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Hu L, Qian B, Yan Z, Bing K, Mei L, Qu X. Case report and literature review: Malignant adenomyoepithelioma after breast augmentation. Front Surg 2022; 9:981045. [PMID: 36311924 PMCID: PMC9606651 DOI: 10.3389/fsurg.2022.981045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/15/2022] [Indexed: 11/07/2022] Open
Abstract
Background Breast malignant adenomyoepithelioma (MAME) after breast augmentation has never been reported. Case summary We reported a case of a 55-year-old woman who was diagnosed with breast MAME 16 years after breast augmentation. Breast augmentation was performed on the patient with two 200 ml round textured prostheses in the subpectoral plane through axillary incisions in 2004. However, a breast ultrasound in 2020 revealed a suspicious malignant lump in the right breast, which was finally confirmed as MAME by pathology. Skin-sparing modified radical mastectomy and immediate breast reconstruction with expander implantation were performed. Subsequently, the patient received three cycles of chemotherapy with the regimen of anthracycline and cyclophosphamide. In the following nearly 2 years of follow-up, no tumor recurrence and metastasis were found, and the overall treatment was satisfactory for the patient. Conclusion Here, we present a unique case in which a patient was diagnosed with breast MAME after breast augmentation. Skin-sparing modified radical mastectomy and immediate breast reconstruction with expander implantation are feasible approaches that yield at least short-term oncological safety and acceptable aesthetic results. However, whether there is a potential relationship between MAME and breast implants remains to be further explored. Meanwhile, due to the rarity of breast MAME, more authoritative strategies considering both oncological safety and aesthetics to seek better long-term therapeutic effects are needed.
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Affiliation(s)
- Longqing Hu
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bei Qian
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhecheng Yan
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kaijian Bing
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Mei
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Correspondence: Li Mei Xincai Qu
| | - Xincai Qu
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Correspondence: Li Mei Xincai Qu
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Fracol M, Shah N, Dolivo D, Hong S, Giragosian L, Galiano R, Mustoe T, Kim JYS. Can Breast Implants Induce Breast Cancer Immunosurveillance? An Analysis of Antibody Response to Breast Cancer Antigen following Implant Placement. Plast Reconstr Surg 2021; 148:287-298. [PMID: 34398081 DOI: 10.1097/prs.0000000000008165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Women with cosmetic breast implants have significantly lower rates of subsequent breast cancer than the general population (relative risk, 0.63; 95 percent CI, 0.56 to 0.71). The authors hypothesize that breast implant-induced local inflammation stimulates immunosurveillance recognition of breast tumor antigen. METHODS Sera were collected from two cohorts of healthy women: women with long-term breast implants (i.e., breast implants for >6 months) and breast implant-naive women. Antibody responses to breast tumor antigens were tested by enzyme-linked immunosorbent assay and compared between cohorts by unpaired t test. Of the implant-naive cohort, nine women underwent breast augmentation, and antibody responses before and after implant placement were compared by paired t test. RESULTS Sera were collected from 104 women: 36 (34.6 percent) long-term breast implants and 68 (65.4 percent) implant-naive women. Women with long-term breast implants had higher antibody responses than implant-naive women to mammaglobin-A (optical density at 450 nm, 0.33 versus 0.22; p = 0.003) and mucin-1 (optical density at 450 nm, 0.42 versus 0.34; p = 0.02). There was no difference in antibody responses to breast cancer susceptibility gene 2, carcinoembryonic antigen, human epidermal growth factor receptor-2, or tetanus. Nine women with longitudinal samples preoperatively and 1 month postoperatively demonstrated significantly elevated antibody responses following implant placement to mammaglobin-A (mean difference, 0.13; p = 0.0002) and mucin-1 (mean difference 0.08; p = 0.02). There was no difference in postimplant responses to other breast tumor antigens, or tetanus. CONCLUSIONS Women with long-term breast implants have higher antibody recognition of mammaglobin-A and mucin-1. This study provides the first evidence of implant-related immune responses to breast cancer antigens. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
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Affiliation(s)
- Megan Fracol
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine
| | - Nikita Shah
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine
| | - David Dolivo
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine
| | - Seok Hong
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine
| | - Lexa Giragosian
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine
| | - Robert Galiano
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine
| | - Thomas Mustoe
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine
| | - John Y S Kim
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine
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Abstract
This review discusses the historical development of smooth and textured silicone gel filled implants, and examines the reasoning behind product development and aspects of surgical technique from a surgeon's perspective.
