FLUID RETENTION IN BIOPLASTY MISTI GOLD II BREAST PROSTHESES WITH DEVELOPMENT OF CAPSULAR CONTRACTURE

We compared the incidence of capsular contracture in an implant (Bioplasty Misti® Gold II) which has a textured surface and is filled with polyvinyl-pirrolidone (PVP)-hydrogel, with that in saline-filled implants with textured surfaces when the implants are placed subcutaneously during immediate reconstruction after subcutaneous mastectomy. In 41 patients, mean age 55 years (range 30-81), with breast cancer that was not suitable for breast conservation, 20 patients had 22 Misti Gold II prostheses inserted (two patients bilaterally) and 21 patients had saline-filled prostheses (one patient bilaterally). The development of capsular contracture was assessed using Baker's classification and applanation tonometry. Fourteen patients with Misti Gold II implants were classified one year postoperatively as Baker 2 and 3 compared with five with saline-filled implants (p     

Objective evaluation of two differently-shaped permanent expander prostheses used for breast reconstruction.

When a breast is being reconstructed with an implant, a capsule of connective tissue always forms around the implant and a capsular contracture can develop. Radiotherapy increases the incidence of capsular contracture. To evaluate the results after breast reconstruction with differently-shaped textured implants, and the effect of radiotherapy on the softness of the reconstruction, 140 patients given permanent breast expander prostheses between 1994 and 2000 were studied. In 99 patients a round implant and in 41 an anatomically-shaped implant was used. Radiotherapy was given to 24 patients. For objective assessment, applanation tonometry was recorded when the desired breast volume was achieved, and 6 and 12 months later. This study showed that, regardless of the shape of the implant, the softness of the breast reconstruction was similar, as shown by the contact area of the applanation tonometry disc. Radiotherapy transiently reduced the softness of the breast.     

Objective evaluation of two differently-shaped permanent expander prostheses used for breast reconstruction

When a breast is being reconstructed with an implant, a capsule of connective tissue always forms around the implant and a capsular contracture can develop. Radiotherapy increases the incidence of capsular contracture. To evaluate the results after breast reconstruction with differently-shaped textured implants, and the effect of radiotherapy on the softness of the reconstruction, 140 patients given permanent breast expander prostheses between 1994 and 2000 were studied. In 99 patients a round implant and in 41 an anatomically-shaped implant was used. Radiotherapy was given to 24 patients. For objective assessment, applanation tonometry was recorded when the desired breast volume was achieved, and 6 and 12 months later. This study showed that, regardless of the shape of the implant, the softness of the breast reconstruction was similar, as shown by the contact area of the applanation tonometry disc. Radiotherapy transiently reduced the softness of the breast.     

Clinical follow up of the lateral thoracodorsal flap in breast reconstruction: comparative evaluation from two plastic surgical centres.

A follow up study that compared the results from two plastic surgical centres comprised 95 patients after breast reconstruction with the lateral thoracodorsal (LTD) flap combined with either a smooth or textured saline-filled implant. It was conducted a median of 39 months (range 15-67) after the reconstruction. We investigated the size of the reconstructed breast and LTD flap, symmetry of the breasts, orientation of the mastectomy scar, and the rate of capsular contracture, which were similar in the two centres. However, according to the modified Baker classification and applanation tonometry reconstructions with smooth-surfaced implants and drainage of the implant pocket resulted in softer breasts (p = 0.03). The LTD flap technique in breast reconstruction was a good choice, particularly for women who required a minor breast reconstruction, and the technique can be recommended for suitable patients.     

Capsular contracture around saline-filled and textured subcutaneously-placed implants in irradiated and non-irradiated breast cancer patients: five years of monitoring of a prospective trial.

