1
|
Kim N, Cho WK, Park W, Lee JE, Nam SJ, Kim SW, Yu J, Chae BJ, Lee SK, Ryu JM, Ko ES, Kim H. Outcomes of whole breast radiation therapy in Asian breast cancer patients with prior cosmetic implants. Breast Cancer 2024; 31:391-400. [PMID: 38368487 DOI: 10.1007/s12282-024-01547-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/16/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND As breast augmentation has become more popular, an increasing number of women with augmented breasts require treatment for breast cancer. This study aimed to assess the outcomes of postoperative whole breast radiation therapy (WB-RT) in Asian patients with breast cancer who underwent prior cosmetic breast implantation. METHODS We retrospectively reviewed the medical records of 61 patients with breast cancer who had prior cosmetic breast implants (prior-CBI) and underwent breast-conserving surgery (BCS) and WB-RT between 2015 and 2020. The median implant volume was 238.8 cc, with a median interval of 84.7 months between the prior-CBI and BCS. WB-RT was administered with either conventional fractionation (CF-RT) at 50 Gy in 25 fractions (N = 36) or hypofractionation (HF-RT) at 42.6 Gy in 16 fractions (N = 25). The incidences of implant-related complications (IRC) and their contributing factors were analyzed. RESULTS After a median follow-up of 43.5 months, the 3-year cumulative incidences of IRC and implant loss were 17.2% and 4.9%, respectively. Among the four (6.6%) patients who opted for implant removal after RT, three were potentially related to RT-related capsular contracture. There was no difference in the 3-year cumulative IRC rates following CF-RT and HF-RT (12.2% and 26.7%, respectively; p = 0.120). The risk factors for IRC included a larger implant size (> 260 cc) and a higher ratio of breast tissue to implant volume. CONCLUSIONS This study demonstrated a favorable safety profile of WB-RT for treatment of breast cancer in Asian women with prior-CBI. The integration of HF-RT following BCS was thought to be a feasible approach.
Collapse
Affiliation(s)
- Nalee Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Won Kyung Cho
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Jeong Eon Lee
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seok Jin Nam
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seok Won Kim
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jonghan Yu
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byung Joo Chae
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sei Kyung Lee
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jai-Min Ryu
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Sook Ko
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Haeyoung Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea.
| |
Collapse
|
2
|
Vinci V, Belgiovine C, Janszen G, Agnelli B, Pellegrino L, Calcaterra F, Cancellara A, Ciceri R, Benedetti A, Cardenas C, Colombo F, Supino D, Lozito A, Caimi E, Monari M, Klinger FM, Riccipetitoni G, Raffaele A, Comoli P, Allavena P, Mavilio D, Di Landro L, Klinger M, Rusconi R. Breast implant surface topography triggers a chronic-like inflammatory response. Life Sci Alliance 2024; 7:e202302132. [PMID: 38383454 PMCID: PMC10881835 DOI: 10.26508/lsa.202302132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 02/23/2024] Open
Abstract
Breast implants are extensively employed for both reconstructive and esthetic purposes. However, the safety of breast implants with textured surfaces has been questioned, owing to a potential correlation with anaplastic large-cell lymphoma and the recurrence of breast cancer. This study investigates the immune response elicited by different prosthetic surfaces, focusing on the comparison between macrotextured and microtextured breast implants. Through the analysis of intraoperatively harvested periprosthetic fluids and cell culture experiments on surface replicas, we demonstrate that macrotextured surfaces elicit a more pronounced chronic-like activation of leucocytes and an increased release of inflammatory cytokines, in contrast to microtextured surfaces. In addition, in vitro fluorescent imaging of leucocytes revealed an accumulation of lymphocytes within the cavities of the macrotextured surfaces, indicating that the physical entrapment of these cells may contribute to their activation. These findings suggest that the topography of implant surfaces plays a significant role in promoting a chronic-like inflammatory environment, which could be a contributing factor in the development of lymphomas associated with a wide range of implantable devices.
Collapse
Affiliation(s)
- Valeriano Vinci
- IRCCS Humanitas Research Hospital, Rozzano, Italy
- https://ror.org/020dggs04 Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Cristina Belgiovine
- IRCCS Humanitas Research Hospital, Rozzano, Italy
- https://ror.org/00s6t1f81 Department of Clinical, Surgical, Diagnostics and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Gerardus Janszen
- Department of Aerospace Science and Technology, Politecnico di Milano, Milan, Italy
| | - Benedetta Agnelli
- https://ror.org/020dggs04 Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Luca Pellegrino
- https://ror.org/020dggs04 Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Francesca Calcaterra
- IRCCS Humanitas Research Hospital, Rozzano, Italy
- https://ror.org/00wjc7c48 Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
| | - Assunta Cancellara
- IRCCS Humanitas Research Hospital, Rozzano, Italy
- https://ror.org/00wjc7c48 Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
| | - Roberta Ciceri
- IRCCS Humanitas Research Hospital, Rozzano, Italy
- https://ror.org/00wjc7c48 Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
| | - Alessandra Benedetti
- Department of Aerospace Science and Technology, Politecnico di Milano, Milan, Italy
| | | | | | | | - Alessia Lozito
- https://ror.org/020dggs04 Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Edoardo Caimi
- https://ror.org/020dggs04 Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Marta Monari
- IRCCS Humanitas Research Hospital, Rozzano, Italy
| | | | - Giovanna Riccipetitoni
- https://ror.org/00s6t1f81 Department of Clinical, Surgical, Diagnostics and Pediatric Sciences, University of Pavia, Pavia, Italy
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | | | - Paola Allavena
- IRCCS Humanitas Research Hospital, Rozzano, Italy
- https://ror.org/020dggs04 Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Domenico Mavilio
- IRCCS Humanitas Research Hospital, Rozzano, Italy
- https://ror.org/00wjc7c48 Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
| | - Luca Di Landro
- Department of Aerospace Science and Technology, Politecnico di Milano, Milan, Italy
| | - Marco Klinger
- IRCCS Humanitas Research Hospital, Rozzano, Italy
- https://ror.org/00wjc7c48 Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
| | - Roberto Rusconi
- IRCCS Humanitas Research Hospital, Rozzano, Italy
- https://ror.org/020dggs04 Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| |
Collapse
|
3
|
Krivanek TJ, Powell LE, Deshpande SS, Landis GH. Assessing Readability of US Food and Drug Administration-Required Labeling for Breast Implants. Plast Reconstr Surg 2024; 153:1050e-1052e. [PMID: 37749798 DOI: 10.1097/prs.0000000000011091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Affiliation(s)
- Taylor J Krivanek
- Division of Plastic Surgery, Department of Surgery, University of Minnesota Medical Center, Minneapolis, MN
| | | | | | | |
Collapse
|
4
|
ElSherif A, Bernard S, Djohan R, Atallah A, Tu C, Valente SA. Nipple necrosis rate with submuscular versus prepectoral implant-based reconstruction in nipple sparing mastectomy: Does it differ? Am J Surg 2024; 230:57-62. [PMID: 38071140 DOI: 10.1016/j.amjsurg.2023.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/09/2023] [Accepted: 11/27/2023] [Indexed: 03/22/2024]
Abstract
BACKGROUND This study aims to compare the rate of nipple necrosis between the submuscular (SM) versus the prepectoral (PP) implant placement after immediate breast reconstruction (IBR). METHODS An institutional review board-approved database was reviewed of patients who underwent nipple sparing mastectomy (NSM) with IBR at our institution between 2016 and 2019. Patients who had SM versus PP IBR were compared. Incidence of nipple necrosis was evaluated between the two groups. RESULTS A total of 525 NSM with IBR were performed in 320 patients with SM reconstruction in 61% (n = 322) and PP in 39% (n = 203) of the mastectomies. Overall, 43 nipples experienced some form of necrosis with 1% of mastectomies experiencing nipple loss. There was no difference between SM group and PP group at the rate of nipple necrosis (9 % vs 7 %, P = 0.71). CONCLUSION In patients undergoing NSM with IBR, the rate of nipple necrosis, nipple loss or complications did not differ between groups whether the implant was placed SM or PP, supporting the safety of this newer procedure.
Collapse
Affiliation(s)
- Ayat ElSherif
- Division of Breast Surgery, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Steven Bernard
- Department of Plastic & Reconstructive Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Risal Djohan
- Department of Plastic & Reconstructive Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Amani Atallah
- Division of Breast Surgery, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Chao Tu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Stephanie A Valente
- Division of Breast Surgery, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA.
| |
Collapse
|
5
|
Vorstenbosch J, Ghione P, Plitas G, Horwitz S, Kim M, Cordeiro P, Nelson J, McCarthy C. ASO Visual Abstract: Surgical Management and Long-Term Outcomes of BIA-ALCL: A Multidisciplinary Approach. Ann Surg Oncol 2024; 31:2042-2043. [PMID: 38117389 DOI: 10.1245/s10434-023-14733-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Affiliation(s)
| | - Paola Ghione
- Lymphoma Section, Department of Medicine, Roswell Park Comprehensive Cancer Centre, Buffalo, NY, USA
| | - George Plitas
- Breast Surgical Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Steven Horwitz
- Hematology and Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Minji Kim
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peter Cordeiro
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonas Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Colleen McCarthy
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|
6
|
Rochlin D, Matros E, Lee C, Sheckter C. The Financial Impact of S Code Termination for Autologous Breast Reconstruction: Considerations for Patient Access. Plast Reconstr Surg 2024; 153:658e-660e. [PMID: 37566527 PMCID: PMC10858972 DOI: 10.1097/prs.0000000000010983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Affiliation(s)
- Danielle Rochlin
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Evan Matros
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Clara Lee
- Department of Plastic and Reconstructive Surgery, The Ohio State University, Columbus, OH
| | - Clifford Sheckter
- Division of Plastic and Reconstructive Surgery and S-SPIRE Center, Department of Surgery, Stanford University School of Medicine, Stanford, CA
| |
Collapse
|
7
|
Araujo AS, Silva RMV, Souza DN. Evaluation of conventional IMRT and VMAT strategies for postmastectomy radiation therapy after immediate implant-based reconstruction using the new ESTRO-ACROP contouring guidelines. Radiat Environ Biophys 2024; 63:59-70. [PMID: 38300284 DOI: 10.1007/s00411-024-01059-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 01/03/2024] [Indexed: 02/02/2024]
Abstract
This study evaluated the usability of conventional templates based on the new contour guidelines of the European Society of Radiation and Oncology and Advisory Committee in Radiation Oncology Practice (ESTRO-ACROP) for treatment plans of postmastectomy radiotherapy after immediate implant-based reconstruction. Intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) plans generated with two different treatment planning systems (TPSs, Eclipse and Monaco) were examined. Six computed tomography scans of patients aged 35-54 years were retrospectively analysed who had undergone mastectomy and breast reconstruction using silicone implants after being diagnosed with left breast cancer. Six radiation oncologists participated in this study, and each of them contoured the target volume of one left breast using conventional contour (CTV-CONV) and new contour (CTV-ESTRO) methods. This study showed that compared with CTV-CONV, using CTV-ESTRO with objectives and cost functions similar to those of TPSs worsened the target volume coverage and increased the total number of monitor units. Considering the organs at risk, CTV-ESTRO tended to increase the mean dose delivered to the contralateral lung. It is concluded that the approach used for the new ESTRO-ACROP contour method cannot be applied in a manner similar to that for the conventional breast contour method, implying that the new ESTRO-ACROP contour method may require more time for improving plans for a given treatment.