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Affiliation(s)
- D Perry
- Anglia Ruskin University, Chelmsford, UK
| | - J D Frame
- Anglia Ruskin University, Chelmsford, UK
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4
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Zingaretti N, Galvano F, Vittorini P, De Francesco F, Almesberger D, Riccio M, Vaienti L, Parodi PC. Smooth Prosthesis: Our Experience and Current State of Art in the Use of Smooth Sub-muscular Silicone Gel Breast Implants. Aesthetic Plast Surg 2019; 43:1454-1466. [PMID: 31342127 DOI: 10.1007/s00266-019-01464-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The objective of this clinical review is to provide an overview of the use of silicone gel-filled breast implants placed in the sub-muscular position, with a focus on complication rates reported for both smooth and textured implants. Furthermore, our experience in this field is also reviewed. METHODS MEDLINE, EMBASE, Web of Science, Scopus, the Cochrane Central and Google Scholar databases were reviewed to identify the literature related to smooth breast implants. Each article was reviewed by two independent reviewers to ensure all relevant publications were identified. The literature search identified 98 applicable articles. Of these, just a few articles were found to have a therapeutic level of evidence. The reference lists in each relevant paper were screened manually to include relevant papers not found through the initial search. RESULTS Eight articles report the risk of capsular contracture when the breast implants were placed in the sub-muscular position. Six of these articles report a similar rate of capsular contracture in smooth and textured implants. Local complications such as wrinkling, late seroma and double capsules were found to be associated with the use of textured breast implants (4 articles). All articles concerning BIA-ALCL reported a total absence occurring in smooth breast implants. All cases have been associated with textured mammary prostheses. CONCLUSION With our expertise in the field and the results of this up-to-date literature review, it can be concluded that there are no significant advantages of using one type of implant surface over the other when placed in the sub-pectoral position. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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5
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Wohlgemuth FB, Brasil MBQ, d'Acampora AJ. Risk of breast implant-associated anaplastic large cell lymphoma in patients submitted to breast implantation: A systematic review. Breast J 2019; 25:932-937. [PMID: 31155830 DOI: 10.1111/tbj.13370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 11/28/2022]
Abstract
Although breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare disease, its incidence has been increasing. The aim of this study was to assess the risk of BIA-ALCL in women with breast implants. A systematic search was carried out in Pubmed, Scopus, ScienceDirect, LIVIVO, Cochrane Library, Google Scholar, and OpenGrey databases. The risk assessment of bias was based on the Newcastle-Ottawa Scale. The rarity of BIA-ALCL was a major limitation. Although we have found evidence of an increased risk of BIA-ALCL, further studies are needed to understand why some large samples did not present any case of the disease.
