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Nepon H, Julien C, Petrecca S, Kalashnikov N, Safran T, Murphy A, Dionisopoulos T, Davison P, Vorstenbosch J. The cellular and molecular properties of capsule surrounding silicone implants in humans vary uniquely according to the tissue type adjacent to the implant. J Biomed Mater Res A 2024. [PMID: 38864257 DOI: 10.1002/jbm.a.37762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 04/15/2024] [Accepted: 05/29/2024] [Indexed: 06/13/2024]
Abstract
The foreign body reaction (FBR) to biomaterials results in fibrous encapsulation. Excessive capsule fibrosis (capsular contracture) is a major challenge to the long-term stability of implants. Clinical data suggests that the tissue type in contact with silicone breast implants alters susceptibility to developing capsular contracture; however, the tissue-specific inflammatory and fibrotic characteristics of capsule have not been well characterized at the cellular and molecular level. In this study, 60 breast implant capsule samples are collected from patients and stratified by the adjacent tissue type including subcutaneous tissue, glandular breast tissue, or muscle tissue. Capsule thickness, collagen organization, immune and fibrotic cellular populations, and expression of inflammatory and fibrotic markers is quantified with histological staining, immunohistochemistry, and real-time PCR. The findings suggest there are significant differences in M1-like macrophages, CD4+ T cells, CD26+ fibroblasts, and expression of IL-1β, IL-6, TGF-β, and collagen type 1 depending on the tissue type abutting the implant. Subglandular breast implant capsule displays a significant increase in inflammatory and fibrotic markers. These findings suggest that the tissue microenvironment contributes uniquely to the FBR. This data could provide new avenues for research and clinical applications to improve the site-specific biocompatibility and longevity of implantable devices.
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Affiliation(s)
- Hillary Nepon
- Division of Plastic & Reconstructive Surgery, McGill University, Montreal General Hospital, Quebec, Canada
- Division of Surgical and Interventional Sciences, McGill University, Montreal General Hospital, Quebec, Canada
| | - Cedric Julien
- McGill University Hospital Centre Research Institute, Montreal General Hospital, Quebec, Canada
| | - Sarah Petrecca
- Faculty of Medicine and Health Sciences, McGill University, Quebec, Canada
| | - Nikita Kalashnikov
- Division of Surgical and Interventional Sciences, McGill University, Montreal General Hospital, Quebec, Canada
- Faculty of Medicine and Health Sciences, McGill University, Quebec, Canada
| | - Tyler Safran
- Division of Plastic & Reconstructive Surgery, McGill University, Montreal General Hospital, Quebec, Canada
| | - Amanda Murphy
- Division of Plastic & Reconstructive Surgery, McGill University, Montreal General Hospital, Quebec, Canada
| | - Tassos Dionisopoulos
- Division of Plastic & Reconstructive Surgery, McGill University, Montreal General Hospital, Quebec, Canada
| | - Peter Davison
- Division of Plastic & Reconstructive Surgery, McGill University, Montreal General Hospital, Quebec, Canada
| | - Joshua Vorstenbosch
- Division of Plastic & Reconstructive Surgery, McGill University, Montreal General Hospital, Quebec, Canada
- McGill University Hospital Centre Research Institute, Montreal General Hospital, Quebec, Canada
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Vinsensia M, Schaub R, Meixner E, Hoegen P, Arians N, Forster T, Hoeltgen L, Köhler C, Uzun-Lang K, Batista V, König L, Zivanovic O, Hennigs A, Golatta M, Heil J, Debus J, Hörner-Rieber J. Incidence and Risk Assessment of Capsular Contracture in Breast Cancer Patients following Post-Mastectomy Radiotherapy and Implant-Based Reconstruction. Cancers (Basel) 2024; 16:265. [PMID: 38254756 PMCID: PMC10813520 DOI: 10.3390/cancers16020265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
Our study aims to identify the risk factors and dosimetry characteristics associated with capsular contracture. METHODS We retrospectively analyzed 118 women with breast cancer who underwent PMRT following an IBR between 2010 and 2022. Patients were treated with PMRT of 50.0-50.4 Gy in 25-28 fractions. Capsular contracture was categorized according to the Baker Classification for Reconstructed Breasts. RESULTS After a median follow-up of 22 months, the incidence of clinically relevant capsular contracture (Baker III-IV) was 22.9%. Overall, capsular contracture (Baker I-IV) occurred in 56 patients (47.5%) after a median of 9 months after PMRT. The rate of reconstruction failure/implant loss was 25.4%. In the univariate analysis, postoperative complications (prolonged pain, prolonged wound healing, seroma and swelling) and regional nodal involvement were associated with higher rates of capsular contracture (p = 0.017, OR: 2.5, 95% CI: 1.2-5.3 and p = 0.031, respectively). None of the analyzed dosimetric factors or the implant position were associated with a higher risk for capsular contracture. CONCLUSION Postoperative complications and regional nodal involvement were associated with an increased risk of capsular contracture following breast reconstruction and PMRT, while none of the analyzed dosimetric factors were linked to a higher incidence. Additional studies are needed to identify further potential risk factors.