Collapse
Affiliation(s)
- Andreyson S Araujo
- Departamento de Física, Universidade Federal de Sergipe, São Cristóvão, SE, 49100-000, Brazil
| | | | - Divanizia N Souza
- Departamento de Física, Universidade Federal de Sergipe, São Cristóvão, SE, 49100-000, Brazil.
| |
Collapse
|
8
|
Zhang T, Ye J, Tian T. Implant Based Breast Reconstruction Using a Titanium-Coated Polypropylene Mesh (TiLOOP® Bra): A Systematic Review and Meta-analysis. Aesthetic Plast Surg 2024; 48:925-935. [PMID: 37464216 DOI: 10.1007/s00266-023-03500-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/30/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Implant-based breast reconstruction (IBBR) can be performed using a variety of biological and synthetic meshes. However, there has yet to be a consensus on the optimal mesh. This study investigates the safety and patient satisfaction of using TiLOOP® Bra in IBBR and compares its postoperative complication risk with that of porcine acellular dermal matrix (ADM) and SERAGYN® BR. METHODS The literature review was performed via PRISMA criteria, 23 studies met the inclusion criteria for the TiLOOP® Bra review, and 5 studies met the inclusion criteria for the meta-analysis. Patient characteristics and per-breast complications were collected. Data were analyzed using Cochrane RevMan and IBM SPSS. RESULTS In 3175 breasts of 2685 patients that underwent IBBR using TiLOOP® Bra, rippling was observed as the most common complication, followed by seroma and capsular contracture. No significant difference in the overall complication rate between pre- and sub-pectoral IBBR using TiLOOP® Bra. However, the meta-analysis showed that the TiLOOP® Bra group had significantly lower odds of implant loss, seroma, wound dehiscence, and the need for reoperation or hospitalization than the ADM group. Additionally, the TiLOOP® Bra group had a significantly lower seroma rate compared to the SERAGYN® BR group, while the other outcome indicators were similar between the two groups. CONCLUSION TiLOOP® Bra has become increasingly popular in IBBR in recent years. This review and meta-analysis support the favorable safety profile of TiLOOP® Bra reported in the current literature. The meta-analysis revealed that TiLOOP® Bra has better safety than ADM and a comparable risk of complications compared to SERAGYN® BR. However, as most studies had low levels of evidence, further investigations are necessary. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
- Tingjian Zhang
- General Surgery Department, Yongchuan Hospital of Chongqing Medical University, No. 439, Xuanhua Road, Yongchuan District, Chongqing, 402160, China
| | - Jing Ye
- Department of Surgery, Maternal and Child Health Hospital of Yongchuan, Chongqing, 402160, China
| | - Tian Tian
- General Surgery Department, Yongchuan Hospital of Chongqing Medical University, No. 439, Xuanhua Road, Yongchuan District, Chongqing, 402160, China.
| |
Collapse
|
9
|
Fritsch H, Celik M, Warm M, Thangarajah F, Vogel-Minea C, Malter W, Pisek A, Eichler C. Sonographic Assessment of Breast Implants Using Strain Elastography and Shear Wave Elastography in an Animal Model. Anticancer Res 2024; 44:497-501. [PMID: 38307560 DOI: 10.21873/anticanres.16837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND/AIM To date, magnetic resonance imaging (MRI) remains the gold standard for diagnosing breast implant rupture. As MRI is an expensive procedure with limited availability, the improvement of sonographic assessment is desirable. A potentially useful tool in this regard is elastography. To evaluate the diagnostic benefits of strain elastography and shear wave elastography under standardized conditions we developed an animal model. MATERIALS AND METHODS An animal model was created by preparing an implant site in a chicken breast, imitating tissue layers covering a breast implant after mastectomy. Different broken and intact implants were inserted. Thereby, measurements were performed using strain elastography and shear wave elastography. For strain elastography, the resulting images were investigated on repeated patterns. The data generated by shear wave elastography were analyzed for significant differences between the ruptured and intact implants. RESULTS The animal model using chicken breast generated realistic images and measurements comparable to those of a human breast. Hence, ruptured and intact implants could be compared under standardized conditions. Statistical analysis showed no significant difference between intact and ruptured implants with respect to the data generated by shear wave elastography. Qualitative analysis using strain wave elastography showed different patterns between intact and ruptured implants in the animal model. Intact implants showed a characteristic sonographic image of three layers in certain levels. CONCLUSION Shear wave elastography does not seem to produce reliable data for the evaluation of breast implants, whereas qualitative analysis using strain elastography might be a useful tool to improve diagnostic accuracy.
Collapse
Affiliation(s)
- Hanna Fritsch
- St. Franziskus Hospital Muenster, Breast Cancer Center, Muenster, Germany;
| | - Melisa Celik
- Department of Gynaecology and Obstetrics, University Hospital Cologne, Cologne, Germany
| | - Matthias Warm
- Breast Cancer Center, Municipal Hospital Holweide, Cologne, Germany
| | - Fabinshy Thangarajah
- Department of Gynaecology and Obstetrics, University Hospital Duisburg-Essen, Essen, Germany
| | - Claudia Vogel-Minea
- Department of Diagnostic and Interventional Senology, Breast Cancer Center, Rottal-Inn Kliniken Eggenfelden, Eggenfelden, Germany
| | - Wolfram Malter
- Department of Gynaecology and Obstetrics, University Hospital Cologne, Cologne, Germany
| | - Anett Pisek
- St. Franziskus Hospital Muenster, Breast Cancer Center, Muenster, Germany
| | - Christian Eichler
- St. Franziskus Hospital Muenster, Breast Cancer Center, Muenster, Germany
- Department of Gynaecology and Obstetrics, University Hospital Cologne, Cologne, Germany
| |
Collapse
|
10
|
Swanson E. A Safe and Effective Alternative to Acellular Dermal Matrix in the Treatment of Capsular Contracture of the Breast. Ann Plast Surg 2024; 92:139-143. [PMID: 37983821 DOI: 10.1097/sap.0000000000003741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
|
11
|
Bauer TM, Gallagher KA. Biofilm-derived oxylipin 10-HOME mediated immune response in women with breast implants. J Clin Invest 2024; 134:e176547. [PMID: 38299590 PMCID: PMC10836797 DOI: 10.1172/jci176547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
Breast implant illness (BII) is a poorly understood disease in which patients develop symptoms typical of autoimmune conditions following breast implantation. There is no known underlying cause, and patients often resort to breast implant removal and capsulectomy to alleviate symptoms. In this issue of the JCI, Khan and colleagues examined 86 breast explants from patients that reported BII symptoms and 55 control explants. The BII group showed a disproportionally high degree of biofilm, which was associated with oxylipin (10-HOME) on the implant surfaces. Injections of 10-HOME in the mammary fat pad of a murine model recapitulated BII symptoms and increased Th1 cell populations. Notably, macrophages in the periprosthetic tissue from BII patients were more likely to exhibit a proinflammatory phenotype, and naive T cells exposed to 10-HOME caused naive macrophages to differentiate to a proinflammatory phenotype. This work provides a pathophysiologic mechanism for a currently understudied and poorly characterized disease.
Collapse
Affiliation(s)
| | - Katherine A Gallagher
- Department of Surgery and
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
12
|
Herzog I, Pandher M, Mansukhani PA, Kapadia K, Lee ES. Is YouTube Propagating Concerns About Breast Implant Illness? Ann Plast Surg 2024; 92:144-147. [PMID: 38170971 DOI: 10.1097/sap.0000000000003743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
BACKGROUND An increasing number of patients who underwent breast implant surgery are reporting a cluster of concerning physical and psychological symptoms-newly coined term breast implant illness (BII). YouTube is a popular educational tool for plastic surgery patients. OBJECTIVES The purposes of this study were to assess the quality and reliability of YouTube videos on BII, compare the quality and reliability of different video categories and publishers, and determine the frequencies of reported BII symptoms. METHODS On YouTube, videos were searched for the term breast implant illness , and the first 100 results were collected. Engagement parameters and symptoms of BII mentioned in each video were recorded. Video power index, a modified DISCERN instrument, and the Global Quality Scale (GQS) were used to assess popularity, reliability, and quality, respectively. RESULTS Ninety videos met the inclusion criteria. More than half mentioned fatigue (66%), cognitive dysfunction (59%), or muscle and/or joint pain (57%). Videos with a plastic surgeon present had higher DISCERN ( P = 0.001) and GQS ( P = 0.002) scores than those without. Educational videos had higher DISCERN and GQS scores than patient experience ( P < 0.0001, P = 0.001) and entertainment and advertisement videos ( P = 0.014, P = 0.022). Videos published by plastic surgeons had higher Video power index ( P = 0.033), DISCERN ( P < 0.0001), and GQS scores ( P < 0.0001) than those by nonmedical publishers. CONCLUSIONS The top YouTube videos for BII are generally of low reliability and low-to-moderate quality. Patients unaware of YouTube's limited quality control measures for health education videos are susceptible to misinformation. Additional social media content created by plastic surgeons can improve the quality and accuracy of videos viewed by patients.
Collapse
Affiliation(s)
- Isabel Herzog
- From the Rutgers New Jersey Medical School, Newark, NJ
| | | | | | | | | |
Collapse
|
13
|
Chen Y, Yang C, Yang S, Chen X, Huang L. Serratus Anterior Fascia for Immediate Implant-Based Breast Reconstruction: A Case Series of 65 Patients With Breast Cancer. Ann Plast Surg 2024; 92:169-173. [PMID: 38157477 DOI: 10.1097/sap.0000000000003769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
OBJECTIVE After immediate implant-based breast reconstruction (IIBR) after mastectomy, implant exposure or capsular contracture can occur. This study aimed to evaluate IIBR using serratus anterior fascia in patients with breast cancer. METHODS This retrospective case series study enrolled patients with breast cancer underwent IIBR using the serratus anterior fascia after mastectomy in the Department of Breast Surgery of Fujian Cancer Hospital between January 2021 and December 2022. RESULTS Sixty-five cases with breast cancer underwent IIBR using serratus anterior fascia were enrolled, with a median age of 39 years (range, 24-57 years) and body mass index of 21.32 kg/m 2 (range, 19-25 kg/m 2 ). The aesthetic outcomes of the reconstructed breasts showed good in 53 cases (81.6%), moderate in 11 cases (16.9%), and poor in 1 case (1.5%) due to offset position. Two cases showed poor wound healing, which improved after repeat suturing and 5 cases developed partial ischemic necrosis of the nipple, which scabbed and healed spontaneously. CONCLUSIONS Implant-based breast reconstruction using serratus anterior fascia may provide good aesthetic outcomes with few complications.
Collapse
Affiliation(s)
- Ying Chen
- From the Department of Breast Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian, China
| | | | | | | | | |
Collapse
|
14
|
Tokita HK, Assel M, Simon BA, Lin E, Sarraf L, Masson G, Pilewskie M, Vingan P, Vickers A, Nelson JA. ASO Visual Abstract: Regional Blocks Benefit Patients Undergoing Bilateral Mastectomy with Immediate Implant-Based Reconstruction, Even After Discharge. Ann Surg Oncol 2024; 31:1014-1015. [PMID: 37947977 DOI: 10.1245/s10434-023-14498-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Affiliation(s)
- Hanae K Tokita
- Department of Anesthesiology and Critical Care Medicine, Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Melissa Assel
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brett A Simon
- Department of Anesthesiology and Critical Care Medicine, Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emily Lin
- Department of Anesthesiology and Critical Care Medicine, Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Leslie Sarraf
- Department of Anesthesiology and Critical Care Medicine, Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Geema Masson
- Department of Anesthesiology and Critical Care Medicine, Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Perri Vingan
- Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew Vickers
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonas A Nelson
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
15
|
Mamsen FPW, Fischer-Nielsen A, Svalgaard JD, Jensen JD, Jønsson B, Duscher D, Christensen J, Van Leeuwen M, Kiilerich CH, Roider L, Sterodimas A, Munthe-Fog L, Kølle SFT. Cosmetic Breast Augmentation with Autologous Ex Vivo-Expanded Adipose-Derived Mesenchymal Stem/Stromal Cell (Stemform®)-Enriched Fat Grafts: A Study of the First Twenty-Two Real-World Patients. Aesthetic Plast Surg 2024; 48:98-115. [PMID: 38049686 PMCID: PMC10912442 DOI: 10.1007/s00266-023-03711-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/10/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Fat grafting is commonly utilized in breast surgery, and since it was first described, clinicians and researchers have stridden towards improvement of graft retention. Current advancements include adding adipose-derived mesenchymal stem/stromal cells (MSC(AT)s), which have demonstrated promise for improved graft retention. OBJECTIVES This study reports outcomes for the first twenty-two patients undergoing breast augmentation (Stemform BA) or artificial implant replacement (Stemform AIR) with MSC(AT)-enriched fat in a real-world setting. METHODS Autologous MSC(AT)s were isolated and expanded ex vivo, then mixed with lipoaspirate and injected as enriched fat for Stemform BA and AIR. The breast volume was measured preoperatively and at 3 and 12 months postoperative using a 3D Infinity Dual-Lens Camera and LifeVizApp software. Additionally, independent plastic surgeons evaluated clinical images, and patient satisfaction was obtained at equal time points. RESULTS Twenty-two patients were included. All completed 3 and 12 months clinical follow-up and 3 months volume measurements. Nineteen patients completed 12 months volume measurements. The median fat graft retention at 12 months was 95.7% (IQR = 82.44-103.12%) for Stemform BA patients and 113.0% (IQR = 94.8-131.2%) for Stemform AIR patients. The Stemform BA patients had a median breast enlargement of 172.0% (IQR = 156.7-241.0%). The implant replacement volume of Stemform AIR patients was 102% (IQR = 85.1-130.3%). The patient reported 92.8% and 100% would elect to repeat treatment if they had the opportunity for Stemform BA and Stemform AIR, respectively. CONCLUSION Breast augmentation and breast implant replacement patients receiving ex vivo-expanded MSC(AT)-enriched fat grafts had high graft retention and patient satisfaction scores. The paper confirms the clinical efficacy of using ex vivo-expanded MSC(AT)s. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
- Frederik Penzien Wainer Mamsen
- StemMedical A/S, Gyngemose Parkvej 50, 2860, Copenhagen, Denmark.
