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Vinci V, Belgiovine C, Janszen G, Agnelli B, Pellegrino L, Calcaterra F, Cancellara A, Ciceri R, Benedetti A, Cardenas C, Colombo F, Supino D, Lozito A, Caimi E, Monari M, Klinger FM, Riccipetitoni G, Raffaele A, Comoli P, Allavena P, Mavilio D, Di Landro L, Klinger M, Rusconi R. Breast implant surface topography triggers a chronic-like inflammatory response. Life Sci Alliance 2024; 7:e202302132. [PMID: 38383454 PMCID: PMC10881835 DOI: 10.26508/lsa.202302132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 02/23/2024] Open
Abstract
Breast implants are extensively employed for both reconstructive and esthetic purposes. However, the safety of breast implants with textured surfaces has been questioned, owing to a potential correlation with anaplastic large-cell lymphoma and the recurrence of breast cancer. This study investigates the immune response elicited by different prosthetic surfaces, focusing on the comparison between macrotextured and microtextured breast implants. Through the analysis of intraoperatively harvested periprosthetic fluids and cell culture experiments on surface replicas, we demonstrate that macrotextured surfaces elicit a more pronounced chronic-like activation of leucocytes and an increased release of inflammatory cytokines, in contrast to microtextured surfaces. In addition, in vitro fluorescent imaging of leucocytes revealed an accumulation of lymphocytes within the cavities of the macrotextured surfaces, indicating that the physical entrapment of these cells may contribute to their activation. These findings suggest that the topography of implant surfaces plays a significant role in promoting a chronic-like inflammatory environment, which could be a contributing factor in the development of lymphomas associated with a wide range of implantable devices.
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Affiliation(s)
- Valeriano Vinci
- IRCCS Humanitas Research Hospital, Rozzano, Italy
- https://ror.org/020dggs04 Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Cristina Belgiovine
- IRCCS Humanitas Research Hospital, Rozzano, Italy
- https://ror.org/00s6t1f81 Department of Clinical, Surgical, Diagnostics and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Gerardus Janszen
- Department of Aerospace Science and Technology, Politecnico di Milano, Milan, Italy
| | - Benedetta Agnelli
- https://ror.org/020dggs04 Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Luca Pellegrino
- https://ror.org/020dggs04 Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Francesca Calcaterra
- IRCCS Humanitas Research Hospital, Rozzano, Italy
- https://ror.org/00wjc7c48 Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
| | - Assunta Cancellara
- IRCCS Humanitas Research Hospital, Rozzano, Italy
- https://ror.org/00wjc7c48 Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
| | - Roberta Ciceri
- IRCCS Humanitas Research Hospital, Rozzano, Italy
- https://ror.org/00wjc7c48 Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
| | - Alessandra Benedetti
- Department of Aerospace Science and Technology, Politecnico di Milano, Milan, Italy
| | | | | | | | - Alessia Lozito
- https://ror.org/020dggs04 Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Edoardo Caimi
- https://ror.org/020dggs04 Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Marta Monari
- IRCCS Humanitas Research Hospital, Rozzano, Italy
| | | | - Giovanna Riccipetitoni
- https://ror.org/00s6t1f81 Department of Clinical, Surgical, Diagnostics and Pediatric Sciences, University of Pavia, Pavia, Italy
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | | | - Paola Allavena
- IRCCS Humanitas Research Hospital, Rozzano, Italy
- https://ror.org/020dggs04 Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Domenico Mavilio
- IRCCS Humanitas Research Hospital, Rozzano, Italy
- https://ror.org/00wjc7c48 Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
| | - Luca Di Landro
- Department of Aerospace Science and Technology, Politecnico di Milano, Milan, Italy
| | - Marco Klinger
- IRCCS Humanitas Research Hospital, Rozzano, Italy
- https://ror.org/00wjc7c48 Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
| | - Roberto Rusconi
- IRCCS Humanitas Research Hospital, Rozzano, Italy
- https://ror.org/020dggs04 Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
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Su B, Chen L, Zhang B, Wang H, Zhou J, Du B. Major Clinical Adverse Events of Breast Implant in the Manufacturer and User Facility Device Experience Database. J Patient Saf 2024:01209203-990000000-00216. [PMID: 38635526 DOI: 10.1097/pts.0000000000001219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
OBJECTIVE Search the Manufacturer and User Facility Device Experience database to collect information on adverse events of breast implant. We analyzed the local complications and the breast implant illness (BII) of silicone breast implants, as well as saline breast implants separately, aim to provide a reference for women who want to breast augmentation. MATERIALS AND METHODS The Manufacturer and User Facility Device Experience database was queried for events reports related to the breast implant between July 1, 2012, and June 30, 2022. Event year and reporting year were summarized. Patient problem was collected and analyzed to distinguish between local complications and BII. RESULTS A total of 108,728 adverse events in the past 3 years were analyzed, silicone breast implants accounted for 62.1% and saline breast implants accounted for 37.9%. The most common local complication of women receiving silicone breast implants was "Capsular Contracture," accounting for 48.73%. However, the incidence of "capsular contracture" in women who received saline breast implants was only 17.49%. The most common BII was "fatigue/weakness" in both women receiving 2 different breast implants, 17.20% in women receiving silicone breast implants and 24.71% in women receiving saline breast implants. Of note, in all the reports, there was a wide variation in the timing of reporting as compared with the timing of the adverse event. CONCLUSIONS Although the adverse events of breast implant cannot completely be determined from this study, we provide a reference for women who want to get breast implants, so that they can choose breast implants more carefully. In addition, a better understanding of BII may allow them to think further about whether the benefits of breast implants outweigh the risks.
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Affiliation(s)
- Bing Su
- From the Nanfang Hospital, Southern Medical University, Guangzhou
| | - Lichuan Chen
- Pufeisheng Pharmaceutical Technology Co, Ltd, Nanjing
| | - Bohan Zhang
- Center for ADR Monitoring of Guangdong, Guangzhou, China
| | - Hong Wang
- Center for ADR Monitoring of Guangdong, Guangzhou, China
| | - Jie Zhou
- Pufeisheng Pharmaceutical Technology Co, Ltd, Nanjing
| | - Benjun Du
- From the Nanfang Hospital, Southern Medical University, Guangzhou
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Yang XJ, Wang WH, Zou JY, Wang J, Yang ZQ. Triplane technique for breast reconstruction after breast cancer surgery: A case series report. Medicine (Baltimore) 2024; 103:e37559. [PMID: 38552090 PMCID: PMC10977549 DOI: 10.1097/md.0000000000037559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/20/2024] [Indexed: 04/02/2024] Open
Abstract
RATIONALE Implant-based breast reconstruction is an important method for post-mastectomy breast reconstruction. Currently, the most commonly used technique is the biplane technique. However, the high rate of postoperative complications, the inability of pockets to accommodate larger implants, and the expensive costs of biological mesh make the development of new surgical methods urgent. The triplane technique for breast reconstruction is an ideal candidate method. PATIENT CONCERNS The main local symptoms were breast lump, abnormal breast skin, nipple discharge, and abnormal nipple or areola in 24 patients. DIAGNOSES The study included 24 female patients who underwent breast reconstruction using the triplane technique after radical breast cancer surgery. INTERVENTIONS The surgical procedure involved measuring the dimensions of the breast, designing the incision, and creating a pocket for the implant using the triplane technique, which includes the pectoralis major muscle, the pectoralis major fascia continuing to the rectus abdominis fascia, and the latissimus dorsa muscle fascia continuing to the rectus abdominis fascia. Postoperative follow-up included regular assessments of pain and evaluation of breast appearance. OUTCOMES No cases of postoperative infection were observed in all patients. During the 1-year follow-up period after surgery, 5 patients (20.8%) who needed radiotherapy after mastectomy for cancer showed slight darkening of skin flap pigment after using the triplane technique implant. No cases of exposure or infection of the expanders were reported, and 1 patient underwent expander replacement with a permanent prosthesis. All patients expressed satisfaction with the reconstructed breast shape. The 10 patients (41.7%) experiencing postoperative swelling and pain. However, the pain gradually subsided during the postoperative recovery period. No cases of local recurrence or distant metastasis of breast cancer were observed during the 1-year-follow-up period. LESSONS The triplane technique for breast reconstruction after breast cancer surgery provides good implant coverage, reduces the risk of complications, and is cost-effective.
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Affiliation(s)
- Xiao-Juan Yang
- The Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Provincial Cancer Hospital, Kunming, Yunnan, P.R. China
| | - Wen-Huan Wang
- The Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Provincial Cancer Hospital, Kunming, Yunnan, P.R. China
| | - Jie-Ya Zou
- The Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Provincial Cancer Hospital, Kunming, Yunnan, P.R. China
| | - Ji Wang
- The Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Provincial Cancer Hospital, Kunming, Yunnan, P.R. China
| | - Zhuang-Qing Yang
- The Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Provincial Cancer Hospital, Kunming, Yunnan, P.R. China
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Tanzella U, Ueberreiter K, Krapohl LF, Bell A, Krapohl BD. Results of a patient survey using an online questionnaire after implant removal for breast implant illness. GMS Interdiscip Plast Reconstr Surg DGPW 2024; 13:Doc04. [PMID: 38654894 PMCID: PMC11036085 DOI: 10.3205/iprs000186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
The use of silicone breast implants has a history of over 60 years. In recent years, specific health issues among implant wearers have repeatedly come into focus. The term "breast implant illness" has been circulating in scientific literature and on social media for several years. It describes a cluster of up to 60 different symptoms. The present results of an online survey conducted within a clinic's patient population of the last 8 years show, among other things, the evolution of 8 reported symptoms before and after breast implant removal. In the comparison before and after, there is a significant reduction in the intensity of symptoms after implant removal. A causal relationship with the removal of the implants is to be presumed.