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Affiliation(s)
- Felipe Barbieri Wohlgemuth
- Programa de Pós-Graduação em Ciências Médicas, Hospital Universitário - Universidade Federal de Santa Catarina, Florianópolis, Brasil
| | - Marília Bastos Quirino Brasil
- Programa de Pós-Graduação em Ciências Médicas, Hospital Universitário - Universidade Federal de Santa Catarina, Florianópolis, Brasil
| | - Armando José d'Acampora
- Programa de Pós-Graduação em Ciências Médicas, Hospital Universitário - Universidade Federal de Santa Catarina, Florianópolis, Brasil
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Prasad K, Zhou R, Zhou R, Schuessler D, Ostrikov KK, Bazaka K. Cosmetic reconstruction in breast cancer patients: Opportunities for nanocomposite materials. Acta Biomater 2019; 86:41-65. [PMID: 30576863 DOI: 10.1016/j.actbio.2018.12.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 12/08/2018] [Accepted: 12/17/2018] [Indexed: 12/23/2022]
Abstract
The most common malignancy in women, breast cancer remains a major medical challenge that affects the life of thousands of patients every year. With recognized benefits to body image and self-esteem, the use of synthetic mammary implants for elective cosmetic augmentation and post-mastectomy reconstruction continues to increase. Higher breast implant use leads to an increased occurrence of implant-related complications associated with implant leakage and rupture, capsular contracture, necrosis and infections, which include delayed healing, pain, poor aesthetic outcomes and the need for revision surgeries. Along with the health status of the implant recipient and the skill of the surgeon, the properties of the implant determine the likelihood of implant-related complications and, in doing so, specific patient outcomes. This paper will review the challenges associated with the use of silicone, saline and "gummy bear" implants in view of their application in patients recovering from breast cancer-related mastectomy, and investigate the opportunities presented by advanced functional nanomaterials in meeting these challenges and potentially opening new dimensions for breast reconstruction. STATEMENT OF SIGNIFICANCE: Breast cancer is a significant cause of morbidity and mortality in women worldwide, which is difficult to prevent or predict, and its treatment carries long-term physiological and psychological consequences. Post-mastectomy breast reconstruction addresses the cosmetic aspect of cancer treatment. Yet, drawbacks of current implants contribute to the development of implant-associated complications, which may lead to prolonged patient care, pain and loss of function. Nanomaterials can help resolve the intrinsic biomechanical mismatch between implant and tissues, enhance mechanical properties of soft implantable materials, and provide an alternative avenue for controlled drug delivery. Here, we explore advances in the use of functionalized nanomaterials to enhance the properties of breast implants, with representative examples that highlight the utility of nanomaterials in addressing key challenges associated with breast reconstruction.
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Affiliation(s)
- Karthika Prasad
- School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; CSIRO-QUT Joint Sustainable Processes and Devices Laboratory, Commonwealth Scientific and Industrial Research Organisation, P.O. Box 218, Lindfield, NSW 2070, Australia
| | - Renwu Zhou
- School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; CSIRO-QUT Joint Sustainable Processes and Devices Laboratory, Commonwealth Scientific and Industrial Research Organisation, P.O. Box 218, Lindfield, NSW 2070, Australia
| | - Rusen Zhou
- School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; CSIRO-QUT Joint Sustainable Processes and Devices Laboratory, Commonwealth Scientific and Industrial Research Organisation, P.O. Box 218, Lindfield, NSW 2070, Australia
| | - David Schuessler
- Product Development, Allergan, 2525 Dupont Drive, Irvine, CA 92612, United States
| | - Kostya Ken Ostrikov
- School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; CSIRO-QUT Joint Sustainable Processes and Devices Laboratory, Commonwealth Scientific and Industrial Research Organisation, P.O. Box 218, Lindfield, NSW 2070, Australia
| | - Kateryna Bazaka
- School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; CSIRO-QUT Joint Sustainable Processes and Devices Laboratory, Commonwealth Scientific and Industrial Research Organisation, P.O. Box 218, Lindfield, NSW 2070, Australia.
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Radiographer mammographers' attitudes towards implementing new techniques for imaging the augmented breast, after viewing a training DVD or receiving cascade training: A survey. Radiography (Lond) 2019; 25:39-45. [PMID: 30599828 DOI: 10.1016/j.radi.2018.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 07/25/2018] [Accepted: 07/30/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Mammographers in the NHSBSP are required to implement the Eklund ('Pushback') technique after viewing a training DVD or receiving cascade training. This study aims to evaluate Radiographers' attitudes towards imaging the augmented breast following viewing the training DVD or receiving cascade training. METHODOLOGY Questionnaires containing both open and closed questions collected quantitative and qualitative data across three breast screening units. A total of 60 radiographers were targeted. Their responses were analysed using Pearson's Chi-Square. An evaluation of likelihood and association of variables was performed using inferential statistics. RESULTS Of the 60 mammographers targeted, 38 (63%) completed the questionnaires. Quantitative results indicated that most mammographers (78%) had watched the DVD. Of these responders, (51.14%) found the DVD somewhat helpful in raising their confidence to attempt the new techniques. When inferential statistics was used to evaluate if confidence was associated with location or level of qualifications, these showed no significance ('p' = 0.085 and 0.312 respectively). Results indicated that longer years of practice had an association with ability to attempt techniques, however, this was not statistically significant (χ2 = 3.939, df = 6, p = 0.685). Qualitative responses indicated that cascade training increased confidence more than viewing the DVD. Both qualitative and quantitative data indicated that cascade training in addition to the DVD is required. CONCLUSION Although the DVD was a helpful training tool, it did not sufficiently raise confidence for all viewers. Cascaded training in addition to the DVD was required to effectively raise confidence.
