Future directions in breast implant surgery.

Breast implant surgery will remain a major component of the practice of plastic surgery. The future may hold promise for the introduction of new implants for the augmentation of the breast and for reconstruction. The constant demand and pressure placed on the manufacturers to keep developing new fillers are proof that satisfaction with saline implants is lacking. Today, however, the saline implant may be believed to be the safest breast implant available for clinical application. The demand necessitates that implants be used for enhancement of a woman's self image and for reconstruction. The smooth-surface implants are considered more popular and safer for patients, perhaps because it has been well documented that the shell may have been the cause of the problem. However, the constancy in holding on using and reapplying the same principles of a faulty shell may not be as scientific an endeavor as we have done in the past, and to keep placing different fillers in the faulty shell. Perhaps the lamination process used in manufacturing, the air in the shell, or wear and tear produces mechanical weakening of the shell that eventually will lead to loss of integrity of the silicone-shell breast implant. The global community is looking to plastic surgeons for a solution. The applications and the demand for breast implants are global in nature. Meanwhile, as clinicians are waiting for a new implantable breast device, they will continue to use what is available and advise patients that the implantation of a breast prosthesis is not a life-long endeavor. There is a need, however, for the implants to be maintained by the process of exchange every 8 to 10 years. Breast reaugmentation is to be performed as a standard because plastic surgeons will be waiting for further clarifications from the regulators or the scientific community. The goal is to produce a good outcome and maintain safety for the patients with a high standard of care.

Mutations in the gene encoding c-Abl-binding protein SH3BP2 cause cherubism.

Cherubism (MIM 118400) is an autosomal dominant inherited syndrome characterized by excessive bone degradation of the upper and lower jaws followed by development of fibrous tissue masses, which causes a characteristic facial swelling. Here we describe seven mutations in the SH3-binding protein SH3BP2 (MIM 602104) on chromosome 4p16.3 that cause cherubism.

Functional impact of distraction osteogenesis of the midface on expressive language development.

This is a discussion of the impact of distraction osteogenesis on the major function of communication as noted in oral motor control for expressive language. Our experience has been primarily with preadolescent and adolescent patients of school age whose expressive language skills are undergoing continuing development.

New refinements in controlled depth osteotomy (CDO).

To enhance the safety of the patient a controlled depth (CD) osteotomy cutter was designed. The power-oriented depth controlled osteotomy cutter (PODCO) was developed and used in patients and infants craniofacial surgery. As the power equipment was technologically advanced, a new design allowed us to keep the same principle with a technologically advanced cutter. The new 1 mm cutter allows the surgeon to dial in the desired depth so that the osteotomy can be performed with precision and enhanced safety to the patient.

Cleft palate: modern technology and neuroscience merge.

This is a report of a cleft palate-craniofacial team's experience with 768 patients that have had clefting over 22 years, with a primary focus on function and prevention of communication disorders associated traditionally with cleft palate. The treatment philosophy is based on tenets of child development and the dependency of neuropsychobiological development on the child's inherent competency, and early environmental stimulation and support. The applied treatments include ensuring early and adequate hearing, psychosocial adaptation of the parent and child through training for applications of indirect therapies, and early fistula-free surgical closure of the cleft that produces minimal scarring and a mobile velum. Team members have extensive backgrounds in child development that seem to have helped the majority of families in their complex efforts of daily care and sensory stimulation, and their children have developed early the ability to adapt modified structures to normal functions. Only one of these patients has needed or received secondary palatal surgery for correction of velopalatal insufficiency. Fifty-six children who did not achieve acceptable 2 to 3-year old communication criteria were referred for speech and language evaluation and therapy. These patients were reported to exhibit oral motor deficits described as developmental verbal dyspraxia.

Silicone gel breast implant failure and frequency of additional surgeries: analysis of 35 studies reporting examination of more than 8,000 explants.

Although it is well known that silicone gel breast implants (SGBIs) produce many "local" complications (i.e., pain, hard fibrous capsules, disfigurement, chronic inflammation, implant shell failure) and necessitate frequent surgical revisions, no large cohort retrospective quantitative analysis of clinical data has been reported to date, especially for the prevalence of failures and additional surgeries. Data from 35 different studies that encompass more than 8000 explanted SGBIs have now been analyzed and are reported here. Because examination of a prosthesis when explanted is the definitive method for determining shell integrity, the only studies that were used were ones that reported implant duration, the total number of SGBIs explanted, and the number of SGBIs for which shell rupture or failure ("not intact") was confirmed upon surgical removal. An exponential regression plot of data indicated a direct correlation of implant duration with percent shell failure (r2 = 0. 63 and r = 0.79 ). SGBI failure was found to be 30% at 5 years, 50% at 10 years, and 70% at 17 years. The failure rate was 6% per year during the first 5 years following primary implant surgery. ANOVA comparison of three implant age groups (mean implant durations of 3. 9, 10.2, and 18.9 years) indicated a highly significant statistical correlation of percent failure with implant duration (p < 0.001). Complications necessitating at least one additional surgery occurred for 33% of implants within 6 years following primary implant surgery. Shell failure was found to be an order of magnitude greater than the 4 to 6% rupture prevalence suggested by the AMA Council on Scientific Affairs in 1993, the 0.2 to 1.1% cited by manufacturers at that time, and the 5% rupture that was stated to be "not a safety standard that the FDA can accept."