Breast implant materials: sense and safety.

Cosmetic breast augmentation, and post-mastectomy breast reconstruction surgery using synthetic implants, have become established in surgical practice over more than 20 years. The operative technique for implant placement have changed somewhat during this time, as many different implant presentations have become available, but the same basic materials have remained in use. We have reviewed the present state of knowledge about breast implant materials with particular reference to the possible connection between polydimethylsiloxane and polyurethane to the so-called "Human Adjuvant Disease", and to carcinogenesis. Problems related to capsular contracture and mammography are also discussed.     

Body-jet水动力吸脂系统在自体脂肪颗粒隆乳术中的应用

目的：探讨Body-jet水动力吸脂系统应用于自体脂肪移植隆乳的方法和效果。方法自2012年9月至2013年12月,我们应用Body-jet水动力吸脂系统行自体脂肪注射隆乳术18例。通过Body-jet水动力辅助吸脂系统,收集纯化过滤自体脂肪颗粒,多隧道多层次均匀注射于乳房各层组织中,单侧乳房一次脂肪注射剂量为100~250 mL。结果本组共18例,术后随访6~12个月,术后乳房较术前明显丰满,形态自然,手感柔软,无严重不良并发症,效果较满意。结论 Body-jet水动力吸脂安全、有效,操作方便,是目前较理想的用于自体脂肪移植的方法。     

Silicone gel granuloma following compressive mammography

Silicone implant rupture is well recognized, particularly with the thin-walled implants inserted some years ago. On occasions a chronic granulomatous inflammation has been noted if silicone globules have infitrated the tissues. The rupture may occur apparently spontaneously or after trauma, including attempts at external closed capsulotomy. The case report presented in this article documents rupture and dissemination of silicone caused by compressive mammography. Recent practice suggests that in order to enhance the image produced by mammography, particularly in the presence of the masking of a silicone implant, extreme compression is the preferred technique but perhaps should be regarded with some caution in patients with breast implants.     

Periprosthetic breast capsules and immunophenotypes of inflammatory cells

BACKGROUND: Silicone gel-containing breast implants have been widely used for aesthetic and reconstructive mammoplasty. The development of a periprosthetic capsule is considered a local reparative process against the breast implant in which a variety of inflammatory cells may appear. Nevertheless, only few reports have evaluated the immunophenotypes of those inflammatory cells. Herein, we aim to provide more information in this regard evaluating 40 patients with breast implants. METHODS: We studied the immunophenotype of the inflammatory cells of capsular implants using antibodies against lymphocytes (CD3, CD4, CD8, CD20, CD45, and CD30) and histiocytes (CD68). Percentages of CD3 and CD20 positive cells were compared using the unpaired Student's?t test. Fisher's test was also used to compare Baker grades by implant type, implant profile, and location and the presence of inflammatory cells by implant type. RESULTS: The associations between Baker grades and implant type and location were statistically nonsignificant (p?=?0.42 in both cases). However, the use of low profile implants was significantly associated (p?=?0.002) with a higher proportion of Baker grades 3 and 4. We found evidence of inflammation in 92.5?% of all implant capsules, with a statistically significant (p?=?0.036) higher proportion in textured breast implants. T cells predominated over B cells. Textured implants elicited a more marked response to T cells than smooth implants, with a similar proportion of helper and cytotoxic T cells. Textured implants showed statistically significant higher percentages of CD3 positive cells than smooth implants. Percentages of CD20 positive cells were similar in textured and smooth implants. CONCLUSIONS: These results suggest that textured breast implants might induce a stronger local T cell immune response. Our findings could shed some light to understand the association of silicone breast implants and some cases of anaplastic large cell lymphomas. Level of Evidence: Level III, prognostic study.     

