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Lieffering AS, Ramerman L, Verheij RA, Rakhorst HA, Mureau MAM, van der Hulst RRWJ, Hommes JE. Medical Specialist Care Utilization Prior to the Explantation of Cosmetic Silicone Breast Implants: A Nationwide Retrospective Data Linkage Study. Aesthetic Plast Surg 2024:10.1007/s00266-024-04047-5. [PMID: 38698223 DOI: 10.1007/s00266-024-04047-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/09/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Explantation is the proposed treatment for breast implant illness (BII). Little is known about which medical specialists are visited and what diagnoses are made before explantation is provided as the treatment. OBJECTIVES This study investigated medical specialist care utilization in women with cosmetic breast implants who underwent explantation compared to women who chose breast implant replacement surgery and to women without breast implants. METHODS Retrospective cohort study using data linkage with the Dutch Breast Implant Registry and the Dutch health insurance claims database. Visits to medical specialists were examined over the 3 years before explantation. A total of 832 explantation patients were matched and compared to 1463 breast implant replacement patients and 1664 women without breast implants. RESULTS Explantation patients were more likely to have visited > 5 different medical specialties compared to both replacement patients (12.3% vs. 5.7%; p < 0.001) and women without breast implants (12.3% vs. 3.7%; p < 0.001). Among explantation patients, women who underwent explantation because of BII were more likely to have visited > 5 different medical specialties compared to women who underwent explantation because of other reasons (25.0% vs. 11.0%; p < 0.001). CONCLUSIONS Women who underwent explantation of breast implants had higher utilization of medical specialist care in the years before explantation compared to women who underwent breast implant replacement surgery and women without breast implants. Medical specialist care use was especially high among women for whom BII was the registered reason for explantation. These findings suggest further research is needed into the link between BII and the use of medical specialist care. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
| | - Lotte Ramerman
- Nivel, Otterstraat 118-124, 3513 CR, Utrecht, The Netherlands
| | | | - Hinne A Rakhorst
- Department of Plastic, Reconstructive and Hand Surgery, Medical Spectrum Twente, Enschede, The Netherlands
| | - Marc A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - René R W J van der Hulst
- Department of Plastic, Reconstructive and Hand Surgery, and GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands
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2
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Simon E, Pahus L, Chanez P. Pulmonary adverse events of breast silicone implants and silicone injection. Respir Med Res 2023; 84:101065. [PMID: 38042060 DOI: 10.1016/j.resmer.2023.101065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/24/2023] [Accepted: 10/31/2023] [Indexed: 12/04/2023]
Abstract
The incidence of breast implants and silicone injections has continuously increased since their FDA approval for use in the 1960's. The prevalence of overall adverse events is approximately 20%. The actual incidence of pulmonary adverse events is unknown. This review focuses on the pulmonary adverse events of breast implants and silicone injections. Vascular complications are represented by acute and chronic embolisation syndromes with a clinico-radiological presentation of alveolar hemorrhage. Inflammatory complications are numerous, including siliconoma, which is a granulomatous reaction mimicking a mesothelioma. On the other hand, there are some reports arguing a link between the development of auto-immune diseases and breast implants, such as scleroderma, rheumatoid arthritis, Sjögren's syndrome, and dermatomyositis. Finally, for patients with asthma, breast implants may contribute to poor disease control. Cases of eosinophilic granulomatosis with polyangeitis have been described. Thus, it is of interest to decipherate mechanisms and incidence of these effects in prospective studies to better manage pulmonary diseases in patients wearing breast implants in order to understand their role as culprits or bystanders. In addition, characterization of subpopulations with increased risk of adverse events is needed as we highlighted that some subpopulations seem to be at greater risk of developing them, notably asthmatics.