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Affiliation(s)
- Maria Vinsensia
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Riccarda Schaub
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Eva Meixner
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Philipp Hoegen
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Nathalie Arians
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Tobias Forster
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Line Hoeltgen
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Clara Köhler
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Kristin Uzun-Lang
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Vania Batista
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Oliver Zivanovic
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Brustzentrum Heidelberg Klinik St. Elisabeth, 69121 Heidelberg, Germany
| | - Andre Hennigs
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Brustzentrum Heidelberg Klinik St. Elisabeth, 69121 Heidelberg, Germany
| | - Michael Golatta
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Brustzentrum Heidelberg Klinik St. Elisabeth, 69121 Heidelberg, Germany
| | - Jörg Heil
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Brustzentrum Heidelberg Klinik St. Elisabeth, 69121 Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg Ion Beam Therapy Center (HIT), Heidelberg University Hospital, 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Heidelberg, 69120 Heidelberg, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
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Ali A, Picado O, Mathew PJ, Ovadia S, Thaller SR. Risk Factors for Capsular Contracture in Alloplastic Reconstructive and Augmentation Mammaplasty: Analysis of the National Surgical Quality Improvement Program (NSQIP) Database. Aesthetic Plast Surg 2023; 47:1678-1682. [PMID: 35715534 DOI: 10.1007/s00266-022-02972-x] [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: 02/21/2022] [Accepted: 05/01/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Capsular contracture is the most common complication of breast augmentation and reconstruction. It occurs in up to 45% of patients and is theorized to occur secondary to an immune reaction. It can lead to pain, dissatisfaction with aesthetic outcomes, and reoperation. The gold standard for management is capsulectomy. Prior similar studies are limited by narrow inclusion criteria, single-surgeon analysis, small sample size, or univariate analysis. The goal of the following study is to prospectively identify possible risk factors for capsular contracture using a national database. METHODS A retrospective review was conducted utilizing the National Surgical Quality Improvement Program (NSQIP) Database of prospectively collected data of patients undergoing periprosthetic and/or total capsulectomy for capsular contracture from 2013 to 2016. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for variables using a multivariable binary logistic regression model. RESULTS A total of 6547 patients underwent reconstructive or augmentation mammaplasty with a prosthetic implant, out of which 2543 (39%) underwent capsulectomy. Capsular contracture was more likely in older (OR: 1.10, 95% CI: 1.09-1.10, p<.001), overweight (OR: 1.12, 95% CI: 1.10-1.13, p<.001), and cancer patients (OR: 7.71, 95% CI: 2.22-28.8, p=0.001). Wound infection was associated with capsulectomy (OR: 6.69, 95% CI: 1.74-25.8, p<.001). CONCLUSION These identified risk factors should be comprehensively addressed with patients during the informed consent process before breast augmentation or reconstruction with implants. 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)
- Aleeza Ali
- Herbert Wertheim College of Medicine; Florida International University, Miami, Florida, USA
| | - Omar Picado
- Division of Plastic and Reconstructive Surgery; DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Prakash J Mathew
- Division of Plastic and Reconstructive Surgery; DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Steven Ovadia
- Division of Plastic and Reconstructive Surgery; DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Seth R Thaller
- Division of Plastic and Reconstructive Surgery; DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA.
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Cala Uribe LC, Perez Pachon M, Villate Hernandez A, Zannin Ferrero A. Kite Mastopexy: Small Scar and Tissue-conserving Technique. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5265. [PMID: 37718994 PMCID: PMC10501476 DOI: 10.1097/gox.0000000000005265] [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: 07/01/2023] [Accepted: 07/20/2023] [Indexed: 09/19/2023]
Abstract
Background Breasts are considered one of the most physically and sexually appealing features of the female body. Reduction/augmentation techniques have greatly evolved in the last decades.We are reporting our experience with an innovative technique for mastopexy that recovers the aesthetics of the breast and avoids over-resection of its lower pole. Methods Inclusion criteria were women who underwent kite mastopexy with or without implants between January 2018 and May 2022 in a single center (Bogota, Colombia). Exclusion criteria were patients with American Society of Anesthesiology score more than II, with any uncontrolled chronic illness and/or medical history of diabetic mellitus, metabolic syndrome, body mass index more than 32 kg per m2, and active smokers. Results We found 133 consecutive female patients. Age range was 18 and 67 years (median 39). Breast implants were used for the purpose of kite mastopexy in 52% cases. Patients were divided into two groups: implants (group 1) versus no implants (group 2). Procedure 1 involved mastopexy without implants; procedure 2 included current implant users who underwent either implant removal or in whom implants were not used for the sake of mastopexy. Procedures 3 and 4 included patients who underwent either new implant placement or implant exchange, respectively. Average time of surgery was 1.5 hours. Minor complications were mostly related to wound dehiscence. No major complications were reported. Conclusions Kite mastopexy restores the breast aesthetics by following specific markings, a new plication of breast pillars, and a reduced scar. Our technique demonstrates a very low rate of complications while entailing natural and appealing results.