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Affiliation(s)
| | | | | | - Armin Bell
- Park-Klinik Birkenwerder, Birkenwerder, Germany
| | - Björn Dirk Krapohl
- Department of Dento-maxillofacial, Reconstructive, and Plastic Surgery, Carl-Thiem Klinikum, Cottbus, Germany
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Liu HY, Alessandri Bonetti M, De Lorenzi F, Gimbel ML, Nguyen VT, Egro FM. Consulting the Digital Doctor: Google Versus ChatGPT as Sources of Information on Breast Implant-Associated Anaplastic Large Cell Lymphoma and Breast Implant Illness. Aesthetic Plast Surg 2024; 48:590-607. [PMID: 37903939 DOI: 10.1007/s00266-023-03713-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 10/10/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare complication associated with the use of breast implants. Breast implant illness (BII) is another potentially concerning issue related to breast implants. This study aims to assess the quality of ChatGPT as a potential source of patient education by comparing the answers to frequently asked questions on BIA-ALCL and BII provided by ChatGPT and Google. METHODS The Google and ChatGPT answers to the 10 most frequently asked questions on the search terms "breast implant associated anaplastic large cell lymphoma" and "breast implant illness" were recorded. Five blinded breast plastic surgeons were then asked to grade the quality of the answers according to the Global Quality Score (GQS). A Wilcoxon paired t-test was performed to evaluate the difference in GQS ratings for Google and ChatGPT answers. The sources provided by Google and ChatGPT were also categorized and assessed. RESULTS In a comparison of answers provided by Google and ChatGPT on BIA-ALCL and BII, ChatGPT significantly outperformed Google. For BIA-ALCL, Google's average score was 2.72 ± 1.44, whereas ChatGPT scored an average of 4.18 ± 1.04 (p < 0.01). For BII, Google's average score was 2.66 ± 1.24, while ChatGPT scored an average of 4.28 ± 0.97 (p < 0.01). The superiority of ChatGPT's responses was attributed to their comprehensive nature and recognition of existing knowledge gaps. However, some of ChatGPT's answers had inaccessible sources. CONCLUSION ChatGPT outperforms Google in providing high-quality answers to commonly asked questions on BIA-ALCL and BII, highlighting the potential of AI technologies in patient education. LEVEL OF EVIDENCE Level III, comparative study 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)
- Hilary Y Liu
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, G103, Pittsburgh, PA, 15219, USA
| | - Mario Alessandri Bonetti
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, G103, Pittsburgh, PA, 15219, USA
| | - Francesca De Lorenzi
- Department of Plastic Surgery, IRCCS European Institute of Oncology, Via Giuseppe Ripamonti 345, 20122, Milan, Italy
| | - Michael L Gimbel
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, G103, Pittsburgh, PA, 15219, USA
| | - Vu T Nguyen
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, G103, Pittsburgh, PA, 15219, USA
| | - Francesco M Egro
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, G103, Pittsburgh, PA, 15219, USA.
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Azahaf S, Spit KA, de Blok CJ, Bult P, Nanayakkara PW. Silicone Migration from Intact Saline Breast Implants. Plast Reconstr Surg Glob Open 2024; 12:e5608. [PMID: 38333026 PMCID: PMC10852369 DOI: 10.1097/gox.0000000000005608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/28/2023] [Indexed: 02/10/2024]
Abstract
Breast augmentation is a widely performed surgical procedure worldwide, predominantly using silicone gel-filled implants. Concerns have primarily revolved around ruptures and the potential health risks associated with leaked silicone from silicone gel-filled implants. Cases of silicone migration from the shell of saline breast implants remain scarce. This case report introduces a unique case of a 66-year-old patient with silicone migration from intact saline breast implants. The patient presented with a range of symptoms consistent with breast implant illness. Radiological findings suggested the presence of silicone in the axillary lymph nodes, despite the integrity of the implants, thereby confirming silicone migration. Histopathological evaluation revealed a foreign body reaction and the presence of silicone in the axillary lymph nodes. Given the saline filling, the source is likely the polydimethylsiloxane shell. The rarity of documented silicone migration from intact saline breast implants, especially in patients with breast implant illness, underscores the need for more research into the health implications of leaked silicone particles from breast implants.
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Affiliation(s)
- Siham Azahaf
- From Section General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, the Netherlands
| | - Karlinde A. Spit
- From Section General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, the Netherlands
| | - Christel J.M. de Blok
- From Section General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, the Netherlands
| | - Peter Bult
- Department of Pathology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Prabath W.B. Nanayakkara
- From Section General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, the Netherlands
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Nugent N. Breast implant illness: we must counter misinformation around this mysterious condition. BMJ 2024; 384:q265. [PMID: 38302143 DOI: 10.1136/bmj.q265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
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Kasielska-Trojan A, Antoszewski B, Zadrożny M, Pluta P. The Problem of Diagnostic Criteria of Breast Implant Illness in Women After Breast Reconstruction: Review and Discussion of a Case. Aesthetic Plast Surg 2024:10.1007/s00266-023-03832-y. [PMID: 38253885 DOI: 10.1007/s00266-023-03832-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024]
Abstract
INTRODUCTION There has been a rising trend in the use of silicone breast implants for breast reconstructions after breast cancer treatment, as well as in the aesthetic breast procedures. A cluster of non-specific symptoms related to the presence of silicone implant has been called breast implant illness (BII). However, there are no strict criteria of BII which would specifically define this term. The increasing interest in BII among patients and physicians urges verifying own cases of "on-demand" explantations. MATERIAL AND METHODS In this paper, we discussed a case of a patient with initial BII diagnosis, after breast reconstruction, and reviewed the literature on the BII symptoms and aetiology. A decision for aesthetic revision, not explantation, was made as the diagnosis of BII was questioned, and somatisation due to dissatisfaction with the aesthetic result of breast reconstruction was diagnosed. RESULTS Improving aesthetics by implant exchange and contralateral mastopexy caused a full recovery from patient's symptoms. CONCLUSION Based on our case, we point on the fact that BII diagnosis in patients after breast reconstruction is challenging. We suggest that while considering such a diagnosis and further proceedings, e.g. explantation, especially in patients after breast reconstruction, some exclusion criteria should be considered. Dissatisfaction with the result of the surgery can also lead to somatisation and the presence of real clinical symptoms, which should not be confused with the possible autoimmune reaction to silicone particles. 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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Affiliation(s)
- Anna Kasielska-Trojan
- Plastic, Reconstructive and Aesthetic Surgery Clinic, Institute of Surgery, Medical University of Lodz, Kopcinskiego 22, 90-153, Lodz, Poland.
| | - Bogusław Antoszewski
- Plastic, Reconstructive and Aesthetic Surgery Clinic, Institute of Surgery, Medical University of Lodz, Kopcinskiego 22, 90-153, Lodz, Poland
| | - Marek Zadrożny
- Department of Surgical Oncology and Breast Diseases, Polish Mother's Memorial Hospital - Research Institute in Lodz, Lodz, Poland
| | - Piotr Pluta
- Department of Surgical Oncology and Breast Diseases, Polish Mother's Memorial Hospital - Research Institute in Lodz, Lodz, Poland
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Tervaert JWC, Shoenfeld Y, Cruciani C, Scarpa C, Bassetto F. Breast implant illness: Is it causally related to breast implants? Autoimmun Rev 2024; 23:103448. [PMID: 37714420 DOI: 10.1016/j.autrev.2023.103448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/12/2023] [Indexed: 09/17/2023]
Abstract
Once believed to be completely inert implants, Silicon Breast Implants (SBIs) have been shown to be able to induce a chronic inflammatory response in the body which can lead to a variety of possible manifestations ranging from the most common capsular contraction to rarer conditions such as malignancies and autoimmune diseases. Among the latter, new syndromes have been consistently recognized: Breast Implant Illness (BII) and autoimmunity/autoinflammatory syndrome induced by adjuvants (ASIA syndrome/Shoenfeld's Syndrome). The pathophysiological mechanisms underlying such syndromes are not yet clear and the overlap they show with other common conditions have sparked an important debate in the scientific community regarding their existence and their cause-effect relationship with SBIs. In this article Professor Cohen Tervaert and Professor Bassetto, leading experts in the field, are going to present arguments in favor and against such causal relationship according to the latest scientific evidence. Professor Cohen Tervaert is going to demonstrate how the evidence available is enough to prove a causal relationship as defined by the Bradford Hill's criteria. Professor Bassetto is going to highlight how the many biases that afflict the available evidence prevent us from drawing such conclusions. Professor Shoenfeld is going to moderate the discussion with its insightful conclusions.