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Affiliation(s)
- Eléonore Simon
- APHM, Clinique des bronches allergies et sommeil, Marseille, France.
| | - Laurie Pahus
- Aix Marseille Univ, APHM, INSERM CIC 1409 Marseille, France; Aix Marseille Univ, INSERM U1263, INRA 1260 (C2VN), Marseille, France
| | - Pascal Chanez
- APHM, Clinique des bronches allergies et sommeil, Marseille, France; Aix Marseille Univ, INSERM U1263, INRA 1260 (C2VN), Marseille, France
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Hansson E, Zaya S, Meyer S, Freiin von Wrangel A, Wärnberg F, Zackrisson S. Prevalence of women with breast implants in Sweden: a study based on the population-based mammography screening programme. J Plast Surg Hand Surg 2023; 58:96-100. [PMID: 37728392 DOI: 10.2340/jphs.v58.15298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/17/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Knowledge about the prevalence of women with breast implants is paramount in calculations of risks and in estimations of effects on screening and breast cancer treatment. Most of the estimations of prevalence made to date are rough and often based on sales data. The main aim of this study was to calculate the prevalence of breast implants in Swedish women. The secondary aim was to investigate if it is feasible to establish the occurrence of breast implants with the help of the public mammography screening programme, in a country with a publicly funded welfare-type healthcare system and with a clear documentation of screening. METHODS Information on implants was prospectively collected from all screening attendants from 1st of February 2022 to 1st of August 2022 based on a question from the radiographer to the woman and later verified on the mammogram. RESULTS During the study period 4,639 women were screened, of which 182 had implants (3.9%). The frequency varies between 1.6 and 6.4% in different age groups. CONCLUSION The prevalence of breast implants in Swedish women is estimated to be around 4%. The population-based mammography screening programme in countries with a publicly funded welfare-type healthcare system and a clear documentation of mammography screening attendance, seems to be a feasible way to establish the prevalence of breast implants in the population. The large number of women with breast implants warrants further studies regarding the best diagnostic and treatment alternatives for this group. Pre-registration: ClinicalTrials.Gov identifier NCT05222100.
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Affiliation(s)
- Emma Hansson
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Plastic Surgery, Gothenburg, Sweden.
| | - Sarah Zaya
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Radiology and Mammography, Gothenburg, Sweden
| | - Susanne Meyer
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Plastic Surgery, Gothenburg, Sweden
| | - Alexa Freiin von Wrangel
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Radiology and Mammography, Gothenburg, Sweden
| | - Fredrik Wärnberg
- Department of Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden; Region Västra Götaland, Department of Surgery, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Sophia Zackrisson
- Department of Translational Medicine, Diagnostic Radiology, Lund University, Malmö, Sweden; Department of Medical Imaging and Physiology, Skåne University Hospital, Malmö, Sweden
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Schepens MHJ, Trompert AC, van Hooff ML, van der Velde E, Kallewaard M, Verberk-Jonkers IJAM, Cense HA, Somford DM, Repping S, Tromp SC, Wouters MWJM. Using Existing Clinical Information Models for Dutch Quality Registries to Reuse Data and Follow COUMT Paradigm. Appl Clin Inform 2023; 14:326-336. [PMID: 37137338 PMCID: PMC10156444 DOI: 10.1055/s-0043-1767681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Reuse of health care data for various purposes, such as the care process, for quality measurement, research, and finance, will become increasingly important in the future; therefore, "Collect Once Use Many Times" (COUMT). Clinical information models (CIMs) can be used for content standardization. Data collection for national quality registries (NQRs) often requires manual data entry or batch processing. Preferably, NQRs collect required data by extracting data recorded during the health care process and stored in the electronic health record. OBJECTIVES The first objective of this study was to analyze the level of coverage of data elements in NQRs with developed Dutch CIMs (DCIMs). The second objective was to analyze the most predominant DCIMs, both in terms of the coverage of data elements as well as in their prevalence across existing NQRs. METHODS For the first objective, a mapping method was used which consisted of six steps, ranging from a description of the clinical pathway to a detailed mapping of data elements. For the second objective, the total number of data elements that matched with a specific DCIM was counted and divided by the total number of evaluated data elements. RESULTS An average of 83.0% (standard deviation: 11.8%) of data elements in studied NQRs could be mapped to existing DCIMs . In total, 5 out of 100 DCIMs were needed to map 48.6% of the data elements. CONCLUSION This study substantiates the potential of using existing DCIMs for data collection in Dutch NQRs and gives direction to further implementation of DCIMs. The developed method is applicable to other domains. For NQRs, implementation should start with the five DCIMs that are most prevalently used in the NQRs. Furthermore, a national agreement on the leading principle of COUMT for the use and implementation for DCIMs and (inter)national code lists is needed.