- Department of Plastic Surgery, Aleris Hospitals, Gyngemose Parkvej 66, 2860, Copenhagen, Denmark.
| | | | | | | | - Bo Jønsson
- Department of Plastic Surgery, Aleris Hospitals, Gyngemose Parkvej 66, 2860, Copenhagen, Denmark
| | - Dominik Duscher
- Eberhard Karls University Tübingen, 72076, Tübingen, Germany
- Academic Stem Cell Center Vienna, Liechtensteinstrasse 96, 1090, Vienna, Austria
| | | | | | - Claes Hannibal Kiilerich
- Department of Plastic Surgery, Aleris Hospitals, Gyngemose Parkvej 66, 2860, Copenhagen, Denmark
| | - Laura Roider
- Saint Louis University School of Medicine, 1008 S Spring Ave Suite 1500, St. Louis, MO, 63110, USA
| | | | - Lea Munthe-Fog
- StemMedical A/S, Gyngemose Parkvej 50, 2860, Copenhagen, Denmark
| | - Stig-Frederik Trojahn Kølle
- StemMedical A/S, Gyngemose Parkvej 50, 2860, Copenhagen, Denmark
- CeriX Hospital, Strandvejen 191, 2900, Copenhagen, Denmark
| |
Collapse
|
16
|
Gabriel A, Maxwell GP. Discussion: Betadine Soaking of Silicone Coupons Minimally Impacts Acellular Dermal Matrix Incorporation in a Preclinical Primate Model. Plast Reconstr Surg 2023; 152:1273-1274. [PMID: 38019690 DOI: 10.1097/prs.0000000000010751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Affiliation(s)
- Allen Gabriel
- From the Department of Plastic Surgery, Loma Linda University Medical Center
| | - G Patrick Maxwell
- From the Department of Plastic Surgery, Loma Linda University Medical Center
| |
Collapse
|
17
|
Boyd LC, Kareh AM, Rodby KA. Navigating Food and Drug Administration Mandated Breast Implant Patient Literature: A Call to Increase Equitable Healthcare Access Within Plastic Surgery. Ann Plast Surg 2023; 91:651-655. [PMID: 37856237 DOI: 10.1097/sap.0000000000003674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
OBJECTIVES In October 2021, the US Food and Drug Administration mandated patient decision checklists and new labeling for breast implants with the goal of improving the informed decision-making process for patients considering breast implantation. Given growing concerns over breast implant-associated anaplastic large cell lymphoma, breast implant-associated squamous cell carcinoma, and breast implant illness, patients should be able to easily review these resources to make a fully informed decision when considering surgery. This study seeks to elucidate the accessibility, and therefore the utility of the newly mandated literature for the average breast implant patient. METHODS Patient decision checklists and breast implant boxed warnings were obtained from the most used breast implant manufacturers in the United States-Allergan, Mentor, and Sientra. Readability analysis of all Food and Drug Administration required documents was performed using the Flesch Reading Ease Score, Flesch Kincaid Grade Level, Gunning-Fog Index, Coleman-Liau Index, Simplified Measure of Gobbledygook, and Automated Readability Index. RESULTS The overall readability of all Allergan, Mentor, and Sientra patient materials correlates with a college reading level. Documents from all 3 implant manufacturers were of a statistically significantly higher reading level than that recommended by the American Medical Association and US Department of Health and Human Services. No materials were found to be at or below the recommended sixth-grade level. CONCLUSIONS The newly mandated breast implant patient decision guides are written at a college reading level. These materials should be simplified to improve health literacy shared decision making.
Collapse
Affiliation(s)
- Louisa C Boyd
- From the Division of Plastic and Reconstructive Surgery, Saint Louis University School of Medicine, Saint Louis, MO
| | | | | |
Collapse
|
18
|
Shestakova V, Klabukov I, Baranovskii D, Shegay P, Kaprin A. Interest of acellular dermal matrices in immediate breast reconstruction: Immunologic responses are still in the shadows. J Plast Reconstr Aesthet Surg 2023; 87:203-204. [PMID: 37898024 DOI: 10.1016/j.bjps.2023.10.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 10/07/2023] [Indexed: 10/30/2023]
Affiliation(s)
- Victoria Shestakova
- National Medical Research Radiological Center, 249036 Obninsk, Russia; Obninsk Institute for Nuclear Power Engineering, National Research Nuclear University MEPhI, 249031 Obninsk, Russia.
| | - Ilya Klabukov
- National Medical Research Radiological Center, 249036 Obninsk, Russia; Obninsk Institute for Nuclear Power Engineering, National Research Nuclear University MEPhI, 249031 Obninsk, Russia
| | - Denis Baranovskii
- National Medical Research Radiological Center, 249036 Obninsk, Russia
| | - Peter Shegay
- National Medical Research Radiological Center, 249036 Obninsk, Russia
| | - Andrey Kaprin
- National Medical Research Radiological Center, 249036 Obninsk, Russia
| |
Collapse
|
19
|
van der Wielen A, Negenborn V, Burchell GL, Remmelzwaal S, Lapid O, Driessen C. Less is more? One-stage versus two-stage implant-based breast reconstruction: A systematic review and meta-analysis of comparative studies. J Plast Reconstr Aesthet Surg 2023; 86:109-127. [PMID: 37716248 DOI: 10.1016/j.bjps.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/19/2023] [Accepted: 08/13/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Most breast reconstructions are implant-based and can be performed either in a one-stage, direct-to-implant or in a two-stage, expander-implant-based reconstruction. The objective of this systematic review is to compare the safety and patient satisfaction of the two reconstruction approaches. METHODS A literature search was conducted on 27 September 2022 using various databases. Studies comparing one-stage and two-stage implant reconstructions and reporting the following outcomes were included: patient satisfaction, aesthetics, complications, and/or costs. Reviews, case reports, or series with less than 20 patients and letters or comments were excluded. Comparisons were made between the one-stage reconstruction with and without acellular dermal matrix (ADM) and two-stage implant-based breast reconstruction groups. The data extracted from all articles were analysed using random-effects meta-analyses. RESULTS Of the 1381 records identified, a total of 33 articles were included, representing 21529 patients. There were no significant differences between the one-stage and two-stage groups, except for the costs. The one-stage operation without ADM had lower costs than the two-stage operation without ADM, although the use of an ADM substantially increased the price of the operation to more than a two-stage reconstruction. DISCUSSION Equal patient satisfaction, aesthetic outcomes, and complication rates with lower costs justify one-stage breast reconstruction in carefully selected patients. This review shows that there is no evidence-based superior surgical approach. Future research should focus on the costs of the ADM versus an additional stage and patient-reported outcomes.
Collapse
Affiliation(s)
- Alexander van der Wielen
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Vera Negenborn
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, De Boelelaan 1117, Amsterdam, the Netherlands
| | - George Louis Burchell
- Amsterdam UMC location Vrije Universiteit Amsterdam, Medical Library, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Sharon Remmelzwaal
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology & Data Science, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Oren Lapid
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Caroline Driessen
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, De Boelelaan 1117, Amsterdam, the Netherlands.
| |
Collapse
|
20
|
Nolan IT, Farajzadeh MM, Boyd CJ, Bekisz JM, Gibson EG, Salibian AA. Do we need acellular dermal matrix in prepectoral breast reconstruction? A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2023; 86:251-260. [PMID: 37793198 DOI: 10.1016/j.bjps.2023.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/28/2023] [Accepted: 09/12/2023] [Indexed: 10/06/2023]
Abstract
Acellular dermal matrices (ADMs) are commonly used in prepectoral breast reconstruction. However, ADM is associated with high cost and potentially infection and seroma. Comparative studies on prepectoral reconstruction with and without ADM are limited to small, single-institution series. The purpose of this study was to perform a meta-analysis of prepectoral reconstruction with and without ADM. A systematic literature review was performed to identify studies comparing prepectoral reconstruction with and without ADM using PubMed, EMBASE, and Cochrane databases. Pooled rates of patient demographics and outcomes were analyzed. Meta-analytic effect size estimates were calculated for reconstructive complications in studies comparing reconstruction with and without ADM. In total, 515 reconstructions from four studies were included. Most cases were nipple-sparing mastectomies and utilized tissue-expander reconstructions. Meta-analysis demonstrated no significant difference in the rate of complications between cohorts with and without ADM. Short-term complications included reconstructive failure (1.2% in ADM cohort and 2.8% in no-ADM), seroma (1.2% and 8.3%, respectively), hematoma (1.2% and 2.1%), infection (4.7% and 4.2%), and mastectomy flap ischemia and/or necrosis (2.4% and 5.2%). Long-term complications included rippling (3.3% in ADM and 5.1% in no-ADM cohorts) and capsular contracture (6.8% and 3.4%, respectively). This meta-analysis demonstrated no difference in the rate of complications between cases with and without ADM. However, the outcomes data from no-ADM reconstruction mostly reflect robust mastectomy flaps. Surgeon discretion as informed by specific clinical scenarios should guide decisions regarding the use of ADM in prepectoral breast reconstruction.
Collapse
Affiliation(s)
- Ian T Nolan
- Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL 60607, United States
| | - Matthew M Farajzadeh
- Hansjörg Wyss Department of Plastic and Reconstructive Surgery, New York University School of Medicine, New York, NY 10016, United States
| | - Carter J Boyd
- Division of Plastic and Reconstructive Surgery, University of California Davis School of Medicine, Sacramento, CA 95816, United States
| | - Jonathan M Bekisz
- Division of Plastic and Reconstructive Surgery, University of California Davis School of Medicine, Sacramento, CA 95816, United States
| | - Ella G Gibson
- Hansjörg Wyss Department of Plastic and Reconstructive Surgery, New York University School of Medicine, New York, NY 10016, United States
| | - Ara A Salibian
- Hansjörg Wyss Department of Plastic and Reconstructive Surgery, New York University School of Medicine, New York, NY 10016, United States.
| |
Collapse
|
21
|
O'Connell RL, Sharma B, El-Sharkawi D, Wotherspoon A, Attygalle AD, MacNeill F, Khan AA, Tasoulis MK. ASO Visual Abstract: Oncological Outcomes After Multidisciplinary Management of Breast Implant-associated Anaplastic Large Cell Lymphoma (BIA-ALCL). Ann Surg Oncol 2023; 30:6176-6177. [PMID: 37543547 DOI: 10.1245/s10434-023-14013-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2023]
Affiliation(s)
- Rachel L O'Connell
- Breast Surgery Unit, The Royal Marsden NHS Foundation Trust, London, UK
- The Institute of Cancer Research, London, UK
| | - Bhupinder Sharma
- The Institute of Cancer Research, London, UK
- Department of Radiology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Dima El-Sharkawi
- Heamato-oncology Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Andrew Wotherspoon
- Heamato-oncology Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Histopathology Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Ayoma D Attygalle
- Heamato-oncology Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Histopathology Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Fiona MacNeill
- Breast Surgery Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Aadil A Khan
- The Institute of Cancer Research, London, UK
- Plastic Surgery Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Marios-Konstantinos Tasoulis
- Breast Surgery Unit, The Royal Marsden NHS Foundation Trust, London, UK.