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Affiliation(s)
- Jan Willem Cohen Tervaert
- Division of Rheumatology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; School for Mental Health and Neurosciences (MHeNs), Maastricht University, Maastricht, the Netherlands
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Reichman University, Herzliya, Israel..
| | - Claudio Cruciani
- Division of Rheumatology, Department of Internal Medicine, Azienda Ospedaliera di Padova, University of Padova, Padova, Veneto, Italy
| | - Carlotta Scarpa
- Unit of Plastic and Reconstruction Surgery, Azienda Ospedaliera di Padova, University of Padova, Padova, Veneto, Italy
| | - Franco Bassetto
- Unit of Plastic and Reconstruction Surgery, Azienda Ospedaliera di Padova, University of Padova, Padova, Veneto, Italy
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Mamsen FPW, Fischer-Nielsen A, Svalgaard JD, Jensen JD, Jønsson B, Duscher D, Christensen J, Van Leeuwen M, Kiilerich CH, Roider L, Sterodimas A, Munthe-Fog L, Kølle SFT. Cosmetic Breast Augmentation with Autologous Ex Vivo-Expanded Adipose-Derived Mesenchymal Stem/Stromal Cell (Stemform®)-Enriched Fat Grafts: A Study of the First Twenty-Two Real-World Patients. Aesthetic Plast Surg 2024; 48:98-115. [PMID: 38049686 PMCID: PMC10912442 DOI: 10.1007/s00266-023-03711-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/10/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Fat grafting is commonly utilized in breast surgery, and since it was first described, clinicians and researchers have stridden towards improvement of graft retention. Current advancements include adding adipose-derived mesenchymal stem/stromal cells (MSC(AT)s), which have demonstrated promise for improved graft retention. OBJECTIVES This study reports outcomes for the first twenty-two patients undergoing breast augmentation (Stemform BA) or artificial implant replacement (Stemform AIR) with MSC(AT)-enriched fat in a real-world setting. METHODS Autologous MSC(AT)s were isolated and expanded ex vivo, then mixed with lipoaspirate and injected as enriched fat for Stemform BA and AIR. The breast volume was measured preoperatively and at 3 and 12 months postoperative using a 3D Infinity Dual-Lens Camera and LifeVizApp software. Additionally, independent plastic surgeons evaluated clinical images, and patient satisfaction was obtained at equal time points. RESULTS Twenty-two patients were included. All completed 3 and 12 months clinical follow-up and 3 months volume measurements. Nineteen patients completed 12 months volume measurements. The median fat graft retention at 12 months was 95.7% (IQR = 82.44-103.12%) for Stemform BA patients and 113.0% (IQR = 94.8-131.2%) for Stemform AIR patients. The Stemform BA patients had a median breast enlargement of 172.0% (IQR = 156.7-241.0%). The implant replacement volume of Stemform AIR patients was 102% (IQR = 85.1-130.3%). The patient reported 92.8% and 100% would elect to repeat treatment if they had the opportunity for Stemform BA and Stemform AIR, respectively. CONCLUSION Breast augmentation and breast implant replacement patients receiving ex vivo-expanded MSC(AT)-enriched fat grafts had high graft retention and patient satisfaction scores. The paper confirms the clinical efficacy of using ex vivo-expanded MSC(AT)s. 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)
- Frederik Penzien Wainer Mamsen
- StemMedical A/S, Gyngemose Parkvej 50, 2860, Copenhagen, Denmark.
- Department of Plastic Surgery, Aleris Hospitals, Gyngemose Parkvej 66, 2860, Copenhagen, Denmark.
| | | | | | | | - Bo Jønsson
- Department of Plastic Surgery, Aleris Hospitals, Gyngemose Parkvej 66, 2860, Copenhagen, Denmark
| | - Dominik Duscher
- Eberhard Karls University Tübingen, 72076, Tübingen, Germany
- Academic Stem Cell Center Vienna, Liechtensteinstrasse 96, 1090, Vienna, Austria
| | | | | | - Claes Hannibal Kiilerich
- Department of Plastic Surgery, Aleris Hospitals, Gyngemose Parkvej 66, 2860, Copenhagen, Denmark
| | - Laura Roider
- Saint Louis University School of Medicine, 1008 S Spring Ave Suite 1500, St. Louis, MO, 63110, USA
| | | | - Lea Munthe-Fog
- StemMedical A/S, Gyngemose Parkvej 50, 2860, Copenhagen, Denmark
| | - Stig-Frederik Trojahn Kølle
- StemMedical A/S, Gyngemose Parkvej 50, 2860, Copenhagen, Denmark
- CeriX Hospital, Strandvejen 191, 2900, Copenhagen, Denmark
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11
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Herrero-Ruiz SP, Garrido-Ríos AA, Fernández de la Fuente L, Baeza-Hernández G, Echeverría-García B, Borbujo J. A case of systemic lupus erythematosus in the context of ASIA syndrome because of silicone breast implants. Int J Dermatol 2023; 62:1549-1550. [PMID: 37767717 DOI: 10.1111/ijd.16866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/29/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023]
Affiliation(s)
- Sara P Herrero-Ruiz
- Department of Dermatology, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | | | | | | | | | - Jesus Borbujo
- Department of Dermatology, Hospital Universitario de Fuenlabrada, Madrid, Spain
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Virzì D, Caruso F, Castiglione G, Marino M, Latino M, Cunsolo G, Cinquerrui A, Gioco R, Balafa K, Rapisarda M, Rocco N, Catanuto G. Thoraco-dorsal artery perforator flap for totally autologous primary breast reconstruction. Assessment of feasibility with standard reporting scales. Eur J Surg Oncol 2023; 49:106988. [PMID: 37500311 DOI: 10.1016/j.ejso.2023.106988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/10/2023] [Accepted: 07/16/2023] [Indexed: 07/29/2023]
Abstract
This study reports on feasibility and applicability of totally autologous primary breast reconstructions based on TDAP flaps using a standard set of internationally approved reporting scales. We reviewed 15 cases in patients with a good donor area in the back not suitable for implant or free flaps reconstructions. Complications according to Clavien Dindo were: 1 Grade 1 (seroma in the back). The ABS-BAPRAS quality assurance indicators 10, 11, and 12 were entirely fulfilled. No pedicled flap loss occurred; no unplanned return to theatre and no unplanned readmission within 3 months. Breast-related quality of life values are reported at 3 months and one year in four domains of the BREAST Q v. 2.0 (breast reconstruction post-op questionnaire). At 1 year the mean Q-score for satisfaction with breast was 70.5, for psychosocial well-being was 72.3; for sexual well-being was 58.8; for physical well-being (chest wall) was 70.60. The TDAP based totally autologous breast reconstruction reported to be a feasible and safe alternative to implant based or free flaps reconstructions according to consolidate international outcome reporting measures.
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Affiliation(s)
- Dario Virzì
- Humanitas Istituto Clinico Catanese Contrada Cubba Marletta 2, Misterbianco, CT, Italy
| | - Francesco Caruso
- Humanitas Istituto Clinico Catanese Contrada Cubba Marletta 2, Misterbianco, CT, Italy
| | - Gaetano Castiglione
- Humanitas Istituto Clinico Catanese Contrada Cubba Marletta 2, Misterbianco, CT, Italy
| | - Mariagloria Marino
- Humanitas Istituto Clinico Catanese Contrada Cubba Marletta 2, Misterbianco, CT, Italy
| | - Marco Latino
- Humanitas Istituto Clinico Catanese Contrada Cubba Marletta 2, Misterbianco, CT, Italy
| | - Gaetano Cunsolo
- Humanitas Istituto Clinico Catanese Contrada Cubba Marletta 2, Misterbianco, CT, Italy
| | - Ada Cinquerrui
- Humanitas Istituto Clinico Catanese Contrada Cubba Marletta 2, Misterbianco, CT, Italy
| | - Rossella Gioco
- Humanitas Istituto Clinico Catanese Contrada Cubba Marletta 2, Misterbianco, CT, Italy
| | - Konstantina Balafa
- Humanitas Istituto Clinico Catanese Contrada Cubba Marletta 2, Misterbianco, CT, Italy
| | - Martina Rapisarda
- Humanitas Istituto Clinico Catanese Contrada Cubba Marletta 2, Misterbianco, CT, Italy
| | - Nicola Rocco
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy; Fondazione G.Re.T.A. (Group for Reconstructive and Therapeutic Advancements) ETS, Italy.
| | - Giuseppe Catanuto
- Humanitas Istituto Clinico Catanese Contrada Cubba Marletta 2, Misterbianco, CT, Italy; Fondazione G.Re.T.A. (Group for Reconstructive and Therapeutic Advancements) ETS, Italy
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13
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Zhang Z, Qi J, Zhang X, Wang J, Li Z, Xin M. What Can We Learn from Breast Implant Explantation: a 28-Year, Multicenter Retrospective Study of 1004 Explantation Cases. Aesthetic Plast Surg 2023; 47:1743-1750. [PMID: 37204467 PMCID: PMC10196311 DOI: 10.1007/s00266-023-03365-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 04/08/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Implant-based breast augmentation remains popular, but the controversy over the safety and longevity of implants has continued. An event-based analysis of reasons for implant explantation may provide us with some insight into the controversy. METHODS Data from May 1994 to October 2022 of explantation cases from aesthetic breast augmentation in three medical centers were retrospectively reviewed. Patient characteristics, time to explantation, reasons for visit, the major reason for explantation and intraoperative findings were analyzed. RESULTS A total of 522 patients with 1004 breasts were included in our study. Objective explantation reasons accounted for 34.0% in primary augmentation breasts and 47.6% in revision augmentation breasts, which were significantly different (p = 0.006). The most common complaint was dissatisfaction with breast appearance, followed by concerns about implant safety, poor hand feeling and pain. 43.5% of the implants worn for more than 10 years were removed for objective reasons, which was found significantly different with the proportion of objective reasons in implants removed within 1 year and 1-5 years postoperatively (p < 0.008). CONCLUSION The proportion of different reasons for implant explantation varies across the times of surgeries and the years that the implant had been worn. As the years of implant wearing increase, the proportion of subjective reasons decreases in implant removal cases and objective reasons increase among them. 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)
- Ziying Zhang
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, China
| | - Jun Qi
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, China
| | - Xuefeng Zhang
- Department of Aesthetic Surgery, Bravou Plastic Surgery Hospital, No.21, Section 4, Renmin South Road, Wuhou District, Chengdu, 610000, China
| | - Jian Wang
- Department of Cosmetic Surgery, Dalian Metime Medical Cosmetic Hospital, No 427 Zhongshan Road, Shahekou District, Dalian, 116021, China
| | - Zhengyao Li
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, China
| | - Minqiang Xin
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, China.
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14
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Asiedu A, Johnson QQ, Shah S, Osafo AS, Kumi-Woode N. A Case Report on Breast Implant Illness. Cureus 2023; 15:e45601. [PMID: 37868430 PMCID: PMC10588524 DOI: 10.7759/cureus.45601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 10/24/2023] Open
Abstract
In this case report, we discuss the case of a 64-year-old woman who presented with an unusual complaint of a chronic cough associated with pleuritic chest pain of 15 years following a saline-filled breast implant surgery. Initially, these were minimally abated by acid reflux medications. However, her cough worsened despite other interventions. In the work-up to determine the etiology of her complaints, the most common causes of a chronic cough were considered. The history ruled out post-nasal drip, and pulmonary function tests excluded asthma and chronic obstructive pulmonary disease (COPD), although she had a family history. An IgE allergy panel and an Aspergillus antibody test were also normal. However, an esophagram revealed a significant finding of mild to moderate Gastroesophageal reflux disease (GERD). Ultimately, the subsequent removal of the implants led to a dramatic resolution of her symptoms. It is worth noting that breast implants, like any other medical device, carry certain risks. Complications such as infections, implant rupture, capsular contracture, and changes in breast sensations are known risks associated with breast augmentation surgery.