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Affiliation(s)
- Maike H J Schepens
- Cirka BV, Healthcare Strategy and Innovation, Zeist, The Netherlands
- Department of Biomedical Data Sciences, LUMC, Leiden, The Netherlands
| | | | - Miranda L van Hooff
- Department of Orthopedics, Radboud UMC, Nijmegen, The Netherlands
- Department of Orthopedics, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Erik van der Velde
- Dutch Association of Medical Specialists, Utrecht, The Netherlands
- Zorgverbeteraars, Healthcare IT Consulting, Roden, The Netherlands
| | | | - Iris J A M Verberk-Jonkers
- Dutch Association of Medical Specialists, Utrecht, The Netherlands
- Department of Nephrology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Huib A Cense
- Department of Surgery, Rode Kruis Hospital, Beverwijk, The Netherlands
- Department of Health System Innovation. Faculty of Economics and Business, Groningen University. Groningen, The Netherlands
| | - Diederik M Somford
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Sjoerd Repping
- Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Selma C Tromp
- Dutch Association of Medical Specialists, Utrecht, The Netherlands
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Michel W J M Wouters
- Department of Biomedical Data Sciences, LUMC, Leiden, The Netherlands
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
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Blok YL, Plat VD, van der Hage JA, Krekel NMA, Mureau MAM. Nation-wide validation of a multicenter risk model for implant loss following implant-based breast reconstruction. J Plast Reconstr Aesthet Surg 2022; 75:4347-4353. [PMID: 36241506 DOI: 10.1016/j.bjps.2022.08.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/19/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Implant loss following breast reconstruction is a devastating complication, which should be prevented as much as possible. This study aimed to validate a previously developed multicenter risk model for implant loss after implant-based breast reconstructions, using national data from the Dutch Breast Implant Registry (DBIR). METHODS The validation cohort consisted of patients who underwent a mastectomy followed by either a direct-to-implant (DTI) or two-stage breast reconstruction between September 2017 and January 2021 registered in the DBIR. Reconstructions with an autologous adjunctive and patients with missing data on the risk factors extracted from the multicenter risk model (obesity, smoking, nipple preserving procedure, DTI reconstruction) were excluded. The primary outcome was implant loss. The predicted probability of implant loss was calculated using beta regression coefficients extracted from the multicenter risk model and compared to the observed probability. RESULTS The validation cohort consisted of 3769 reconstructions and implant loss occurred after 307 reconstructions (8.1%). Although the observed implant loss rate increased when the risk factors accumulated, the predicted and observed probabilities of implant loss did not match. Of the four risk factors in the multicenter risk model, only obesity and smoking were significantly associated to implant loss. CONCLUSION The multicenter risk model could not be validated using nationwide data of the DBIR and is therefore not accurate in Dutch practice. In the future, the risk model should be improved by including other factors to provide a validated tool for the preoperative risk assessment of implant loss.
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Affiliation(s)
- Y L Blok
- Department of Plastic and Reconstructive surgery, Leiden University Medical Center, Leiden, the Netherlands.