Elemental analysis and clinical implications of calcification deposits associated with silicone breast implants

Calcification of the fibrous capsule surrounding silicone breast implants is a well-recognized occurrence that increases with time following implantation. These mineralized deposits potentially confound mammographic breast cancer surveillance already made difficult by the obscuring effects of silicone breast implants. The authors performed elemental analysis of silicone breast implant-associated calcifications to define better their chemical composition as related to mammographic and clinical significance. Electron probe microanalysis and infrared spectroscopy revealed all of the calcification deposits to be calcium complexed with tribasic phosphate. No evidence of calcium oxalate, calcium carbonate, silicone, or talc was observed. Caution must be employed in interpreting mammograms in women with silicone breast implants as well as those who have had their silicone breast implants removed. High-density mammographic calcifications indicative of calcium phosphate associated with a silicone breast implant may represent an accepted consequence of implantation or nearby carcinoma. We recommend baseline mammography on women who have had their silicone breast implants removed to prevent unnecessary fine-needle aspiration or tissue biopsy of retained breast capsule calcifications during subsequent routine surveillance for carcinoma.     

Progenitor‐Enriched Adipose Tissue Transplantation as Rescue for Breast Implant Complications

Abstract: Breast enhancement with artificial implants is one of the most frequently performed cosmetic surgeries but is associated with various complications, such as capsular contracture, that lead to implant removal or replacement at a relatively high rate. For replacement, we used transplantation of progenitor‐supplemented adipose tissue (cell‐assisted lipotransfer; CAL) in 15 patients. The stromal vascular fraction containing adipose tissue progenitor cells obtained from liposuction aspirates was used to enrich for progenitor cells in the graft. Overall, clinical results were very satisfactory, and no major abnormalities were seen on magnetic resonance imaging or mammogram after 12 months. Postoperative atrophy of injected fat was minimal and did not change substantially after 2 months. Surviving fat volume at 12 months was 155 ± 50 mL (Right; mean ± SD) and 143 ± 80 mL (Left) following lipoinjection from an initial mean of 264 mL. These preliminary results suggest that CAL is a suitable methodology for the replacement of breast implants.     

Secondary shaping of the free TRAM: an inferior pedicle reduction mammaplasty.

Secondary shaping of the transverse rectus abdominis myocutaneous (TRAM) flap is a routine treatment, and includes liposuction, skin excision, inframammary fold replacement, dermal fat grafts or lipofilling. Major flap revision may include an augmentation procedure with implants or expanders. We present an inferior pedicle breast reduction in a woman who underwent breast reconstruction using a free TRAM flap. To our knowledge, there are no reports about reduction mammaplasty or mastopexy in Free TRAM flap breast reconstruction. Reduction mammaplasty should be regarded as a valuable option in free TRAM or deep inferior epigastric perforator secondary reshaping.     

Breast Enlargement after Liposuction: Comparison of Incidence between Power Liposuction versus Traditional Liposuction

BACKGROUND: We previously reported that a significant percentage of patients who underwent power liposuction noted an increase in their breast size. OBJECTIVE: To determine whether the documented observation of breast enlargement after power liposuction also occurs after traditional liposuction. METHODS: Charts were retrospectively reviewed and patient interviews were conducted for 70 female patients who had traditional liposuction. Analyses were made based on several factors, including age, pre- and postoperative weight, total fat aspirate volume, treated body areas, and hormonal medications for patients who did and did not have breast enlargement. These results were then compared with patients who experienced an increase in breast size after power, liposuction. RESULTS: Thirty-seven percent of the study patients (26 of 70) undergoing traditional liposuction reported an increase in breast size. Sixty-five percent of these women (17 of 26) reported an increase of one or more cup sizes. Larger fat aspirate volumes and liposuction of the abdomen and hip or abdomen, hip, and thigh areas were factors associated with the patients who noted breast enlargement after traditional liposuction. CONCLUSIONS: An increase in breast size was reported in 37% of patients after traditional liposuction and in 34% of patients after power liposuction. We conclude that breast enlargement after both traditional and power liposuction is not related to the mechanical effects of power liposuction. We propose the same hypothesis reported in our previous study that an altered androgen to estrogen ratio after liposuction is likely responsible for this noted occurrence. Weight gain may also be a factor.     

Silicone breast implants and immune disease.

