Les complications postopératoires en chirurgie d'augmentation mammaire

[Pasteurellosis breast implant infection: A case report and literature review]

Breast implant infection is a potential complication after surgery. This case reports an unusual infection. A patient undergoes a skin sparing mastectomy for a carcinoma with an immediate breast implant reconstruction. Few days after, she consults for pain, erythema and fluctuating breast collection. The implant is removed and a lavage is done. Bacteriological cultures yield Pasteurella Multocida. She has close contact with cats. Her cat scratches a drain. It looks crucial to educate patients before they go back home. Correct postoperative cares and avoid pets are important to prevent complications.

A 10-Year Follow-Up Experience of 383 Patients with Bilateral Smooth Inflatable Breast Implants Filled with Saline Solution

INTRODUCTION

In light of the concerns regarding the occurrence of anaplastic large-cell lymphoma, seromas, and scar capsules, there appears to be merit in analysis and presentation of the results of our series of inflatable smooth implants filled with saline solution, for which the follow-up was more than 10 years.

PATIENTS AND METHOD

We carried out a retrospective study, including all of the patients who underwent a first breast implant for cosmetic reasons, between 2003 and 2006.

RESULTS

A total of 383 patients with 766 smooth implants filled with saline solution were included in our study. No cases of lymphoma and seroma were diagnosed. Eleven patients exhibited a postoperative hematoma, and four went on to develop a capsule. Twenty-two patients (5.7%) developed a Baker Grade III or IV capsule that required revision surgery. Two patients (0.5%) opted for a bilateral prosthesis replacement due to visual rippling. In total, there were 26 (3.4%) early deflations of prostheses.

DISCUSSION

There is not a statistically significant correlation between the occurrence of hematomas and the formation of a capsule. We found a lower shell rate with smooth-walled versus textured implants. The fact of having a decline of 10 years allows to be exhaustive. As for wrinkling and ripples, their occurrence has not been increased by the use of inflatable retropectoral implants.

CONCLUSION

Smooth inflatable implants filled with saline solution have numerous advantages such as the possibility of a very small approach route and perioperative adaptability of the volume. In light of the lack of indication of anaplastic large-cell lymphoma with smooth implants, they are clearly an attractive alternative to textured implants filled with silicone gel.

LEVEL OF EVIDENCE IV

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[Radiological trap and oncological precautions in a patient who has undergone a permanent withdrawal of PIP breast implants]

We report the case of a 57-year-old patient who presented radiological images similar to ruptured breast implants one year after the supposed withdrawal of the latter. This woman had benefited for the first time from cosmetic PIP breast implants in 2000. Early in 2014, she requested the removal of the implants without renewal because she was feeling pain and functional discomfort. A few months after the operation, she consulted for breast swelling in the upper pole of the breast. Radiological assessment showed liquid formations compatible with the presence of implants. At our request, the rereading of the MRI by the radiologist definitively concluded on a bilateral seroma within the persistent fibrous capsule. In the absence of symptoms, clinical monitoring had been decided. But at the recrudescence of anaplastic large cell lymphoma cases associated with breast implants, a cytological sampling was intended. In case of cytological abnormality or recurrence of the seroma, a surgical procedure should be performed. In conclusion, the removal of a breast implant without capsulectomy may result in the formation of a seroma whose images resemble those of an implant. It is always worthwhile to provide precise clinical data to the radiologist in order to help him to make informed interpretations. Every serous effusion in a breast lodge having contained a silicone implant must evoke the diagnosis of anaplastic large cell lymphoma.

[Should we drain after pre-pectoral breast implants? Analysis of a cohort of 400 patients operated for breast augmentation with pre-pectoral silicone implants]

AIM OF THE STUDY

During breast augmentation, surgical drainage remains a source of debate. The objective of the study was to determine the interest of the drainage after pre-pectoral breast implants pre, analyzing the risk of hematoma and capsular contracture.

PATIENTS AND METHODS

We retrospectively analyzed a cohort of 400 patients who underwent a first aesthetic breast augmentation by pre-pectoral silicone gel implants. Patients were followed with a maximum of nine years and a minimum of one year.

RESULTS

The mean age of patients was 37 years (18-64). Ninety-two percent (368 cases) had no drainage (patients "low risk of bleeding") and 8% (32 cases) underwent a bilateral drainage (patients "high risk of bleeding"). We recorded 1.75% hematoma (7 cases) and 2% of capsular contracture (8 cases).

CONCLUSION

We believe that the drainage should not be systematic for pre-pectoral breast implants. In patients at high risk of bleeding that we drained, it does not prevent the occurrence of a possible hematoma. In patients at low risk of bleeding that we have not drained, we do not observed more hematoma or capsular contracture than data published for drained patients.

[Acute periprosthetic infection after aesthetic breast augmentation. Report of three cases of implant "salvage". Proposal of a standardized protocol of care]

The authors report three cases of contaminated implant "salvage" after aesthetic breast augmentation. Patients' care included a lavage of the pocket, a change of the implant and an adapted bi-antibiotherapy of 6 weeks, including 8 days intravenous. In one case, this protocol has been started after failure of antibiotherapy alone. Patients, reviewed at 13 months or more, were not showing any signs of infection. One of them was showing a Baker's grade 3 capsule contracture on the infected side. Through a literature review, we discuss the modalities of an effective conservative treatment and its justification.