| | - V D Plat
- Department of Plastic and Reconstructive surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - J A van der Hage
- Department of Surgical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - N M A Krekel
- Department of Plastic and Reconstructive surgery, Alrijne Ziekenhuis, Leiderdorp, the Netherlands
| | - M A M Mureau
- Department of Plastic and Reconstructive surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Spit KA, Scharff M, de Blok CJ, Niessen FB, Bachour Y, Nanayakkara PW. Patient-reported systemic symptoms in women with silicone breast implants: a descriptive cohort study. BMJ Open 2022; 12:e057159. [PMID: 35680258 PMCID: PMC9185500 DOI: 10.1136/bmjopen-2021-057159] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE An unknown portion of women with silicone breast implants (SBI) report development of systemic symptoms, recently named as 'breast implant illness (BII)'. We aim to describe the symptoms and characteristics of women with SBI reporting these systemic symptoms and compare the clinical course of women who chose to keep their implants, to women who had their implants removed. DESIGN Observational cohort study. SETTING Specialised BII out-patient clinic at Amsterdam UMC, the Netherlands, from 2011 to 2020. PARTICIPANTS All women presenting to the BII clinic with SBI and systemic symptoms. RESULTS 467 women were included for baseline analyses and 398 women for follow-up. Most frequently reported systemic symptoms at baseline included fatigue (88%), arthralgia (71%), morning stiffness (59%), myalgia (48%), cognitive impairment (33%), peripheral neurological symptoms (30%) and lymphadenopathy (22%). Furthermore, 56% reported pre-existing allergies at baseline and positive antinuclear antibodies were observed in 23%. At follow-up with a median of 3.3 years (IQR 2-4), 152 women had their implants removed on clinical grounds. Symptoms improved significantly in 65 women (43%), improved moderately in 37 women (24%), did not change in 37 women (24%) and deteriorated in 13 women (9%). Women who underwent explantation showed more improvement of their systemic symptoms compared with women who did not (OR 2.9, 95% CI 1.3 to 6.2). Additionally, women who underwent explantation within 10 years after implantation improved significantly better than women who got the implants removed after 10 years (p=0.007). Lastly, local symptoms decreased from 75% to 34% after implant removal (p<0.0001). CONCLUSION Most women with SBI who developed systemic symptoms experienced improvement after explantation, especially when removed within 10 years after implantation. Early recognition of the pattern of systemic symptoms in women with SBI is important and implant removal should be considered.
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Affiliation(s)
- Karlinde Amber Spit
- Internal Medicine, Amsterdam UMC, Locatie VUmc, Amsterdam, Noord-Holland, The Netherlands
| | - Miranda Scharff
- Internal Medicine, Amsterdam UMC, Locatie VUmc, Amsterdam, Noord-Holland, The Netherlands
| | - Christel Jm de Blok
- Department of Endocrinology, Amsterdam UMC, VUMC Location, Amsterdam, Noord-Holland, The Netherlands
| | - Frank B Niessen
- Department of Plastic Surgery, Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, The Netherlands
| | - Yara Bachour
- Internal Medicine, Amsterdam UMC, Locatie VUmc, Amsterdam, Noord-Holland, The Netherlands
- Public Health Service of Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - Prabath W Nanayakkara
- Internal Medicine, Amsterdam UMC, Locatie VUmc, Amsterdam, Noord-Holland, The Netherlands
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Hillberg N, Hogenboom J, Hommes J, Van Kuijk S, Keuter X, van der Hulst R. Risk of major postoperative complications in breast reconstructive surgery with and without an acellular dermal matrix; Development of a prognostic prediction model. JPRAS Open 2022; 33:92-105. [PMID: 35812357 PMCID: PMC9260237 DOI: 10.1016/j.jpra.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 04/21/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Acellular dermal matrices (ADM) have been suggested to allow for different approaches and reduce the risk of postoperative complications in implant-based breast surgery. Surgeons seem to embrace ADMs around the world, although a lack of consistent evidence regarding the factors that increase the risk of major postoperative complications remains. Purpose To develop and internally validate a model to predict the risk of a major postoperative complication in breast reconstructive surgery with and without an ADM. Methodology The DBIR is an opt-out registry that holds characteristics of all breast implant surgeries in the Netherlands since 2015. Using a literature-driven preselection of predictors, multivariable mixed-effects logistic regression modelling was used to develop the prediction model. Results A total of 2939 breasts were eligible, of which 11% underwent an ADM-assisted procedure (single-stage or two-stage). However, 31% underwent a two-stage procedure (with or without the use of ADM). Of all breasts, 10.2% developed a major postoperative complication. Age (OR 1.01), delayed timing (OR 0.71), and two-stage technique (OR 4.46) were associated with the outcome. Conclusion The data suggest that ADM use was not associated with a major postoperative complication, while two-stage reconstructions were strongly associated with an increased risk of major complications. Despite these findings, ADMs are not as popular in the Netherlands as in the USA. The predictive capabilities of the developed model are mediocre to poor, but because of the above findings, we believe that the role of the two-stage technique as a golden standard should be put up for debate.