Silicone was originally regarded as inert in the human body. Silicone medical devices have been associated with various complications that may involve an immune reaction to silicone or a silicone organic complex. There have been more than 80 cases reported in the medical literature of a varied systemic autoimmune illness in patients who have had various foreign materials placed in the breast. Controversy exists as to which complications have a cause and effect relationship, and which represent coincidental findings. It is difficult to distinguish between nonspecific local reactions and reactions that have an immunological basis. Approximately 1,000,000 to 2,000,000 women in the United States have had silicone breast implants inserted for reconstruction or augmentation mammaplasty; 28 of those patients have been reported to have developed a systemic autoimmune disease. Data on the 28 reported cases do not in any way prove a causal relationship between breast implants and immune disease. Given the natural incidence of autoimmune diseases, we would expect a coincidental occurrence in the United States of more than 1,000 cases of autoimmune disease in women who had undergone breast implant surgery. Additional information must be obtained to resolve the question. The true incidence of autoimmune disease in patients with implants needs to be determined. A prospective registry of implant patients should be established and comprehensive retrospective information obtained on the implant patient population. Further experimental work is necessary on the bioreactivity of silicone. Patients with implants and autoimmune disease, once identified, must be carefully evaluated by physicians who are experienced in the treatment of autoimmune disease.     

Breast Implant Stability in the Subfascial Plane and the New Shaped Silicone Gel Breast Implants

The author presents his experience with breast augmentation using a next-generation, form-stable, anatomically shaped silicone gel breast implant. Rotation is a potential complication for anatomically shaped breast implants. Anatomically shaped saline implants have been reported to have a rotation rate as high as 14%, while lower rotation rates of 1–2.6% for anatomic cohesive gel silicone implants have been reported. Currently, these implants are limited in the United States to US FDA-approved clinical trials. The author reviews the appropriate surgical techniques to prevent rotation when using these devices. A recent innovation, placement of the superior pole of the implant underneath the superficial fascia of the pectoralis major muscle, is described. Primary and secondary breast augmentations in 241 procedures using the Allergan Style 410 implant resulted in a 0.0% rotation rate. Overall, the anatomic form-stable silicone gel breast implants, when placed subfascially, improve common complications such as capsular contracture and implant rupture with improved aesthetic outcomes and patient satisfaction.     

Male chest correction. Pectoral implants and gynecomastia

Implants have been developed in different sizes and shapes to mimic the pectoralis major muscle and its nipple-areolar complex below it. These soft, solid silicone implants have the approximate dimensions in height, length, and thickness as the muscle the implant is to mimic. Some improvements in the treatment of breast hypertrophy have also allowed a better result in the surgery of gynecomastia. The challenge of obtaining a smooth and flat result has been helped by the technique of liposuction with circum-areolar excision.     

Prosthetic breast implant rupture: imaging--pictorial essay

In recent years, requests for breast implant surgery have occurred for several reasons. First, the number of diagnosed breast cancer cases has increased, and the number of reconstructive surgeries consequently has multiplied. Second, the number of patients who constantly try to achieve a better physical shape, corresponding in Western countries to the common image of prosperous and tonic breasts, has proliferated. These circumstances have led to an increasingly frequent need for more accurate and sophisticated imaging methods to study prosthetic breast implants and their integrity. Diagnostic imaging for the study of patients with suspected breast implant ruptures uses different techniques of radiologic investigation such as mammography and ultrasonography, even if the current gold standard is magnetic resonance imaging (MRI).This study aimed to draw attention to the main MRI signs capable of highlighting contractures or ruptures of the implants that are not always clinically detectable and thus to provide plastic surgeons with an adequate instrument for discerning any possible alterations in prosthetic implants. Furthermore, it was necessary to stress the importance of teamwork. In fact, proper cooperation and coordination between radiologists and dedicated plastic surgeons are fundamental for the proper management of patients and the complications they may experience.     

Maximizing aesthetic outcome in autologous breast reconstruction with implants and lipofilling

Background

Free flap breast reconstruction is an option widely sought in postmastectomy breast reconstruction. However, the volume of autologous tissue from the patient is often not sufficient for symmetrical reconstruction. In these cases, flaps can be used in combination with implants or autologous fat injections to augment volume and achieve shape, symmetry, and contour.