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Hopper I, Best RL, McNeil JJ, Mulvany CM, Moore CCM, Elder E, Pase M, Cooter RD, Evans SM. Pilot for the Australian Breast Device Registry (ABDR): a national opt-out clinical quality registry for breast device surgery. BMJ Open 2017; 7:e017778. [PMID: 29288178 PMCID: PMC5770948 DOI: 10.1136/bmjopen-2017-017778] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To establish a pilot clinical quality registry (CQR) to monitor the quality of care and device performance for breast device surgery in Australia. PARTICIPANTS All patients having breast device surgery from contributing hospitals in Australia. A literature review was performed which identified quality indicators for breast device surgery. FINDINGS TO DATE A pilot CQR was established in 2011 to capture prospective data on breast device surgery. An interim Steering Committee and Management Committee were established to provide clinical governance, and guide quality indicator selection. The registry's minimum dataset was formulated in consultation with stakeholder groups; potential quality indicators were assessed in terms of (1) importance and relevance, (2) usability, (3) feasibility to collect and (4) scientific validity. Data collection was by a two-sided paper-based form with manual data entry. Seven sites were recruited, including one public hospital, four private hospitals and two day surgeries. Patients were recruited and opt-out consent used. FUTURE PLANS The pilot breast device registry provides high-quality population-based data. It provides a model for developing a national CQR for breast devices; its minimum dataset and quality indicators reflect the opinions of the broad range of stakeholders. It is easily scalable, and has formed the basis for other international surgical groups establishing similar registries.
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Affiliation(s)
- Ingrid Hopper
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (SPHPM), Monash University, Melbourne, Victoria, Australia
| | - Renee L Best
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (SPHPM), Monash University, Melbourne, Victoria, Australia
| | - John J McNeil
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (SPHPM), Monash University, Melbourne, Victoria, Australia
| | - Catherine M Mulvany
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (SPHPM), Monash University, Melbourne, Victoria, Australia
| | - Colin C M Moore
- Australian Centre for Cosmetic Surgery, Neutral Bay, New South Wales, Australia
- Australasian College of Cosmetic Surgery, Parramatta, New South Wales, Australia
| | - Elisabeth Elder
- Breast Surgeons of Australia and New Zealand (BreastSurgANZ), Randwick, New South Wales, Australia
- Westmead Breast Cancer Institute, Westmead Hospital, Westmead, New South Wales, Australia
| | - Marie Pase
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (SPHPM), Monash University, Melbourne, Victoria, Australia
| | - Rodney D Cooter
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (SPHPM), Monash University, Melbourne, Victoria, Australia
- Australian Society of Plastic Surgeons, St Leonards, New South Wales, Australia
- Australasian Foundation for Plastic Surgery, St Leonards, New South Wales, Australia
| | - Sue M Evans
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (SPHPM), Monash University, Melbourne, Victoria, Australia
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Weems AC, Wacker KT, Carrow JK, Boyle AJ, Maitland DJ. Shape memory polyurethanes with oxidation-induced degradation: In vivo and in vitro correlations for endovascular material applications. Acta Biomater 2017; 59:33-44. [PMID: 28647624 PMCID: PMC5821471 DOI: 10.1016/j.actbio.2017.06.030] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 06/12/2017] [Accepted: 06/20/2017] [Indexed: 11/30/2022]
Abstract
The synthesis of thermoset shape memory polymer (SMP) polyurethanes from symmetric, aliphatic alcohols and diisocyanates has previously demonstrated excellent biocompatibility in short term in vitro and in vivo studies, although long term stability has not been investigated. Here we demonstrate that while rapid oxidation occurs in these thermoset SMPs, facilitated by the incorporation of multi-functional, branching amino groups, byproduct analysis does not indicate toxicological concern for these materials. Through complex multi-step chemical reactions, chain scission begins from the amines in the monomeric repeat units, and results, ultimately, in the formation of carboxylic acids, secondary and primary amines; the degradation rate and product concentrations were confirmed using liquid chromatography mass spectrometry, in model compound studies, yielding a previously unexamined degradation mechanism for these biomaterials. The rate of degradation is dependent