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Affiliation(s)
| | | | | | - Andreina Zannin Ferrero
- Therapy and Metabolism Research Group, Universidad De La Sabana School of Medicine, Bogota, Colombia
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Janzekovic J, Hunt J, Peltz T, Wagels M, Brown T, Hutmacher DW. Biomechanical Principles of Breast Implants and Current State of Research in Soft Tissue Engineering for Cosmetic Breast Augmentation. Aesthetic Plast Surg 2022; 46:1-10. [PMID: 34494126 DOI: 10.1007/s00266-021-02559-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/22/2021] [Indexed: 12/17/2022]
Abstract
Currently there are limited implant-based options for cosmetic breast augmentation, and problems associated with those have been increasingly appreciated, most commonly capsular contracture, which occurs due to a chronic foreign body reaction against non-degradable implant materials such as silicone and polyurethane leading to scar tissue formation, pain, and deformity. The underlying biomechanical concepts with implants create a reciprocal stress-strain relationship with local tissue, whilst acting as a deforming force. This means that with time, as the implant continues to have an effect on surrounding tissue the implant and host's biomechanical properties diverge, making malposition, asymmetry, and other complications more likely. Research directed towards development of alternative therapies based on tissue engineering and regenerative medicine seeks to optimize new tissue formation through modulation of tissue progenitors and facilitating tissue regeneration. Scaffolds can guide the process of new tissue formation by providing both an implant surface and a three-dimensional space that promotes the development of a microenvironment that guides attachment, migration, proliferation, and differentiation of connective tissue progenitors. Important to scaffold design are the architecture, surface chemistry, mechanical properties, and biomaterial used. Scaffolds provide a void in which vascularization, new tissue formation, and remodelling can sequentially occur. They provide a conduit for delivery of the different cell types required for tissue regeneration into a graft site, facilitating their retention and distribution. Whilst recent research from a small number of groups is promising, there are still ongoing challenges to achieving clinical translation. This article summarizes the biomechanical principles of breast implants, how these impact outcomes, and progress in scaffold-guided tissue engineering approaches to cosmetic breast augmentation. 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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Affiliation(s)
- Jan Janzekovic
- Centre for Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Brisbane, QLD, 4000, Australia
- Plastic and Reconstructive Surgery, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, QLD, 4102, Australia
| | - Jeremy Hunt
- Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Tim Peltz
- Centre for Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Brisbane, QLD, 4000, Australia
- Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
- St Luke's and Prince of Wales Hospital Plastic Surgery Research Group, Potts Point, NSW, 2011, Australia
| | - Michael Wagels
- Plastic and Reconstructive Surgery, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, QLD, 4102, Australia
- St Luke's and Prince of Wales Hospital Plastic Surgery Research Group, Potts Point, NSW, 2011, Australia
| | - Tim Brown
- Centre for Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Brisbane, QLD, 4000, Australia.
- Plastic Surgeon in Private Practice in Melbourne, 40-42 Clyde Road, Suite 2, Berwick, VIC, 3806, Australia.
- School of Mechanical, Medical and Process Engineering, Science and Engineering Faculty, Queensland University of Technology, Brisbane, QLD, 4000, Australia.
| | - Dietmar W Hutmacher
- Centre for Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Brisbane, QLD, 4000, Australia
- School of Mechanical, Medical and Process Engineering, Science and Engineering Faculty, Queensland University of Technology, Brisbane, QLD, 4000, Australia
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, 4000, Australia
- ARC ITTC in Additive Biomanufacturing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, 4000, Australia
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Bachour Y. Capsular Contracture in Breast Implant Surgery: Where Are We Now and Where Are We Going? Aesthetic Plast Surg 2021; 45:1328-1337. [PMID: 33559094 DOI: 10.1007/s00266-021-02141-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/13/2021] [Indexed: 11/25/2022]
Abstract
Capsular contracture is the leading complication after surgery with breast implants. A lot of progress has been made investigating this complication over the years, and knowledge has been gained on this complication. Currently, the exact cause for capsular contracture is still unclear. It has been hypothesized that immunobiological factors (i.e., immunological and bacterial factors) and several risk factors play a central role in its development. In this paper, we give an overview of the known immunological factors that have been investigated in contracted and non-contracted capsules, as well as the role of bacterial formation around breast implants. We also report on risk factors that might increase the risk of capsular development. Lastly, it provides the latest research on this matter and discusses future perspectives as follow-up research is needed to unravel the pathogenic process leading to capsular contracture. This knowledge is of interest to establish medical therapies in order to prevent such side effects. Overall, capsular contracture seems to be a multifactorial condition consisting of several risk factors. 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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Affiliation(s)
- Yara Bachour
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC- location VUmc, De Boelelaan 1117, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
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A Comprehensive Outcome Review of Subfascial Breast Augmentation over a 10-Year Period. Plast Reconstr Surg 2021; 146:1249-1257. [PMID: 33234953 DOI: 10.1097/prs.0000000000007333] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Subfascial placement of breast implants has the advantages of subglandular and submuscular placement without the adverse outcomes. There are few large series with longitudinal follow-up and outcome measures. METHODS Seven hundred eighty-three patients underwent subfascial breast augmentation and were followed up for 10 years. Adverse outcomes, changes in breast morphometry, and patient satisfaction were outcome measures. RESULTS All morphometry increased except soft-tissue thickness at the lateral sternal margin. The distance from the nipple-areola complex to the inframammary crease increased by 40 percent, with a concomitant 6.2 percent increase in the distance from the suprasternal notch to the nipple-areola complex. The capsular contracture rate was 6.48 percent, and correlates with a lateral sternal margin of less than 20 mm (r = 0.57, p < 0.001). Ripples occurred in patients with less than 10 mm of soft tissue at the lateral sternal margin; 11.6 percent of patients would choose a larger implant and 2.7 percent would choose a smaller implant. CONCLUSIONS Subfascial placement of breast implants provides a reliable technique. It can be used in patients with at least 20 mm of soft tissue at the lateral sternal margin. Those with 10 to 20 mm should be counseled that ripples may occur if they lose body fat. The technique is unsuitable for individuals with less than 10 mm measurable at the lateral sternal margin. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Hammond JB, Kosiorek HE, Cronin PA, Rebecca AM, Casey WJ, Wong WW, Vargas CE, Vern-Gross TZ, McGee LA, Pockaj BA. Capsular contracture in the modern era: A multidisciplinary look at the incidence and risk factors after mastectomy and implant-based breast reconstruction. Am J Surg 2020; 221:1005-1010. [PMID: 32988607 DOI: 10.1016/j.amjsurg.2020.09.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/20/2020] [Accepted: 09/15/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Capsular contracture causes pain, poor cosmesis, and reoperations. This study analyzes its incidence and risk factors in a more modern treatment era. METHODS Patients undergoing mastectomy with implant reconstruction from 2010 to 18 were reviewed. Univariate and multivariate analysis evaluated rates and risk factors for capsular contracture. RESULTS Among 451 patients, the majority underwent nipple-sparing mastectomy (262, 58.1%) with one-stage reconstruction (283, 62.7%) utilizing subpectoral implants (353, 77.4%) and acellular dermal matrix (354, 78.5%). Overall capsular contracture incidence was 9.8%; the rate after post-mastectomy radiation therapy (PMRT) was 18.7%, and 7.5% for patients without PMRT. Significant factors included neoadjuvant chemotherapy (P = 0.006), hematoma (P = 0.047), and PMRT (P = 0.001). Multivariate analysis showed that PMRT increased risk of capsular contracture (OR = 3.12, 95% CI 1.55-6.26, P = 0.001), and adjuvant chemotherapy was protective (OR = 0.289, 95% CI 0.114-0.731, P = 0.01). CONCLUSIONS Incidence of capsular contracture is lower than previously reported. Advancing therapeutic techniques may reduce the risk of this complication.
