Augmentation mammaplasty using implants: a review

The Role of High Resolution Ultrasonography in Elucidating Features of the Breast Implants in Asymptomatic Patients After Implant-based Augmentation Mammaplasty

BACKGROUND

We conducted this study to describe the feasibility of high-resolution ultrasound (HRUS) in characterizing a breast implant in patients receiving an implant-based augmentation mammaplasty.

METHODS

The current study was conducted in a total of 612 patients (n =6 12) receiving an implant-based augmentation mammaplasty at other hospitals between August 31, 2017 and August 31, 2020. Of these, 136 patients (n = 136; 272 breasts) receiving reoperation were included in the current study. We compared between the patients' subjective awareness of a breast implant and its HRUS findings and an agreement between HRUS findings of a breast implant and its findings at reoperation.

RESULTS

The proportion of the patients receiving a silicone gel-filled breast implant was increased from 65.44% (89/136) to 81.61% (111/136) on HRUS. Moreover, HRUS was effective in identifying a manufacturer of the device.

CONCLUSIONS

In conclusion, our results indicate that HRUS is feasible in characterizing a breast implant in patients receiving an implant-based augmentation mammaplasty. But further prospective, large-scale studies are warranted to corroborate our results.

LEVEL OF EVIDENCE V

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Current status of breast implant-associated anaplastic large cell lymphoma in South Korea

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a unique type of lymphoma caused by breast implants. Concerns about BIA-ALCL have increased worldwide, and three domestic cases have been reported in South Korea. However, the incidence of the disease is not clear, and the risk probability has been reported to be up to 1/3,000. The most important factor in BIA-ALCL is the texturing of the implanted devices. Since the type of texturing is heterogeneous among products and companies, it is important for physicians to be aware of the spectrum of products and their implied risk. The pathophysiology of BIA-ALCL is presumed to be a combination of chronic inflammation related to the microenvironment and genetic predisposition. Further studies will allow accurate diagnosis and prognosis of the disease. The prognosis of BIA-ALCL is favorable if patients with late seroma or pericapsular masses are diagnosed early and complete surgical removal is achieved. Accurate diagnosis includes cytology or pathology with immunohistochemistry, including the CD30 protein and anaplastic lymphoma kinase. An essential factor in surgical success is radical excision with total capsulectomy. However, there is no evidence for prophylactic removal of a textured implant without symptoms. Careful examination and consultation should precede the implant removal, which can lead to deformity or complications. Domestic collaboration among healthcare providers for diagnosis and treatment is needed along with active reporting and registration of suspected patients. Finally, worldwide cooperation and improved awareness leading to regular surveillance are crucial in the era of BIA-ALCL.

Round versus Anatomical Implants in Primary Cosmetic Breast Augmentation: A Meta-Analysis and Systematic Review

BACKGROUND

Choosing implant shape (round or anatomical) is one of the most essential yet controversial decisions in cosmetic breast augmentation. Many surgeons choose implant shape based on personal experience or expert opinion. This is the first systematic review and meta-analysis comparing the aesthetic effect between anatomical and round implants in primary cosmetic breast augmentation.

METHODS

The authors searched the PubMed, MEDLINE, Embase, ScienceDirect, Web of Knowledge, Scopus, and Cochrane Central Register of Controlled Trials databases for studies that compared anatomical and round implants in primary cosmetic breast augmentation. Primary outcomes were postoperative aesthetic effect and correct identification rate of implant shape. Random effects models were used to obtain pooled standardized mean difference and 95 percent confidence intervals.

RESULTS

One randomized comparative and four observational comparative studies met the inclusion criteria. No aesthetic superiority was found in the anatomical implant group with regard to overall appearance (standardized mean difference, 0.06; 95 percent CI, -0.40 to 0.53), naturalness (standardized mean difference, 0.18; 95 percent CI, -1.51 to 1.15), projection, upper pole contour, and lower pole contour. Pooled correct identification rate of implant shape by plastic surgeons was 52 percent (95 percent CI, 0.46 to 0.58).

CONCLUSIONS

Generally, anatomical implants do not seem to have an aesthetic superiority compared to round implants. Plastic surgeons seemed to be unable to accurately differentiate the two implant shapes in vivo. Further studies should focus on identifying the specific indications for the use of anatomical implants.

Human Embryonic Stem Cell-Derived Endothelial Precursor Cell Conditioned Medium Reduces the Thickness of the Capsule Around Silicone Implants in Rats

BACKGROUND

We postulated that the fibrotic capsule around a silicone implant could be induced by ischemic conditions, based on previous reports that hypoxia is an important microenvironmental factor in the development of tissue fibrosis.

OBJECTIVE

This study aimed to determine the effect of human embryonic stem cell (hESC)-derived endothelial precursor cell (EPC) conditioned medium (CM), which has strong angiogenic potential, on the development of capsule around the silicone implant in a rat model.

METHODS AND MATERIALS

Three groups had a mini-silicone implant with a smooth surface inserted. In 2 experimental groups, hESC-EPC CM was administered into the subcutaneous pocket either 1 or 2 times. After 2 months, the capsules were harvested and analyzed by histologic examination.

RESULTS

There was a significant reduction in the thickness of the peri-implant capsules (P < 0.05) between the control and experimental groups. There is no tendency that hESC-EPC CM reduces inflammatory reaction in early postoperative periods. The experimental group showed increased angiogenesis compared to the control group (P < 0.05).