on the hydrogen peroxide concentration, and comparison of explanted samples reveals a much slower rate in vivo compared to the widely accepted literature in vitro real-time equivalent of 3% H2O2. Cytotoxicity studies of the material surface, and examination of the degradation product accumulations, indicate that degradation has negligible impact on cytotoxicity of these materials. STATEMENT OF SIGNIFICANCE This paper presents an in-depth analysis on the degradation of porous, shape memory polyurethanes (SMPs), including traditional surface characterization as well as model degradation compounds with absolute quantification. This combination of techniques allows for determination of rates of degradation as well as accumulation of individual degradation products. These behaviors are used for in vivo-in vitro comparisons for determination of real time degradation rates. Previous studies have primarily been limited to surface characterization without examination of degradation products and accumulation rates. To our knowledge, our work presents a unique example where a range of material scales (atomistic-scale model compounds along with macroscopic porous SMPs) are used in conjunction with ex planted samples for calculation of degradation rates and toxicological risk.
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Affiliation(s)
- Andrew C Weems
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843-3120, USA
| | - Kevin T Wacker
- Department of Chemistry, Texas A&M University, College Station, TX 77843-3120, USA
| | - James K Carrow
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843-3120, USA
| | - Anthony J Boyle
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843-3120, USA
| | - Duncan J Maitland
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843-3120, USA.
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10
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Abstract
This paper presents patients satisfaction using anatomical polyurethane breast implants. We performed surgery on 525 patients, 370 of which were primary and 155 were secondary to various causes such as capsular contracture, ruptured implants, volume changes, and incorrect positioning of the implant. The advantages of silicone polyurethane covers shown high level of patient satisfaction, low incidence of capsular contracture, and absence of implant rotation, and late seroma.
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11
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Harvey KL, Clark SE. A guide to breast implants for the non-breast specialist. WOMENS HEALTH 2016; 12:533-537. [PMID: 29334026 DOI: 10.1177/1745505716687562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Breast augmentation is an increasingly popular cosmetic surgery procedure, and breast implants can also be used in reconstructive surgery following mastectomy. Problematic breast implants can present to any discipline of medicine, most frequently to primary care or acute service such as emergency medicine. This guide aims to inform the non-breast specialist in how to assess and treat common problems and when referral to specialist services is necessary.
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Affiliation(s)
- Kate L Harvey
- Department of Breast Surgery, Poole General Hospital, Poole Hospital NHS Foundation Trust, Poole, UK
| | - Sarah E Clark
- Department of Breast Surgery, Poole General Hospital, Poole Hospital NHS Foundation Trust, Poole, UK
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Current Trends in the Oncologic and Surgical Managements of Breast Cancer in Women with Implants: Incidence, Diagnosis, and Treatment. Aesthetic Plast Surg 2016; 40:256-65. [PMID: 26857708 DOI: 10.1007/s00266-016-0612-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 01/08/2016] [Indexed: 10/22/2022]
Abstract
UNLABELLED Breast augmentation is the most common cosmetic surgery in the United States, and thousands of augmented patients develop breast cancer each year. The possible effects of implants on cancer incidence, diagnosis, and treatment usually generate a disarming confusion. The present paper represents an update of the more recent oncologic and surgical strategies, aiming to support plastic and general surgeons in such challenging aspects. Several aspects of breast cancer management in augmented women are investigated, including (1) risk estimation and cancer characteristics, stage at diagnosis, and prognosis; (2) cancer diagnosis with clinical examination, mammography, ultrasound, and magnetic resonance imaging; (3) cancer treatment including breast conservation, intraoperative radiotherapy, sentinel node biopsy and mastectomy, and reconstruction. A brief resume of recommendations and conclusions is suggested, elucidating correct trends in the oncologic management of augmented patients