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Affiliation(s)
- N.S. Hillberg
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Postal box 5800, 6202 Maastricht, The Netherlands
- School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Postal box 616, 6200 MD Maastricht, The Netherlands
- Author responsible for editorial correspondence: N.S. Hillberg, Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Postal box 5800, 6202 Maastricht, The Netherlands. +31 433877000.
| | - J. Hogenboom
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - J. Hommes
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Postal box 5800, 6202 Maastricht, The Netherlands
| | - S.M.J. Van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - X.H.A. Keuter
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Postal box 5800, 6202 Maastricht, The Netherlands
| | - R.R.W.J. van der Hulst
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Postal box 5800, 6202 Maastricht, The Netherlands
- School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Postal box 616, 6200 MD Maastricht, The Netherlands
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Hansen J, Ahern S, Gartoulla P, Khu Y, Elder E, Moore C, Farrell G, Hopper I, Earnest A. Identification of Predictive Factors for Patient-Reported Outcomes in the Prospective Australian Breast Device Registry. Aesthet Surg J 2022; 42:470-480. [PMID: 34382642 DOI: 10.1093/asj/sjab314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are an important tool for evaluating outcomes following breast device procedures and are used by breast device registries. PROMs can assist with device monitoring through benchmarked outcomes but need to account for demographic and clinical factors that may affect PROM responses. OBJECTIVES This study aimed to develop appropriate risk-adjustment models for the benchmarking of PROM data to accurately track device outcomes and identify outliers in an equitable manner. METHODS Data for this study were obtained from the Australian Breast Device Registry, which consists of a large prospective cohort of patients with primary breast implants. The 5-question BREAST-Q implant surveillance module was used to assess PROMs at 1 year following implant insertion. Logistic regression models were used to evaluate associations between demographic and clinical characteristics and PROMs separately by implant indication. Final multivariate risk-adjustment models were built sequentially, assessing the independent significant association of these variables. RESULTS In total, 2221 reconstructive and 12,045 aesthetic primary breast implants with complete 1-year follow-up PROMs were included in the study. Indication for operation (post-cancer, risk reduction, or developmental deformity) was included in the final model for all reconstructive implant PROMs. Site type (private or public hospital) was included in the final breast reconstruction model for look, rippling, and tightness. Age at operation was included in the reconstruction models for rippling and tightness and in the aesthetic models for look, rippling, pain, and tightness. CONCLUSIONS These multivariate models will be useful for equitable benchmarking of breast devices by PROMs to help track device performance. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- Jessy Hansen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Pragya Gartoulla
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ying Khu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Elisabeth Elder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Colin Moore
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Gillian Farrell
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ingrid Hopper
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Arul Earnest
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Barati N, Vrolijk JJ, Becherer BE, van Bommel ACM, Hommes JE, Mureau MAM, van der Hulst RRJW, Young-Afat DA, Rakhorst HA. Using a Digital Implant Catalog Improves Data Quality and Reduces Administrative Burden in the Dutch Breast Implant Registry. Aesthet Surg J 2022; 42:NP275-NP281. [PMID: 34555146 DOI: 10.1093/asj/sjab336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Correct registration of implant characteristics is essential to monitor implant safety within implant registries. Currently, in the nationwide Dutch Breast Implant Registry (DBIR), these characteristics are being registered manually by plastic surgeons, resulting in administrative burden and potentially incorrect data entry. OBJECTIVES This study evaluated the accuracy of manually registered implant data, possible consequences of incorrect data, and the potential of a Digital Implant Catalog (DIC) on increasing data quality and reducing the administrative burden. METHODS Manually entered implant characteristics (fill, shape, coating, texture) of newly inserted breast implants in the DBIR, from 2015 to 2019, were compared with the corresponding implant characteristics in the DIC. Reference numbers were employed to match characteristics between the 2 databases. The DIC was based on manufacturers' product catalogs and set as the gold standard. RESULTS A total of 57,361 DBIR records could be matched with the DIC. Accuracy of implant characteristics varied from 70.6% to 98.0%, depending on the implant characteristic. The largest discrepancy was observed for "texture" and the smallest for "coating." All manually registered implant characteristics resulted in different conclusions about implant performance compared with the DIC (P < 0.01). Implementation of the DIC reduced the administrative burden from 14 to 7 variables (50%). CONCLUSIONS Implementation of a DIC increases data quality in the DBIR and reduces the administrative burden. However, correct registration of reference numbers in the registry by plastic surgeons remains key for adequate matching. Furthermore, all implant manufacturers should be involved, and regular updates of the DIC are required.