One hundred and seven breast cancer patients underwent subcutaneous mastectomy and immediate reconstruction with a subcutaneously-placed, round, saline-filled prosthesis with a textured surface. The primary aim of this prospective study was to determine the frequency of capsular contracture in both irradiated and non-irradiated breasts after this operation. Two different types of round implants with different pore sizes on their textured surfaces, Siltex and Microcell, were randomly chosen. Twenty-four patients received radiotherapy within the first year following the operation. Capsular contracture was measured by the Baker/Palmer classification and by applanation tonometry at regular intervals for 5 years or as long as the patients lived (median 60 months). Twenty-two patients (20.6%) developed capsular contracture, defined as Baker three or four. Sixteen of those were reoperated, 15 with open capsulotomy with or without implant exchange, one with closed compression capsulotomy, and monitored thereafter for 5 years or until death (median 60 months). All 107 patients could be monitored for 2 years, while 87 reported for the 5-year follow-up. The rate of capsular contracture was significantly higher (p=0.01) for irradiated breasts than for non-irradiated ones, 41.7 and 14.5%, respectively. It was slightly higher (p<0.05) for large-pore implants than for those with smaller (and more numerous) pores. There was a good correlation between the two different methods for measuring capsular contracture. None of the 16 reoperated patients had a recurrence of capsular contracture within 5 years. The results indicate a high rate of capsular contracture after this operation, especially when followed by radiation. However, a fairly simple procedure to treat capsular contracture seems to give good long-term results.     

CLINICAL FOLLOW UP OF THE LATERAL THORACODORSAL FLAP IN BREAST RECONSTRUCTION: COMPARATIVE EVALUATION FROM TWO PLASTIC SURGICAL CENTRES

A follow up study that compared the results from two plastic surgical centres comprised 95 patients after breast reconstruction with the lateral thoracodorsal (LTD) flap combined with either a smooth or textured saline-filled implant. It was conducted a median of 39 months (range 15-67) after the reconstruction. We investigated the size of the reconstructed breast and LTD flap, symmetry of the breasts, orientation of the mastectomy scar, and the rate of capsular contracture, which were similar in the two centres. However, according to the modified Baker classification and applanation tonometry reconstructions with smooth-surfaced implants and drainage of the implant pocket resulted in softer breasts (p = 0.03). The LTD flap technique in breast reconstruction was a good choice, particularly for women who required a minor breast reconstruction, and the technique can be recommended for suitable patients.     

不同类型乳房假体隆乳术后并发症的临床分析

目的 统计不同类型的乳房假体置人人体后，远期并发症发生的几率，并分析其原因。方法 总结1993年至2002年间假体隆乳573例，随访到手术方法相同、假体放置位置相同、同一医生组手术的隆乳妇女427例共852只乳房，使用4种不同类型乳房假体：毛面硅凝胶、光面硅凝胶、毛面生理盐水充注式、光面生理盐水充注式乳房假体。出现的远期并发症有纤维包膜挛缩、假体破裂渗漏、疼痛移位等，对各种假体并发症发生率进行统计分析，比较各类假体的优劣。结果 427例852只中803只效果满意，无明显并发症，占94．24％。发生并发症者42例49只乳房，占5．76％。并发症中乳房硬化属Baker‘s分级Ⅲ～Ⅳ级的有26只，缩小变形24只，移位疼痛10只，经手术取出发现假体破裂渗漏的有30只。其中纤维包膜挛缩引起乳房硬化多发生于硅凝胶假体，假体渗漏引起乳房缩小变形多发生于生理盐水充注式假体；假体在体内放置时间越长，发生并发症的几率越高。结论 经统计学处理发现，光面生理盐水假体并发症明显少于光面硅凝胶假体，毛面硅凝胶假体和毛面生理盐水假体并发症发生率没有明显差异。49只有不同并发症的乳房假体中有30只假体破裂渗漏，占61．22％，假体破裂渗漏后又容易引发其它并发症，说明假体质量的提高是减少并发症的关键，长期留置体内假体的老化是目前的难题。     

Textured or smooth implants for breast augmentation? A prospective controlled trial

This study examines the hypothesis that textured surface silicone implants reduce the incidence of adverse capsular contracture in breast augmentation. A total of 53 patients were entered into a prospective study; they were randomly assigned to receive either smooth or textured implants which were placed in the submammary plane. Of these, 50 patients were assessed at 12 months by a panel of observers who did not know which type of implants had been used. Adverse capsular contracture (Baker grades 3 and 4) was found in 28 breasts augmented with smooth surface implants (58%) and in 4 breasts in the textured surface implant group (8%). This reduction in adverse contracture using textured surface implants was highly significant (p less than 0.0001). Careful trial design is essential in studies of this sort in order that we can obtain useful data regarding the causes and prevention of adverse capsular contracture.     