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Affiliation(s)
- Jacob B Hammond
- Division of Surgical Oncology & Endocrine Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Heidi E Kosiorek
- Department of Health Sciences Research, Section of Biostatistics, Mayo Clinic, Phoenix, AZ, USA
| | - Patricia A Cronin
- Division of Surgical Oncology & Endocrine Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Alanna M Rebecca
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Phoenix, AZ, USA
| | - William J Casey
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Phoenix, AZ, USA
| | - William W Wong
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Carlos E Vargas
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | | | - Lisa A McGee
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Barbara A Pockaj
- Division of Surgical Oncology & Endocrine Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ, USA.
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9
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Quantitative Appraisal Through MRI of Breast Tissue Thickness and Implant Projection After Breast Augmentation with High- and Extra-High-Profile Round Implants. Aesthetic Plast Surg 2020; 44:52-59. [PMID: 31722065 DOI: 10.1007/s00266-019-01533-z] [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: 08/18/2019] [Accepted: 10/25/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Changes in breast tissue thickness and in implant projection 5 years after augmentation with high- and extra-high-profile round implants were measured through MRI with a DICOM standard viewer. METHODS Twenty-four females with small-volume breast asymmetry without hypertrophy or ptosis underwent subfascial breast augmentation for cosmetic purposes, by using micro-textured soft cohesive silicone gel-filled round implants, from a single manufacturer. MRI measured the linear antero-posterior dimension of breast tissue thickness and projection of the implants. Statistical analysis of data was performed by Pearson correlation coefficient, line graph, and scatter diagram. RESULTS The "r" of Pearson for right and left breasts indicated a significant correlation between the breast tissue thickness before and 5 years after augmentation. Closeness of the lines displayed in the line graph indicated strong linear positive correlation between the breast tissue thicknesses. The "r" values for projection of right and left implants indicated a significant correlation between the projection standardized by the manufacturer and that encountered 5 years after augmentation with high- and extra-high-profile round implants. A scatter diagram of data indicated a strong positive correlation between implant projection standardized by the manufacturer and that encountered 5 years after augmentation, on both breasts. CONCLUSION Soft cohesive silicone gel-filled high- and extra-high-profile round implants supported breast tissue compressing without significant loss of the implant projection. Despite the consistency of the soft cohesive silicone gel, the implant softness and flexibility were preserved, resulting in low-pressure gradient over the mammary parenchyma without significant changes of the breast tissue thickness. EBM LEVEL IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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10
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Bachour Y, Poort L, Verweij SP, van Selms G, Winters HAH, Ritt MJPF, Niessen FB, Budding AE. PCR Characterization of Microbiota on Contracted and Non-Contracted Breast Capsules. Aesthetic Plast Surg 2019; 43:918-926. [PMID: 31049639 PMCID: PMC6652165 DOI: 10.1007/s00266-019-01383-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 04/21/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The aetiology of capsular contracture around breast implants remains unclear. The leading theory is that a subclinical infection around the implant plays a role in the development of capsular contractions. Several studies found associations between the presence of bacteria and the occurrence of capsular contraction. However, it is unclear whether detected bacteria originate from the breast capsule, breast glandular tissue or skin contamination. Moreover, this has never been investigated with molecular techniques. The aim of this study was to assess the bacterial microbiota on breast capsules, glandular tissue and skin using a highly sensitive PCR assay. MATERIALS AND METHODS Fifty breast capsules were collected during implant removal or replacement. Ten specimens of glandular breast tissue and breast skin were collected in females who were undergoing reduction mammoplasty. A sample specimen (4 mm) was sterilely obtained from all tissues. All specimens were analysed by IS-pro, a 16S-23S interspace region-based PCR assay. RESULTS Low numbers of Staphylococcus spp. (four species in four capsules) were found on breast capsules. There was no difference in bacterial presence between normal and contracted capsules. The skin of the breast-harboured Streptococcus spp. and Staphylococcus spp. while the glandular tissue was sterile. CONCLUSION The low numbers of bacteria found on the capsules are most likely caused by contamination during capsule removal. More and larger studies are needed to investigate the bacterial presence on breast capsules using a PCR assay. This is the first study in which breast capsules have been studied using a highly sensitive PCR assay. