms the potentialities of both shaped micro-textured and round smooth implants in reconstructive surgery.
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Tolksdorf J, Horch RE, Grüner JS, Schmid R, Kengelbach-Weigand A, Schubert DW, Werner S, Schneidereit D, Friedrich O, Ludolph I. Size matters-in vitro behaviour of human fibroblasts on textured silicone surfaces with different pore sizes. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2020; 31:23. [PMID: 32016560 PMCID: PMC6997250 DOI: 10.1007/s10856-020-6360-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/07/2020] [Indexed: 05/14/2023]
Abstract
Capsular contracture remains a challenge in plastic surgery and represents one of the most common postoperative complications following alloplastic breast reconstruction. The impact of the surface structure of silicone implants on the foreign body reaction and the behaviour of connective tissue-producing cells has already been discussed. The aim of this study was to investigate different pore sizes of silicone surfaces and their influence on human fibroblasts in an in vitro model. Four different textures (no, fine, medium and coarse texture) produced with the salt-loss technique, have been assessed in an in vitro model. Human fibroblasts were seeded onto silicone sheets and evaluated after 1, 4 and 7 days microscopically, with viability assay and gene expression analysis. Comparing the growth behaviour and adhesion of the fibroblasts on the four different textures, a dense cell layer, good adhesion and bridge-building ability of the cells could be observed for the fine and medium texture. Cell number and viability of the cells were increasing during the time course of experiments on every texture. TGFß1 was lowest expressed on the fine and medium texture indicating a trend for decreased fibrotic activity. For silicone surfaces produced with the salt-loss technique, we were able to show an antifibrotic effect of smaller sized pores. These findings underline the hypothesis of a key role of the implant surface and the pore size and pore structure in preventing capsular contracture.
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Affiliation(s)
- Julia Tolksdorf
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital of Erlangen Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Raymund E Horch
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital of Erlangen Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Jasmin S Grüner
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital of Erlangen Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Rafael Schmid
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital of Erlangen Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Annika Kengelbach-Weigand
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital of Erlangen Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Dirk W Schubert
- Institute of Polymer Materials, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Martensstrasse 7, 91058, Erlangen, Germany
| | - Siegfried Werner
- Institute of Polymer Materials, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Martensstrasse 7, 91058, Erlangen, Germany
| | - Dominik Schneidereit
- Institute of Medical Biotechnology, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Paul-Gordan-Str. 3, 91052, Erlangen, Germany
| | - Oliver Friedrich
- Institute of Medical Biotechnology, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Paul-Gordan-Str. 3, 91052, Erlangen, Germany
| | - Ingo Ludolph
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital of Erlangen Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Germany.
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41
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A multi-center, retrospective, preliminary observational study to assess the safety of BellaGel® after augmentation mammaplasty. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-020-01626-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Abstract
Background
BellaGel® is the only cohesive silicone gel-filled breast implant from a Korean manufacturer, and it was first developed in 2005. It was approved by the CE in 2008, thus becoming the first Asian breast implant available in the EU. We conducted this study to assess the safety of BellaGel® in patients receiving augmentation mammaplasty.
Methods
We evaluated a consecutive series of 239 patients (478 breasts) who received esthetic augmentation mammaplasty using the BellaGel® (round smooth, round textured, round nanotextured, and anatomical textured types of implant) (HansBiomed Co. Ltd., Seoul, Korea) at three clinics in Korea (JW Plastic Surgery Center, BS The Body Plastic Surgery Clinic and Grace Plastic Surgery Clinic) during a period from December 1, 2015 to January 31, 2018.
Results
A total of 239 patients with a mean age of 33.1 ± 8.5 years old were followed up during a mean period of 399.58 ± 232.71 days, where there were no cases of capsular contracture in our clinical series of the patients. Other complications include one case (0.4%) of seroma, three cases (1.3%) of hematoma, and one case (0.4%) of infection. Moreover, there were no significant differences in the cumulative incidences of complications between the four types of the BellaGel® (χ2 = 2.322, df = 3, P = 0.508). Furthermore, the cumulative Kaplan-Meier survival rate was estimated at 0.979 (95% CI 0.961–0.997).
Conclusions
Our results indicate that the BellaGel® is such a safe breast implant that surgeons might consider using it for esthetic augmentation mammaplasty.
Level of evidence: Level III, risk/prognostic study.
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Abstract
This review discusses the historical development of smooth and textured silicone gel filled implants, and examines the reasoning behind product development and aspects of surgical technique from a surgeon's perspective.
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Affiliation(s)
- D Perry
- Anglia Ruskin University, Chelmsford, UK
| | - J D Frame
- Anglia Ruskin University, Chelmsford, UK
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43
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Vickery K. Special Issue: Microbial Biofilms in Healthcare: Formation, Prevention and Treatment. MATERIALS 2019; 12:ma12122001. [PMID: 31234513 PMCID: PMC6630215 DOI: 10.3390/ma12122001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 12/20/2022]
Abstract
Biofilms are a structured community of microorganisms that are attached to a surface. Individual bacteria are embedded in a bacterial-secreted matrix. Biofilms have significantly increased tolerance to removal by cleaning agents and killing by disinfectants and antibiotics. This special issue is devoted to diagnosis and treatment of biofilm-related diseases in man. It highlights the differences between the biofilm and planktonic (single cell) lifestyles and the diseases biofilms cause from periodontitis to breast implant capsular contracture. Biofilm-specific treatment options are detailed in experimental and review manuscripts.
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Affiliation(s)
- Karen Vickery
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney 2109, Australia.
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Costa D, Johani K, Melo D, Lopes L, Lopes Lima L, Tipple A, Hu H, Vickery K. Biofilm contamination of high‐touched surfaces in intensive care units: epidemiology and potential impacts. Lett Appl Microbiol 2019; 68:269-276. [DOI: 10.1111/lam.13127] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 11/28/2022]
Affiliation(s)
- D.M. Costa
- Surgical Infection Research Group Faculty of Medicine and Health Sciences Macquarie University Sydney NSW Australia
- Faculty of Nursing Federal University of Goiás Goiania Brazil
| | - K. Johani
- Surgical Infection Research Group Faculty of Medicine and Health Sciences Macquarie University Sydney NSW Australia
- Central Military Laboratories and Blood Bank Prince Sultan Military Medical City Riyadh Saudi Arabia
| | - D.S. Melo
- Faculty of Nursing Federal University of Goiás Goiania Brazil
| | - L.K.O. Lopes
- Faculty of Nursing Federal University of Goiás Goiania Brazil
| | | | - A.F.V. Tipple
- Surgical Infection Research Group Faculty of Medicine and Health Sciences Macquarie University Sydney NSW Australia
| | - H. Hu
- Surgical Infection Research Group Faculty of Medicine and Health Sciences Macquarie University Sydney NSW Australia
| | - K. Vickery
- Surgical Infection Research Group Faculty of Medicine and Health Sciences Macquarie University Sydney NSW Australia
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