- The Institute of Cancer Research, London, UK.
| |
Collapse
|
22
|
Vingan PS, Kim M, Rochlin D, Allen RJ, Nelson JA. Prepectoral Versus Subpectoral Implant-Based Reconstruction: How Do We Choose? Surg Oncol Clin N Am 2023; 32:761-776. [PMID: 37714642 DOI: 10.1016/j.soc.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
Aspects of a patient's lifestyle, their state of health, breast size, and mastectomy skin flap quality are factors that influence the suggested plane of dissection in implant-based breast reconstruction. This article aims to review developments in prosthetic breast reconstruction and provide recommendations to help providers choose whether prepectoral or subpectoral reconstruction in the best approach for each of their patients.
Collapse
Affiliation(s)
- Perri S Vingan
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Minji Kim
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Danielle Rochlin
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Robert J Allen
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Jonas A Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| |
Collapse
|
23
|
Glicksman C, McGuire P, Kadin M, Barnes K, Wixtrom R, Lawrence M, Haws M, Ferenz S, Sung CJ, Hamilton RG, Faasse K. Longevity of Post-Explantation Systemic Symptom Improvement and Potential Etiologies: Findings From the ASERF Systemic Symptoms in Women-Biospecimen Analysis Study: Part 4. Aesthet Surg J 2023; 43:1194-1204. [PMID: 37040435 PMCID: PMC10501748 DOI: 10.1093/asj/sjad098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Breast Implant Illness (BII) describes a variety of symptoms reported by patients with breast implants. Biospecimens data revealed minimal statistical differences between BII and non-BII cohorts. Baseline analysis of PROMIS data demonstrated significant differences between the BII cohort and the 2 control cohorts. OBJECTIVES This study was designed to determine if patients in the BII cohort obtained any symptom improvement after explantation, whether symptom improvement was related to the type of capsulectomy, and which symptoms improved. METHODS A prospective blinded study enrolled 150 consecutive patients divided equally into 3 cohorts. Baseline demographic data and a systemic symptoms survey, including PROMIS validated questionnaires, were obtained at baseline, 3 to 6 weeks, 6 months, and 1 year. RESULTS A total of 150 patients were enrolled between 2019 and 2021. Follow-up at 1 year included 94% of the BII cohort and 77% of non-BII and mastopexy cohorts. At 1 year, 88% of patients showed at least partial symptom improvement, with a reduction of 2 to 20 symptoms. The PROMIS score in the BII cohort decreased at 1 year for anxiety, sleep disturbances, and fatigue. Systemic symptom improvement was noted out to 1 year in the BII cohort regardless of the type of capsulectomy performed. CONCLUSIONS Parts 1-3 in this series concluded that there were no consistent differences in biospecimen results between the cohorts. Unlike the data observed in the biospecimen analysis, BII patients had heightened symptoms and poorer PROMIS scores at baseline compared to the control cohorts. The reduction of negative expectations and a potential nocebo effect could contribute to this improvement. LEVEL OF EVIDENCE: 4
Collapse
Affiliation(s)
- Caroline Glicksman
- Corresponding Author: Dr Caroline Glicksman, 2164 State Highway 35, Building A, Sea Girt, NJ 08750, USA. E-mail: ; Instagram: @drcarolineglicksman
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Ha JH, Cheun JH, Jung JJ, Kim HK, Lee HB, Shin HC, Moon HG, Han W, Myung Y, Jeong JH, Heo CY, Chang H, Kim EK, Jin US. Impact of implant surface type on breast cancer relapse after breast reconstruction: propensity score-matched study. Br J Surg 2023; 110:1288-1292. [PMID: 37307506 PMCID: PMC10480036 DOI: 10.1093/bjs/znad147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 02/06/2023] [Accepted: 04/30/2023] [Indexed: 06/14/2023]
Affiliation(s)
- Jeong Hyun Ha
- Interdisciplinary Program of Medical Informatics, Seoul National University
College of Medicine, Seoul, South Korea
- Department of Plastic and Reconstructive Surgery, Seoul National University
Hospital, Seoul, South
Korea
| | - Jong-Ho Cheun
- Department of General Surgery, Seoul Metropolitan Government–Seoul National
University Boramae Medical Centre, Seoul,
South Korea
| | - Ji-Jung Jung
- Department of Surgery, Seoul National University Hospital,
Seoul, South Korea
| | - Hong-Kyu Kim
- Department of Surgery, Seoul National University Hospital,
Seoul, South Korea
| | - Han-Byoel Lee
- Department of Surgery, Seoul National University Hospital,
Seoul, South Korea
- Department of Surgery, Seoul National University College of
Medicine, Seoul, South
Korea
- Cancer Research Institute, Seoul National University,
Seoul, South Korea
- Biomedical Research Institute, Seoul National University
Hospital, Seoul, South
Korea
| | - Hee-Chul Shin
- Department of Surgery, Seoul National University Bundang
Hospital, Seongnam, South
Korea
| | - Hyeong-Gon Moon
- Department of Surgery, Seoul National University Hospital,
Seoul, South Korea
- Genomic Medicine Institute, Medical Research Centre, Seoul National
University College of Medicine, Seoul, South Korea
| | - Wonshik Han
- Department of Surgery, Seoul National University Hospital,
Seoul, South Korea
- Department of Surgery, Seoul National University College of
Medicine, Seoul, South
Korea
- Cancer Research Institute, Seoul National University,
Seoul, South Korea
- Biomedical Research Institute, Seoul National University
Hospital, Seoul, South
Korea
- Genomic Medicine Institute, Medical Research Centre, Seoul National
University College of Medicine, Seoul, South Korea
| | - Yujin Myung
- Department of Plastic and Reconstructive Surgery, Seoul National University
Bundang Hospital, Seongnam, South Korea
| | - Jae Hoon Jeong
- Department of Plastic and Reconstructive Surgery, Seoul National University
Bundang Hospital, Seongnam, South Korea
| | - Chan Yeong Heo
- Department of Plastic and Reconstructive Surgery, Seoul National University
Bundang Hospital, Seongnam, South Korea
- Department of Plastic and Reconstructive Surgery, Seoul National University
College of Medicine, Seoul, South Korea
| | - Hak Chang
- Department of Plastic and Reconstructive Surgery, Seoul National University
Hospital, Seoul, South
Korea
- Department of Plastic and Reconstructive Surgery, Seoul National University
College of Medicine, Seoul, South Korea
| | - Eun-Kyu Kim
- Department of Surgery, Seoul National University Bundang
Hospital, Seongnam, South
Korea
| | - Ung Sik Jin
- Department of Plastic and Reconstructive Surgery, Seoul National University
Hospital, Seoul, South
Korea
- Department of Plastic and Reconstructive Surgery, Seoul National University
College of Medicine, Seoul, South Korea
| |
Collapse
|
25
|
Hessler M, Huq F, Deirawan H, Al-Mufarrej F, Daveluy S. Breast implant-induced cutaneous lymphoma. Int J Dermatol 2023; 62:e486-e488. [PMID: 36841857 DOI: 10.1111/ijd.16620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 01/04/2023] [Accepted: 02/07/2023] [Indexed: 02/27/2023]
Affiliation(s)
- Monica Hessler
- Transitional Year Residency, Wayne State University School of Medicine, Detroit, MI, USA
| | - Farhan Huq
- Department of Dermatology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Hany Deirawan
- Department of Dermatology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Faisal Al-Mufarrej
- Department of Surgery, Division of Plastic Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Steven Daveluy
- Department of Dermatology, Wayne State University School of Medicine, Detroit, MI, USA
| |
Collapse
|
26
|
Vrolijk JJ, Young-Afat DA, Mureau MAM, Rakhorst HA, van Bommel ACM, Hoornweg MJ. Ensuring access to post-cancer breast reconstructions: COVID-19 lessons from the Dutch Breast Implant Registry. Eur J Surg Oncol 2023; 49:106984. [PMID: 37543001 DOI: 10.1016/j.ejso.2023.106984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/07/2023] [Accepted: 07/11/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND COVID-19 has impacted breast implant surgery for oncological and non-oncological patients worldwide. This population-based study aimed to evaluate the impact of the COVID-19 pandemic on access to reconstructive and cosmetic breast implant surgery in the Netherlands using real-world data to describe trends, and to identify lessons to prevent future capacity problems within (inter)national healthcare. METHODS This longitudinal study included patients undergoing breast implant surgery from the mandatory nationwide Dutch Breast Implant Registry. For 2020, the first COVID-19 wave, intermediate period, and second wave were defined. We compared data from during the pandemic to a pre-pandemic (2019) reference year, assessing differences in the number of registered breast implants, and patient and surgery-related characteristics. RESULTS A total of 34133 breast implants (17459 patients) were included. Compared to 2019, fewer implants were registered for post-cancer (n=484; -14.7%), cosmetic (n=480; -3.6%), and gender-affirming indications (n=104; -38.0%) during 2020. Fewer implants were registered in academic (n=196; -22.0%) and regional hospitals (n=1591; -16.5%), but more in private clinics (n=725; +10.1%). After the first wave, up to twice as many implants were registered in private clinics compared to 2019. No differences were found in characteristics of patients undergoing surgery in 2020 versus 2019. CONCLUSION Hospital-based reconstructive and gender-affirming surgery were heavily impacted during the pandemic, while private-clinic-based cosmetic surgery quickly recovered. These outcomes are useful to fuel discussions about how healthcare could be reorganized in times of capacity problems. We suggest exploring options to deploy private clinics for ambulatory surgery aiming to keep hospital capacity available for acutely ill patients.
Collapse
Affiliation(s)
- J Juliët Vrolijk
- Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center +, Maastricht, the Netherlands; Dutch Institute for Clinical Auditing, Leiden, the Netherlands
| | - Danny A Young-Afat
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Marc A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Hinne A Rakhorst
- Department of Plastic, Reconstructive and Hand Surgery, Medisch Spectrum Twente, Enschede, the Netherlands; Department of Plastic Surgery, Ziekenhuis Groep Twente, Almelo and Hengelo, the Netherlands
| | - Annelotte C M van Bommel
- Department of Plastic, Reconstructive and Hand Surgery, Netherlands Cancer Institute (Antoni van Leeuwenhoek), the Netherlands
| | - Marije J Hoornweg
- Department of Plastic, Reconstructive and Hand Surgery, Netherlands Cancer Institute (Antoni van Leeuwenhoek), the Netherlands.
| |
Collapse
|
27
|
de Lacerda Mariz JPS, de Macedo JLS, Rosa SC, da Silva LM, de Sousa Cardoso AR, de Macedo LFR. Breast Implant-Associated Anaplastic Large-Cell Lymphoma in a Postbariatric Patient. Obes Surg 2023; 33:2598-2601. [PMID: 37347398 DOI: 10.1007/s11695-023-06692-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/13/2023] [Accepted: 06/16/2023] [Indexed: 06/23/2023]
Affiliation(s)
- João Pedro Santana de Lacerda Mariz
- Department of Plastic and Reconstructive Surgery, Asa Norte Regional Hospital, SQS 213 Bloco H Apto 303. Asa Sul, 70 292-080, Brasília, DF, Brazil
| | - Jefferson Lessa Soares de Macedo
- Department of Plastic and Reconstructive Surgery, Asa Norte Regional Hospital, SQS 213 Bloco H Apto 303. Asa Sul, 70 292-080, Brasília, DF, Brazil.