and refusing well-established misconceptions: (1) breast augmentation does not increase the risk of breast cancer incidence, and it does not influence the prognosis; (2) possible risks exist in cancer detection due to technical difficulties; (3) sentinel lymph node detection is feasible; (4) intraoperative radiotherapy represents a good chance for conserving treatment; (5) immediate reconstruction with submuscular-subfascial implants is the most common procedure after mastectomy, and biological substitutes could support this procedure. Breast clinicians should be alerted because of high expectations of this subgroup of patients, accustomed to emphasize the aesthetic result. LEVEL OF EVIDENCE V This journal requires that the authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Abstract
The emerging epidemic of Hodgkin and non-Hodgkin lymphomas worldwide continues to defy our understanding and forces the search for the causative factors. Adjuvants are known to act as triggers of immune and inflammatory responses. Animal experiments have demonstrated that long-term inflammation is related to aggravation of the immune network resulting in cellular and humoral responses leading to autoimmunity and lymphoma development. Chronic stimulation of the immune system is thought to be the key mechanism through which infectious diseases as well as autoimmune diseases can lead to lymphomagenesis. Many adjuvants can act similarly perturbing immune system's function, inducing a state of prolonged immune activation related to chronic lymphatic drainage. Several mechanisms were proposed by which adjuvants induce inflammation, and they are discussed herein. Some of them are triggering inflammasome; others bind DNA, lipid moieties in cells, induce uric acid production or act as lipophilic and/or hydrophobic substances. The sustained inflammation increases the risk of genetic aberrations, where the initial polyclonal activation ends in monoclonality. The latter is the hallmark of malignant lymphoma. Thus, chronic adjuvant stimulation may lead to lymphoma.
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Fischer S, Hirche C, Reichenberger MA, Kiefer J, Diehm Y, Mukundan S, Alhefzi M, Bueno EM, Kneser U, Pomahac B. Silicone Implants with Smooth Surfaces Induce Thinner but Denser Fibrotic Capsules Compared to Those with Textured Surfaces in a Rodent Model. PLoS One 2015; 10:e0132131. [PMID: 26151888 PMCID: PMC4495016 DOI: 10.1371/journal.pone.0132131] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 06/10/2015] [Indexed: 12/05/2022] Open
Abstract
Purpose Capsular contracture is the most frequent long-term complication after implant-based breast reconstruction or augmentation. The aim of this study was to evaluate the impact of implant surface properties on fibrotic capsule formation in an animal model. Materials and Methods Twenty-four rats received 1 scaled down silicone implant each; 12 of the rats received implants with textured surfaces, and the other 12 received implants with smooth surfaces. After 60 and 120 days, rats in each group underwent 7-Tesla Magnetic Resonance Imaging (MRI) and high-resolution ultrasound (HR-US), and specimens of the capsules were acquired and used to measure capsule thickness through histology, collagen density through picro sirius red staining, and analyses of expression of pro-fibrotic and inflammatory genes (Collagen1-4, TGFb1, TGFb3, Smad3, IL4, IL10, IL13, CD68) through qRT-PCR. Furthermore, MRI data were processed to obtain capsule volume and implant surface area. Results On day 60, histology and HR-US showed that fibrotic capsules were significantly thicker in the textured implant group with respect to the smooth implant group (p<0.05). However, this difference did not persist on day 120 (p=0.56). Capsule thickness decreased significantly over the study period in both smooth and textured implant groups (p<0.05). Thickness measurements were substantiated by MRI analysis and volumes changed accordingly. Implant surface area did not vary between study dates, but it was different between implant types. On day 60, the density of collagen in the fibrotic capsules was significantly lower in the textured implant group with respect to the smooth group (p<0.05), but again this difference did not persist on day 120 (p=0.67). Collagen 1 and CD68 were respectively over- and under expressed in the textured implant group on day 60. Significant differences in the expression of other genes were not observed. Conclusion Silicone implants with textured surfaces led to temporarily thicker but less dense fibrotic capsules compared with smooth surfaces. 7-Tesla MRI and HR-US are capable for non-invasive in-vivo assessment of capsular fibrosis in an animal model and can provide unique insights into the fibrotic process by 3D reconstruction and surface area measurement.