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Abramo AC, Scartozzoni M, Lucena TW, Sgarbi RG. High- and Extra-High-Profile Round Implants in Breast Augmentation: Guidelines to Prevent Rippling and Implant Edge Visibility. Aesthetic Plast Surg 2019; 43:305-312. [PMID: 30483933 DOI: 10.1007/s00266-018-1264-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/22/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Rippling and implant edge visibility after breast augmentation depends on several factors. Among the most relevant are breast soft tissue thickness, particularly the retroareolar mammary parenchyma, and implant profile. They were correlates to prevent these occurrences. METHODS Thirty patients underwent breast augmentation through subfascial dissection involving the pectoralis, serratus, external oblique, and rectus abdominis fascias. The thickness of the retroareolar mammary parenchyma distributed patients into two groups. Group I: patients with thickness equal to or greater than 4.0 cm received high-profile 85% fill round implants. Group II: patients with thickness up to 3.9 cm received extra-high-profile 100% fill round implants. MRI was performed preoperatively and 5 years after augmentation to evaluate breast tissue changes and implant contouring. RESULTS Seventeen patients with high-profile implants and thirteen patients with extra-high-profile implants had noticeable improvement of the breasts without the occurrence of rippling or implant edge visibility. A natural appearance of the breast, increased mammary cone, balanced upper and lower pole contouring was maintained at 5 years postoperatively. MRI performed 5 years after breast augmentation validated patient clinical outcomes not evidencing implant deformities, or soft tissue thinning, parenchymal atrophy or chest wall deformities. CONCLUSIONS The adequate correlation between retroareolar mammary parenchyma thickness with high-profile 85% fill and extra-high-profile 100% fill textured round implants was of utmost importance in preventing rippling and implant edge visibility. The wide fascial support, width of the implant smaller than the breast diameter, and soft cohesive gel-filled implants were co-adjuvant factors in preventing rippling and implant edge visibility. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Bachour Y, Bargon CA, de Blok CJM, Ket JCF, Ritt MJPF, Niessen FB. Risk factors for developing capsular contracture in women after breast implant surgery: A systematic review of the literature. J Plast Reconstr Aesthet Surg 2018; 71:e29-e48. [PMID: 29980456 DOI: 10.1016/j.bjps.2018.05.022] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 03/18/2018] [Accepted: 05/26/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Capsular contracture is the most frequent complication in breast augmentation or reconstruction with breast implants. The exact mechanism for this complication is not completely understood. Yet, it is most likely to be a multifactorial condition. Several patient-, surgery-, and implant-specific risk factors have been related to cause capsular contracture. This review aims to provide a clear overview of all risk factors for capsular contracture. METHODS A systematic literature review was performed focusing on patient-, surgery-, and/or implant-related factors related to capsular contracture in breast implants. PubMed, Embase, and Wiley/Cochrane Library databases were searched for relevant articles published from inception up to October 20, 2016. The included studies were assessed for the following main variables: study characteristics, patient characteristics, indication for surgery, type of surgery, implant characteristics, and other characteristics. RESULTS Data on the risk factors for the development of capsular contracture were retrieved from 40 studies. A presumptive increased risk in the development of capsular contracture is shown for the following variables: longer duration of follow-up, breast reconstructive surgery in patients with a history of breast cancer, subglandular implant placement, postoperative hematoma, and a textured implant surface. There is little, weak, or no evidence for the association of other factors with capsular contracture. This review also shows a large heterogeneity between studies and within the definition of capsular contracture. CONCLUSION This review provides an overview of the relationship between patient-, surgery-, and implant-specific risk factors in the development of capsular contracture.
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Affiliation(s)
- Yara Bachour
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Claudia A Bargon
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Christel J M de Blok
- Department of Internal Medicine, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - Johannes C F Ket
- Medical Library, University Library, VU University, De Boelelaan 1117, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - Marco J P F Ritt
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Frank B Niessen
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
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Surface Areas of Textured Breast Implants: Implications for the Biofilm Theory of Capsule Formation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1700. [PMID: 29707459 PMCID: PMC5908488 DOI: 10.1097/gox.0000000000001700] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 01/19/2018] [Indexed: 01/31/2023]
Abstract
Supplemental Digital Content is available in the text. Background: Increased surface area of mammary implants is suggested as a causative agent for the development of biofilms, which may lead to capsular contraction. The aim of this study was to quantify the surface areas of round implants of different textures and examine how these data can be interpreted with regard to clinical observation. Methods: Surface areas of textured round breast implants were calculated from previously reported confocal scanning microscopic assessment, and dimensions sourced from 3 breast implant manufacturers (McGhan, Mentor, and Silimed). Statistical comparisons were made between manufacturers for different implant volumes, profiles, and texturing. Results: There was a difference in surface area between manufacturers for all implant profiles and between manufacturers for equivalent volume implants (F (3, 253) = 2,828.87; P < 0.001). Silimed polyurethane implants (mean area = 6.12 × 106 mm2) was the highest. Natrelle (mean area = 1.2 × 106 mm2) was the next highest, followed by Siltex (mean area = 4.8 × 105 mm2). Mentor smooth implants (mean area = 4 × 104 mm2) had the lowest mean surface area. There were no differences in surface area between the different profiles for Siltex, Silimed polyurethane, and Mentor smooth implants of the same volume. Conclusions: The increased surface area produced by texturing, although different between manufacturers, seems to provide protection against capsular contraction. Correlation with clinical data indicates that the surface area alone cannot account for these differences. Smooth implants, which have the smallest surface area have the highest incidence of capsular contraction. These data are at odds with the biofilm theory of capsular contraction.
