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Maciel PJ. Optimizing Aesthetic Outcomes after Retroglandular Breast Implant Explantation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6052. [PMID: 39129850 PMCID: PMC11315498 DOI: 10.1097/gox.0000000000006052] [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: 02/05/2024] [Accepted: 06/14/2024] [Indexed: 08/13/2024]
Abstract
The safety of silicone breast implants has been questioned due to concerns such as the risk of associated lymphoma, as well as rheumatological and systemic symptoms. This has resulted in an increased demand for explantation, posing the challenge of addressing stigmas related to implant removal. There is a dearth of literature on techniques for restoring breast contour postexplantation. After implant removal, the original breast anatomy is altered, and depressed areas may manifest in random locations. To reposition the breast tissue displaced by the implant, we enlarge the retroglandular pocket and subsequently use sutures for centripetal traction, relocating the tissue back to the footprint area but now in an improved position, delineating the breast contour. This maneuver enables us to restore the breast contour to an anatomical condition akin to preimplantation; diminish the final explantation defect, creating a more suitable pocket for delicate mastopexy flaps; recruit breast tissue, allowing internal sutures to conceal tissue irregularities; and redesign the breast contour area on the chest to achieve better symmetry.
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Affiliation(s)
- Patrícia J. Maciel
- From Instituto de Cirurgia Plástica Santa Cruz and Private Practice Prime Saúde e Bem- estar, São Paulo, SP, Brazil
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Simultaneous Salvage Auto-augmentation: Contemporary Strategy for Management of the Breast Explantation Patient. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4860. [PMID: 36891568 PMCID: PMC9988272 DOI: 10.1097/gox.0000000000004860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/18/2023] [Indexed: 03/08/2023]
Abstract
The treatment of patients requiring explantation of breast prostheses is a complicated clinical issue, for which a consensus regarding the best way forward is still evolving. We believe that simultaneous salvage auto-augmentation (SSAA) is a viable option for the treatment of patients with explantation. Methods Sixteen cases (32 breasts) were reviewed over a 19-year period. The management of the capsule is based on intraoperative findings and not on preoperative evaluation because of the poor interobserver correlation of Baker grades. Results The mean age and clinical follow-up duration were 48 years (range: 41-65) and 9 months, respectively. We observed no complications, and only one patient underwent unilateral surgical revision of the periareolar scar, under local anaesthesia. Conclusions This study suggests that SSAA with or without autologous fat injection is a safe option for women undergoing explantation, with potential aesthetic and cost-saving benefits. In the current climate of public anxiety regarding breast implant illness, breast implant-associated atypical large cell lymphoma, and asymptomatic textured implants, it is anticipated that the number of patients desiring explantation and SSAA will continue to increase.
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Santanelli di Pompeo F, Clemens MW, Atlan M, Botti G, Cordeiro PG, De Jong D, Di Napoli A, Hammond D, Haymaker CL, Horwitz SM, Hunt K, Lennox P, Mallucci P, Miranda RN, Munhoz AM, Swanson E, Turner SD, Firmani G, Sorotos M. 2022 Practice Recommendation Updates From the World Consensus Conference on BIA-ALCL. Aesthet Surg J 2022; 42:1262-1278. [PMID: 35639805 PMCID: PMC9924046 DOI: 10.1093/asj/sjac133] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Laboratory and clinical research on breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is rapidly evolving. Changes in standard of care and insights into best practice were recently presented at the 3rd World Consensus Conference on BIA-ALCL. OBJECTIVES The authors sought to provide practice recommendations from a consensus of experts, supplemented with a literature review regarding epidemiology, etiology, pathogenesis, diagnosis, treatment, socio-psychological aspects, and international authority guidance. METHODS A literature search of all manuscripts between 1997 and August 2021 for the above areas of BIA-ALCL was conducted with the PubMed database. Manuscripts in different languages, on non-human subjects, and/or discussing conditions separate from BIA-ALCL were excluded. The study was conducted employing the Delphi process, gathering 18 experts panelists and utilizing email-based questionnaires