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Affiliation(s)
- Andrea Asiedu
- Primary Care, Premier Medical Associates, The Villages, USA
| | | | - Sundeep Shah
- Internal Medicine, Premier Medical Associates, The Villages, USA
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15
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Ioppolo L, Amenta A, Alessandri-Bonetti M, Borelli F, Calapai M, Veronesi P, De Lorenzi F. One-step Glandular Reconstruction after Breast Implant Removal: Technical Refinements and Grafting of the Inferior Dermoglandular Flap. Plast Reconstr Surg Glob Open 2023; 11:e5247. [PMID: 37691704 PMCID: PMC10489352 DOI: 10.1097/gox.0000000000005247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 07/18/2023] [Indexed: 09/12/2023]
Abstract
The number of breast implant removal procedures are rising. Among the reasons why patients seek breast implant removal, the autoimmune/inflammatory syndrome induced by adjuvants (ASIA), also named breast implant illness, is increasingly common. ASIA is an entity that incorporates diverse autoimmune conditions induced by the exposure to various adjuvants, including silicone, and it is characterized by systemic symptoms reminiscent of autoimmune disorders. Implant removal has the most effective treatment for ASIA. We describe a technique for glandular cone reconstruction after complete capsulectomy and implant removal. It combines an inverted-T superomedial pedicled mastopexy with fat grafting of the breast quadrants and of the inferior dermoglandular flap in two patients affected by ASIA. Implant removal allowed symptom resolution in both patients at 10 and 12 months follow-up. Both patients were satisfied with the aesthetic outcome after implant removal in terms of breast softness, projection, and volume. Our technique is easy, reproducible, and allowed for restoration of breast contour, volume, and shape after implant removal. Although initially conceived in patients with ASIA, this technique can be used for patients seeking implant removal for any indication.
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Affiliation(s)
- Leonardo Ioppolo
- From the Department of Plastic Surgery, Marrelli Hospital, Crotone, Italy
| | - Antonio Amenta
- From the Department of Plastic Surgery, Marrelli Hospital, Crotone, Italy
| | - Mario Alessandri-Bonetti
- Department of Plastic Surgery, University of Milan, Milan, Italy
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Francesco Borelli
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, Milan, Italy
| | - Marco Calapai
- Department of Breast Surgery, Ospedale San Vincenzo, Taormina, Italy
| | - Paolo Veronesi
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
- Department of Breast Surgery, European Institute of Oncology, IRCCS, Milan, Italy
| | - Francesca De Lorenzi
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, Milan, Italy
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16
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Debuc B, Gendron N, Cras A, Rancic J, Philippe A, Cetrulo CL, Lellouch AG, Smadja DM. Improving Autologous Fat Grafting in Regenerative Surgery through Stem Cell-Assisted Lipotransfer. Stem Cell Rev Rep 2023; 19:1726-1754. [PMID: 37261667 DOI: 10.1007/s12015-023-10568-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 06/02/2023]
Abstract
Autologous fat transplantation -i.e., lipofilling- has become a promising and popular technique in aesthetic and reconstructive surgery with several application such as breast reconstruction, facial and hand rejuvenation. However, the use of this technology is still limited due to an unpredictable and low graft survival rate (which ranges from 25%-80%). A systematic literature review was performed by thoroughly searching 12 terms using the PubMed database. The objective of this study is to present the current evidence for the efficacy of adjuvant regenerative strategies and cellular factors, which have been tested to improve fat graft retention. We present the main results (fat retention rate, histological analysis for pre-clinical studies and satisfaction/ complication for clinical studies) obtained from the studies of the three main fat grafting enrichment techniques: platelet-rich plasma (PRP), the stromal vascular fraction (SVF) and adipose-derived stem cells (ADSCs) and discuss the promising role of recent angiogenic cell enrichment that could induce early vascularization of fat graft. All in all, adding stem or progenitor cells to autologous fat transplantation might become a new concept in lipofilling. New preclinical models should be used to find mechanisms able to increase fat retention, assure safety and transfer these technologies to a good manufacturing practice (GMP) compliant facility, to manufacture an advanced therapy medicinal product (ATMP).
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Affiliation(s)
- Benjamin Debuc
- Department of Plastic Surgery, European Georges Pompidou Hospital, AP-HP, Paris, France
- Innovative Therapies in Haemostasis, INSERM UMR-S 1140, University of Paris, F-75006, Paris, France
| | - Nicolas Gendron
- Innovative Therapies in Haemostasis, INSERM UMR-S 1140, University of Paris, F-75006, Paris, France
- Department of Hematology, European Georges Pompidou Hospital, AP-HP, 20 Rue Leblanc, F-75015, Paris, France
| | - Audrey Cras
- Innovative Therapies in Haemostasis, INSERM UMR-S 1140, University of Paris, F-75006, Paris, France
- Department of Cell Therapy, Saint Louis Hospital, AP-HP, F-75010, Paris, France
| | - Jeanne Rancic
- Innovative Therapies in Haemostasis, INSERM UMR-S 1140, University of Paris, F-75006, Paris, France
| | - Aurélien Philippe
- Innovative Therapies in Haemostasis, INSERM UMR-S 1140, University of Paris, F-75006, Paris, France
- Department of Hematology, European Georges Pompidou Hospital, AP-HP, 20 Rue Leblanc, F-75015, Paris, France
| | - Curtis L Cetrulo
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Shriners Hospitals for Children-Boston, Boston, MA, USA
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Alexandre G Lellouch
- Innovative Therapies in Haemostasis, INSERM UMR-S 1140, University of Paris, F-75006, Paris, France
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Shriners Hospitals for Children-Boston, Boston, MA, USA
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - David M Smadja
- Innovative Therapies in Haemostasis, INSERM UMR-S 1140, University of Paris, F-75006, Paris, France.
- Department of Hematology, European Georges Pompidou Hospital, AP-HP, 20 Rue Leblanc, F-75015, Paris, France.
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17
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Brennan C, Moorhouse A, Vermeland R, Kneeshaw P. Anaplastic large cell lymphoma in people with breast implants. BMJ 2023; 382:e073834. [PMID: 37433618 DOI: 10.1136/bmj-2022-073834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
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18
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Abstract
Over the past several decades, mRNA vaccines have evolved from a theoretical concept to a clinical reality. These vaccines offer several advantages over traditional vaccine techniques, including their high potency, rapid development, low-cost manufacturing, and safe administration. However, until recently, concerns over the instability and inefficient distribution of mRNA in vivo have limited their utility. Fortunately, recent technological advancements have mostly resolved these concerns, resulting in the development of numerous mRNA vaccination platforms for infectious diseases and various types of cancer. These platforms have shown promising outcomes in both animal models and humans. This study highlights the potential of mRNA vaccines as a promising alternative approach to conventional vaccine techniques and cancer treatment. This review article aims to provide a thorough and detailed examination of mRNA vaccines, including their mechanisms of action and potential applications in cancer immunotherapy. Additionally, the article will analyze the current state of mRNA vaccine technology and highlight future directions for the development and implementation of this promising vaccine platform as a mainstream therapeutic option. The review will also discuss potential challenges and limitations of mRNA vaccines, such as their stability and in vivo distribution, and suggest ways to overcome these issues. By providing a comprehensive overview and critical analysis of mRNA vaccines, this review aims to contribute to the advancement of this innovative approach to cancer treatment.
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Affiliation(s)
- Mohammad Chehelgerdi
- Novin Genome (NG) Lab, Research and Development Center for Biotechnology, Shahrekord, Iran.
- Young Researchers and Elite Club, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran.
| | - Matin Chehelgerdi
- Novin Genome (NG) Lab, Research and Development Center for Biotechnology, Shahrekord, Iran
- Young Researchers and Elite Club, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran
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19
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Pompei B, Grufman V, Zoccali G, Farhadi J. Breast implant reverse surgery: A step-by-step approach. J Plast Reconstr Aesthet Surg 2023; 82:200-208. [PMID: 37186975 DOI: 10.1016/j.bjps.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 03/31/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023]
Abstract
The popularity of breast augmentation has seen a decrease in number in the recent years. Simultaneously, the request for breast implant removal has increased impressively. A total of 77 women undergoing breast implant removal with no exchange were divided into four groups depending on the type of "reverse surgery" following the explantation: simple implant removal, implant removal with lipofilling, implant removal with mastopexy, and implant removal with mastopexy and lipofilling. Following this, an algorithm was created to standardize the ideal "reverse" surgery. After surgery, all the patients were followed for at least 6 months to understand their level of satisfaction regarding the outcome of the surgery. The majority of patients were highly satisfied after explantation. Implant-related issues were found to be the main cause for explantation surgery. Capsulectomy was performed in the minority of cases, as the capsule was found to be an ideal layer for fat grafting. Grouping the patients into 4 categories allowed us to investigate a pattern behind the decision to undergo a certain type of secondary procedure and to create an algorithm with general rules that can be used as a guide for surgeons. The increased demand for this type of surgery underlines a new interesting trend in plastic surgery that, together with Breast Implant-Associated Anaplastic Large Cell Lymphoma advent, will probably have implications on the communication between surgeons and patients and most likely on the choice of choosing different ways of breast volume augmentation.
