Epidemiological investigation of local complications after cosmetic breast implant surgery in Denmark

Concern has been raised recently regarding the absence of information on the occurrence and severity of local complications after cosmetic breast implantation. The authors evaluated the occurrence of local complications in a large epidemiological retrospective cohort study of women with cosmetic breast implants in Denmark. All women with breast implants were identified from the files of two private clinics of plastic surgery in Denmark. Information on implant characteristics, surgical procedure, as well as short- and long-term complications was obtained through medical record review. Patient characteristics were obtained through a self-administered questionnaire. A total of 754 women (1,572 implants) had at least one cosmetic implantation performed at the study clinics. Average age at implantation was 32 years. Implant types included silicone double lumen with textured surface, 31.2%; silicone single lumen with textured surface, 27.8%; silicone single lumen with smooth surface, 24.5%; silicone double lumen with smooth surface, 0.8%; and other or missing information, 15.7%. Average implant size was 247 ml (range, 110-630 ml). Placement was submuscular for 91.3% of implants, subglandular for 2.6%, and 6.1% had no available information. Overall, 77.8% of implantations were not followed by complications, 17.8% were followed by one complication, 3.6% were followed by two complications, and 0.8% were followed by three or more complications. In 94.6% of implantations, no additional hospitalizations were recorded as a result of complications. Forty-seven of 57 explantations/reimplantations were secondary to postoperative complications. General complications such as hematoma and infection were rare, occurring in 2.3% and 2.0% of implantations respectively. Capsular contracture remains the most common complication, occurring in 11.4% of implantations. In this investigation, among the first epidemiological studies of local complications, the authors found cosmetic breast implant surgery to be associated with a low frequency of normal surgical complications such as infection, hematoma, and wound dehiscence. Most complications were mild and did not lead to additional hospitalization. The complication that led most frequently to the need for additional surgery/hospitalization was capsular contracture. Kj?ller K, H?lmich LR, Jacobsen PH, Friis S, Fryzek J, McLaughlin JK, Lipworth L, Henriksen TF, J?rgensen S, Bittmann S, Olsen JH. Epidemiological investigation of local complications after cosmetic breast implant surgery in Denmark.     

Local complications after cosmetic breast implant surgery in Finland

Concerns regarding potential health effects of silicone breast implants have recently shifted from long-term illnesses to postoperative local complications. In this study, occurrence of local complications and treatment procedures were evaluated in a population of 685 Finnish women who received cosmetic silicone breast implants between 1968 and 2002. Patient records were abstracted, and additional information was gathered using a structured questionnaire that was mailed to 470 of the women in the cohort. Overall, 36% of the women had 1 or more diagnoses of postoperative complications in their medical records. The most common complication was capsular contracture, occurring in 17.7% of women and 15.4% of implantations. Other complications were more rare. The majority of women (74%) needed no postoperative treatment. However, 22% of women required 1 or more surgical procedures after the primary implantation. Most of the women were satisfied with the implantation, but only 40% considered the preoperative information on possible risks related to implantation as sufficient. With respect to the occurrence of local complications following cosmetic breast implantation, the findings of this study are consistent with previous studies. Frequencies of complications were remarkably similar in medical records and self-reports.     

Capsular contracture after breast reconstruction with tissue expansion

Tissue expansion before placement of an implant for breast reconstruction is said to lessen the chance of capsular contracture. Forty-nine patients who had undergone post-mastectomy breast reconstruction using tissue expansion were reviewed. Capsular contracture was assessed using the Baker scale and compared with the speed of expansion, the degree of over-expansion and the interval between full expansion and placement of the definitive prosthesis. The overall incidence of capsular contracture (Baker III or worse) was 29%. Only one patient, however, has required capsulotomy for capsular contracture alone. Neither the speed of expansion nor the degree of over-expansion influenced the onset of contracture. Those patients with breasts assessed in Baker group I had a significantly longer interval between full expansion and reconstruction than those in Baker group III (p = 0.05). A modification of Baker's scale is suggested for the assessment of reconstructed breasts. Prospective studies are required to define the optimum timing for tissue expansion procedures.     

Health-related quality of life issues after cosmetic breast implant surgery in Finland

The purpose of this study is to compare women with cosmetic breast implants with population controls to examine health-related quality of life. A questionnaire including quality-of-life questions was mailed to 399 Finnish women who had had cosmetic breast implants during the years 1973-2002. The response rate of the study was 85. Results were compared with average Finnish women from a representative population sample. There were no differences in total score of health-related quality of life between women with breast implants and controls. Women with breast implants had lower health-related quality of life in dimensions of distress and sexual activity and partly also in dimensions of sleeping and mental function when compared with controls. On the other hand, operated women reported significantly less discomfort and symptoms than controls. Differences in health-related quality of life between women with breast implants and controls were largest in dimensions of distress, sexual activity, sleeping, and symptoms.     