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A decision-making method for breast augmentation based on 25 years of practice. Arch Plast Surg 2018; 45:196-203. [PMID: 29506335 PMCID: PMC5869427 DOI: 10.5999/aps.2017.00535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 09/19/2017] [Accepted: 09/26/2017] [Indexed: 12/04/2022] Open
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The aetiopathogenesis of capsular contracture: A systematic review of the literature. J Plast Reconstr Aesthet Surg 2017; 71:307-317. [PMID: 29301730 DOI: 10.1016/j.bjps.2017.12.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 10/05/2017] [Accepted: 12/05/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Capsular contracture is the most frequent complication after breast augmentation or reconstruction with breast implants. The immune system plays a prominent role in capsular contracture formation, albeit to an unknown extent. Bacterial contamination in situ has been hypothesized to be causative for capsular contracture. How this relates to the immunological processes involved is unknown. This article aims to provide an overview of immunological and bacterial factors involved in development of capsular contracture. MATERIALS AND METHODS We undertook a systematic literature review focused on immunological factors and microbiota in relation to capsular contraction around implants. This systematic review was performed in accordance with the PRISMA guidelines. PubMed, EMBASE, and the Cochrane databases were searched from inception up to October 2016. Included studies were assessed for the following variables: subject characteristics, number of capsules, primary indication for surgery, surgical procedure, follow-up or implant duration, study methods, type of antibiotics or medical therapies and outcomes related to microbiota and immunological factors. RESULTS Data on immunological factors and bacterial contamination were retrieved from 64 included studies. Notably the presence of macrophages and Staphylococcus epidermidis within capsules was often associated with capsular contracture. CONCLUSION This review provides a clear overview of the immunological factors associated with capsular contracture and provides a hypothetical immunological model for development of the disease. Furthermore, an overview of bacterial contamination and associations with capsular contracture has been provided. Follow-up research may result in clinical recommendations to prevent capsular contracture.
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Nava MB, Rocco N, Tunesi G, Catanuto G, Rancati A, Dorr J. Decisional pathways in breast augmentation: how to improve outcomes through accurate pre-operative planning. Gland Surg 2017; 6:203-209. [PMID: 28497024 DOI: 10.21037/gs.2017.03.01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Breast augmentation is the most commonly performed surgical procedure in aesthetic plastic surgery. Accurate pre-operative planning is crucial to obtain the best outcomes. We present our planning method deriving from a more than 30-year experience in aesthetic breast surgery, matching together patients tissues' characteristics and patients' wishes. We schematized our planning method in an easy-to-use flow diagram to help the decisional process in breast augmentation.
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Affiliation(s)
- Maurizio B Nava
- Valduce Hospital, Como, Italy.,Department of Plastic Surgery, University of Milan, Milan, Italy
| | - Nicola Rocco
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | | | - Giuseppe Catanuto
- Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Catania, Italy
| | - Alberto Rancati
- Chief Oncoplastic Surgery Instituto Henry Moore, University Of Buenos Aires, Buenos Aires, Argentina
| | - Julio Dorr
- University of Buenos Aires, Buenos Aires, Argentina
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Montemurro P, Cheema M, Hedén P, Ferri M, Quattrini Li A, Avvedimento S. Role of Macrotextured Shaped Extra Full Projection Cohesive Gel Implants in Primary Aesthetic Breast Augmentation. Aesthet Surg J 2017; 37:408-418. [PMID: 27836857 DOI: 10.1093/asj/sjw199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Extra full projection implants are used in a select group of aesthetic breast surgery patients. Their use is selective enough that they have not been included in long term manufacturer studies and the indications for their use have attracted much debate. Only a handful of studies have reported the outcomes from implantation of these devices. Objectives We review our experience of using extra full projection anatomically shaped macrotextured silicone gel implants discussing our rationale, indications, and results. Methods All patients undergoing primary aesthetic breast surgery with extra full projection anatomical implants by the first author (P.M.) over a seven-year period (January 2009 to December 2015) were included. Results Three hundred and ten female patients had 620 macrotextured extra full projection anatomically shaped cohesive silicone gel breast implants of mean volume 338 cc (range, 195-615 cc) placed over the seven-year period. All of them had at least a 6-months follow up. There were 39 complications (12.6%) at an average follow up of 12.3 months, including implant malposition/rotation (5.4%), capsular contracture (2.6%), and bottoming out (1.6%). A total of 41 patients (13.2%) were reoperated, of which 30 (9.7%) were due to a complication and 11 (3.5%) because of patient choice. Most of the complications were in the initial part of the case series. Conclusions The outcomes following the use of extra full projection implants in a carefully selected group of patients are comparable in the short term to those reported for other shaped implants and complications appear to decrease with experience. Level of Evidence 4.
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Affiliation(s)
| | | | - Per Hedén
- Plastic surgeons i private practice in Stockholm, Sweden