Effect of cortisone on capsular contracture in double-lumen breast implants: Ten years' experience

Two groups of patients are compared with respect to capsular contracture after insertion of silicone breast prostheses. Six hundred seventy four women received single-lumen gel prostheses and 700 received double-lumen prostheses with cortisone. The addition of 12.5 mg of prednisolone to double-lumen prostheses diminished capsular contracture (Baker II to IV) dramatically; in patients with simple augmentation from 19% to 4.9%, in patients with subcutaneous mastectomy from 54% to 14.9%, and in patients with breast reconstruction from 64% to 24.4%. The use of double-lumen implants has three distinct advantages: (l) There is no bleeding and therefore no contact of the body with the silicone gel. (2) There is no danger of ruptured implants, even if the outer shell shows leakage. (3) if prednisolone is administered, capsular contracture is prevented to a significant degree.     

毛面乳房假体和光面乳房假体隆乳术后包膜挛缩率的Meta分析

目的 利用Meta分析方法定量比较光面乳房假体和毛面乳房假体隆乳术后的包膜挛缩发生率.方法 以breast augmentation、capsular contracture、smooth implant、textured implant、隆乳、乳房假体等检索词在MEDLINE数据库、EMBASE数据库、Cochrane图书馆、中国生物医学文献数据库、维普生物数据库等检索,最大限度地收集毛面乳房假体和光面乳房假体隆乳的文献,提取其包膜挛缩和其他并发症的数据进行整合,以获得比值比（odds ratio,OR）合并值.各合并数据使用RevMan 5.2软件进行分析.结果 对11项研究毛面乳房假体和光面乳房假体的临床对照试验进行Meta分析后得出,包膜挛缩发生率的合并OR值为0.32,95％可信区间（CI）为0.18～0.58,P=0.0002.除包膜挛缩外,其他并发症发生率的合并OR值为1.31,95％ CI为0.96～1.77,P=0.09.结论 毛面乳房假体隆乳术后发生包膜挛缩风险低于光面乳房假体.     

Does the Surface Structure of Implants Have an Impact on the Formation of a Capsular Contracture?

Background The formation of a fibrous capsule around a silicone breast implant is part of a physiologic foreign body reaction after breast augmentation. In contrast, the formation of a capsular contracture is a local complication of unknown cause. This study aimed to discover whether the surface structure of the implant (textured vs smooth) has any impact on the formation of a capsular contracture. Methods This prospective study included 48 female patients with unilateral capsular fibrosis grades 1 to 4 in Baker’s clinical scaling system. Of these patients, 14 received implants with a textured surface (Mentor), and 34 received implants with a smooth surface (Mentor). The implants all were placed in a submuscular position by the same experienced plastic surgeon. The clinical data were assessed using standardized patient questionnaires. For histologic diagnosis, operatively excised capsular tissue was examined. Preoperatively, venous blood samples for determining serum hyaluronan concentrations were taken from the patients. The control group consisted of 20 patients without capsular fibrosis. Results The separate analysis of clinical data for the patients with textured and those with smooth-surfaced breast implants showed a slightly reduced degree of symptoms for the patients with textured silicone breast implants, as compared with those who had smooth-surfaced implants. The histologic assessment of the fibrosis showed a symmetric distribution for Wilflingseder scores 1 to 3 (29% each), whereas 13% of the capsular tissues could be assigned to Wilflingseder score 4. In contrast, the histologic assessment of the patients with smooth-surfaced implants predominantly showed a Wilflingseder score of 3 (65%). The serologic investigations via enzyme-linked immunoassay (ELISA) showed serum hyaluronan concentrations of 10 to 57 ng/ml (25.0 ± 11.7 ng/ml). Therefore, no statistically significant differences in terms of serum hyaluronan levels could be determined between the two groups of patients. In comparison with the control group, the patients with implants showed elevated serum hyaluronan levels (p < 0.05). Conclusions The histologic examination and serum hyaluronan concentration analysis showed no statistically significant difference between smooth-surfaced and textured implants (Mentor) with respect to the development of capsular contracture. On the other hand, the severity of capsular contracture showed a positive linear correlation with the degree of local inflammatory reactions, which were independent of the implant surface.     