- Superior School of Health Sciences/FEPECS, Brasília, Brazil.
| | - Simone Corrêa Rosa
- Department of Plastic and Reconstructive Surgery, Asa Norte Regional Hospital, SQS 213 Bloco H Apto 303. Asa Sul, 70 292-080, Brasília, DF, Brazil
- Medical School of the Catholic University of Brasília, Brasília, DF, Brazil
| | - Lúcio Marques da Silva
- Department of Plastic and Reconstructive Surgery, Asa Norte Regional Hospital, SQS 213 Bloco H Apto 303. Asa Sul, 70 292-080, Brasília, DF, Brazil
| | - Augusto Ribeiro de Sousa Cardoso
- Department of Plastic and Reconstructive Surgery, Asa Norte Regional Hospital, SQS 213 Bloco H Apto 303. Asa Sul, 70 292-080, Brasília, DF, Brazil
| | | |
Collapse
|
28
|
Xuan T, Yuan X, Zheng S, Wang L, Wang Q, Zhang S, Qi F, Luan W. Repeated Lipoteichoic Acid Injection at Low Concentration Induces Capsular Contracture by Activating Adaptive Immune Response through the IL-6/STAT3 Signaling Pathway. Plast Reconstr Surg 2023; 152:349-359. [PMID: 36700876 DOI: 10.1097/prs.0000000000010224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Capsular contracture is the most common complication of breast implantation surgery. Bacterial contamination was considered to play an important role in the occurrence of capsular contracture, and Gram-positive bacteria such as Staphylococcus epidermidis were discovered in the clinical specimens. Lipoteichoic acid (LTA) was a component of the cell wall of Gram-positive bacteria and was sufficient in the pathogenicity of the bacteria. The authors assumed that LTA could trigger the immunologic response against the implant and cause capsular contracture. METHODS The authors developed a rat model of capsular contracture by repeated injection of 10 μg/mL LTA. The histologic changes of the capsule tissue were measured by hematoxylin and eosin, sirius red, Masson, and immunohistochemical staining. The expression of related cytokines was measured by quantitative real-time polymerase chain reaction. The downstream pathway activation was shown by Western blot. The authors also applied tocilizumab, an interleukin (IL)-6 receptor antagonist, to verify the role of IL-6 in this pathologic process. RESULTS The authors discovered that repeated LTA injection, at a low concentration, could induce the thickening of capsule tissue, the deposition of collagen fiber, and the activation of myofibroblasts. The IL-6/signal transducer and activator of transcription 3 signaling pathway was activated in this process, and the inhibition of IL-6 receptor could relieve the symptoms. B cells and T-helper cells, especially T-helper type 1, could be related to this phenomenon. CONCLUSIONS The authors' research corroborated that subclinical infection could trigger capsular contracture, and the immune system played an important role in this process. The authors' results provided a possible research direction for the mechanism of bacterial infection-induced immune response against breast implants. CLINICAL RELEVANCE STATEMENT The authors' research provides a possible research direction for the mechanism of bacterial infection-induced immune response against breast implants, and a potential target for predicting the prognosis of capsular contracture.
Collapse
Affiliation(s)
- Tianfan Xuan
- From the Department of Plastic Surgery, Zhongshan Hospital, Fudan University
- Treatment Center of Burn and Trauma, Affiliated Hospital of Jiangnan University, Jiangnan University
| | - Xin Yuan
- Department of Plastic and Burn Surgery, West China School of Medicine, West China Hospital, Sichuan University
| | - Shaoluan Zheng
- Department of Plastic Surgery, Zhongshan Hospital, Fudan University (Xiamen Branch)
| | - Lu Wang
- From the Department of Plastic Surgery, Zhongshan Hospital, Fudan University
| | - Qiang Wang
- From the Department of Plastic Surgery, Zhongshan Hospital, Fudan University
| | - Simin Zhang
- From the Department of Plastic Surgery, Zhongshan Hospital, Fudan University
| | - Fazhi Qi
- From the Department of Plastic Surgery, Zhongshan Hospital, Fudan University
| | - Wenjie Luan
- From the Department of Plastic Surgery, Zhongshan Hospital, Fudan University
| |
Collapse
|
29
|
Castagnetti F, Coiro S, Foroni M, Falco G, Mele S, Cenini E, Morando L, Begnini E, Borgonovo G, Ferrari G. Reply to Letter to the Editor: A Pure Autologous Dermal Graft and Dermal Flap Pocket in Prepectoral Implant Reconstruction After Skin-Reducing Mastectomy: A One-Stage Autologous Reconstruction Alternative to Acellular Dermal Matrices. Aesthetic Plast Surg 2023; 47:99-100. [PMID: 35960366 DOI: 10.1007/s00266-022-03056-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 07/31/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Fabio Castagnetti
- Breast Surgery Unit, AZIENDA USL-IRCCS Reggio Emilia, viale Risorgimento No 80, 42123, Reggio Emilia, Italy.
| | - Saverio Coiro
- Breast Surgery Unit, AZIENDA USL-IRCCS Reggio Emilia, viale Risorgimento No 80, 42123, Reggio Emilia, Italy
| | - Monica Foroni
- Breast Surgery Unit, AZIENDA USL-IRCCS Reggio Emilia, viale Risorgimento No 80, 42123, Reggio Emilia, Italy
| | - Giuseppe Falco
- Breast Surgery Unit, AZIENDA USL-IRCCS Reggio Emilia, viale Risorgimento No 80, 42123, Reggio Emilia, Italy
| | - Simone Mele
- Breast Surgery Unit, AZIENDA USL-IRCCS Reggio Emilia, viale Risorgimento No 80, 42123, Reggio Emilia, Italy
| | - Eugenio Cenini
- Breast Surgery Unit, AZIENDA USL-IRCCS Reggio Emilia, viale Risorgimento No 80, 42123, Reggio Emilia, Italy
| | - Ljuba Morando
- Breast Surgery Unit, AZIENDA USL-IRCCS Reggio Emilia, viale Risorgimento No 80, 42123, Reggio Emilia, Italy
| | - Evelina Begnini
- Breast Surgery Unit, AZIENDA USL-IRCCS Reggio Emilia, viale Risorgimento No 80, 42123, Reggio Emilia, Italy
| | - Giulia Borgonovo
- Breast Surgery Unit, AZIENDA USL-IRCCS Reggio Emilia, viale Risorgimento No 80, 42123, Reggio Emilia, Italy
| | - Guglielmo Ferrari
- Breast Surgery Unit, AZIENDA USL-IRCCS Reggio Emilia, viale Risorgimento No 80, 42123, Reggio Emilia, Italy
| |
Collapse
|
30
|
Hassan AM, Butler CE. Invited Commentary: Untangling the Web of Industry Payment, Publication Bias, and Cost Concerns in Acellular Dermal Matrix Use for Breast Reconstruction. J Am Coll Surg 2023; 236:1197-1199. [PMID: 36939124 DOI: 10.1097/xcs.0000000000000690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
|
31
|
Coriddi M, Burke EA, Myers P, Soudant C, McCarthy CM. Autoimmune Disease and Breast Implants: Systematic Review of Outcomes. Ann Plast Surg 2023; 90:385-388. [PMID: 34117137 PMCID: PMC8660949 DOI: 10.1097/sap.0000000000002930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Given that the use of breast implants for both cosmetic and reconstructive purposes is growing in the United States, an evaluation of factors that may affect the outcome of breast implant surgery is needed. A systematic review was conducted to evaluate the question: Does a personal or family history of autoimmune disease affect outcomes in breast implant surgery? The literature search yielded 2425 records, but after removal of duplicates, abstract screening, and full-text assessment, only 2 studies met the inclusion criteria for the final review. Both studies provided level III evidence and the average Methodological Index for Non-Randomized Studies score was 16.5 (range, 15-18 of 24), indicating a fair level of evidence overall. This systematic review found no evidence to support that a diagnosis of an autoimmune disease and/or a family history of autoimmune diseases will lead to poor surgical outcomes in breast implant surgery. Further study is warranted.
Collapse
Affiliation(s)
- Michelle Coriddi
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elizabeth Anne Burke
- Division of Plastic and Reconstructive Surgery, NorthShore University HealthSystem, Chicago, IL
| | - Paige Myers
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Celine Soudant
- Medical Library, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Colleen M. McCarthy
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| |
Collapse
|
32
|
Mercer N. What Is Missing From the 2022 Practice Recommendation Updates From the World Consensus Conference on BIA-ALCL? Aesthet Surg J 2023; 43:NP136-NP137. [PMID: 36284495 DOI: 10.1093/asj/sjac274] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 02/07/2023] Open
|
33
|
Lee YJ, Kanchwala SK, Cho H, Jolly JC, Jablonka E, Tanis M, Kamien RD, Yang S. Natural Shaping of Acellular Dermal Matrices for Implant-Based Breast Reconstruction via Expansile Kirigami. Adv Mater 2023; 35:e2208088. [PMID: 36394177 DOI: 10.1002/adma.202208088] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/29/2022] [Indexed: 06/16/2023]
Abstract
To complete a successful and aesthetic breast reconstruction for breast cancer survivors, tissue reinforcing acellular dermal matrices (ADMs) are widely utilized to create slings/pockets to keep breast implants or autologous tissue transfer secured against the chest wall in the desired location. However, ADM sheets are 2D and cannot completely cover the entire implant without wrinkles. Here, guided by finite element modeling, a kirigami strategy is presented to cut the ADM sheets with locally and precisely controlled stretchability, curvature, and elasticity. Upon expansion, a single kirigami ADM sheet can conformably wrap the implant regardless of the shape and size, forming a natural teardrop shape; contour cuts prescribe the topographical height and fractal cuts in the center ensures horizontal expandability and thus conformability. This kirigami ADM can provide support to the reconstructed breast in the desired regions, potentially offering optimal outcomes and patient-specific reconstruction, while minimizing operative time and cost.
