Sting Technique: A New Procedure for Hypoplasic Lower Breast Poles.

BACKGROUND: In breast augmentation patients affected by hypoplasic lower poles are a difficult challenge for plastic surgeons. Indeed in these cases it is difficult to create a nice and round contour, especially if a tight thoracic skin is present. Various techniques have been described in the past in order to solve this problem including parenchymal manipulation, fat grafting alone or after subcutaneous release of the stenotic tissue (Rigottomy). Following a large experience with the use of needles to deliver fat grafting in fibrotic tissue of different type of scars the Authors report in this paper their preliminary experience with a new surgical technique consisting of a multiple percutaneous stings of the skin and gland of the inferior breast quadrants associated to an implant to correct a flat, rigid and hypoplasic lower breast pole. METHODS: A total of 24 patients affected by this malformation have been treated during the breast augmentation procedure using the above-mentioned technique. Hypoplasic lower poles (skin and subcutaneous tissues) have been punctured several times using an 18 G needle before inserting the implant. Results have been evaluated by the Authors and patients grading them from 0, extremely poor, to 10, extremely satisfactory outcome. RESULTS: Aesthetic results evaluated by the surgeons group reported a mean outcome of 7.9, whereas the ones of the patients reported a mean value of 8.3. In one case a capsulotomy for monolateral capsular contracture was performed. In another patient the aesthetic result was revised performing a fat grafting in order to further correct the lower pole. In six cases a subcutaneous blood effusion, due to the prick of the skin, was experienced while in two patients with darker skin (Fitzpatrick III) the use of the needle left pigmented spots that completely disappeared after the use of hydroquinone cream 4% for two months. CONCLUSIONS: Even with the limitations of this preliminary study, such as the small number of patients and the short follow-up, the sting technique seems to be an efficacious and safe new tool in the armamentarium of plastic surgeons to treat hypoplasic breasts with stenotic lower poles. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Breast implant-associated anaplastic large cell lymphoma: emotional impact and guidelines for psychological support.

PURPOSE: During the last two decades, the number of breast implants used in aesthetic, oncologic, and risk-reducing surgery has increased substantially mainly due to the improvement and confirmed safety of these devices. Since the identification of the first case of anaplastic large cell lymphoma associated with a breast implant (BIA-ALCL) 20 years ago, there has been an increase in the number of reports of this very rare disease, demonstrating a clear association with breast implants. While the majority of cases are localized and cured by implant removal and full capsulectomy, a small percentage require chemotherapy and the mortality rate is very low. Nevertheless, the evidence linking BIA-ALCL to implant surface texturing has raised concerns about the long-term safety of these devices resulting in patient and regulatory authority concerns globally. METHODS AND RESULTS: In this commentary, we report the current debate on BIA-ALCL and the main European government's actions, with a special focus on the emotional impact that media coverage has on cancer patients. We comment the emotional impact of such risk for patients with breast implant, the hard process of patient's acceptance for mastectomy and reconstructive surgery, and how this is an essential part of recovery and return to the normal living for many women. CONCLUSION: We conclude by providing guidelines for patient-physician communication and patients' psychological support on this topic of delicate actuality. Our contribution aims at guiding the medical community in managing risk communication about BIA-ALCL with a multidisciplinary approach, according to the most recently available published evidence.

[Optimization of primary aesthetic breast augmentation using implants: an evidence-based level approach]. / Optimisation de l'augmentation mammaire primaire par implants: approche basée sur le niveau de preuve.

The primary aesthetic breast augmentation has been the most performed cosmetic surgery procedure in the world for over 40 years. The current literature focuses on the new concept of "process of breast augmentation" and the importance of non-surgical part (patient selection, preoperative planning and personalized management of postoperative care) in potentiating the cosmetic results and reducing the rate of complications and reoperations. This review of literature discusses, through an analysis of scientific evidence levels, every step of the whole process of breast augmentation in order to determine the current best practices tailored to each patient to optimize satisfactory and durable cosmetic outcomes.

Aging of non-implanted Natrelle™ gel breast implants.

This study questions the aging of non-implanted breast prostheses for a period of 9-60 months. Every 6 months, two non-implanted Natrelle™ prostheses were tested to measure the strength at break, the elongation at break, and the thickness of the shell. Then, the breaking stress was calculated from the preceding quantities. All these quantities were observed by separating the samples taken from the anterior and posterior sides of the prostheses. One-way ANOVA analyses (analysis of variance) were performed to define the influence of aging duration, lot membership, and side. In addition, the elongation at break and the thickness of the shell showed significant variations as a function of aging regardless of the side but without any trend emerging. For other quantities, there were significant disparities between the anterior and posterior sides of the prostheses, differences between prostheses from different lots, and similarities between prostheses from the same lot. Finally, the thickness is an important parameter. Since manufacturing is a manual process, it is necessary to check the thickness, which must be homogeneous on both sides. Always weaker on the anterior side than on the posterior side, it influences the mechanical properties. We recommend, like other studies, that its control be part of the quality controls during manufacturing.