Methods

A retrospective chart review was performed on patients who underwent postmastectomy free flap reconstruction with secondary augmentation using autologous fat grafting or implant from 2008 to 2011.

Results

Twenty-four patients (39 breasts) received further augmentation of autologous tissue reconstruction during this period. Sixteen patients (26 breasts) had fat graft augmentation only, four patients (eight breasts) had implant augmentation only, and three patients (five breasts) had both procedures. Among patients who had fat grafting, operative intervention was required twice for fat necrosis. Contrastingly, of patients who received implants, one patient required operative intervention for implant malpositioning. These differences were not significant (P?=?0.57). The group with both fat grafting and implant augmentation had significantly higher aesthetic scores regarding overall appearance, contour, and volume, but not projection, than the group with fat grafting only and the group with implant only.

Conclusions

Autologous fat grafting offers several contouring aesthetic advantages, including selectively augmenting areas of hollowness to improve contour and maximize symmetry. However, implant augmentation generally allows for a larger increase in projection in a single procedure, with similar rates of postaugmentation complications. Use of both autologous fat grafting and implant augmentation may allow for superior aesthetic results. Level of Evidence: Level IV, therapeutic study.     

Gluteal augmentation surgery: indications and surgical management.

The most common surgical techniques performed for gluteal augmentation employ the use of implants and a combination of liposuction/lipo-injection procedures. We review the major literature concerning this subject with emphasis on gluteal implants, the various indications, surgical techniques and complications are discussed and we present some of our cases. Contour reconstruction, indications such as malformation, asymmetry, trauma and radiotherapy may require custom-made or regular implants, liposuction or lipo-injection procedures and sometimes free flaps. Gluteal implants for aesthetic purposes are widely used, particularly in South America, are easy to perform with a high success rate, whereas lipS200osuction and lipo-injection procedures require considerable experience in Coleman fat injection.     

A New Concept in Male Chest Reshaping: Anatomical Pectoral Implants and Liposculpture

A new concept of male chest reshaping has been developed. In a population of 12 patients, 10 had a male chest enhancement using only a new shaped silicon gel implant, and two had a combination of liposuction and pectoral implants. The very natural appearance of this new implant, with or without a liposuction, seems to dramatically improve the quality of the cosmetic results.     

Autoinflation of saline-filled inflatable breast implants

Spontaneous autoinflation of saline-filled breast implants is a rare phenomenon; only 20 cases have been reported in the world literature. Over the past seven years, three patients have presented with significant unilateral autoinflation of their smooth, single-lumen, round, saline-filled implants. This developed at various times: progressively over 23 years with a Simaplast implant; between the ninth and 10th year after augmentation with a leaflet valve implant; and slowly over the first four years with a leaflet valve implant. The etiology of the autoinflation was shown to be different for the two types of implants. The Simaplast implant had likely been injected with a hypertonic filling solution – one that was twice as concentrated as ‘normal saline’. This would have created an osmotic gradient, which would have facilitated autoexpansion by diffusion. The implant solution remained clear and transparent. In addition, there were no detectable levels of glucose, uric acid or albumin in the fluid. By contrast, auto-inflation of the leaflet valve implants likely resulted from mechanical alterations of the valve mechanism. This type of implant is known to have a high deflation rate, with frequent partial deflations. It is interesting that one of the patients with the leaflet valve implants presented with an autoexpansion on one side and a partial deflation on the other side. Both implants were from the same lot number. The same mechanism that caused partial deflations may have also allowed fluid from the implant pocket to pass through the valve into the lumen of these implants. This could allow glucose, protein and cellular elements to enter into the lumen (these would not pass through an intact elastomeric shell) which would create an osmotic gradient, allowing water to enter the elastomeric shell by diffusion. The fluid in these leaflet valve implants was brownish yellow, very viscous and turbid. It contained elevated levels of glucose and uric acid which would not have passed through the elastomeric shell. Over the past 10 years, four different theories have been proposed in an attempt to explain the etiology of autoinflation. However, the findings of the present study indicate that there are only two mechanisms – a hypertonic filling solution and alterations of the valve mechanism.     