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Affiliation(s)
- Nariman Barati
- Dutch Breast Implant Registry, Dutch Institute for Clinical Auditing, Leiden, the Netherlands
| | - J Juliët Vrolijk
- Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center Grow, Maastricht, the Netherlands
| | - Babette E Becherer
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Annelotte C M van Bommel
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Juliëtte E Hommes
- Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Marc A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - René R J W van der Hulst
- Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center Grow, Maastricht, the Netherlands
| | - Danny A Young-Afat
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Hinne A Rakhorst
- Department of Plastic, Reconstructive and Hand Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
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10
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Sadok N, Tiwow ID, Roo-Brand G, Friedrich AW, Werker PM. The Effect of Extra Safety Measures on Incidence of Surgical Site Infection After Alloplastic Breast Reconstruction. J Plast Reconstr Aesthet Surg 2022; 75:2197-2204. [DOI: 10.1016/j.bjps.2022.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 11/27/2021] [Accepted: 01/09/2022] [Indexed: 10/19/2022]
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11
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Vishwanath S, Pellegrini B, Parker E, Earnest A, Kalbasi S, Gartoulla P, Elder E, Farrell G, Moore C, Cooter RD, Ahern S, McNeil JJ, Hopper I. Breast Device Surgery in Australia: Early Results from the Australian Breast Device Registry. J Plast Reconstr Aesthet Surg 2021; 74:2719-2730. [PMID: 33931327 DOI: 10.1016/j.bjps.2021.03.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 03/03/2021] [Accepted: 03/13/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Australian Breast Device Registry (ABDR) is a clinical quality registry designed to monitor the performance of breast devices; and the quality and safety of breast device surgery. OBJECTIVE To report on breast device surgery characteristics across Australia. METHODS Participants were registered patients in the ABDR from 2012 to 2018. Results are described using percentages, mean and median. Revision rates were calculated using survival analysis methods. RESULTS A total of 37,603 patients were registered and had undergone reconstruction (post-cancer 15.1%, risk-reducing mastectomy 3.4% and developmental deformity 2.4%) or cosmetic augmentation (74.7%) procedures. The majority of breast implant devices were silicone filled with textured surface (reconstruction 74.0% and augmentation 64.0%). Sub-pectoral plane was the most common for both reconstruction (60.1%) and augmentation (76.6%) procedures. For reconstruction surgery, the most common surgical incision was previous mastectomy scar (44.0%) and inframammary (31.8%), and for augmentation, it was inframammary (83.4%). Intraoperative/postoperative antibiotic usage for reconstruction was 85.8% and augmentation was 89.4%. Revision incidence due to complication at 12 months post-cancer reconstruction was 5.1%, risk-reducing reconstruction 5.7% and developmental deformity implants 4.5%. Revision incidence due to complication at 12 months after augmentation procedure was 1.1%. Patient-reported outcome measures (PROMs) indicate high levels of satisfaction at 1 year for augmentation and reconstruction procedures. CONCLUSION We report on early data from the ABDR and reflect on the uptake of the registry by surgeons and patients. The registry also benefits from international collaborative approaches to addressing challenges and is committed to facilitate international post-market surveillance.