Collapse
Affiliation(s)
- Young-Joo Lee
- Department of Materials Science and Engineering, University of Pennsylvania, Philadelphia, Pennsylvania, 19104, USA
| | - Suhail K Kanchwala
- University of Pennsylvania, Division of Plastic and Reconstructive Surgery, Perelman Center of Advanced Medicine, Philadelphia, Pennsylvania, 19104, USA
| | - Hyesung Cho
- Department of Materials Science and Engineering, University of Pennsylvania, Philadelphia, Pennsylvania, 19104, USA
| | - Jason Christopher Jolly
- Department of Materials Science and Engineering, University of Pennsylvania, Philadelphia, Pennsylvania, 19104, USA
| | - Eric Jablonka
- University of Pennsylvania, Division of Plastic and Reconstructive Surgery, Perelman Center of Advanced Medicine, Philadelphia, Pennsylvania, 19104, USA
| | - Michael Tanis
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania, 19104, USA
| | - Randall D Kamien
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania, 19104, USA
| | - Shu Yang
- Department of Materials Science and Engineering, University of Pennsylvania, Philadelphia, Pennsylvania, 19104, USA
| |
Collapse
|
34
|
Naidu NS. Invited Discussion: "How do Positions of Nipple and Inframammary Fold Change After Autologous Breast Augmentation with Fat Grafting?". Aesthetic Plast Surg 2022; 46:2138-2139. [PMID: 35764809 DOI: 10.1007/s00266-022-02979-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 06/02/2022] [Indexed: 11/25/2022]
|
35
|
Botti G, Botti C, Ciancio F. A Single Center's Clinical Experience With Ergonomix Breast Implants. Aesthet Surg J 2022; 42:NP312-NP318. [PMID: 34919632 DOI: 10.1093/asj/sjab422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This retrospective study reports on the early experience of a private surgical center with Motiva Ergonomix SilkSurface breast implants. OBJECTIVES The aim of this study was to examine the incidence of complications and satisfaction levels in women who received primary and revision breast augmentation or augmentation-mastopexy with Ergonomix SilkSurface breast implants. METHODS A total of 356 consecutive patients received Ergonomix SilkSurface breast implants between April 2014 and October 2018 by 3 different surgeons and were followed-up for a minimum of 12 months. Complications were assessed by measuring the rate of rupture, capsular contracture, malposition, late seroma, double capsule, reoperation, symmastia, ptosis, extrusion, and infection. Satisfaction with aesthetic results was assessed on a Likert scale by both surgeon and patient. RESULTS Only 6 major complications were observed in these 356 patients (712 implants): 1 unilateral implant ptosis ("bottoming out") at 12 months (0.14%) and 2 capsular contractures (0.28%), 1 at 14 months and 1 at 2 years. At all time points, 98% of the patients were "extremely satisfied or very satisfied" with the aesthetic results, and the surgeons categorized the outcomes as "very important or important improvement" in 96% of the cases. CONCLUSIONS Motiva Ergonomix SilkSurface devices provided high patient satisfaction up to more than 5 years postoperatively with very few complications. These data are consistent with other reports in the literature. The observed favorable outcomes might be attributed, at least in part, to the bioengineered "cell-friendly" surface of these implants. LEVEL OF EVIDENCE: 4
Collapse
|
36
|
Ding BW, Wang HQ, He SS, Wang S, Huang QF, Han CY, Liu J, Yin ZM, Sun JY, Wang Y, Yin J. [Application of acellular bovine pericardium patch in implant based immediate breast reconstruction]. Zhonghua Wai Ke Za Zhi 2022; 60:237-243. [PMID: 35078299 DOI: 10.3760/cma.j.cn112139-20211012-00485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Objective: To examine the clinical effect of acellular bovine pericardium patch in implant based immediate breast reconstruction. Methods: The clinicopathological information of 141 breast cancer patients, who admitted to Department of Breast Reconstruction and Oncoplastic Surgery, Tianjin Medical University Cancer Hospital, underwent immediate mammoplasty with implants combined with acellular bovine pericardium patches were analyzed from June 2016 to October 2019. All patients were female, with the age of (38.8±8.5) years (range: 13 to 60 years). The body mass index was (21.9±2.5) kg/m2 (range: 16.0 to 32.3 kg/m2). There were 39 cases of duct carcinoma in situ, 46 cases of stage Ⅰ, 40 cases of stage Ⅱ and 16 cases of stage Ⅲ. All patients received nipple-areola-sparing mastectomy or skin-sparing mastectomy with sentinel lymph node biopsy or axillary lymph node dissection, and prosthesis implantation with sub-pectoralis combined with breast patch. The correlation of clinicopathological characters and complications was assessed by t test, χ2 test, Fisher's exact probability method and Logistic regression. Pre-and post-operative aesthetic, quality of life scores were recorded. Results: The operation time (M(IQR)) was 3.6(1.5) hours (range: 3.0 to 6.5 hours). The early postoperative complication rate was 22.0% (31/141), prosthesis removal was the main postoperative complication, accounting for 64.5% (20/31) of the total complications, of which 15 cases occurred in the first 30 patients. The follow-up time was 28(8) months (range: 20 to 53 months), The most frequent long-term complications were capsular contracture and implant displacement, with the incidence of 11.2% (14/125) and 10.4% (13/125), respectively. Multivariate analysis showed that prosthesis volume ≥300 ml (OR=8.173, 95%CI: 1.302 to 51.315, P=0.021) and peri-areolar incision (OR=7.809, 95%CI: 2.162 to 28.211, P<0.01) were independent relative factors for the occurrence of short-term postoperative local complications. After 2 years of operation, the score of breast appearance satisfaction was 71.7±15.5, postoperative effect satisfaction was 90.4±9.5, psychological satisfaction was 90.7±17.1, sexual satisfaction was 70.1±25.1. The immediate postoperative satisfaction rate at discharge was 95.4% (134/141), and 17.6% (22/125) of patients had the intention to received revision surgery. Conclusions: Prosthesis volume ≥300 ml and peri-areolar incision were independent realtive factors for short-term local complications after bovine pericardium patch combined with prosthesis implantation in the immediate breast reconstruction. After completing the learning curve, the postoperative complications of the procedure could be decreased.
Collapse
Affiliation(s)
- B W Ding
- Department of Breast Reconstruction and Oncoplastic Surgery, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
| | - H Q Wang
- Department of Breast Reconstruction and Oncoplastic Surgery, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
| | - S S He
- Department of Breast Reconstruction and Oncoplastic Surgery, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
| | - S Wang
- Department of Breast Reconstruction and Oncoplastic Surgery, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
| | - Q F Huang
- Department of Breast Reconstruction and Oncoplastic Surgery, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
| | - C Y Han
- Department of Breast Reconstruction and Oncoplastic Surgery, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
| | - J Liu
- Department of Breast Reconstruction and Oncoplastic Surgery, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
| | - Z M Yin
- Department of Breast Reconstruction and Oncoplastic Surgery, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
| | - J Y Sun
- Department of Breast Reconstruction and Oncoplastic Surgery, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
| | - Y Wang
- Department of Breast Reconstruction and Oncoplastic Surgery, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
| | - J Yin
- Department of Breast Reconstruction and Oncoplastic Surgery, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
| |
Collapse
|
37
|
Stark B, Magnéli M, van Heijningen I, Parreira C, Bösch U, Rouif M, Halle M. Considerations on the Demography of BIA-ALCL in European Countries Based on an E(A)SAPS Survey. Aesthetic Plast Surg 2021; 45:2639-2644. [PMID: 34286385 PMCID: PMC8677632 DOI: 10.1007/s00266-021-02411-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 06/05/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND A growing body of evidence indicates that breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is associated with the use of certain breast implants. Regional variations have been reported, and a genetic susceptibility has also been suggested. However, large variations in the ability to correctly diagnose BIA-ALCL and to further report and register cases exist between countries and may in part explain variations in the demography. MATERIAL AND METHODS A survey was conducted by The European Association of Societies of Aesthetic Plastic Surgery E(A)SAPS and sent to 48 European countries. The primary aim was to identify the total number of confirmed cases of and deaths from BIA-ALCL in each country during four consecutive measurements over a two-year period. RESULTS An increase in BIA-ALCL cases during four repeated measurements from a total of 305 in April 2019 to 434 in November 2020 was reported by 23 of the 33 responding countries. A nearly 100-fold variation in the number of cases per million inhabitants was noted, where Netherlands had the highest rate (4.12) followed by Finland (1.99). Countries with the lowest reported rates were Austria (0.078), Romania (0.052) and Turkey (0.048). CONCLUSION The current study displays a notable variation ßin the number of confirmed BIA-ALCL cases across Europe, even for countries with established breast implant registers. Variations in diagnosis and reporting systems may explain the differences, but the influence of genetic variations and the prevalence of high-risk implants cannot be excluded. Incomplete sales data along with medical tourism preclude an absolute risk assessment. 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 .
Collapse
Affiliation(s)
- Birgit Stark
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
| | - Martin Magnéli
- Institution for Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Ivar van Heijningen
- Plastic Surgery Department, AZ Zeno and Duinbergen Clinic, Knokke-Heist, Belgium
| | - Carlos Parreira
- Hospital Garcia de Orta, Avenue Torrado da Silva, 2805-267, Almada, Portugal
- Clinica Corpuslaser, Av Estados Unidos da America, 100,1ºD, 1700-179, Lisbon, Portugal
| | - Urs Bösch
- Plastic Surgery, MEON Clinic, Lucerne, Switzerland
| | - Michel Rouif
- , 30, Bld Heurteloup, 37000, Tours, Loire Valley, France
| | - Martin Halle
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
38
|
Kalstrup J, Balslev Willert C, Brinch-Møller Weitemeyer M, Hougaard Chakera A, Hölmich LR. Immediate direct-to-implant breast reconstruction with acellular dermal matrix: Evaluation of complications and safety. Breast 2021; 60:192-198. [PMID: 34688959 PMCID: PMC8551207 DOI: 10.1016/j.breast.2021.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Immediate direct-to-implant breast reconstruction with acellular dermal matrix (ADM) is the method of choice for many plastic surgeons and patients, but the use of ADM remains a controversial subject in the literature. This study aimed to investigate complications, reconstructive failure and possible risk factors in direct-to-implant breast reconstruction with ADM (primarily Strattice™). METHODS We retrospectively examined all patients undergoing immediate direct-to-implant breast reconstruction with ADM, during a five-year period (2014-2019) at a university clinic. Study outcomes were all complications and explantations. Complications were stratified within and after 6 months postoperatively and subcategorized by type of intervention. Explantations were subcategorized into loss of implant or salvage with immediate insertion of a tissue expander, the same or a new implant. RESULTS We included 154 patients and 232 breasts. Complications within 6 months per patient included hematoma (4%), seroma (8%), infection (9%), necrosis, wound dehiscence and delayed wound healing (19%). The total complication rate per patient was 34%. Explantation occurred in 20 patients (13%) of which 9 (6% of all) had implant loss. Preoperative radiotherapy was a significant predictor of explantation (adjusted OR 4.9, 95% confidence interval (CI), 1.0-23.5; p = 0.045), and smoking was also associated with risk of explantation, although only borderline significant (adjusted OR 4.0, 95% CI, 1.0-15.8; p = 0.050). CONCLUSION This study demonstrates acceptable rates of re-operations and implant loss compared to other studies but highlights the importance of proper patient selection with regards to risk factors to minimize complications.
Collapse
Affiliation(s)
- Julie Kalstrup
- Department of Plastic and Reconstructive Surgery, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
| | - Cecilie Balslev Willert
- Department of Plastic and Reconstructive Surgery, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Marie Brinch-Møller Weitemeyer
- Department of Plastic and Reconstructive Surgery, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
| | - Annette Hougaard Chakera
- Department of Plastic and Reconstructive Surgery, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Lisbet Rosenkrantz Hölmich
- Department of Plastic and Reconstructive Surgery, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark.
| |
Collapse
|
39
|
Sullivan B, Ryan I, Henderson PW. Objective Comparison of FDA-Approved Breast Implant Products in the USA: 5-Year Update. Aesthetic Plast Surg 2021; 45:2568-2577. [PMID: 34128092 DOI: 10.1007/s00266-021-02395-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/29/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND There are currently four companies offering FDA-approved breast implants: Allergan, Sientra, Mentor, and Ideal Implant. In 2015, our paper "Objective Comparison of Commercially Available Breast Implant Devices" sought to provide a unique conceptual framework to better understand the similarities and differences between FDA-approved breast implant products and tissue expanders. This paper uses the same variables, such as fill material, shape, relative dimensions, and surface coating, to aid understanding of both the surgical trainee and the operating surgeon of what devices each company offers, with a focus on how the market has evolved over the ensuing 5 years. METHODS The product catalogs of each FDA-approved company were carefully explored to determine the current available breast implants and tissue expanders. Subsequently, flow charts were created to provide a clear and objective survey of each companies' offerings, highlighting where there are overlap and deficiencies, and where there has been contraction or growth. RESULTS Disruptions to the industry, including both technological innovation and the recognition of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), have caused a significant shift in the details of the available permanent breast implants, breast tissue expanders, sizers, and warranty programs. CONCLUSION As it has been in 2015, company jargon and brand names continue to make it challenging to discern the similarities and differences between company devices and programs. This project remained independent of any company's funding, support, or input, making it a uniquely objective and informative survey of the current breast implant market that should assist surgeons in decision-making regarding the breast implant procedures. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
- Brianne Sullivan
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Isabel Ryan
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peter W Henderson
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| |
Collapse
|
40
|
Roberts K, Mills N, Metcalfe C, Lane A, Clement C, Hollingworth W, Taylor J, Holcombe C, Skillman J, Fairhurst K, Whisker L, Cutress R, Thrush S, Fairbrother P, Potter S. Best-BRA (Is subpectoral or prepectoral implant placement best in immediate breast reconstruction?): a protocol for a pilot randomised controlled trial of subpectoral versus prepectoral immediate implant-based breast reconstruction in women following mastectomy. BMJ Open 2021; 11:e050886. [PMID: 34848516 PMCID: PMC8634330 DOI: 10.1136/bmjopen-2021-050886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Implant-based breast reconstruction (IBBR) is the most commonly performed reconstructive procedure following mastectomy. IBBR techniques are evolving rapidly, with mesh-assisted subpectoral reconstruction becoming the standard of care and more recently, prepectoral techniques being introduced. These muscle-sparing techniques may reduce postoperative pain, avoid implant animation and improve cosmetic outcomes and have been widely adopted into practice. Although small observational studies have failed to demonstrate any differences in the clinical or patient-reported outcomes of prepectoral or subpectoral reconstruction, high-quality comparative evidence of clinical or cost-effectiveness is lacking. A well-designed, adequately powered randomised controlled trial (RCT) is needed to compare the techniques, but breast reconstruction RCTs are challenging. We, therefore, aim to undertake an external pilot RCT (Best-BRA) with an embedded QuinteT Recruitment Intervention (QRI) to determine the feasibility of undertaking a trial comparing prepectoral and subpectoral techniques. METHODS AND ANALYSIS Best-BRA is a pragmatic, two-arm, external pilot RCT with an embedded QRI and economic scoping for resource use. Women who require a mastectomy for either breast cancer or risk reduction, elect to have an IBBR and are considered suitable for both prepectoral and subpectoral reconstruction will be recruited and randomised 1:1 between the techniques.The QRI will be implemented in two phases: phase 1, in which sources of recruitment difficulties are rapidly investigated to inform the delivery in phase 2 of tailored interventions to optimise recruitment of patients.Primary outcomes will be (1) recruitment of patients, (2) adherence to trial allocation and (3) outcome completion rates. Outcomes will be reviewed at 12 months to determine the feasibility of a definitive trial. ETHICS AND DISSEMINATION The study has been approved by the National Health Service (NHS) Wales REC 6 (20/WA/0338). Findings will be presented at conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN10081873.