Free Silicone With Giant Cell Reaction Can Enhance on Breast MRI.

Background Breast augmentation with silicone implants is commonplace, and such implants have a risk of rupture which increases over time. Most implant ruptures are asymptomatic, and magnetic resonance imaging (MRI) is a recommended imaging modality for surveillance to detect these events. If a silicone leak enhances on MRI, it is currently categorized according to the Breast Imaging Reporting and Data System (BI-RADS) as category 4, which results in a recommendation for biopsy even when free silicone leakage is the most likely diagnosis. In this article, we present a case series that illustrates this issue with the BI-RADS system and propose an algorithmic approach that may allow some patients to be placed into BI-RADS category 3 and avoid biopsy. Methodology Eight cases of silicone breast implant rupture were identified at the University of Texas Medical Branch at Galveston over a five-year period. Two cases were excluded because MRI was not performed. The remaining six cases were evaluated for history and physical findings as well as mammogram, ultrasound, and MRI. All identified cases had been categorized as BI-RADS 4 and underwent biopsy. Results The six cases in this series exhibited pre-biopsy radiographic findings that were most consistent with silicone implant rupture. The ruptures were proven by biopsy, and no evidence of malignancy was identified in any of the patients. Conclusions Free silicone from breast implant rupture can present with enhancement on MRI. The two main categories of breast MRI enhancement, namely, mass and non-mass, include malignancies in their differential diagnoses and result in a BI-RADS category 4 designation. By correlating the findings with other imaging modalities, some of these patients can be classified as BI-RADS category 3 and biopsy can safely be avoided.

Medical professionals' knowledge of the use of external breast prostheses among breast cancer patients in China-a cross-sectional study.

BACKGROUND: Breast loss has a negative effect on women physically, psychologically and socially. External breast prostheses can improve patients' figure physically, increase their self-confidence, and thus improve quality of life. Little is known about the knowledge of medical professionals on the use of external breast prostheses in mainland China. This study sought to examine medical professionals' knowledge of the use of external breast prostheses among breast cancer patients in China. METHODS: Self-designed questionnaires were administered to 635 medical professionals specializing in breast cancer in China to examine their knowledge. RESULTS: Medical professionals who were older in age, those who had higher levels of education and those who had senior professional titles had a broader professional knowledge of external breast prostheses. Medical professionals who were younger in age and those who had junior professional titles thought that the patients were willing to choose direct-adhesive breast prostheses. Medical professionals who were older in age, those who had higher levels of education, those who had senior professional titles and those who had been working for many (but less than 30) years were more likely to think that patients could wear external breast prostheses shortly after surgery, and at all times except when sleeping. More highly educated doctors, head nurses and medical staffs from the East were more likely to think that patients would accept the use of high-priced external breast prostheses. CONCLUSIONS: Medical professionals' knowledge about the wearing of external breast prostheses is lacking. A number of factors, including age, education level, professional title, number of years working years and geographical region have different effects on medical professionals' knowledge. Medical professionals with a good knowledge of external breast prostheses, especially specialist breast nurses, can provide patients with comprehensive information about breast prostheses, assist patients in selecting the appropriate prostheses, understand patients' wearing experiences, and help to reduce patients' physical and mental distress.

A Nonsurgical Approach to Adolescent Breast Asymmetry Using External Prostheses.

PURPOSE: Currently, there are few nonsurgical treatment options for pediatric patients with developmental breast asymmetry. Our group established a partnership with a prosthetic unit within a local oncology center to provide custom-fit breast prostheses for young women with breast asymmetry. The purpose of this study was to describe the effect of this experience on patients' self-esteem and body image. METHODS: Patients were administered an anonymous satisfaction survey at least 1 month after their first fitting at the prosthetic unit. The survey was designed to evaluate body image, self-esteem, as well as social and emotional well-being before and after treatment. Thematic analysis was used to assess their experiences. RESULTS: Seventeen patients, aged 12-19 years, visited the prosthetic unit and subsequently completed the retrospective survey. After using the breast prostheses, 14 (82.4%) patients reported an improvement in body image and 12 (70.6%) patients reported an improvement in self-esteem. Benefits pertaining to three emergent themes were revealed: "body wholeness/symmetry," "body image and psychological well-being," and "esthetic outcome." CONCLUSIONS: Results from the survey demonstrate the ease and efficacy of a form of nonsurgical treatment for adolescent breast asymmetry. Our partnership with an adult oncology center can serve as a national model to support the development of similar treatment programs. Existing resources that have been previously used only for adult breast cancer survivors can be effectively applied to the adolescent population to ameliorate the negative psychological effects of breast asymmetry.

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.

PIP implant biodurability: a post-publicity update.