Colchicine and capsular contracture around breast prostheses

Capsular contracture around the prosthetically reconstructed, breast is a very common problem which often leads to an unacceptable result. Colchicine, a drug known to inhibit contracture activity, was studied in an animal model of capsular contracture. Twenty-four 130 cc silicone gel breast prostheses were implanted subcutaneously into twelve rabbits. Colchicine was given daily in oral doses to half of the animals; the other half were used as controls. The prostheses were maintained insitu for two months. The degree of capsular contracture, as measured by applanation tonometry, was significantly less in the colchicine treated groups. The difference was often visually apparent. This study appears to be the first to demonstrate a significant inhibition of capsular contracture in an animal model by colchicine, an oral medication commonly used in the treatment of gout.Hospital where the work was done: Providence Hospital Southfield, Michigan, USA Correspondence to: C.B. Kelly     

The Postoperative Shape of Round and Teardrop Saline-filled Breast Implants

Background: Teardrop saline-filled breast implants have been portrayed as having a more natural shape and appearance than round saline-filled implants. However, there are no data in the literature supporting this assertion. Objective: This study was conducted to evaluate the postoperative shape of round implants and compare it with the shape of teardrop implants. Methods: With patients upright and with nothing touching the breasts, lateral radiographs were taken to document the in vivo shape of breast implants. A total of 14 round saline-filled implants in 7 breast augmentation patients were studied. Implants included both smooth-surface and Siltex textured-surface models. Some implants were placed submuscularly and others subglandularly. None of the patients had capsular contracture. For comparison, 12 teardrop saline-filled implants in 6 breast augmentation patients were studied; all of these patients had BioCell textured-surface implants placed submuscularly, and none had capsular contracture. Results: Lateral radiographs with patients upright show that round and teardrop implants have similar teardrop shapes in vivo. Postoperative photographs also show a similar appearance. Lateral radiographs with patients recumbent show that the teardrop implant remains teardrop-shaped whereas the round implant settles back evenly. Conclusions: Although round and teardrop implants exhibit significantly different shapes on a table, they have similar teardrop shapes in vivo with patients upright. Because the appearance of the breasts with patients upright is similar for the 2 implant types, there is no basis for the claim that teardrop implants provide a more natural appearance. Round implants are actually more “anatomical” because they are teardrop-shaped with patients upright and settle back evenly with patients recumbent, as do normal breasts.     

Breast reconstruction with polyurethane implants: preliminary report

Today, immediate breast reconstruction is widely accepted in breast cancer surgery. There are many reconstruction procedures that combine cancer indications with patient's expectations. Improved techniques in the use of textured or polyurethane-coated implants and tissue expanders, associated with increasingly more conservative mastectomy procedures, may result in better cosmetic outcomes and less complications, even in patients that require postoperative radiotherapy. From June 2002 to December 2008, 166 unilateral breast reconstructions were performed immediately using definite prosthesis with polyurethane-coated (6) or textured (24) implants, or later, after implant of 136 tissue expanders, using polyurethane-coated (113) or textured (23) implants. Eighty-six two-stage breast reconstructions were irradiated where later 63 polyurethane-coated implants and 23 textured implants have been inserted. Results were analysed evaluating complications associated with temporary expanders and with the two definite implants, with or without RT, respectively. Excluding capsular contracture, total complication rate was 14.7% with expanders, 5.0% with polyurethane implants and 12.8% with textured implants. In this study, severe capsular contracture was reported in 21.7% of cases with textured prosthesis and in 6.3% of cases with polyurethane implants in patients receiving RT. This difference was statistically significant. As of today, no case of clinically noticeable capsular contracture was seen in non-irradiated patients receiving breast reconstruction with polyurethane-coated implants. These results allow us to establish RT, which is not a severe contraindication to breast reconstruction with implants. Polyurethane implants have provided encouraging results either in terms of lower complication rate and likelihood of capsular contracture.     