Collapse
Affiliation(s)
- Kirsty Roberts
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Nicola Mills
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Chris Metcalfe
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Athene Lane
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Clare Clement
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | | | - Jodi Taylor
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Chris Holcombe
- Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Joanna Skillman
- Department of Plastic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Katherine Fairhurst
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Lisa Whisker
- Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Ramsey Cutress
- Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Steven Thrush
- Breast Unit, Worcestershire Acute Hospitals NHS Trust, Worcester, Worcestershire, UK
| | | | - Shelley Potter
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
- Bristol Breast Care Centre, North Bristol NHS Trust, Westbury on Trym, UK
| |
Collapse
|
41
|
Hölmich LR, Hamilton-Dutoit SJ, d'Amore FA. [Breast implant-associated anaplastic large cell lymphoma]. Ugeskr Laeger 2021; 183:V04210341. [PMID: 34761740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Breast implant-associated anaplastic large cell lymphoma is an uncommon malignancy associated with textured breast implants, and since 2014 13 Danish cases have been identified. Early diagnosis is important to minimise morbidity. Most patients present with swelling of the breast due to seroma within the fibrous capsule, fewer with a tumour. The diagnosis is based on cytology/histology with finding of typical anaplastic large cells, positive for CD30 and negative for anaplastic lymphoma kinase. Staging includes bone marrow examination and PET-CT scan, and a minority need systemic treatment, as argued in this review.
Collapse
|
42
|
Eisenberg T. Does Overfilling Smooth Inflatable Saline-Filled Breast Implants Decrease the Deflation Rate? Experience with 4761 Augmentation Mammaplasty Patients. Aesthetic Plast Surg 2021; 45:1991-1999. [PMID: 33712871 PMCID: PMC8481168 DOI: 10.1007/s00266-021-02198-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/14/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Research suggests that overfilling saline inflatable breast implants may decrease their deflation rates. To date, there has been no large-scale study comparing breast implants filled within vs. beyond the manufacturer's recommended fill volumes. METHODS A retrospective comparative study was conducted for 4761 women who underwent aesthetic augmentation mammaplasty by the author. Patients were divided into two groups: Group 1 includes 2960 patients who had breast augmentation between 2002 and 2009 with implants filled within the manufacturer's recommended fill volumes. Group 2 includes 1801 patients who had breast augmentation between 2011 and 2018. Their implants were overfilled with an average volume between 42 and 50 cc, or 10-13%, respectively. All surgeries were performed with Mentor Style 1600 saline breast implants (smooth, round moderate profile) through an inframammary incision; implants were placed in the subpectoral (dual) plane. Also evaluated was the yearly increase in deflation rates. RESULTS Group I had 119 deflations, representing a deflation rate of 4.02%. Group 2 had 33 deflations, providing a deflation rate of 1.83%. The author found a protective effect in overfilling the device (p < 0.00001 and Z-score of 4.17). Fold failure was the major reason for deflation in both groups. The implants filled within the manufacturer's recommended volume had a yearly increase in deflation rate of 0.41%, not 1% as is commonly reported. The overfilled implants did not have a yearly increase in deflation rate. CONCLUSION Overfilling Mentor Style 1600 saline breast implants (smooth, round moderate profile) 10-13% significantly reduced the deflation rate. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
- Ted Eisenberg
- Nazareth Hospital, 2375 Woodward Street, Suite 102, Philadelphia, PA, 19115, USA.
| |
Collapse
|
43
|
Chopra CS, Thistlethwaite P, Herrera F, Suliman A. Iatrogenic intrathoracic encapsulated siliconoma from a ruptured breast implant. BMJ Case Rep 2021; 14:e243870. [PMID: 34497056 PMCID: PMC8438724 DOI: 10.1136/bcr-2021-243870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2021] [Indexed: 11/03/2022] Open
Abstract
Our patient was a 57-year-old woman with a history of bilateral retropectoral silicone breast augmentation and axillary hyperhidrosis who underwent a bilateral thoracic sympathectomy via video-assisted thoracoscopic surgery by a surgeon at an outside hospital approximately 20 years ago. The left side required an open thoracotomy. Shortly after the surgery, she developed a left-sided Baker 4 capsular contracture and the left implant was noted to be ruptured. Both implants were exchanged. Several years later the patient began to experience progressive fatigue. Work-up revealed a left lung nodule and she underwent a biopsy that confirmed silicone granulomas. It was hypothesised that at the time of her initial thoracotomy the implant was violated resulting in silicone spillage into the thoracic cavity. The patient was referred to our institution for advanced management of her intrathoracic silicosis. The patient underwent bilateral removal of her silicone implants, total capsulectomy and needle-localised removal of her left thoracic silicone masses. She had an uneventful postoperative course with resolution of her fatigue.
Collapse
Affiliation(s)
- Christina Shree Chopra
- School of Medicine, California University of Science & Medicine, Colton, CA, USA
- Division of Plastic Surgery, University of California, San Diego, San Diego, CA, USA
| | - Patricia Thistlethwaite
- Surgery, Division of Cardiovascular and Thoracic Surgery, University of California San Diego, La Jolla, CA, USA
| | - Fernando Herrera
- Division of Plastic Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Ahmed Suliman
- Division of Plastic Surgery, University of California, San Diego, San Diego, CA, USA
| |
Collapse
|
44
|
Kappos EA, Schulz A, Regan MM, Moffa G, Harder Y, Ribi K, Potter S, Pusic AL, Fehr MK, Hemkens LG, Holzbach T, Farhadi J, Simonson C, Knauer M, Verstappen R, Bucher HC, Zwahlen D, Zimmermann F, Schwenkglenks M, Mucklow R, Shaw J, Bjelic-Radisic V, Chiorescu A, Chun YS, Farah S, Xiaosong C, Nigard L, Kuemmel S, Reitsamer R, Hauschild M, Fulco I, Tausch C, Fischer T, Sarlos D, Constantinescu MA, Lupatsch JE, Fitzal F, Heil J, Matrai Z, de Boniface J, Kurzeder C, Haug M, Weber WP. Prepectoral versus subpectoral implant-based breast reconstruction after skin-sparing mastectomy or nipple-sparing mastectomy (OPBC-02/ PREPEC): a pragmatic, multicentre, randomised, superiority trial. BMJ Open 2021; 11:e045239. [PMID: 34475143 PMCID: PMC8413865 DOI: 10.1136/bmjopen-2020-045239] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 07/20/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The emphasis on aesthetic outcomes and quality of life (QoL) has motivated surgeons to develop skin-sparing or nipple-sparing mastectomy (SSM/ NSM) for breast cancer treatment or prevention. During the same operation, a so-called immediate breast reconstruction is performed. The breast can be reconstructed by positioning of a breast implant above (prepectoral) or below (subpectoral) the pectoralis major muscle or by using the patients' own tissue (autologous reconstruction). The optimal positioning of the implant prepectoral or subpectoral is currently not clear. Subpectoral implant-based breast reconstruction (IBBR) is still standard care in many countries, but prepectoral IBBR is increasingly performed. This heterogeneity in breast reconstruction practice is calling for randomised clinical trials (RCTs) to guide treatment decisions. METHODS AND ANALYSIS International, pragmatic, multicentre, randomised, superiority trial. The primary objective of this trial is to test whether prepectoral IBBR provides better QoL with respect to long-term (24 months) physical well-being (chest) compared with subpectoral IBBR for patients undergoing SSM or NSM for prevention or treatment of breast cancer. Secondary objectives will compare prepectoral versus subpectoral IBBR in terms of safety, QoL and patient satisfaction, aesthetic outcomes and burden on patients. Total number of patients to be included: 372 (186 per arm). ETHICS AND DISSEMINATION This study will be conducted in compliance with the Declaration of Helsinki. Ethical approval has been obtained for the lead investigator's site by the Ethics Committee 'Ethikkommission Nordwest- und Zentralschweiz' (2020-00256, 26 March 2020). The results of this study will be published in a peer-reviewed medical journal, independent of the results, following the Consolidated Standards of Reporting Trials standards for RCTs and good publication practice. Metadata describing the type, size and content of the datasets will be shared along with the study protocol and case report forms on public repositories adhering to the FAIR (Findability, Accessibility, Interoperability, and Reuse) principles. TRIAL REGISTRATION NUMBER NCT04293146.