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Affiliation(s)
- Barbara Pompei
- Department of Plastic and Reconstructive Surgery, Ente Ospedaliero Cantonale, Lugano, Switzerland.
| | | | - Giovanni Zoccali
- Department of Plastic and Reconstructive Surgery-IRCCS, National Cancer Institute "Regina Elena", Italy
| | - Jian Farhadi
- Plastic Surgery Group, Zurich, Switzerland; University of Basel, Basel, Switzerland
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20
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Chen H, Chen Y, Liu X, Cai M. Multiple uptake of 99mTc-MDP in chest due to breast implant rupture in a patient with lung adenocarcinoma. Clin Case Rep 2023; 11:e7578. [PMID: 37323269 PMCID: PMC10268217 DOI: 10.1002/ccr3.7578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 05/20/2023] [Accepted: 06/02/2023] [Indexed: 06/17/2023] Open
Abstract
A 57-year-old woman was diagnosed as lung adenocarcinoma. 99mTc-MDP bone scan showed multiple radioactivity concentrated lesions on bilateral chest wall, which were confirmed as calcification foci after breast implant rupture by SPECT/CT. SPECT/CT could be used for differential diagnosis of breast implant rupture and malignant lesions.
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Affiliation(s)
- Haibin Chen
- Department of SurgeryShanxi Provincial Hospital of Integrated Traditional Chinese and Western MedicineTaiyuanChina
| | - Yao Chen
- Department of Medical ImagingShanxi Medical UniversityTaiyuanChina
| | - Xiaoji Liu
- Department of Forensic MedicineShanxi Medical UniversityTaiyuanChina
| | - Min Cai
- Department of Nuclear MedicineShanxi Provincial People's Hospital & Fifth Hospital of Shanxi Medical UniversityTaiyuanChina
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21
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Plavsic A, Arandjelovic S, Dimitrijevic M, Kusic N, Tomic Spiric V, Popovic B, Jovicic Z, Peric Popadic A, Miskovic R. Autoimmune/inflammatory syndrome induced by adjuvants in a woman with Hashimoto thyroiditis and familial autoimmunity-a case report and literature review. Front Immunol 2023; 14:1139603. [PMID: 37287963 PMCID: PMC10242122 DOI: 10.3389/fimmu.2023.1139603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/09/2023] [Indexed: 06/09/2023] Open
Abstract
Introduction Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) consists of a wide spectrum of symptoms and immunological features that are believed to develop in predisposed individuals after exposure to an adjuvant, including a silicone breast implant (SBI). Different autoimmune diseases (AIDs) have been associated with ASIA, but ASIA development after SBI in women with Hashimoto thyroiditis (HT) and familial autoimmunity has rarely been described. Case report A 37-year-old woman presented in 2019 with arthralgia, sicca symptoms, fatigue, + antinuclear antibody (ANA), + anti SSA, and + anticardiolipin Immunoglobulin G (IgG) antibodies. She was diagnosed with HT and vitamin D deficiency in 2012. The familial autoimmunity was present: the patient's mother had been diagnosed with systemic lupus erythematosus and secondary Sjogren's syndrome and her grandmother with cutaneous lupus and pernicious anemia. In 2017, the patient had a cosmetic SBI procedure that was complicated by repeated right breast capsulitis. After 2 years of irregular visits due to COVID-19, she presented with + ANA, + anticentromere antibodies both in sera and seroma, sicca syndrome, arthralgias, twinkling in extremities, abnormal capillaroscopic findings, and reduced diffusing capacity of the lungs for carbon monoxide. She was diagnosed with ASIA, and antimalarial and corticosteroid therapy were introduced. Conclusion In patients with HT and familial autoimmunity, SBI should be carefully considered due to the possibility of ASIA development. Hashimoto thyroiditis, familial autoimmunity, and ASIA seem to be interconnected in the complex mosaic of autoimmunity in predisposed individuals.
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Affiliation(s)
- Aleksandra Plavsic
- Clinic for Allergy and Immunology, University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Snezana Arandjelovic
- Clinic for Allergy and Immunology, University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Milan Dimitrijevic
- Clinic for Allergy and Immunology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Natasa Kusic
- Clinic for Allergy and Immunology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Vesna Tomic Spiric
- Clinic for Allergy and Immunology, University Clinical Centre of Serbia, Belgrade, Serbia
- Clinic for Endocrinology, Diabetes, and Metabolic Diseases, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Bojana Popovic
- Faculty of Medicine, University Clinical Centre of Serbia, Belgrade, Serbia
- Clinic for Endocrinology, Diabetes, and Metabolic Diseases, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Zikica Jovicic
- Clinic for Allergy and Immunology, University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Aleksandra Peric Popadic
- Clinic for Allergy and Immunology, University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Rada Miskovic
- Clinic for Allergy and Immunology, University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University Clinical Centre of Serbia, Belgrade, Serbia
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22
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Giovannini E, Travascio L, Follacchio GA, Bauckneht M, Criscuoli B, De Cataldo C, Iozzelli A, Cimini A, Ricci M. Medical Imaging of Inflammations and Infections of Breast Implants. Diagnostics (Basel) 2023; 13:diagnostics13101807. [PMID: 37238291 DOI: 10.3390/diagnostics13101807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/01/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
Breast implants are widely used for reconstructive and/or cosmetic purposes. Inflammations and infections of breast implants represent important complications in clinical practice. The proper management of complications is necessary: diagnostic imaging plays a key role in detecting sites of inflammation and/or infection. The present review aims to illustrate the radiological findings of these conditions with different imaging techniques, such as mammography (MX), ultrasound (US), magnetic resonance imaging (MRI), and nuclear medicine imaging. A knowledge of these findings is essential for radiologists and nuclear medicine physicians to provide helpful information for the clinical management of these complications.
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Affiliation(s)
| | - Laura Travascio
- Nuclear Medicine Unit, P.O. Spirito Santo, 65124 Pescara, Italy
| | | | - Matteo Bauckneht
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Health Sciences (DISSAL), University of Genoa, 16132 Genova, Italy
| | | | - Camilla De Cataldo
- Department of Breast Imaging and Emergency Radiology, San Salvatore Hospital, 67100 L'Aquila, Italy
| | - Andrea Iozzelli
- Radiology Unit, Macerata Hospital, AST, 62100 Macerata, Italy
| | - Andrea Cimini
- Nuclear Medicine Unit, St. Salvatore Hospital, 67100 L'Aquila, Italy
| | - Maria Ricci
- Nuclear Medicine Unit, Cardarelli Hospital, 86100 Campobasso, Italy
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23
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Clegg DJ, Salomon BJ, Porter CG, Mazonas TW, Heidel RE, Stephenson SM, Herbig KS, Chun JT, Lloyd JM, Boukovalas S. The Impact of Prior Breast Augmentation on Breast Reconstruction after Mastectomy. Plast Reconstr Surg Glob Open 2023; 11:e5025. [PMID: 37360240 PMCID: PMC10287142 DOI: 10.1097/gox.0000000000005025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/03/2023] [Indexed: 06/28/2023]
Abstract
The risk of women developing breast cancer after augmentation mammaplasty may be lower than the general population, with minimal current literature on breast reconstruction in this population. We sought to evaluate the impact of previous augmentation on postmastectomy breast reconstruction. Methods Retrospective review of patients who underwent mastectomies from 2017 to 2021 at our institution was performed. Analysis included frequencies and percentages, descriptive statistics, chi-square analysis, and Fisher exact test. Results Four hundred seventy patients were included, with average body mass index of 29.1 kg/m2, 96% identifying as White, and an average age at diagnosis of 59.3 years. Twenty (4.2%) patients had a prior breast augmentation. Reconstruction was performed in 80% of the previously augmented patients compared to 49.9% of nonaugmented patients (P = 0.01). Reconstruction was alloplastic in 100% of augmented and 88.7% of nonaugmented patients (P = 0.15). All reconstructed augmented patients underwent immediate reconstruction compared with 90.5% of nonaugmented patients (P = 0.37), and two-stage reconstruction was most common (75.0% versus 63.5%; P = 0.42). Of the previously augmented patients, 87.5% increased implant volume, 75% underwent same implant plane reconstruction, and 68.75% underwent same implant-type reconstruction as their augmentation. Conclusions Previously augmented patients were more likely to undergo reconstruction after mastectomy at our institution. All reconstructed augmented patients underwent alloplastic reconstruction, with most performed immediately in staged fashion. Most patients favored silicone implants and maintained the same implant type and plane of reconstruction, with increased implant volume. Larger studies are required to further investigate these trends.
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Affiliation(s)
- Devin J. Clegg
- From the Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tenn
| | - Brett J. Salomon
- From the Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tenn
| | - Christopher G. Porter
- From the Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tenn
| | - Thomas W. Mazonas
- From the Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tenn
| | - Robert E. Heidel
- Department of Surgery, Division of Biostatistics, University of Tennessee Graduate School of Medicine, Knoxville, Tenn
| | - Stacy M. Stephenson
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tenn
| | - Kathleen S. Herbig
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tenn
| | - Joseph T. Chun
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tenn
| | - Jillian M. Lloyd
- Department of Surgery, Division of Surgical Oncology, University of Tennessee Graduate School of Medicine, Knoxville, Tenn
| | - Stefanos Boukovalas
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tenn
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Cohen Tervaert JW, van Eeden C, Butt I, Redmond D, Clifford A, Osman M, Yacyshyn E. Vaccine hesitancy is not increased in patients with ASIA (autoimmune/inflammatory syndrome induced by adjuvants) when compared to patients with vasculitis. Clin Rheumatol 2023; 42:1727-1728. [PMID: 37004592 PMCID: PMC10066990 DOI: 10.1007/s10067-023-06591-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 03/21/2023] [Accepted: 03/26/2023] [Indexed: 04/04/2023]
Affiliation(s)
- Jan Willem Cohen Tervaert
- Division of Rheumatology, Department of Medicine, University of Alberta, Alberta, Edmonton, Canada.
