Accuracy of mammography, sonography and magnetic resonance imaging for detecting silicone breast implant ruptures: A retrospective observational study of 367 cases.

INTRODUCTION: The purpose of this study was to assess the efficacy of magnetic resonance imaging, ultrasound and mammography in detecting breast implant rupture. METHODS: This retrospective study included all cases of breast implant revision. Implant integrity was determined preoperatively by magnetic resonance imaging, ultrasound and mammography. The primary study endpoint was the surgical finding. The sensitivity, specificity, positive and negative predictive value and positive and negative likelihood ratio of the tests were evaluated. RESULTS: Two hundred and thirty-four (234) patients were included; 213 mammographies, 295 ultrasounds and 160 magnetic resonance imagings were carried out. While 114 clinical ruptures were confirmed, 253 implants remained intact. Magnetic resonance imaging was the most sensitive (99%); outperforming mammography (sensitivity: 70%). Mammography was the most accurate in diagnosis of intact implant (specificity: 93%), and magnetic resonance imaging was second (specificity: 78%). Ultrasound was rated intermediately. Positive mammography signifies a rupture in 84% of cases, whereas magnetic resonance imaging (positive predictive value: 78%) can be mistaken in 20% of cases. Negative ultrasound and magnetic resonance imaging rule out a rupture (negative predictive value of 93% and 99% respectively). Mammography and ultrasound are more accurate than magnetic resonance imaging in diagnosing implant rupture (positive likelihood ratios of 9.78, 8.24 and 4.44 respectively). Magnetic resonance imaging provides convincing affirmation of implant integrity (negative likelihood ratio: 0.02). CONCLUSION: Ultrasound seems to be the most reliable imaging method for patients younger than 50 years. In cases where doubt exists, mammography ensures supplementary assessment. In patients over 50 years of age, mammography and ultrasound should be carried out immediately. If necessary, magnetic resonance imaging rules out a hypothesized rupture.

[Concomitant breast surgery with a vertical latero-thoracic incision in continuity with a brachioplasty incision: About twelve (12) cases after massive weight loss]. / Plastie brachio-thoraco-mammaire : à propos de 12 cas après amaigrissement massif.

INTRODUCTION: The need of iterative surgeries, the proximity of two anatomical areas, the combination of an aesthetic surgery with a surgery covered by health insurance are the reasons which motivated the authors to provide a simultaneous procedure on arms and breast in patients achieving massive weight loss. We propose a vertical continuation of the lateral mastopexy incision superiorly, in continuity with a simultaneous brachioplasty incision to treat the excess skin and subcutaneous tissue of the lateral chest wall, either by resection, or by increasing the breast with the patients own autologous tissue. METHODS: Between 2010 and 2017, twelve patients aged between 31 and 56 years, with 42 being the average, have undergone a technique that utilises a vertical continuation of the lateral mastopexy incision superiorly, in continuity with a simultaneous brachioplasty incision: transverse skin incisions and free nipple transplantation for correction of extreme gynaecomastia (2 cases), mastopexy with resection of the excess tissue of the lateral chest wall (8 cases), autologous breast augmentation by the use of intercostal artery perforator flaps (2 cases). Mean body mass index (BMI) was 24kg/m2 [23; 32] after average weight loss of 56kg [14; 112] following diet (3 cases) or bariatric surgery (9 cases). RESULTS: Mean operative time was 4hours [3: 6], mean length of hospital stay was 4 days [2; 9]. We observed one major complication (hematoma) and one minor complication (wound dehiscence). At a mean follow-up of 21 months (ranged from 15 days to 84 months), the lateral flank scarring was well tolerated, with the additional benefit of reducing flank fullness. CONCLUSION: The extended lateral flank scar allows reducing the excess skin and subcutaneous tissue of the lateral chest wall, while being easily concealable. This technique offers an elegant solution to this excess that used to persist after multistage surgeries.

[Thirty-six (36) French cases of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL): What do we know about their prosthetic histories, and what conclusions may be drawn?] / Trente-six cas français de lymphomes anaplasiques à grandes cellules associés aux implants mammaires. Que savons-nous sur leur histoire prothétique ?

INTRODUCTION: Breast implant-associated anaplastic large cell lymphoma is a recent pathology; the one known risk factor is breast implantation. METHODS: A retrospective study was conducted on the French BIA-ALCL cases diagnosed by the Lymphopath network and reported to the National Medical Safety Agency (ANSM). Wishing to obtain supplementary data on the prosthetic history of implants, we sent the referent surgeons a questionnaire. RESULTS: By combining the relevant ANSM data and questionnaire data, we studied the histories of 32 unilateral cases of BIA-ALCL and 2 bilateral cases of BIA-ALCL. Mean patient age on diagnosis was 59 (29; 83). Twelve BIA-ALCL cases occurred after breast augmentation for esthetic purposes, 22 following mastectomy for neoplasia and 2 after symmetrization of the contralateral breast in reconstruction. Fifteen BIA-ALCL cases were diagnosed on single prostheses, all of them macrotextured with macrotexturing obtained by projection of biocell salt crystals, also known as the biocell "salt loss" technique. The other 21 BIA-ALCL cases were diagnosed on multiple prostheses (2 to 5), and all of them had had at least one contact with a biocell implant. Mean duration of exposure to implants was 11 years (4; 31). Mean duration of exposure to the macrotextured shell surfaces obtained by the salt loss technique was 9 years (2; 23). Six patients were exposed to a temporary macrotextured Expander implant obtained with the aforementioned salt loss technique. No patient was exposed to the macrotextured Expander implant alone. CONCLUSION: Salt loss macrotextured implants, particularly those of the biocell-type, were found in the prosthetic history of all 36 BIA-ALCL cases in this series.

Designing a minimally-invasive, ultrasound-guided, percutaneous flexor tendon sheath lavage technique: a cadaver study.

The goal of this study was to develop a minimally-invasive, ultrasound-guided percutaneous flexor tendon sheath lavage technique on cadaver model. Two catheters were inserted using ultrasound guidance at the proximal and distal ends of the tendon sheath in 20 fingers from cadaveric forearms. Percutaneous injection of a saline solution colored with methylene blue resulted in anterograde lavage of the flexor tendon sheath. The technique was successful in 13 out of 20 cases. The proximal catheter was in the correct position in 17 cases and the distal catheter was correctly positioned in 15 cases. The flexor tendons were continuous in all cases and had puncture wounds in 9 cases. Based on our study, this minimally-invasive, ultrasound-guided percutaneous lavage of the flexor tendon sheath was effective in 65% of cases and safe in 100% of cases in the index, middle and ring fingers. If this percutaneous lavage fails, it is always possible to switch to a conventional open technique.