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Affiliation(s)
- Swarna Vishwanath
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Breanna Pellegrini
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Emily Parker
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Arul Earnest
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Saeid Kalbasi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Pragya Gartoulla
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Elisabeth Elder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Westmead Breast Cancer Institute, Australia; University of Sydney, Sydney, Australia; Breast Surgeons of Australia & New Zealand, Australia
| | - Gillian Farrell
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Cabrini Hospital - Brighton, Australia; Peter McCallum Cancer Centre, Melbourne, Australia; Australian Society of Plastic Surgeons, Australia
| | - Colin Moore
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Australasian College of Cosmetic Surgery, Australia
| | - Rodney D Cooter
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ingrid Hopper
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
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Bargon CA, Becherer BE, Young-Afat DA, van Bommel A, Hommes J, Hoornweg MJ, Keuter X, de Fazio S, Melnikov D, Monton Echeverria J, Perks G, Lumenta DB, Couturaud B, von Fritschen U, Stark B, Hölmich LR, Crosbie A, Lispi L, Campanale A, Cooter RD, Pusic AL, Hopper I, Mureau M, Rakhorst HA. Moving breast implant registries forward: Are they FAIR and Functional? J Plast Reconstr Aesthet Surg 2020; 74:4-12. [PMID: 33153904 DOI: 10.1016/j.bjps.2020.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 08/20/2020] [Accepted: 10/10/2020] [Indexed: 11/15/2022]
Affiliation(s)
- C A Bargon
- Department of Plastic, Reconstructive and Hand Surgery, St. Antonius Hospital, Utrecht, the Netherlands; Department of Oncological Surgery, St. Antonius Hospital, Utrecht, the Netherlands
| | - B E Becherer
- Dutch Institute for Clinical Auditing (DICA), Leiden, the Netherlands; Department of Plastic and Reconstructive Surgery, Erasmus Medical Centre, Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
| | - D A Young-Afat
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - Acm van Bommel
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Centre Utrecht, the Netherlands
| | - J Hommes
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, the Netherlands
| | - M J Hoornweg
- Department of Plastic, Reconstructive and Hand Surgery, Netherlands Cancer Institute (Antoni van Leeuwenhoek), the Netherlands
| | - Xha Keuter
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, the Netherlands
| | - S de Fazio
- International Liaison SICPRE (Società Italiana di Chirurgia Plastica Ricostruttiva ed Estetica), Italian Society of Plastic Reconstructive Regenerative and Aesthetic Surgery, Italy
| | - D Melnikov
- Department of Plastic Surgery, First Moscow State Medical University, I.M.Sechenova, Moscow, Russia
| | - J Monton Echeverria
- Department of Plastic Surgery, Complejo Hospitalario Universitario de Albacete, Spain
| | - Gab Perks
- Breast and Cosmetic Implant Registry (BCIR), United Kingdom; Department of Plastic, Reconstructive and Burns Surgery, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - D B Lumenta
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 5, A-8036 Graz, Austria
| | - B Couturaud
- Department of Plastic and Reconstructive Surgery, Curie Institute, Paris, France
| | - U von Fritschen
- Department of Plastic and Aesthetic Surgery, Hand Surgery, HELIOS Hospital Emil von Behring, Berlin, Germany
| | - B Stark
- Kliniken för Rekonstruktiv Plastikkirurgi Karolinska Institute, Stockholm, Sweden
| | - L R Hölmich
- Department of Plastic Surgery, Herlev and Gentofte Hospital and Department of Clinical Medicine, Copenhagen University, Denmark
| | - A Crosbie
- Devices Division, Medicines & Healthcare products Regulatory Agency MHRA, United Kingdom
| | - L Lispi
- Directorate General of Medical Devices and Farmaceutical Service - Italian Ministry of Health, Italy
| | - A Campanale
- Directorate General of Medical Devices and Farmaceutical Service - Italian Ministry of Health, Italy
| | - R D Cooter
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Australian Society of Plastic Surgeons, Sydney, NSW, Australia
| | - A L Pusic
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - I Hopper
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mam Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus Medical Centre, Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
| | - H A Rakhorst
- Department of Plastic, Reconstructive and Hand Surgery, Medisch Spectrum Twente/ Ziekenhuisgroep Twente, Koningsplein 1, 7512 KZ Enschede, the Netherlands.