Collapse
Affiliation(s)
- Elisabeth A Kappos
- Breast Center, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Alexandra Schulz
- University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Meredith M Regan
- IBCSG Statistical Center, Division of Biostatistics, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Giusi Moffa
- Department of Mathematics and Computer Science, University of Basel, Basel, Switzerland
| | - Yves Harder
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale di Lugano and Centro di Senologia della Svizzera Italiana, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Faculty of Biomedical Science, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Karin Ribi
- Quality of Life Office, International Breast Cancer Study Group Coordinating Center, Bern, Switzerland
| | - Shelley Potter
- Centre for Surgical Research, Bristol Medical School and Bristol Breast Care Centre, North Bristol NHS Trust, University of Bristol, Bristol, UK
| | - Andrea L Pusic
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mathias K Fehr
- Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
| | - Lars G Hemkens
- University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- Basel Institute for Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
- Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany
| | - Thomas Holzbach
- Department of Hand and Plastic Surgery, Spital Thurgau AG, Frauenfeld, Thurgau, Switzerland
- Breast Center Thurgau, Thurgau, Switzerland
| | - Jian Farhadi
- University of Basel, Basel, Switzerland
- Breast Center Zurich, Zurich, Switzerland
- Plastic Surgery Group, Switzerland
| | | | - Michael Knauer
- Breast Center Eastern Switzerland, St. Gallen, Switzerland
| | - Ralph Verstappen
- Breast Center St. Gallen, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
- Department of Hand, Plastic and Reconstructive Surgery, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Heiner C Bucher
- University of Basel, Basel, Switzerland
- Basel Institute for Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Daniel Zwahlen
- Department of Radiation Oncology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Frank Zimmermann
- University of Basel, Basel, Switzerland
- Department of Radiation Oncology, University of Basel, Basel, Switzerland
| | - Matthias Schwenkglenks
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Rosine Mucklow
- Independent patient expert, Buxtorf Quality Services, Basel, Switzerland
- Patient Advocacy Group, Oncoplastic Breast Consortium, Basel, Switzerland
| | - Jane Shaw
- Patient Advocacy Group, Oncoplastic Breast Consortium, Basel, Switzerland
| | - Vesna Bjelic-Radisic
- Breast Unit, University Hospital Helios Wuppertal, University Witten Herdecke, Wuppertal, Germany
| | - Amelia Chiorescu
- Department of Breast, Endocrine tumours and Sarcoma, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Yoon S Chun
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Subrina Farah
- IBCSG Statistical Center, Division of Biostatistics, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Chen Xiaosong
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Linda Nigard
- Södersjukhuset, Bröstsektionen, Kirurgkliniken, Stockholm, Sweden
| | - Sherko Kuemmel
- Breast Unit, Kliniken Essen-Mitte, Essen, Germany
- Charité - Universitätsmedizin Berlin, Department of Gynecology with Breast Center, Berlin, Germany
| | - Roland Reitsamer
- Breast Center Salzburg, University Clinic Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Maik Hauschild
- Department of Gynecology and Obstetrics, Gesundheitszentrum Fricktal, Rheinfelden, Switzerland
| | - Ilario Fulco
- Breast Center, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Breast Center, Hirslanden Clinic Aarau, Aarau, Switzerland
| | | | - Thomas Fischer
- Lindenhofgruppe, Centerclinic, Brustzentrum Bern, Bern, Switzerland
| | - Dimitri Sarlos
- Department of Obstetrics and Gynecology, Kantonsspital Aarau AG, Aarau, Switzerland
| | - Mihai A Constantinescu
- Department of Plastic and Hand Surgery, Inselspital University Hospital, Bern, Switzerland
- University of Bern, Bern, Switzerland
| | - Judith E Lupatsch
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
| | - Florian Fitzal
- Breast Health Center and Department of Surgery, Medical University, Vienna, Austria
| | - Joerg Heil
- Department of Obstetrics and Gynecology, University Breast Unit, University Women's Hospital Heidelberg, Heidelberg, Germany
| | - Zoltan Matrai
- National Institute of Oncology, Department of Breast and Sarcoma Surgery, Budapest, Hungary
| | - Jana de Boniface
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, Capio St. Göran's Hospital, Stockholm, Sweden
| | - Christian Kurzeder
- Breast Center, University Hospital Basel, University of Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Department of Gynecology and Obstetrics, University Hospital Basel, Basel, Switzerland
| | - Martin Haug
- Breast Center, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Walter P Weber
- Breast Center, University Hospital Basel, University of Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| |
Collapse
|
45
|
Khan UD. Invited Response on: Letter to the Editor: Layered Mastopexy with Augmentation in Muscle Splitting Biplane-A Modification for Lower Pole Safety and Stability. Aesthetic Plast Surg 2021; 46:122-124. [PMID: 34426847 DOI: 10.1007/s00266-021-02538-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 08/14/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Umar Daraz Khan
- Re-shape Clinic, Reshape House, 2-4 High Street, West Malling, Kent, ME19 6QR, England.
| |
Collapse
|
46
|
Ryu JY, Yang JD. Invited Response on: "Usefulness of Incisional Negative Pressure Wound Therapy for Decreasing Wound Complication Rates and Seroma Formation Following Prepectoral Breast Reconstruction". Aesthetic Plast Surg 2021; 45:1950-1951. [PMID: 33709223 DOI: 10.1007/s00266-021-02202-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 02/18/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Jeong Yeop Ryu
- Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, Korea
| | - Jung Dug Yang
- Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, Korea.
| |
Collapse
|
47
|
Walker NJ, Park JG, Maus JC, Motamedi V, Rebowe RE, Runyan CM, Tucker SL. Prepectoral Versus Subpectoral Breast Reconstruction in High-Body Mass Index Patients. Ann Plast Surg 2021; 87:136-143. [PMID: 33560000 DOI: 10.1097/sap.0000000000002682] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The effect of body mass index (BMI) on complication rates in prepectoral implant-based breast reconstruction is not well established. The purpose of this study was to compare complication rates between different BMI groups in subpectoral and prepectoral reconstruction. METHODS A single-surgeon, 4-year, retrospective review was performed of consecutive prosthetic breast reconstructions. During this time, the senior author's practice shifted from a subpectoral to prepectoral technique. Patients were stratified into BMI subgroups (<25, 25-35, and >35 kg/m2) and complication rates were analyzed. A survey was administered to blinded medical personnel and patients comparing esthetic results. RESULTS Implant-based reconstructions were performed in 195 patients (103 subpectoral and 92 prepectoral). No significant difference in major complication rate was observed between techniques. Among patients with BMI greater than 35 kg/m2, implant exposure occurred at a significantly higher rate in the prepectoral group (P = 0.04). In patients with BMI greater than 25 kg/m2, minor asymmetry was more prevalent with prepectoral reconstruction (12.3% vs 0%; P = 0.02). Regardless of technique, the odds of reoperation increased by 7% per point increase in BMI, although this did not reach statistical significance (P = 0.07; odds ratio, 1.07; 95% confidence interval, 0.99-1.15).A total of 66 survey responses were received. Physicians rated esthetic results more positively than patients did. Patients with a BMI of less than 25 kg/m2 were rated better than other BMI groups in nearly all categories. The position of submuscular reconstruction was rated significantly better than prepectoral. CONCLUSIONS There is a trend toward higher complication rates in prepectoral versus subpectoral breast reconstruction with increasing BMI. Nonetheless, the technique appears to be safe, with comparable clinical and cosmetic results.
Collapse
|
48
|
Stümpfle RL, Piccinini PS, Zanin EM. Transabdominal Breast Augmentation With Silicone Gel Implants. Ann Plast Surg 2021; 87:126-131. [PMID: 34176905 DOI: 10.1097/sap.0000000000002921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Breast augmentation is frequently performed together with abdominoplasty. Although breast augmentation incisions generally heal well, patients almost universally will appreciate having fewer scars; this is the basic rationale for transabdominal breast augmentation. In addition, a transabdominal approach may decrease the risk of implant contamination because there is no contact of the implants with skin. METHODS A chart review of the senior author's private practice, from 2012 to 2020, was performed; 68 female patients who underwent abdominoplasty in association with transabdominal breast augmentation, with at least 1 year of follow-up, were included. All patients underwent liposuction, standard abdominoplasty with wide suprafascial abdominal flap undermining, and liposuction of the abdominal flap as needed. Round, silicone gel implants (Mentor Siltex, Santa Monica, CA) were used. RESULTS A total of 68 patients were operated on. Mean age was 49 years (range, 25-68 years), mean body mass index was 25.7 kg/m2 (range, 22.3-29.5 kg/m2). The most commonly used implant volume (mode) was 270 mL (range, 225-395 mL). Implants were high (75%) or ultrahigh profile (25%). Eight patients (15%) had previously undergone breast augmentation. Seven patients (12%) underwent simultaneous breast fat grafting. There were no major complications. There were no complications related to the breast augmentation (ie, no extrusion or infection, malposition requiring revision, or capsular contracture). No patients requested upsizing or other revision of their implants.With regard to the abdominoplasty, there were 4 cases of well-circumscribed seroma treated with serial aspiration in the office. There were no cases of abdominoplasty site infection. Five patients required revision of abdominoplasty incisions. Two patients requested revision liposuction after weight gain. CONCLUSIONS Breast augmentation through an abdominoplasty incision may incur benefits beyond the obvious single surgical scar. Overall, transabdominal breast augmentation, in adequately selected patients, is an option which is safe, does not increase operative time, can lead to good results, and may potentially decrease some complications related to breast augmentation through other incision sites.
Collapse
Affiliation(s)
| | | | - Eduardo Madalosso Zanin
- Plastic Surgery Division, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil. R.B.L. is in private practice in Porto Alegre, Brazil
| |
Collapse
|
49
|
Sinnott CJ, Pronovost MT, Persing SM, Wu R, Young AO. The Impact of Premastectomy Versus Postmastectomy Radiation Therapy on Outcomes in Prepectoral Implant-Based Breast Reconstruction. Ann Plast Surg 2021; 87:S21-S27. [PMID: 33833185 DOI: 10.1097/sap.0000000000002801] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Prepectoral implant-based breast reconstruction is being increasingly performed over subpectoral reconstruction because of the reduced invasiveness of the procedure, postoperative pain, and risk of animation deformity. Radiation therapy is a well-known risk factor for complications in implant-based breast reconstruction. The effect of premastectomy versus postmastectomy radiation therapy on outcomes after prepectoral breast reconstruction has not been well-defined. The purpose of this study was to compare the impact of premastectomy versus postmastectomy radiation therapy on outcomes after prepectoral breast reconstruction. METHODS A retrospective chart review was performed on all patients who underwent prepectoral implant-based breast reconstruction with inferior dermal flap and acellular dermal matrix performed by a single surgeon from 2010 to 2019. Demographic, clinical and operative data were reviewed and recorded. Outcomes were assessed by comparing rates of capsular contracture, infection, seroma, hematoma, dehiscence, mastectomy skin flap necrosis, rippling, implant loss, local recurrence and metastatic disease, between patients receiving premastectomy and postmastectomy radiation therapy and nonradiated patients. RESULTS Three hundred and sixty-nine patients (592 breasts) underwent prepectoral implant-based breast reconstruction. Twenty-six patients (28 breasts) received premastectomy radiation, 45 patients (71 breasts) received postmastectomy radiation, and 305 patients (493 breasts) did not receive radiation therapy. Patients with premastectomy radiation had higher rates of seroma (14.3% vs 0.2%), minor infection (10.7% vs 1.2%), implant loss (21.4% vs 3.4%) and local recurrence (7.1% vs 1.0%), compared with nonradiated patients (P < 0.05). Patients with postmastectomy radiation had higher rates of major infection (8.4% vs 2.4%), capsular contracture (19.7% vs 3.2%), implant loss (9.9% vs 3.4%), and local recurrence (5.6% vs 1.0%) when compared with nonradiated patients (P < 0.03). Outcomes after prepectoral breast reconstruction were comparable between premastectomy and postmastectomy radiation patients, respectively, with regard to major infection (7.1% vs 8.4%), dehiscence (3.6% vs 1.4%), major mastectomy skin flap necrosis (7.1% vs 2.8%), capsular contracture (10.7% vs 19.7%), implant loss (21.4% vs 9.9%), and local recurrence (7.1% vs 5.6%) (P ≥ 0.184). However, premastectomy radiation patients had a higher rate of seroma compared with postmastectomy radiation patients (14.3% vs 0%; P = 0.005). CONCLUSIONS In prepectoral implant breast reconstruction, premastectomy and postmastectomy radiation therapy were associated with higher rates of infection and implant loss compared with nonradiated patients. Postmastectomy radiation was associated with a higher rate of capsular contracture compared with nonradiated patients, and a comparable rate of capsular contracture compared with premastectomy radiation therapy patients. Premastectomy radiation was associated with a higher rate of seroma compared with postmastectomy radiation and nonradiated patients.
Collapse
Affiliation(s)
| | | | - Sarah M Persing
- Keck School of Medicine of University of Southern California, Los Angeles
| | - Robin Wu
- Stanford University School of Medicine, Stanford, CA
| | - Anke Ott Young
- Yale New Haven Health/Bridgeport Hospital, Bridgeport, CT
| |
Collapse
|
50
|
Atiyeh BS, Costagliola M, Rampillon F, Chahine F. Comment on Plane Change Versus Capsulotomy: A Comparison of Treatments for Capsular Contraction in Breast Augmentation Using the Subfascial Plane. Aesthetic Plast Surg 2021; 45:1360-1362. [PMID: 33399952 DOI: 10.1007/s00266-020-02072-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Bishara S Atiyeh
- Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Michel Costagliola
- Faculté de Médecine Toulouse-Rangueil, Pr Emérite-Chirurgie Réparatrice et Esthétique, Toulouse, France
| | | | | |
Collapse
|