Capsular contracture after breast reconstruction with the lateral thoracodorsal flap

Early postoperative manipulation of breast implants in patients who underwent breast reconstruction utilizing a lateral thoracodorsal falp is described. This manipulation did not reduce the rate of firm capsular contracture after the reconstruction with the flap, but only postponed its development. Open capsulotomies, however, yielded stationary soft breasts to a statistically significant extent. The patient's acceptance, of the reconstructed breast as a natural part of her own, body was high. It was not influenced by the occurrence of firm capsular contracture.     

Capsular contracture and ripple deformity of breast implants

Our surgical understanding and preference for an implant design suggests that location of the implant in the retromuscular plane gives an aesthetically better looking clinical result, there is less rippling when the chest wall is vertical, and the implant flattens when the patient is lying supine. An implant with a textured posterior wall and smooth anterior wall assists adherence of the implant at the desired level. It also induces a pseudo-bursa over its anterior surface which, being larger than the implant surface, allows it to flatten naturally when the patient is lying or raising the arm. A gel-filled implant gives the most natural quality to an implant and the contents displace less readily and therefore do not tend to cause rippling.     

Capsular contracture in subfascial breast augmentation: recommendations and treatment

Capsular contracture is the most common long-term complication of breast augmentation. In subfascial breast augmentation, there had been reports of 0% to 2% of capsular contracture (Serra-Renom et al., Plast Reconstr Surg 116:640–645; Ventura and Marcello, Aesthetic Plast Surg 29:379–383; Tijerina et al., Aesthetic Plast Surg 34:16–22; Graf et al., Plast Reconstr Surg 111(2):904–908). Graf et al. mentioned a 2.3% of capsular contracture grade II in 263 patients that underwent subfascial breast augmentation (Graf et al., Plast Reconstr Surg 111(2):904–908). There are several theories that can explain the presence of a capsular contracture, and the most described are: the microbiology theory and the contamination of the pocket due to a foreign body (Araco et al., Plast Reconstr Surg 124(6): 1808–1819; Schaub et al., Plast Reconstr Surg 126(6): 2140–2149). In 5?years, 35 patients with breast augmentation were considered for surgical treatment for capsular contracture. From 35 patients, only 4 patients were operated by us initially, the remaining 31 came to us as new patients with a capsular contracture. Each patient had different characteristics and was classified with the Baker scale. Depending on the grade (I–IV) and clinical characteristics of the patient, the surgical treatment was selected between a subcapsular pocket, total capsulectomy with or without implant, or radiation of the capsule. Thirty-five patients were considered for surgical treatment for a capsular contracture. All of our patients had great outcome at short and long term without any signs of complications. Twenty-seven patients were followed for 2?years postop, and 8 patients treated with a subcapsular pocket have less than 2?years of follow-up. In patients with less mammary gland tissue, a subcapsular pocket had reduced the risk of complications of a total capsulectomy due to close relationship between the skin and the capsule. There are several complications that could be present with a total capsulectomy, which are: tissue necrosis, breast irregularities, and/or damage to the skin. This technique had produced great results in patients with lo mammary tissue and a capsular contracture. Capsular contracture is the most common long-term complication in breast augmentation. There are several techniques that can be reproduced to have better outcomes and reduce the risk of complications. We recommend the use of these strategies to help in the treatment of capsular contracture.     

Capsular contracture in augmentation mammaplasty

In a group of 331 augmentation mammaplasties performed at the Clinic of Plastic Surgery in Prague from 1994-1998, capsular contracture was recorded in 6% cosmetic and 12% of reconstruction operations. The main cause was, in particular, the quality of tissue surrounding the implants along with individual disposition. The incidence of this complication did not differ significantly in relation to the placement of the prosthesis beneath the muscle or gland. Based on histological analysis and the clinical finding, it is obvious that disintegration of the prosthesis does not always lead to severe grades of capsular contracture. It is despite the presence of foreign bodies in the connective tissue.     