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Sieber DA, Stark RY, Chase S, Schafer M, Adams WP. Clinical Evaluation of Shaped Gel Breast Implant Rotation Using High-Resolution Ultrasound. Aesthet Surg J 2017; 37:290-296. [PMID: 28207033 DOI: 10.1093/asj/sjw179] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Clinical trials have demonstrated through core and independent studies that anatomical devices are safe and effective with low complication rates. The rotation rate of shaped breast implants in the literature is 0 to 8.2%. Currently there are no studies evaluating the efficacy of in office ultrasound or clinical rotation vs actual rotation rates seen on high-resolution ultrasound (HRUS). Objectives The purpose of the study is to demonstrate the ease and reliability of HRUS for evaluating the rotation rate of 2 different brands of anatomic implants and to correlate this with the presumed clinical rate, as well as independent evaluators assessments. Methods A total of 69 patients were followed up at routine intervals and were evaluated for rotation. Any implant rotated past >30° off of midline (outside 5-7 o’clock) was considered to be rotated. To determine if radiographic rotation was clinically evident, 20 composite patient photos were blindly evaluated. Results A random total of 69 patients underwent bilateral augmentation mammoplasty with form stable anatimic gel implants using 138 implants. Twenty-nine of the 69 (42%) patients and 37 of the 138 (27%) implants were found to be rotated-using HRUS. Eight of the 69 (12%) patients had bilateral rotations. Independent evaluators were able to identify two of 12 (17%) possible rotations, or 2 rotations in 40 (5%) total implants. Conclusions Anatomic form stable gel implants are actually rotated up to 25 times more frequently than previously thought, but these rotations do not translate into clinically significant sequela. High-resolution ultrasound is a simple alternative for breast implant surveillance and is better accepted by patients than magnetic resonance imaging (MRI). The clinical value of HRUS is also discussed and recommendations for FDA implant labeling changes are provided in this article. Level of Evidence 4
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Affiliation(s)
- David A. Sieber
- Dr Sieber is a plastic surgeon in private practice in San Francisco, CA. Dr Stark is a Resident, and Dr Adams is an Associate Clinical Professor, Department of Plastic Surgery and Program Director of the Aesthetic Surgery Fellowship at UTSW, University of Texas Southwestern, Dallas, TX. Ms Chase is the Vice President of Clinical Affairs, Xtant Medical, Belgrade, MT. Dr Schafer is President and Chief Technology Officer, PhotoSonix Medical Inc., Signal Hill, CA
| | - Ran Y. Stark
- Dr Sieber is a plastic surgeon in private practice in San Francisco, CA. Dr Stark is a Resident, and Dr Adams is an Associate Clinical Professor, Department of Plastic Surgery and Program Director of the Aesthetic Surgery Fellowship at UTSW, University of Texas Southwestern, Dallas, TX. Ms Chase is the Vice President of Clinical Affairs, Xtant Medical, Belgrade, MT. Dr Schafer is President and Chief Technology Officer, PhotoSonix Medical Inc., Signal Hill, CA
| | - Serena Chase
- Dr Sieber is a plastic surgeon in private practice in San Francisco, CA. Dr Stark is a Resident, and Dr Adams is an Associate Clinical Professor, Department of Plastic Surgery and Program Director of the Aesthetic Surgery Fellowship at UTSW, University of Texas Southwestern, Dallas, TX. Ms Chase is the Vice President of Clinical Affairs, Xtant Medical, Belgrade, MT. Dr Schafer is President and Chief Technology Officer, PhotoSonix Medical Inc., Signal Hill, CA
| | - Mark Schafer
- Dr Sieber is a plastic surgeon in private practice in San Francisco, CA. Dr Stark is a Resident, and Dr Adams is an Associate Clinical Professor, Department of Plastic Surgery and Program Director of the Aesthetic Surgery Fellowship at UTSW, University of Texas Southwestern, Dallas, TX. Ms Chase is the Vice President of Clinical Affairs, Xtant Medical, Belgrade, MT. Dr Schafer is President and Chief Technology Officer, PhotoSonix Medical Inc., Signal Hill, CA
| | - William P. Adams
- Dr Sieber is a plastic surgeon in private practice in San Francisco, CA. Dr Stark is a Resident, and Dr Adams is an Associate Clinical Professor, Department of Plastic Surgery and Program Director of the Aesthetic Surgery Fellowship at UTSW, University of Texas Southwestern, Dallas, TX. Ms Chase is the Vice President of Clinical Affairs, Xtant Medical, Belgrade, MT. Dr Schafer is President and Chief Technology Officer, PhotoSonix Medical Inc., Signal Hill, CA
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Brown T, Merten S, Mosahebi A, Caddy CM. Response to "In Defense of the International Collaboration of Breast Registry Activities (ICOBRA)". Aesthet Surg J 2016; 36:NP228-30. [PMID: 27053074 DOI: 10.1093/asj/sjw063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2016] [Indexed: 11/14/2022] Open
Affiliation(s)
- Tim Brown
- Dr Brown is a plastic surgeon in private practice in Melbourne, Australia. Dr Merten is a plastic surgeon in private practice in Sydney, Australia. Dr Mosahebi is a Consultant Plastic Surgeon, Royal Free Hospital, London, UK. Dr Caddy is a Consultant Plastic Surgeon, Royal Hallamshire Hospital, Sheffield, UK
| | - Steven Merten
- Dr Brown is a plastic surgeon in private practice in Melbourne, Australia. Dr Merten is a plastic surgeon in private practice in Sydney, Australia. Dr Mosahebi is a Consultant Plastic Surgeon, Royal Free Hospital, London, UK. Dr Caddy is a Consultant Plastic Surgeon, Royal Hallamshire Hospital, Sheffield, UK
| | - Afshin Mosahebi
- Dr Brown is a plastic surgeon in private practice in Melbourne, Australia. Dr Merten is a plastic surgeon in private practice in Sydney, Australia. Dr Mosahebi is a Consultant Plastic Surgeon, Royal Free Hospital, London, UK. Dr Caddy is a Consultant Plastic Surgeon, Royal Hallamshire Hospital, Sheffield, UK
| | - Christopher M Caddy
- Dr Brown is a plastic surgeon in private practice in Melbourne, Australia. Dr Merten is a plastic surgeon in private practice in Sydney, Australia. Dr Mosahebi is a Consultant Plastic Surgeon, Royal Free Hospital, London, UK. Dr Caddy is a Consultant Plastic Surgeon, Royal Hallamshire Hospital, Sheffield, UK
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Systematic review of the effectiveness of polyurethane-coated compared with textured silicone implants in breast surgery. J Plast Reconstr Aesthet Surg 2016; 69:452-60. [DOI: 10.1016/j.bjps.2016.01.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 12/17/2015] [Accepted: 01/11/2016] [Indexed: 11/23/2022]