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13
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A Systematic Review of the National Breast Implant Registry for Application in Korea: Can We Predict "Unpredictable" Complications? ACTA ACUST UNITED AC 2020; 56:medicina56080370. [PMID: 32718052 PMCID: PMC7466367 DOI: 10.3390/medicina56080370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 12/03/2022]
Abstract
Background and Objectives: Since silicone breast implants were introduced to the market several decades ago, the safety of breast implants has remained controversial. Recently, several studies have explored breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) and breast implant illness (BII). Several countries have developed national breast implant registries to improve the safety and quality of breast implant surgery. We performed a systematic review of the current status of national breast implant registries and propose a pilot form of an appropriate breast implant registry model for Korea. Materials and Methods: The systematic review was conducted in accordance with the “preferred reporting items for systematic reviews and meta-analyses (PRISMA) pro forma”. PubMed and Google Scholar databases were searched to identify all articles containing information on national breast implant registries. We limited the search to articles written in the English language from 2010 to 2020. Articles were reviewed by two independent authors. Results: A total of 63 articles related to national breast implant registries, registry principles and national breast implant registry annual reports were identified. After reviewing the literature, 25 national breast implant registry-related articles were included in the full-text synthesis. Currently, four countries, The Netherlands, Australia, Sweden, and the UK, have breast implant registries with well-formed sources for big data. Overall, similarities in data points were detected for three categories: implant-related complications, operation details, and device information. However, there were differences for each registry in terms of governance, funding, and capture rate. Conclusion: After reviewing other countries’ experiences, tentative datasets for the Korean Breast Implant Registry (K-BIR) were developed. The K-BIR can improve the quality of breast implant surgery in Korea by providing datasets on overall processes and outcome measures with quality indicators and risk adjustment factors. This approach will register characteristics of patients and monitor breast implants, complications, and surgical procedures to improve the outcomes of breast implant surgery in Korea. In addition, it can be used as a track-and-trace system with automated notifications to patients in the event of a product recall or other safety concerns related to a specific type of implant. Background and Objectives: Since silicone breast implants were introduced to the market several decades ago, the safety of breast implants has remained controversial. Recently, several studies have explored breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) and breast implant illness (BII). Several countries have developed national breast implant registries to improve the safety and quality of breast implant surgery. We performed a systematic review of the current status of national breast implant registries and propose a pilot form of an appropriate breast implant registry model for Korea. Materials and Methods: The systematic review was conducted in accordance with the “preferred reporting items for systematic reviews and meta-analyses (PRISMA) pro forma”. PubMed and Google Scholar databases were searched to identify all articles containing information on national breast implant registries. We limited the search to articles written in the English language from 2010 to 2020. Articles were reviewed by two independent authors. Results: A total of 63 articles related to national breast implant registries, registry principles and national breast implant registry annual reports were identified. After reviewing the literature, 25 national breast implant registry-related articles were included in the full-text synthesis. Currently, four countries, The Netherlands, Australia, Sweden, and the UK, have breast implant registries with well-formed sources for big data. Overall, similarities in data points were detected for three categories: implant-related complications, operation details, and device information. However, there were differences for each registry in terms of governance, funding, and capture rate. Conclusion: After reviewing other countries’ experiences, tentative datasets for the Korean Breast Implant Registry (K-BIR) were developed. The K-BIR can improve the quality of breast implant surgery in Korea by providing datasets on overall processes and outcome measures with quality indicators and risk adjustment factors. This approach will register characteristics of patients and monitor breast implants, complications, and surgical procedures to improve the outcomes of breast implant surgery in Korea. In addition, it can be used as a track-and-trace system with automated notifications to patients in the event of a product recall or other safety concerns related to a specific type of implant.
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Kühn S, Sader R, Rieger UM. "Without standards, there can be no improvement"-Taiichi Ohno. Gland Surg 2020; 8:591-592. [PMID: 32042663 DOI: 10.21037/gs.2019.11.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Shafreena Kühn
- Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, AGAPLESION Markus Hospital, Academic Teaching Hospital of the Goethe University, Frankfurt am Main, Germany
| | - Robert Sader
- Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Ulrich M Rieger
- Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, AGAPLESION Markus Hospital, Academic Teaching Hospital of the Goethe University, Frankfurt am Main, Germany
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