- Maastricht University, Maastricht, the Netherlands.
| | - Charmaine van Eeden
- Division of Rheumatology, Department of Medicine, University of Alberta, Alberta, Edmonton, Canada
| | - Imama Butt
- Division of Rheumatology, Department of Medicine, University of Alberta, Alberta, Edmonton, Canada
| | - Desiree Redmond
- Division of Rheumatology, Department of Medicine, University of Alberta, Alberta, Edmonton, Canada
| | - Alison Clifford
- Division of Rheumatology, Department of Medicine, University of Alberta, Alberta, Edmonton, Canada
| | - Mo Osman
- Division of Rheumatology, Department of Medicine, University of Alberta, Alberta, Edmonton, Canada
| | - Elaine Yacyshyn
- Division of Rheumatology, Department of Medicine, University of Alberta, Alberta, Edmonton, Canada
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Simeonova D, Georgiev T, Shivacheva T. Takayasu arteritis associated with autoimmune/inflammatory syndrome induced by adjuvants: a case-based review. Rheumatol Int 2023; 43:975-981. [PMID: 36920514 PMCID: PMC10015523 DOI: 10.1007/s00296-023-05309-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/06/2023] [Indexed: 03/16/2023]
Abstract
Takayasu's arteritis (TA) is a chronic granulomatous vasculitis that predominantly affects the aorta and its major branches. Despite advancements in the understanding of the pathogenic pathways of vascular inflammation, the etiology and predisposing factors of TA remain to be fully understood. In susceptible individuals, exposure to adjuvants may trigger, unlock or unmask an autoimmune disorder, presenting as non-specific constitutional symptoms or a fully developed autoimmune syndrome such as vasculitis. Here, we hypothesize that TA could be triggered by siliconosis, a subtype of the autoimmune/inflammatory syndrome induced by adjuvants (ASIA). ASIA, also known as Shoenfeld syndrome, encompasses a wide range of autoimmune and immune-mediated diseases resulting from dysregulation of the immune response after exposure to agents with adjuvant activity. This case report describes the development of large artery vasculitis, TA, in an individual one year following the placement of silicone breast implants. The patient initially presented with non-specific symptoms, and multiple imaging methods were employed, including ultrasound diagnostics, CT angiography, and 18-fluorodeoxyglucose positron emission tomography/CT. These techniques revealed vasculitic alterations in the carotid arteries and thoracic aorta. Initial treatment with glucocorticosteroids proved ineffective, prompting the addition of steroid-sparing immunosuppressive agents. Due to the distinct clinical symptoms, disease progression, implant-associated fibrosis, and resistance to therapy, the potential involvement of implants in the development of large-vessel vasculitis was considered, and a potential association with ASIA was postulated. Although there is limited evidence to support a direct link between adjuvants and the pathogenesis of TA, similarities in cellular immunity between the two conditions exist. The diagnosis of this complex and potentially debilitating condition requires a comprehensive clinical examination, laboratory evaluation, and instrumental assessment. This will aid in identifying potential contributing factors and ensuring successful treatment.
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Affiliation(s)
| | - Tsvetoslav Georgiev
- Rheumatology Clinic, University Hospital St. Marina, Varna, 9010 Bulgaria
- First Department of Internal Medicine, Faculty of Medicine, Medical University-Varna, Varna, Bulgaria
| | - Tanya Shivacheva
- Rheumatology Clinic, University Hospital St. Marina, Varna, 9010 Bulgaria
- First Department of Internal Medicine, Faculty of Medicine, Medical University-Varna, Varna, Bulgaria
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Greenbaum A, Halpert G, Dotan A, Shivatzki S, Heidecke H, Kaplan Neeman R, Ehrenfeld M, Wolfovitz A, Amital H, Henkin Y, Shoenfeld Y. The Prevalence of Hearing Impairments in Women with Silicone Breast Implants. Diseases 2023; 11. [PMID: 36810545 DOI: 10.3390/diseases11010031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/28/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
Many women with silicone breast implants (SBIs) report non-specific complaints, including hearing impairments. Hearing impairment appears to be associated with a number of autoimmune conditions. The current study aimed to evaluate the prevalence and severity of hearing impairments among women with SBIs and to explore potential improvements in their hearing capability following implant removal. Symptomatic women with SBIs (n = 160) underwent an initial anamnestic interview, and women who reported hearing impairments were selected for the study. These women completed self-report telephone questionnaires regarding their hearing difficulties. Some of these women underwent subjective and objective hearing tests. Out of 159 (50.3%) symptomatic women with SBIs, 80 reported hearing impairments, including hearing loss (44/80; 55%) and tinnitus (45/80; 56.2%). Five out of seven (71.4%) women who underwent an audiologic evaluation exhibited hearing loss. Of women who underwent silicone implant removal, 27 out of 47 (57.4%) reported the improvement or resolution of their hearing complaints. In conclusion, hearing impairment is a frequent complaint among symptomatic women with SBIs, and tinnitus was found to be the most common complaint. A significant reduction in hearing difficulties was observed following silicone implant removal. Further studies using larger populations are needed to verify the occurrence of hearing impairments in these women.
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Cohen Tervaert JW, Martinez-Lavin M, Jara LJ, Halpert G, Watad A, Amital H, Shoenfeld Y. Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) in 2023. Autoimmun Rev 2023; 22:103287. [PMID: 36738954 DOI: 10.1016/j.autrev.2023.103287] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
In 2011, a syndrome entitled ASIA (Autoimmune/inflammatory Syndrome Induced by Adjuvants; Shoenfeld's syndrome) was first described. ASIA aimed to organize under a single umbrella, the existing evidence regarding certain environmental factors which possess immune stimulatory properties, in order to shed light on a common pathway of autoimmune pathogenesis. Such environmental immune stimulators, or adjuvants, include among others: aluminum salts as in vaccines, various medical implants, as well as various infectious agents. After the launch of the ASIA syndrome, the expansion and recognition of this syndrome by different researchers from different countries began. During the past decades, evidence had been accumulating that (auto)immune symptoms can be triggered by exposure to environmental immune stimulatory factors that act as an adjuvant in genetically susceptible individuals. A panoply of unexplained subjective and autonomic-related symptoms has been reported in patients with ASIA syndrome. The current review summarizes and updates accumulated knowledge from the past decades, describing new adjuvants- (e.g. polypropylene meshes) and vaccine- (e.g. HPV and COVID vaccines) induced ASIA. Furthermore, a direct association between inflammatory/autoimmune diseases with ASIA syndrome, will be discussed. Recent cases will strengthen some of the criteria depicted in ASIA syndrome such as clear improvement of symptoms by the removal of adjuvants (e.g. silicone breast implants) from the body of patients. Finally, we will introduce additional factors to be included in the criteria for ASIA syndrome such as: (1) dysregulated non-classical autoantibodies directed against G-protein coupled receptors (GPCRs) of the autonomic nervous system and (2)) small fiber neuropathy (SFN), both of which might explain, at least in part, the development of 'dysautonomia' reported in many ASIA patients.
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Affiliation(s)
- Jan Willem Cohen Tervaert
- Division of Rheumatology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; School for Mental Health and Neurosciences (MHeNs), Maastricht University, Maastricht, the Netherlands.
| | - Manuel Martinez-Lavin
- Chief Rheumatology Department, National Institute of Cardiology, Mexico City, Mexico
| | - Luis J Jara
- Rheumatology Division, National Institute of Rehabilitation Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Universidad Nacional Autónoma de Mexico, Mexico City, Mexico
| | - Gilad Halpert
- Department of Molecular Biology, Ariel University, Ariel, Israel; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Abdulla Watad
- Department of Medicine 'B' and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Howard Amital
- Department of Medicine 'B' and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
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Brunori PM, Antonelli E, Del Sordo R, Bassotti G. Unexpected findings in a bright liver. J Intern Med 2023; 293:259-261. [PMID: 36190766 DOI: 10.1111/joim.13576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Paolo Maria Brunori
- Gastroenterology & Hepatology Unit, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Elisabetta Antonelli
- Gastroenterology & Hepatology Unit, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Rachele Del Sordo
- Section of Anatomic Pathology & Histology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Gabrio Bassotti
- Gastroenterology & Hepatology Unit, Santa Maria della Misericordia Hospital, Perugia, Italy.,Gastroenterology, Hepatology & Digestive Endoscopy Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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Mowlavi A, Asghari A, Heydarlou D, Gavilanes E, Sin Z, Mirzania H. Breast Lift Algorithm for the Treatment of Breast Implant Illness Requiring Implant Removal. Aesthetic Plast Surg 2022. [DOI: 10.1007/s00266-022-03178-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/06/2022] [Indexed: 11/24/2022]
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Lyros I, Perrea D, Tosios K, Nikitakis N, Tsolakis IA, Ferdianakis E, Fora E, Lykogeorgos T, Maroulakos MP, Vardas E, Georgaki M, Papadopoulou E, Tsolakis AI. Histological and Biochemical Analysis after Posterior Mandibular Displacement in Rats. Vet Sci 2022; 9:vetsci9110625. [PMID: 36356102 PMCID: PMC9697094 DOI: 10.3390/vetsci9110625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/27/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022] Open
Abstract
Simple Summary The lower jaw has a particular contribution to the human appearance, and so it is not uncommon for people to seek treatment in cases of its extreme growth. The orthodontist often selects to place intraoral devices in order to address the problem. This study used healthy young rats to guide their lower jaws backward. Measurements of biochemical molecules in blood that are related to bone metabolism did not reveal any statistically significant differences. However, noteworthy local microscopic alterations of the condyle were evidenced. They involved histological changes in bone structure and the thickness of cartilage. In conclusion, it seems that the procedure under study might not cause any severe organic disturbance in the lab animals under the conditions of the experiment. Only minor histological effects on condylar morphology were observed. Abstract The present study aimed to investigate any biochemical and histological changes of the rat condyle and mandible in animals that had sustained mandibular growth restriction. Seventy-two male Wistar rats were divided into two equal groups, experimental and control. Each group consisted of three equal subgroups. The animals were sacrificed 30, 60, and 90 days after the start of the experiment. Blood samples were collected from the eye, and the osteoprotegerin (OPG), Receptor Activator of Nuclear Factor Kappa B Ligand (RANKL), and Macrophage Colony-Stimulating factor (MCSF)concentrations were measured by using enzyme-linked immunosorbent assay (ELISA) kits. A histological analysis was performed on the mandibular condyles. The blood serum values of OPG, RANKL, and MCSF did not exhibit any statistically significant difference between groups or subgroups. However, significant histological changes became evident after a histomorphometric condylar examination was performed. The Bone Surface/Total Surface ratio appeared reduced in the anterior and posterior regions of the condyle. In addition, the Posterior Condylar Cartilage Thickness was measured and determined to be significantly diminished. The present intervention that employed orthodontic/orthopedic devices did not prove to have any significant effect on the circulating proteins under study. Posterior displacement of the mandible may culminate only in local histological alterations in condylar cartilage thickness and its osseous microarchitecture.