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Xu H, Li W, Chen Y, Zhu Y, Hao L. New Design for Axillary Dual-Plane Endoscopic Breast Augmentation for Asians: the Feasibility of Two Types of Dual-Plane Implant Pockets in 70 Patients as Measured by the BREAST-Q. Aesthetic Plast Surg 2016; 40:79-88. [PMID: 26684835 DOI: 10.1007/s00266-015-0591-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 11/20/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The design methods for dual-plane implant pockets for axillary endoscopic breast augmentation vary among different countries. We applied a modified approach for an Asian population. METHODS Seventy patients with micromastia underwent our modified approach between 2011 and 2014. Breasts were divided into two types according to the soft-tissue pinch thickness of the lower pole: type I (thickness >2 cm; Group I) and type II (thickness ≤2 cm; Group II). The levels at which the pectoralis major (PM) was severed were 6-6.5 cm and 3-4 cm below the nipple for type I and II pockets, respectively. Then, dissection of the retromammary space was continued from the severance level downward to the new inframammary fold for type I pockets, whereas no dissection was made for type II pockets. All patients completed the pre- and post-operative BREAST-Q augmentation modules. RESULTS During a mean follow-up of 10 months (range, 6-12 months), patients reported higher satisfaction with breasts after surgery than before surgery (satisfaction scores of 64.9 ± 5.6 vs. 14.7 ± 11.0). The mean satisfaction score for the overall outcome was 91.3 ± 17.3. However, there was no significant difference in physical well-being (87.1 ± 10.4 vs. 85.2 ± 11.7). No complications such as severe capsular contracture or displacement occurred. CONCLUSION Distinguishing the need for a type I or II dual-plane pocket can lead to good outcomes and optimal soft-tissue coverage. The higher satisfaction and quality of life reported by our patients indicate that our new design is feasible and safe for most Asians with a medium build. LEVEL OF EVIDENCE II 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)
- Haiqian Xu
- Plastic and Aesthetic Surgery Center, The First Affiliated Hospital of Harbin Medical University, 143 Yiman Street, Nangang District, Harbin, People's Republic of China
| | - Wenjie Li
- Department of Breast Oncological Surgery, The Third Affiliated Hospital (Cancer Hospital) of Harbin Medical University, Harbin, People's Republic of China
| | - Yida Chen
- Plastic and Aesthetic Surgery Center, The First Affiliated Hospital of Harbin Medical University, 143 Yiman Street, Nangang District, Harbin, People's Republic of China
| | - Yangdong Zhu
- Plastic and Aesthetic Surgery Center, The First Affiliated Hospital of Harbin Medical University, 143 Yiman Street, Nangang District, Harbin, People's Republic of China
| | - Lijun Hao
- Plastic and Aesthetic Surgery Center, The First Affiliated Hospital of Harbin Medical University, 143 Yiman Street, Nangang District, Harbin, People's Republic of China.
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Brown T, Merten S, Mosahebi A, Caddy CM. Breast Implant Registries: The Problem with Ambition. Aesthet Surg J 2016; 36:255-9. [PMID: 26530482 DOI: 10.1093/asj/sjv227] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2015] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tim Brown
- Dr Brown is a plastic surgeon in private practice in Melbourne, Australia. Dr Merten is a plastic surgeon in private practice in Sydney, Australia. Dr Mosahebi is a Consultant Plastic Surgeon, Royal Free Hospital, London, United Kingdom. Dr Caddy is a Consultant Plastic Surgeon, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Steven Merten
- Dr Brown is a plastic surgeon in private practice in Melbourne, Australia. Dr Merten is a plastic surgeon in private practice in Sydney, Australia. Dr Mosahebi is a Consultant Plastic Surgeon, Royal Free Hospital, London, United Kingdom. Dr Caddy is a Consultant Plastic Surgeon, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Afshin Mosahebi
- Dr Brown is a plastic surgeon in private practice in Melbourne, Australia. Dr Merten is a plastic surgeon in private practice in Sydney, Australia. Dr Mosahebi is a Consultant Plastic Surgeon, Royal Free Hospital, London, United Kingdom. Dr Caddy is a Consultant Plastic Surgeon, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Christopher M Caddy
- Dr Brown is a plastic surgeon in private practice in Melbourne, Australia. Dr Merten is a plastic surgeon in private practice in Sydney, Australia. Dr Mosahebi is a Consultant Plastic Surgeon, Royal Free Hospital, London, United Kingdom. Dr Caddy is a Consultant Plastic Surgeon, Royal Hallamshire Hospital, Sheffield, United Kingdom
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Natrelle 410 Extra-Full Projection Silicone Breast Implants: 2-Year Results from Two Prospective Studies. Plast Reconstr Surg 2015; 136:638-646. [PMID: 26090764 PMCID: PMC4754780 DOI: 10.1097/prs.0000000000001636] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background: The safety and effectiveness of the Natrelle Style 410 highly cohesive silicone gel breast implant (Allergan, Inc., Irvine, Calif.) in full or moderate height and projection have been shown in a 10-year study. Extra-full projection implants may be an appropriate option for some women undergoing breast reconstruction. Methods: A total of 2795 women received at least one Natrelle 410 extra-full projection implant (X-style) for breast reconstruction in two similarly designed, prospective, multicenter studies. Data collected for 2 years after implantation in these studies were pooled to evaluate complication rates and subject and physician satisfaction. Results: Most subjects (76.0 percent) underwent bilateral reconstruction; a total of 4912 devices were implanted. Complication rates at 2 years were low. The most common complications were asymmetry (4.8 percent) and capsular contracture (3.3 percent). The cumulative risk of reoperation was 21.6 percent by subject and 16.6 percent by device; the most common reasons for reoperation were scarring (n = 97), asymmetry (n = 89), implant malposition (n = 78), and infection (n = 71). Subject and physician satisfaction rates exceeded 90 percent. At 2 years, 97 percent of physicians reported that the shape of the breast reflected the shape of the implant, and that the breast implant had maintained its original position. Conclusions: The safety profile of the Natrelle 410 extra-full projection implant mirrors that of its moderate projection and full projection counterparts. Both physicians and subjects were highly satisfied with the implants 2 years after surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
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