to record the level of agreement with each statement by applying a 5-point Likert Scale. Median response, interquartile range, and comments were employed to accept, reject, or revise each statement. RESULTS The literature search initially yielded 764 manuscripts, of which 405 were discarded. From the remaining 359, only 218 were included in the review and utilized to prepare 36 statements subdivided into 5 sections. After 1 round, panelists agreed on all criteria. CONCLUSIONS BIA-ALCL is uncommon and still largely underreported. Mandatory implant registries and actions by regulatory authorities are needed to better understand disease epidemiology and address initial lymphomagenesis and progression. Deviation from current diagnosis and treatment protocols can lead to disease recurrence, and research on breast implant risk factors provide insight to etiology. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Fabio Santanelli di Pompeo
- Corresponding Author: Prof Fabio Santanelli di Pompeo, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sant’Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy. E-mail: ; Instagram: @diepflap.it
| | - Mark W Clemens
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA and is a Breast Surgery section editor for Aesthetic Surgery Journal
| | - Michael Atlan
- Aesthetic Plastic Reconstructive Unit/CHU TENON PARIS—APHP, Université Pierre et Marie Curie, Paris, France
| | | | - Peter G Cordeiro
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Daphne De Jong
- Amsterdam UMC-Vrije Universiteit Amsterdam, Department of Pathology and Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Arianna Di Napoli
- Pathology Unit, Department of Clinical and Molecular Medicine, Sapienza University, Sant’Andrea Hospital, Rome, Italy
| | | | - Cara L Haymaker
- Department of Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven M Horwitz
- Lymphoma Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Kelly Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peter Lennox
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, BC, Canada and is a clinical editor for Aesthetic Surgery Journal
| | | | - Roberto N Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alexandre M Munhoz
- Plastic Surgery Department, Hospital Moriah, Hospital Sírio-Libanês, Higienópolis, São Paulo, Brazil
| | | | - Suzanne D Turner
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Guido Firmani
- Faculty of Medicine and Psychology, Sapienza University of Rome, Department of Plastic Surgery, Sant’Andrea Hospital, Rome, Italy
| | - Michail Sorotos
- Faculty of Medicine and Psychology, Sapienza University of Rome, Department NESMOS, Sant’Andrea Hospital, Rome, Italy
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Santanelli di Pompeo F, Paolini G, Firmani G, Sorotos M. HISTORY OF BREAST IMPLANTS: BACK TO THE FUTURE. JPRAS Open 2022; 32:166-177. [PMID: 35434240 PMCID: PMC9006741 DOI: 10.1016/j.jpra.2022.02.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/27/2022] [Indexed: 11/19/2022] Open
Abstract
Modern breast implants are a staple of plastic surgery, finding uses in esthetic and reconstructive procedures. Their history began in the 1960s, with the first generation of smooth devices with thick silicone elastomer, thick silicone gel, and Dacron patches on the back. They presented hard consistency, high capsular contracture rates and the patches increased the risk of rupture. In the same decade, polyurethane coating of implants was implemented. A second generation was introduced in the 1970s with a thinner shell, less viscous gel filler and no patches, but increased silicone bleed-through and rupture rates. The third generation, in the early 1980s, featured implants with a thicker multilayered elastomer shell reinforced with silica to reduce rupture risk and prevent silicone bleed-through. A fourth generation from the late 1980s combined thick outer elastomer shells, more cohesive gel filler, and implemented for the first-time outer shell texturing. In the early 1990s, the fifth generation of devices pioneered an anatomical shape with highly cohesive form-stable gel filler and a rough outer shell surface. Surface texturing was hampered by the discovery of Breast Implant Associated-Anaplastic Large Cell Lymphoma and its link with textured devices. From the 2010s, we have the era of the sixth generation of implants, featuring innovations regarding the surface, with biomimetic surfaces, more resistant shells and variations in gel consistency. The road to innovation comprises setbacks such as the FDA moratorium in 1992, the PIP scandal, the Silimed CE mark temporary suspension and the FDA-requested voluntary recall of the Allergan BIOCELL implants.
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