INTRODUCTION: in the year since Poly Implant Prothèse (PIP) found itself the epicentre of intense, global media attention initial studies have started to evaluate the abnormally high premature device failure rate suspected for their mammary prostheses. A cohort free from most of the usual confounding variables affords opportunities to improve upon previous estimates of rupture prevalence, assess the media effect and evaluate contemporary ultrasound scan (USS) accuracy. PATIENTS & METHODS: 460 patients who underwent cosmetic breast augmentation (BA) with PIP silicone prostheses (January 2000-August 2005) have now been followed since their withdrawal in 2010. Initial recall study generated a crude rupture rate of 15.9-33.8% over 6-11 years. Global publicity that followed the lymphoma-related death of a French patient in December 2011 led to 127 patients (27.4%) of our original cohort making de novo or further contact as a direct result. To date, 283 (61.5%) have been reviewed of whom 167 (59%) have undergone breast USS. In toto, 163 (35.4%) have had their implants replaced or removed. RESULTS: Kaplan-Meier analysis places 10-year PIP mammary implant survival between 60 (95% confidence interval (CI): 54-67) and 81% (95% CI: 78-85). Post-publicity evaluees were found to have occult device failure in 31.6%. Of 85 patients who had definitive confirmation of USS findings by surgical exploration, 79 (92.9%) were completely accurate. USS in our series had a sensitivity of 97.3% and specificity of 93.1%. DISCUSSION: this study not only reaffirms PIP's rupture prevalence to be higher than comparative breast prostheses, but also records the media's beneficial effect in improving recall. Importantly, there is a relatively high proportion of patients with ruptured devices of which they are otherwise unaware. Ultrasonography, at least in PIP-augmented women, seems to be a more accurate tool than previously measured, especially in the presence of rupture. Finally, 35.2% resisted all attempts at review despite repeated efforts and widespread media coverage.

Axillary silicone lymphadenopathy secondary to augmentation mammaplasty.

We report a case involving a 45-year-old woman, who presented with an axillary mass 10 years after bilateral cosmetic augmentation mammaplasty. A lump was detected in the left axilla, and subsequent mammography and magnetic resonance imaging demonstrated intracapsular rupture of the left breast prosthesis. An excisional biopsy of the left axillary lesion and replacement of the ruptured implant was performed. Histological analysis showed that the axillary lump was lymph nodes containing large amounts of silicone. Silicone lymphadenopathy is an obscure complication of procedures involving the use of silicone. It is thought to occur following the transit of silicone droplets from breast implants to lymph nodes by macrophages and should always be considered as a differential diagnosis in patients in whom silicone prostheses are present.

Resultados de un programa de seguimiento de las prótesis mamarias pip (poly-implant-prothese) / Results of a program to monitor the pip breast prostheses (poly-implant-prothese)

Objective: The rupture of mammary protheses PIP (poly-implant-prothese) caused an alarm, settling in Spain a protocol for the management of patients. As hospital unit of reference for the management, monitoring and treatment of patients carrying PIP breast implants, we propose objective to make a descriptive study of the current situation in our country and compare it to the hitherto described in the literature. Method: We conducted a transversal study of all patients who came during the years 2012 and 2013, to the Unit of Mammary Pathology of the Universitary General Hospital of Elche. Results: With a total of 285 women, we observed a high rate of implant rupture (50.2 percent) asymptomatic most (84.6 percent). Fact that the year 2006 had the highest percentage of breakage and the appearance of siliconomas. Conclusions: Our series confirms rupture rate similar to that described in the literature for PIP breast implants. We observed a higher percentage of breakage from the year 2006, coinciding with the period of manufacture described poorer quality of these implants. Axillary siliconomas were evident in 35.1 percent of patients, the only locally axillary symptoms.

Objetivo: La rotura de las prótesis mamarias PIP (poly-implant-prothese) ha supuesto una alarma, estableciéndose en España un protocolo para el manejo y seguimiento de las pacientes. Como unidad hospitalaria de referencia para el manejo, seguimiento y tratamiento de las pacientes portadoras de prótesis mamarias PIP, nos proponemos como objetivo realizar un estudio descriptivo de la situación actual en nuestro medio y compararlo con lo hasta ahora descrito en la literatura. Método: Realizamos un estudio transversal de todas las pacientes que acudieron durante los años 2012 y 2013, a la Consulta de la Unidad de Patología Mamaria del Hospital General Universitario de Elche. Resultados: Con un total de 285 mujeres, observamos la elevada tasa de ruptura de los implantes (50,2 por ciento) la mayoría asintomáticos (84,6 por ciento). Siendo el año 2006 el de mayor porcentaje de rotura y la aparición de siliconomas. Conclusiones: Se confirma una tasa de ruptura similar a la descrita en la literatura para los implantes mamarios PIP. Observamos un mayor porcentaje de rotura a partir del año 2006, coincidiendo con el período de fabricación descrito de peor calidad de estos implantes. Se evidenciaron siliconomas axilares en el 35,1 por ciento de las pacientes, siendo la única sintomatología a nivel local axilar.