Characteristics of women with cosmetic breast implants compared with women with other types of cosmetic surgery and population-based controls in Denmark

Herein the authors describe characteristics of women with breast implants compared with women with other types of cosmetic surgery as well as population controls. All women who acquired breast implants from 1977 to 1997 were identified from the files of two private plastic surgery clinics in Denmark. Patient characteristics were obtained through a self-administered questionnaire. The magnitude of differences between patient and control groups was estimated using odds ratios and 95% confidence intervals. Women with breast implants had a significantly lower body mass index and reported a two-fold greater incidence of current smoking compared with women from the general population and compared with women with other cosmetic surgery. Women with implants reported a greater number of full-term pregnancies and were less likely than controls to have had their first birth at age 30 years or older. Women with implants were not more likely than women in either control group to report a history of diseases, including connective tissue diseases, cancer, or depression before their implant surgery. Women with cosmetic breast implants differ from women with other forms of cosmetic surgery and from general population controls with respect to characteristics that may importantly influence health outcomes and that need to be addressed in future breast implant studies.     

硅胶囊隆乳术后包膜挛缩改用聚丙烯酰胺水凝胶填充的临床观察和分析

用聚丙烯酰胺水凝胶替换硅胶囊进行隆乳术,以解决硅胶囊隆乳术后常见的包膜挛缩。采用手术方法对４ 例硅胶囊隆乳术后反复变硬的病人,改用此材料置入原腔穴。经术后３～６ 个月的观察,效果较满意,仅１ 例外形欠佳,术后未见血肿、感染、变硬。对以前采用硅胶囊多次变硬的患者,我们认为可以改用聚丙烯酰胺水凝胶进行填充。     

Early experience with an anatomical soft cohesive silicone gel prosthesis in cosmetic and reconstructive breast implant surgery

Recently, an anatomic breast implant filled with soft cohesive silicone gel was introduced by Mentor Medical Systems onto the European market. This study reports the early experience of a single surgeon with this implant. All patients who received a Contour Profile Gel (CPG) implant from March 2001 to October 2002 were studied. Patient satisfaction with breast shape and consistency was assessed using linear analogue scales with a maximum score of 10. Thirty-five patients received CPG implants for cosmetic (10 patients, 20 breasts) and reconstructive (25 patients, 31 breasts) surgery purposes. Patients were satisfied with their breast shape (mean score: 8.3). Eighty-five percent of the breasts were rated as soft (score >/=6). No serious esthetic complications such as implant malposition or significant capsular contracture were observed. Anatomic soft cohesive gel implants provide excellent results in selected cases. They are well accepted by patients and not associated with an increased rate of complications.     

Risk of breast implant removal after one- versus two-stage breast reconstructive surgery

BackgroundTo date, both one- and two-stage techniques are used in immediate ‘implant-based breast reconstruction’ (IBBR) after mastectomy. Because it is still unknown what technique offers the best clinical outcomes, a multicenter retrospective study was conducted to compare both breast reconstruction techniques.MethodsAll patients, who underwent a mastectomy followed by immediate one- or two-stage IBBR during 2010 - 2016 were included. Our primary outcome measure was explantation of the ‘tissue expander’ (TE) and/ or implants within 60 days after breast reconstruction. Secondary outcomes were overall complication rate and secondary corrections.FindingsAmong a total of 383 women, TE/ implant explantation rate was higher in one-stage (19.9%) than in two-stage (11.3%) treated patients (p = 0.082). Overall complication rate (35.7% and 19.9% respectively, p = 0.008) and secondary corrections (29.8% and 20.3% respectively, p = 0.156) were also higher in one-stage compared to two-stage IBBR respectively. However, explantation (OR = 1.55; 95%CI = 0.67-3.58, p = 0.301) and complication (OR = 1.85; 95%CI = 0.92-3.37, p = 0.084) rates were comparable in one- and two-stage IBBR in our stratified multivariate logistic regression analyses, when controlling for history of smoking, nipple-sparing mastectomy, neoadjuvant radiation therapy, and removed breast tissue weight. A remarkable outcome in this study is that women treated with prophylactic surgery were more likely to have an explantation of the TE/ implant after a one-stage IBBR (OR = 4.49; 95%CI = 1.10-18.3, p = 0.037) than two-stage IBBR. In contrast, no association between type of IBBR and risk of TE/implants removal was found among women with a therapeutic mastectomy (OR = 0.82; 95%CI = 0.24-2.79, p =  = 0.74).ConclusionOne- and two-stage IBBR showed a comparable explantation and complication rate in our retrospective study. In one-stage IBBR more secondary corrections were detected. In addition, women who have to decide on a prophylactic mastectomy should be aware of a significantly higher risk of explantation of their implant after one-stage IBBR.