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Affiliation(s)
- Ioannis Lyros
- Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Correspondence:
| | - Despoina Perrea
- Laboratory of Experimental Surgery and Surgical Research “N.S. Christeas”, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Konstantinos Tosios
- Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Nikolaos Nikitakis
- Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Ioannis A. Tsolakis
- Department of Orthodontics, School of Dentistry, Aristotle University of Thessaloniki, 54623 Thessaloniki, Greece
| | - Efstratios Ferdianakis
- Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Eleni Fora
- Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | | | - Michael P. Maroulakos
- Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Emmanouil Vardas
- Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Maria Georgaki
- Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Erofili Papadopoulou
- Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Apostolos I. Tsolakis
- Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Department of Orthodontics, Case Western Reserve University, Cleveland, OH 44106, USA
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31
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Weitkunat A, Targosinski S, Bauer B, Grünert JG, Winsauer S. [The Emerging Interest in Breast Implant Illness and its impact on Patient Behavior]. HANDCHIR MIKROCHIR P 2022; 54:489-494. [PMID: 36343629 DOI: 10.1055/a-1901-9041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Breast implant illness (BII) is a loosely defined term for a collection of non-specific systemic symptoms that are hypothesised to be associated with breast implants. BII symptoms include fatigue, hair loss, rashes, chronic pain, and others. However, conclusive evidence for a causal relationship between silicone implants and BII remains lacking. In the light of recent findings that textured implants can, in rare cases, lead to breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), a potential link between breast implants and BII is conceivable and justifies further investigation. We observe a growing number of patients seeking consultation and treatment for systemic symptoms related to breast implants, which is reflected in increasing interest in literature and social media. The aim of this work was to investigate the growing interest in BII. We now describe the clinical features of a patient who suffers from symptoms that are consistent with BII and contextualise clinical presentation in a review of literature and google trend analysis.
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Affiliation(s)
- Adina Weitkunat
- Klinik für Hand-, Plastische und Wiederherstellungschirurgie, Kantonsspital St Gallen, Sankt Gallen, Switzerland
| | - Stefan Targosinski
- Klinik für Hand-, Plastische und Wiederherstellungschirurgie, Kantonsspital St Gallen, Sankt Gallen, Switzerland
| | - Benedikt Bauer
- Klinik für Hand-, Plastische und Wiederherstellungschirurgie, Kantonsspital St Gallen, Sankt Gallen, Switzerland
| | - Jörg G Grünert
- Klinik für Hand-, Plastische und Wiederherstellungschirurgie, Kantonsspital St Gallen, Sankt Gallen, Switzerland
| | - Stefan Winsauer
- Klinik für Hand-, Plastische und Wiederherstellungschirurgie, Kantonsspital St Gallen, Sankt Gallen, Switzerland
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Muacevic A, Adler JR. Two Cases of Autoimmune Syndrome Induced by Adjuvants (ASIA): A Multifaceted Condition Calling for a Multidisciplinary Approach. Cureus 2022; 14:e30397. [PMID: 36276594 PMCID: PMC9576548 DOI: 10.7759/cureus.30397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2022] [Indexed: 11/05/2022] Open
Abstract
Silicone implants have been used for cosmetic enhancement and reconstructive purposes for over 60 years. Despite assiduous efforts to ensure safety, there is continuous evidence that they are not as biologically inert as previously postulated. We present two cases of autoimmune syndrome induced by adjuvants (ASIA) in Hispanic women. The first patient developed biopsy-proven immune-mediated necrotizing myopathy that was successfully treated with the combination of silicone explantation along with immunosuppressive therapy. Findings after implant removal demonstrated rupture and leakage of silicone from gluteal implants. The second patient developed autoimmune hemolytic anemia in the setting of a ruptured silicone breast implant. Similarly, the patient was treated with corticosteroids followed by breast implant removal with complete resolution of symptoms. The successful treatment of these patients was achieved by collaboration between rheumatology and plastic surgery, which emphasizes the need for a multidisciplinary approach in the diagnosis and management of patients with ASIA.
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33
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Gupta R, John J, Gupta R, Hart J, DeSano J, Sachanandani NS, Chaiyasate K. Simultaneous Contralateral Autologous Breast Augmentation during Unilateral Breast Reconstruction Utilizing Deep Inferior Epigastric Flaps. Plast Reconstr Surg Glob Open 2022; 10:e4498. [PMID: 36119381 DOI: 10.1097/GOX.0000000000004498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/30/2022] [Indexed: 11/26/2022]
Abstract
It is predicted that 281,550 new cases of invasive breast cancer and 49,290 new cases of ductal carcinoma in situ will be diagnosed this year. In this study, we will detail our experience with simultaneous contralateral autologous breast augmentation during unilateral breast reconstruction utilizing bilateral deep inferior epigastric perforator (DIEP) flaps. Methods A retrospective analysis of patients who underwent simultaneous contralateral autologous breast augmentation during unilateral breast reconstruction utilizing bilateral DIEP flaps by the senior surgeons at Beaumont Health Systems, Royal Oak, was conducted. Demographic data, operative details, complications, medical comorbidities, and patient outcomes were retrospectively analyzed. Results Seven patients who met the inclusion criteria were identified. One patient underwent immediate reconstruction with DIEP flaps, one patient had a history of lumpectomy and underwent delayed partial breast reconstruction, three patients had delayed unilateral DIEP breast reconstruction with contralateral breast augmentation, and two patients had previous augmentations that were revised. All patients examined in this review tolerated the procedures well and had clinically viable flaps along with superior aesthetic outcomes. Conclusions This technique can be applied to various clinical conditions, including immediate breast reconstruction, delayed breast reconstruction, and salvage for failed implant-based reconstruction, leading to optimal patient outcomes and satisfaction. Unilateral breast reconstruction with simultaneous contralateral autologous breast augmentation utilizing bilateral DIEP flaps is a surgical technique that more plastic surgeons should utilize.
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Mahroum N, Elsalti A, Alwani A, Seida I, Alrais M, Seida R, Esirgun SN, Abali T, Kiyak Z, Zoubi M, Shoenfeld Y. The mosaic of autoimmunity - Finally discussing in person. The 13 th international congress on autoimmunity 2022 (AUTO13) Athens. Autoimmun Rev 2022; 21:103166. [PMID: 35932955 PMCID: PMC9349027 DOI: 10.1016/j.autrev.2022.103166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 07/31/2022] [Indexed: 11/29/2022]
Abstract
While autoimmunity is a branch of medicine linked to every single organ system via direct and indirect pathways, meeting in person to discuss autoimmunity during the 13th international congress on autoimmunity (AUTO13) with participants from all over the world had a very good reason. The mechanisms involved in autoimmune diseases are of extreme importance and in fact critical in understanding the course of diseases as well as selecting proper therapies. COVID-19 has served as a great example of how autoimmunity is deeply involved in the disease and directly correlated to severity, morbidity, and mortality. For instance, initially the term cytokine storm dominated, then COVID-19 was addressed as the new member of the hyperferritinemic syndrome, and also the use of immunosuppressants in patients with COVID-19 throughout the pandemic, all shed light on the fundamental role of autoimmunity. Unsurprisingly, SARS-CoV-2 was called the “autoimmune virus” during AUTO13. Subsequently, the correlation between autoimmunity and COVID-19 vaccines and post-COVID, all were discussed from different autoimmune aspects during the congress. In addition, updates on the mechanisms of diseases, autoantibodies, novel diagnostics and therapies in regard to autoimmune diseases such as antiphospholipid syndrome, systemic lupus erythematosus, systemic sclerosis and others, were discussed in dedicated sessions. Due to the magnificence of the topics discussed, we aimed to bring in our article hereby, the pearls of AUTO13 in terms of updates, new aspects of autoimmunity, and interesting findings. While more than 500 abstract were presented, concluding all the topics was not in reach, hence major findings were summarized.