Breast implants in France. New regulations, and qualitative and quantitative study of breast implants sold between 1995 and 2004

Breast implant surgery is now regulated by health laws, which stopped concerns and debates about the safety of the implants in the 90'. After a 6 years ban, silicone gel-filled implants have been allowed by the Afssaps (a national health agency) in 2001, for use in France. The comeback of the silicone gel implants has been a breakthrough in the breast implant market. GOALS OF THE STUDY: Our goal was to assess breast implant use in France, from 1995 til 2004, a time of deep turmoil for breast implant surgery due to new regulations. METHODS: All manufacturers have been requested to participate in the study and send their confidential data regarding the number and type of implants sold yearly, from 1995 to 2004. RESULTS: Breast implant sales rose by 53% in 2001, and increase by +383% from 1995 to 2004. The total number of breast implants sold in 2004 reached about 61 800. Following the lift on their ban, silicon gel-filled implants became immediately first-choice implants (they represented 72% in 2001 and more than 97% of all implants sold in 2004); saline filled implants are now rarely used. Textured envelopes are more often used (they represented 73 to 97% between 1995 and 2004), and smooth envelopes represented about 15%. CONCLUSION: Health agencies in France and Europe would benefit from a better knowledge of the use and follow-up of breast implants. These are plastic surgeon' or scientific society' responsibilities. A national breast implant registry may be a useful tool to gather information, to improve long-term follow-up and to provide better care to women concerned themselves with breast implant surgery.     

Breast Implant and Anaplastic Large Cell Lymphoma Meta-Analysis

Recent studies have shown a relationship between lymphoma and breast implants. We performed a meta-analysis about this problem. We found 80 cases, 50 of which were reported in the United States (62.5%). The average age was 52 years. The average time between breast implant surgery and lymphoma was 11 years. Forty-one percent of the breast implants were silicone, 42.19% were saline and 15.8% were unknown. The coverage of the breast implants was texturized in 21.3% and unknown in 78%. The most common brands were McGhan and Mentor. In 72.6% of the cases, the brand was unknown. The clinical findings were seroma (67.33%), nodes (13.8%), mass (22.1%), other (11.7%) and unknown (32%). The most common surgical treatment was capsulectomy and breast implant removal. In 97% of the cases, ALK was negative and 3% were positive. The most common marker was CD30. The most common chemotherapy regimen was CHOP. Three patients died. Two of the patients had extracapsular extension of the disease and breast cancer history. Lymphoma related with the breast implant was a different type of lymphoma, and in most cases, it was less aggressive. The disease was confined to the capsule. Few patients developed aggressive disease, were extracapsular and showed bad prognosis.     

脂肪抽吸和脂肪颗粒注射隆胸术

目的 :总结肿胀法脂肪抽吸 94例和 6例脂肪颗粒注射隆胸的病例 ,并对手术方法的要点进行了探讨。方法　脂肪抽吸采用了国内已被普遍应用的肿胀法 ,对切口周围皮肤的保护提出采用塑料套管。抽出脂肪量 10 0～ 475 0ml。脂肪颗粒隆胸 :分层注射 ,先从肋骨与胸大肌的间隙开始 ,然后在胸大肌、乳腺组织的间隙 ,皮下组织中均匀将脂肪注入 ,针头边注射边退出。结果　两侧乳房注射量为 15 7～ 2 6 5ml。所有病例中均取得良好效果。结论　证明了脂肪颗粒注射隆胸是一种切实可行的隆胸方法。     

国产充注式乳房假体62例应用报告

为了评估国产充注式乳房假体的临床效果，总结了１９９４年３月至１９９５年５月间手术的６２例１２３侧隆乳病例。假体由上海地区生产，容量２００～４５０ｍｌ，均置于胸大肌后间隙，术中假体作短暂性超定量注水，扩张周围组织。结果：１例假体因缝针误伤致术后乳房缩小，２例因伴乳房下垂欠满意，其余病例效果满意。３２例３个月随访时乳房外形对称，柔软，未见萎缩。认为，①国产充注式乳房假体的质量是好的。②术中假体短暂的超定量注水，扩张周围组织，优点明显，值得推荐。