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Affiliation(s)
- Sebastian Fischer
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America; Department of Hand-, Plastic and Reconstructive Surgery, BG Clinic Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Christoph Hirche
- Department of Hand-, Plastic and Reconstructive Surgery, BG Clinic Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Matthias A Reichenberger
- Ethianum, Clinic for Plastic and Reconstructive Surgery, Aesthetic and Preventive Medicine at Heidelberg University Hospital, Heidelberg, Germany
| | - Jurij Kiefer
- Department of Hand-, Plastic and Reconstructive Surgery, BG Clinic Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Yannick Diehm
- Department of Hand-, Plastic and Reconstructive Surgery, BG Clinic Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Srinivasan Mukundan
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Muayyad Alhefzi
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ericka M Bueno
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ulrich Kneser
- Department of Hand-, Plastic and Reconstructive Surgery, BG Clinic Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Bohdan Pomahac
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
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15
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Abstract
BACKGROUND There is substantial evidence that a type of anaplastic large cell lymphoma (ALCL) is associated with breast implants. However, the course in patients with breast implants seems to be unusually benign compared with other systemic ALCL. The purpose of this study was to identify and analyze recently published cases of breast implant-associated ALCL, with an emphasis on diagnosis, staging, treatment, and outcomes. METHODS The authors conducted a systematic literature review of reported cases of ALCL in patients with breast implants. Publications were identified with a search algorithm and forward searches. Case-based data were abstracted independently and reconciled by multiple investigators. RESULTS Of 248 identified articles, only 102 were relevant to breast implant-associated ALCL, and 27 were included in this study. Fifty-four cases of ALCL in patients with breast implants were identified. Detailed clinical information was lacking in many cases. Most presented with a seroma (76 percent), and approximately half were associated with the capsule (48 percent). Most presented as stage IE (61 percent). All but one case were ALK-negative. Most received chemotherapy (57 percent) and radiation therapy (48 percent), and 11 percent received stem cell transplants. Approximately one-quarter recurred, and 9 percent died. CONCLUSIONS Since the publication of guidance related to breast implant-associated ALCL in 2010, a number of cases have been reported. Despite the typically benign course, many of the cases have been treated with radiation therapy and/or chemotherapy. Increasing awareness of this disease entity among clinicians would be helpful, along with standardizing an approach to diagnosis, staging, and treatment. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, V.
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16
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Pedersen SB, Nielsen JC, Bøtker HE, Farkas DK, Schmidt M, Sørensen HT. Implantable cardioverter-defibrillators and subsequent cancer risk: a nationwide population-based cohort study. ACTA ACUST UNITED AC 2015; 17:902-8. [DOI: 10.1093/europace/euv076] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/16/2015] [Indexed: 11/13/2022]
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17
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Frame JD. Commentary on: Breast implants and the risk of breast cancer: a meta-analysis on cohort studies. Aesthet Surg J 2015; 35:63-5. [PMID: 25568235 DOI: 10.1093/asj/sju093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- James D Frame
- Dr Frame is a Professor of Aesthetic Plastic Surgery at the Post Graduate Medical Institute, Anglia Ruskin University (Chelmsford and Cambridge), Chelmsford, Essex, United Kingdom
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18
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Noels EC, Lapid O, Lindeman JHN, Bastiaannet E. Breast implants and the risk of breast cancer: a meta-analysis of cohort studies. Aesthet Surg J 2015; 35:55-62. [PMID: 25568234 DOI: 10.1093/asj/sju006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The popularity of cosmetic breast augmentation and the incidence of breast cancer have been increasing worldwide. It has been hypothesized that the risk of breast cancer may be greater among patients who have undergone cosmetic breast implantation. OBJECTIVES The authors performed a meta-analysis of the available literature on the risk of breast cancer among women with cosmetic breast implants. METHODS The study was designed as a meta-analysis of observational studies. A systematic search of the English literature (published by August 28, 2013) was conducted in PubMed and EMBASE. Eligible reports were those that included relative risk (RR; the increased or decreased risk of breast cancer associated with breast implants) or the standardized incidence ratio (SIR) of the observed number of cases of breast cancer to the expected number of cases among patients that previously underwent cosmetic breast augmentation. RESULTS Seventeen studies representing 7 cohorts were selected. Some of these were follow-up reports of previously published studies; in such cases, only the most recent reports were included in the meta-analysis. Summary SIR and RR rates and the corresponding 95% confidence intervals (CIs) were calculated with a random-effects (SIR) or fixed-effects (RR) model. The overall SIR estimate was 0.69 (95% CI, 0.56-0.85), and the overall RR, based on 4 studies, was 0.63 (95% CI, 0.56-0.71). CONCLUSIONS Finding of this meta-analysis suggest that women who have undergone cosmetic breast implantation do not have an increased risk of breast cancer.