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Affiliation(s)
- Naim Mahroum
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey.
| | - Abdulrahman Elsalti
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Abdulkarim Alwani
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Isa Seida
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Mahmoud Alrais
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Ravend Seida
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Sevval Nil Esirgun
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Tunahan Abali
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Zeynep Kiyak
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Majdi Zoubi
- Department of Internal Medicine B, HaEmek Medical Center, Afula, Israel, Affiliated to Technion, Faculty of Medicine, Haifa, Israel
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Mahroum N, Shoenfeld Y. Autoimmune Autonomic Dysfunction Syndromes: Potential Involvement and Pathophysiology Related to Complex Regional Pain Syndrome, Fibromyalgia, Chronic Fatigue Syndrome, Silicone Breast Implant–Related Symptoms and Post-COVID Syndrome. Pathophysiology 2022; 29:414-25. [PMID: 35997389 PMCID: PMC9396987 DOI: 10.3390/pathophysiology29030033] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/21/2022] Open
Abstract
The pathophysiological mechanisms involved in chronic disorders such as complex regional pain syndrome, fibromyalgia, chronic fatigue syndrome, silicone breast implant–related symptoms, and post-COVID syndrome have not been clearly defined. The course of the pain in some of the syndromes, the absence of evident tissue damage, and the predominance of alterations in the autonomic nervous system are shared similarities between them. The production of autoantibodies following a trigger in the syndromes was previously described, for instance, trauma in complex regional pain syndrome, infectious agents in fibromyalgia, chronic fatigue syndrome, and post-COVID syndrome, and the immune stimulation by silicone in women with breast implants. In fact, the autoantibodies produced were shown to be directed against the autonomic nervous system receptors, leading to the amplification of the perception of pain alongside various clinical symptoms seen during the clinical course of the syndromes. Therefore, we viewed autoantibodies targeting the autonomic nervous system resulting in autonomic dysfunction as likely the most comprehensive explanation of the pathophysiology of the disorders mentioned. Based on this, we aimed to introduce a new concept uniting complex regional pain syndrome, fibromyalgia, chronic fatigue syndrome, silicone breast implant–related symptoms, and post-COVID syndrome, namely “autoimmune autonomic dysfunction syndromes”. Due to its etiological, pathophysiological, and clinical implications, the suggested term would be more precise in classifying the syndromes under one title. The new title would doubtlessly facilitate both laboratory and clinical studies aimed to improve diagnosis and make treatment options more directed and precise.
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36
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Ribeiro PDC, Sato EI. Autoimmune/autoinflammatory syndrome induced by adjuvants: a focus on silicone. Clin Rheumatol 2022. [PMID: 35798923 DOI: 10.1007/s10067-022-06274-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/30/2022] [Accepted: 06/29/2022] [Indexed: 11/03/2022]
Abstract
Autoimmune/autoinflammatory syndrome induced by adjuvants (ASIA) was first described in 2011 to cover disorders characterized by dysregulation of the immune system after exposure to an adjuvant. In the present review, the authors focus on silicone-induced ASIA. In the last two decades, there has been worldwide increase in the use of silicone breast implant (SBI) as an aesthetic procedure, raising concerns for possible effects on the immune system, especially in people who already have previous immune dysregulation. The authors did a critical review of the most important articles referring to silicone-induced ASIA, including most recent studies regarding physiopathologic mechanism. Despite large-scale epidemiological studies conducted to assess the association between SBI and autoimmune/rheumatic disorders, the results remain inconclusive, and the debate over the safety of SBIs remains heated. The explantation of silicone breast has been indicated for silicone-induced ASIA with improvement of unspecific symptoms in the majority of patients; however, the outcome seems different in patients with definitive autoimmune rheumatic disease (AIRD). There is no prospective study evaluating the risk of flares after SBI in patients who already have an AIRD. Therefore, based on the literature, we cannot contraindicate the procedure; however, we need to advertise about the risk of ASIA to the patients with AIRD. Long-term safety and implant-related outcomes should be discussed with these patients, considering each case individually, assessing genetic and environmental factors, and determining if the autoimmune disease is in remission or not, for shared decision among patient and the physician.
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Cohen Tervaert JW, van Eeden C, Osman M. Response to letter to the editor: Bradford Hill and breast implant illness: evidence for a causal association with breast implants. Expert Rev Clin Immunol 2022; 18:777-778. [PMID: 35713685 DOI: 10.1080/1744666x.2022.2090340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Charmaine van Eeden
- Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mohammed Osman
- Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Spoor J, de Jong D, de Boer M, Rakhorst H, van der Hulst RRJW, Vrancken Peeters MJTFD, Bleiker EMA, Mureau MAM, van Leeuwen FE. Bradford Hill and breast implant illness: no evidence for causal association with breast implants. Expert Rev Clin Immunol 2022; 18:773-775. [PMID: 35702986 DOI: 10.1080/1744666x.2022.2090339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Jonathan Spoor
- Department of Epidemiology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Daphne de Jong
- Department of Pathology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Mintsje de Boer
- Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Hinne Rakhorst
- Department of Plastic and Reconstructive Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Rene R J W van der Hulst
- Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Eveline M A Bleiker
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Marc A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Flora E van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, The Netherlands
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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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Varela-chinchilla CD, Salinas-mcquary G, Segura-azuara NDLÁ, Trinidad-calderón PA. Breast Implant Illness: Surgical, Autoimmune, and Breast Reconstruction Associations. Surgeries 2022; 3:111-25. [DOI: 10.3390/surgeries3020013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Breast implant illness refers to a combination of different symptoms related to breast implant surgery, including fatigue, brain fog, and arthralgias. This malaise occurs after cosmetic and reconstructive breast surgeries, although it has not been proven to be a disease. Even recent studies have reported concluding statements of the etiology, diagnosis, and treatment as unclear and widely unknown. Therefore, this review aimed to determine the associations between the manifestations of breast implant illness in surgery and breast reconstruction, as well as the autoimmune responses involved. Complications associated with breast implants include breast pain, capsular contracture, infections, as well as other manifestations specific to breast reconstruction. Moreover, patients with implants may present with new-onset systemic sclerosis, Sjögren’s syndrome, and connective tissue diseases. However, the incidence of capsular contracture has steadily decreased with each generation of implants, particularly since the development of textured implants, as well as with the use of antibiotics and antiseptic pocket irrigation. However, the incidence of anaplastic large cell lymphoma has increased with the use of textured implants. Remarkably, the autoimmune response to these implants remains unclear. Therefore, close follow-up, careful observation of any symptom presentation, and evidence-based treatment decisions are necessary for patients with breast implants.
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Suh LJ, Khan I, Kelley-Patteson C, Mohan G, Hassanein AH, Sinha M. Breast Implant-Associated Immunological Disorders. J Immunol Res 2022; 2022:8536149. [PMID: 35571560 PMCID: PMC9095406 DOI: 10.1155/2022/8536149] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 04/05/2022] [Accepted: 04/16/2022] [Indexed: 11/18/2022] Open
Abstract
Background Breast implants are commonly placed postbreast cancer reconstruction, cosmetic augmentation, and gender-affirming surgery. Breast implant illness (BII) is a systemic complication associated with breast implants. Patients with BII may experience autoimmune symptoms including fatigue, difficulty concentrating, hair loss, weight change, and depression. BII is poorly understood, and the etiology is unknown. The purpose of this literature review is to characterize BII autoimmune disorders and determine possible causes for its etiology. Methods The PubMed, Google Scholar, Embase, Web of Science, and OVID databases were interrogated from 2010 to 2020 using a query strategy including search term combinations of "implants," "breast implant illness," "autoimmune," and "systemic illness." Results BII includes a spectrum of autoimmune symptoms such as fatigue, myalgias/arthralgias, dry eyes/mouth, and rash. A review of epidemiological studies in the past ten years exhibited evidence affirming an association between breast implants and autoimmune diseases. The most commonly recognized were Sjogren's syndrome, rheumatoid arthritis, systemic sclerosis, chronic fatigue syndrome, and Raynaud's syndrome. Explantation resulted in alleviation of symptoms in over 50% of patients, strengthening the hypothesis linking breast implants to BII. Studies have shown that silicone is a biologically inert material and unlikely to be the cause of these symptoms. This is supported by the fact that increased risk of autoimmune disease was also reported in patients with other implantable biomaterials such as orthopedic implants. Recent studies shed light on a possible role of bacterial biofilm and subsequent host-pathogen interactions as a confounding factor to this problem. Conclusion BII could be dependent on biofilm infection and the microenvironment around the implants. The true pathophysiology behind these complaints must be further investigated so that alternative treatment regimens other than explantation can be developed. Translational significance of these studies is not limited to breast implants but extends to other implants as well.
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Affiliation(s)
- Lily J. Suh
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Imran Khan
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | | | - Ganesh Mohan
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Aladdin H. Hassanein
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Mithun Sinha
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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Mustafá JCR, Fleury EDFC, Dijkman HBPM. Case Report: Evidence of Migratory Silicone Particles Arising From Cohesive Silicone Breast Implants. Front Glob Womens Health 2022; 3:730276. [PMID: 35547828 PMCID: PMC9085291 DOI: 10.3389/fgwh.2022.730276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 03/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background Silicone implants have been used since the 1960s for aesthetic purposes and breast reconstructions. During this period, many women have reported up to 40 similar symptoms, including fatigue, the emergence of autoimmune diseases, Raynaud Phenomenon, arthritis, arthralgias, and hair loss, among others. However, most of the time, these symptoms are neglected by doctors across different specialties and are most often considered a psychosomatic disease. Since 2017, many women suffering from the same complaints have formed social media groups to report their histories and subsequently describe the disease as Breast Implant Illness (BII). The phenomenon of gel bleed and silicone toxicity is known and accepted in literature, but silicone migration into the extracapsular space is still poorly demonstrated, due to the difficulty of monitoring its particles and access to patient data. Methods This work demonstrated the presence of silicone through pathological examination in post-explant breast capsules and in the synovial tissue of the right wrist, detected with special Modified Oil Red O (MORO) staining in a patient with a history of BII. The pathological results were compared to the breast MRI imaging files. Results The MRI images show the permeability change of the implant shell diagnosed as a water-droplet signal. It was also possible to diagnose the gel bleeding as the silicone-induced granuloma of breast implant capsule (SIGBIC) in both implants. Silicone gel bleed and migration of silicone were detected with MORO staining in and outside the capsule and in the synovial tissue of the right wrist. Conclusion In this case study, we showed that silicone migration is possible via cohesive silicone gel breast implant leakage. The accumulation of silicone in the synovial tissue of the right wrist suggests local silicone toxicity and defects.
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Affiliation(s)
| | | | - Henry B. P. M. Dijkman
- Institute of Applied Biosciences and Chemistry, HAN University of Applied Sciences, Nijmegen, Netherlands
- *Correspondence: Henry B. P. M. Dijkman
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