Capsular contracture after cosmetic breast implant surgery in Denmark

The authors investigated the association between the occurrence of capsular contracture and implant and patient characteristics. All women with breast implants from 1977 to 1997 were identified from the files of two private plastic surgery clinics in Denmark. Information on implant and patient characteristics, surgical procedure, and complications was obtained through medical records and self-administered questionnaires. Of 754 women (1,572 implants), average age at implantation was 32 years. Implant types were silicone double lumen, textured, 31.2%; silicone single lumen, textured, 27.8%; silicone single lumen, smooth, 24.5%; silicone double lumen, smooth, 0.8%; and other or missing, 15.7%. Placement was submuscular for more than 90% of implants. Capsular contracture occurred in 7.9% of implanted breasts, on an average of 621 days postoperatively, with 51.6% being bilateral. Overall, 66.1% of capsular contractures were recorded within the first 12 months postoperatively, and 79.0% were recorded within 24 months. Double-lumen implants were associated with a significantly (p < 0.01) reduced occurrence of capsular contracture. In summary, capsular contracture typically occurs within the first 2 years of implantation. Host factors may be important because more than half the capsular contractures in the current study were bilateral. Occurrence of capsular contracture did not appear to be associated with implant surface or placement, occurrence of local complications, or patient characteristics, although these findings should be interpreted cautiously.     

毛面与光面乳房假体隆乳术后并发包膜挛缩的系统评价

目的 对毛面乳房假体与光面乳房假体隆乳术后并发BakerIII级以上包膜挛缩的发生率进行系统评价.方法 计算机检索Medline(1966年5月至2006年5月)、Embase(1966年5月至2006年5月)、Cochrane图书馆(2005年第2期)和中国生物医学文献数据库(1979年5月至2006年5月),人工检索《中华整形外科杂志》(1985年创刊至2006年5月)和《Plastic and Reconstructive Surgery》(新疆医科大学图书馆馆藏期次),收集所有相关随机对照及半随机对照试验,采用RevMan 4.2.8进行Meta分析.结果 通过对6个随机对照试验进行系统评价,采用毛面乳房假体隆乳术后1、10年并发Baker Ill级以上包膜挛缩发生率明显低于光面乳房假体(P＜0.05).结论 毛面乳房假体隆乳术Baker III级以上包膜挛缩的发生率明显低于光面乳房假体.     

Late hematoma after aesthetic breast augmentation with saline-filled,textured silicone prosthesis

Late, progressive enlargement of the breast after augmentation mammaplasty is an extremely rare complication. We present two cases of late capsular hematoma after augmentation mammaplasty with saline-filled, textured silicone implants. The MRI and C-T scan both clearly showed fluid accumulated within the capsule in one case. In this patient, we examined the interior of the fibrous capsule endoscopically, finding no persistent bleeding source. However, the inner lining had granulated tissue with new capillary ingrowth. After replacement with smooth-surface prostheses, neither patient had recurrence of the complication. No identifiable etiology could be demonstrated, however, the breakdown of an eroded capsular artery is suspected, caused by friction between the rough surface of the textured prosthesis and the fibrous capsule.     

Late and Long-Standing Capsular Hematoma After Aesthetic Breast Augmentation with a Saline-Filled Silicone Prosthesis: A Case Report

Late capsular hematoma is an extremely rare complication after the implantation of silicone breast prostheses for aesthetic or reconstructive objectives. We present a unique case of late capsular hematoma in an aesthetic breast augmentation with a saline-filled, textured silicone implant, which remained for a year after formation.     

Applanation tonometry for the evaluation of breast compressibility

Capsular contracture is the main problem following breast augmentation with silicone implants. Subjective assessment has been the predominant method for evaluating breast firmness hitherto, although several objective methods have been described. In this prospective study applanation tonometry was used on 76 women following augmentation mammaplasty. Breast firmness was measured five times during the first postoperative year. Approximation of the breast imprint area to an ellipse was shown to be accurate and to simplify the estimation of the applanation surface, which is proportional to breast compressibility. The results correlated well with the subjective assessments using the Breast Augmentation Classification (BAC). A classification based on applanation tonometry is presented.