CONCLUSIONS

Tissue hypoxia around the implant may be another cause for the peri-implant capsule. A preventive or therapeutic strategy to decrease capsular contracture by relieving the ischemic condition around the implant can be investigated in the future.

In vivo effects of adipose-derived stem cells in inducing neuronal regeneration in Sprague-Dawley rats undergoing nerve defect bridged with polycaprolactone nanotubes

There have been many attempts for regeneration of peripheral nerve injury. In this study, we examined the in vivo effects of non-differentiated and neuronal differentiated adipose-derived stem cells (ADSCs) in inducing the neuronal regeneration in the Sprague-Dawley (SD) rats undergoing nerve defect bridged with the PCL nanotubes. Then, we performed immunohistochemical and histopathologic examinations, as well as the electromyography, in three groups: the control group (14 sciatic nerves transplanted with the PCL nanotube scaffold), the experimental group I (14 sciatic nerves with the non-differentiated ADSCs at a density of 7×10(5) cells/0.1 mL) and the experimental group II (14 sciatic nerves with the neuronal differentiated ADSCs at 7×10(5) cells/0.1 mL). Six weeks postoperatively, the degree of the neuronal induction and that of immunoreactivity to nestin, MAP-2 and GFAP was significantly higher in the experimental group I and II as compared with the control group. In addition, the nerve conduction velocity (NCV) was significantly higher in the experimental group I and II as compared with the control group (P=0.021 and P=0.020, respectively). On the other hand, there was no significant difference in the NCV between the two experimental groups (P>0.05). Thus, our results will contribute to treating patients with peripheral nerve defects using PCL nanotubes with ADSCs.

The effect of montelukast and antiadhesion barrier solution on the capsule formation after insertion of silicone implants in a white rat model

BACKGROUND AND PURPOSES

Capsular contracture is one of the most severe complications that can occur in breast surgery following silicone implant insertion. The purpose of this study was to investigate the effect of montelukast and antiadhesion barrier solution (AABS) on reducing capsular formation and their possible synergism.

MATERIALS AND METHODS

This study was approved by the Animal Ethics Committee (Reference No. KNU 2012-33) and was conducted in accordance with the Kyungpook National University - Institutional Animal Care and Use Committee, Animal Ethics Committee. The experiments in this study were conducted in vivo in 4 groups of 24 rats. Following silicone implant insertion, the pocket was injected with different agents. Group I (control group) was given normal saline injections into the pocket and fed with pure water. Group II was given injections of AABS and fed with pure water. Group III was given injections of normal saline and the medication montelukast during the experimental period. Group IV was given injections of AABS and montelukast as postoperative medication. Peri-implant capsules were excised after 8 weeks and were evaluated for transparency, inflammatory cell content, capsule thickness, collagen pattern and TGF-β expression.

RESULTS

The capsules in the experimental groups (i.e., groups II-IV) were significantly more transparent than those in group I (controls; p < 0.05, Student's t test). The mean capsule thickness of the experimental groups II (296 ± 14.76 μm), III (280 ± 14.77 μm) and IV (276 ± 39.28 μm) was smaller than that of the control group I (361 ± 35.43 μm). Compared to the control group, the histologic findings in the experimental groups suggested a decreased inflammatory response occurring in the peri-implant capsules as they exhibited minor vascularization and a reduced number of mast cells and macrophages. The collagen patterns in the experimental groups were of a lower density than in the control group with the former showing a loose, tidy collagen pattern. The amounts of TGF-β and collagen I were higher in the control group than in the experimental groups. Group IV (the synergic effect group) had a more pronounced effect on all the parameters examined than that in groups II and III with separate drug administration.

CONCLUSIONS

Montelukast and AABS reduced the thickness, the inflammatory cell infiltrate and the myofibroblast content of the peri-implant capsules around silicone implants in this white rat model. They lowered the expression of the fibrotic mediator, TGF-β, and inhibited the peri-implant capsular fibrosis. Therefore, montelukast and AABS are effective in the reduction of silicone-induced peri-implant capsular formation.

An innovative procedure for the treatment of primary and recurrent capsular contracture (CC) following breast augmentation

BACKGROUND

Capsular contracture (CC) is the most frequently reported complication following alloplastic breast augmentation. At present, none of the available preventive measures are effective, and various treatment modalities have been advocated. Reduction of the inflammatory process is critical for successful treatment. Late intracapsular glucocorticosteroid (GC) injections have been somewhat effective for the treatment, but the fine balance between the effectiveness of therapeutic GC dosages and their potential serious side effects is of utmost importance.

OBJECTIVES

The authors investigate whether instillation of a rapid-acting water-soluble GC in the implant pocket during the early proliferative phase of wound healing is more effective than delayed instillation during the remodeling phase.

METHODS

Between 2003 and 2009, 33 consecutive patients presenting with CC (Baker grades III and IV) were managed by capsulectomy with implant replacement and corticosteroid therapy immediately as well as 2 to 3 days later through an indwelling catheter left in place for that period. This delayed but early administration is a novel technique for GC injection.

RESULTS

Complete correction of the contracture with no recurrence was achieved in all patients with a follow-up range of 2 to 10 years.

CONCLUSIONS

This GC administration technique avoids the potential complications of long-term, slow corticosteroid release. It has a targeted anti-inflammatory effect, probably at a critical stage of the healing process, and could effectively prevent CC following alloplastic breast augmentation.