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Affiliation(s)
- Eline C Noels
- Dr Noels is a researcher and Dr Lapid is a plastic surgeon in the Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. Dr Lindeman is a senior researcher in the Department of Vascular Surgery, and Dr Bastiaannet is an epidemiologist and senior researcher in the Department of Surgery and Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Oren Lapid
- Dr Noels is a researcher and Dr Lapid is a plastic surgeon in the Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. Dr Lindeman is a senior researcher in the Department of Vascular Surgery, and Dr Bastiaannet is an epidemiologist and senior researcher in the Department of Surgery and Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan H N Lindeman
- Dr Noels is a researcher and Dr Lapid is a plastic surgeon in the Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. Dr Lindeman is a senior researcher in the Department of Vascular Surgery, and Dr Bastiaannet is an epidemiologist and senior researcher in the Department of Surgery and Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Esther Bastiaannet
- Dr Noels is a researcher and Dr Lapid is a plastic surgeon in the Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. Dr Lindeman is a senior researcher in the Department of Vascular Surgery, and Dr Bastiaannet is an epidemiologist and senior researcher in the Department of Surgery and Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
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19
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Jansen LA, Backstein RM, Brown MH. Breast size and breast cancer: a systematic review. J Plast Reconstr Aesthet Surg 2014; 67:1615-23. [PMID: 25456291 DOI: 10.1016/j.bjps.2014.10.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 08/12/2014] [Accepted: 10/01/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND There are many known breast cancer risk factors, but traditionally the list has not included breast size. The aim of this study was to synthesize the literature on breast size as a risk factor for breast carcinoma by examining studies addressing this question both directly and indirectly. METHODS A systematic review was performed searching MEDLINE from 1950 to November 2010, and updated again in February 2014. Literature was sought to assess the relationship between the following variables and breast cancer: 1) breast size; 2) breast reduction; 3) breast augmentation; and 4) prophylactic subcutaneous mastectomy. Findings were summarized and the levels of evidence were assessed. RESULTS 50 papers were included in the systematic review. Increasing breast size appears to be a risk factor for breast cancer, but studies are limited by their retrospective nature, imperfect size measurement techniques and confounding variables. The evidence is stronger for risk reduction with breast reduction, including prophylactic subcutaneous mastectomy at the extreme. Generally the breast augmentation population has a lower risk of breast cancer than the general population, but it is unclear whether or not this is related to the bias of small breasts in this patient population and the presence of other confounders. CONCLUSIONS There is direct and indirect evidence that breast size is an important factor in the risk of developing breast cancer. Plastic surgeons are in a unique position to observe this effect. Well-designed prospective studies are required to further assess this risk factor.
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Affiliation(s)
- L A Jansen
- Division of Plastic and Reconstructive Surgery, University of Toronto, Canada
| | - R M Backstein
- Division of Plastic and Reconstructive Surgery, University of Toronto, Canada
| | - M H Brown
- Division of Plastic and Reconstructive Surgery, University of Toronto, Canada.
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20
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Lavigne E, Brisson J. Can breast implants hinder breast cancer survival? WOMEN'S HEALTH (LONDON, ENGLAND) 2013; 9:419-20. [PMID: 24007245 DOI: 10.2217/whe.13.42] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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21
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Lavigne E, Holowaty EJ, Pan SY, Xie L, Villeneuve PJ, Morrison H, Brisson J. Do Breast Implants Adversely Affect Prognosis among Those Subsequently Diagnosed with Breast Cancer? Findings from an Extended Follow-Up of a Canadian Cohort. Cancer Epidemiol Biomarkers Prev 2012; 21:1868-76. [DOI: 10.1158/1055-9965.epi-12-0484] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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