Silicone Particles in Capsules Around Breast Implants: An Investigation Into Currently Available Implants in North America.

BACKGROUND: Breast implants have always been composed of a silicone elastomer envelope filled with either silicone gel or saline. Breast implant illness (BII) is a set of symptoms that has previously been linked to the leakage of silicone particles from the implants into the body. OBJECTIVES: Our research aimed to quantify the number of silicone particles present in the capsules of breast implants available in North America. METHODS: Thirty-five periprosthetic capsules were sampled and analyzed, and silicone particles were counted and measured. The capsule surface area was then measured and utilized to calculate particle density and total number of silicone particles. RESULTS: Eighty-five percent of capsules analyzed from silicone gel implants contained silicone, with an average of 62 particles per mm3 of capsular tissue. These implants had approximately 1 million silicone particles per capsule. In contrast, none of the saline implant capsules contained silicone. Capsules from macrotextured tissue expanders contained fewer and larger silicone particles. CONCLUSIONS: Silicone gel implants presented silicone particle bleeding into the periprosthetic capsule, totaling on average 1 million silicone particles per capsule. On the other hand, no silicone particle bleeding was observed from saline breast implants. These data suggest that particle bleeding comes from the inner silicone gel, and not from the smooth outer silicone shell. Previous studies have reported the presence of breast implant illness in patients with both silicone- and saline-filled implants. Therefore, our data suggest that silicone migration is not the sole cause of BII.

Demographic Study and Description of the Surgical Demand in Aesthetic Surgery.

BACKGROUND: The demand for aesthetic surgery presents a continuously growing trend over the years. The population wishing to undergo this type of surgery presents unique characteristics that are profoundly different in motivational, demographic, and clinical features from patients in other specialties. OBJECTIVES: The aim of our multicenter study is to objectively define the surgical demand and the demographic characteristics of our patients comparing them with general population. We try to better define who are our patients. METHODS: We conducted an observational, multicenter, retrospective study analyzing 3329 consultations involving a total of 2092 patients between January 2019 and June 2019. Based on the inclusion criteria, we selected 524 patients whose demographic characteristics, body mass index, addictions, comorbidities, and aesthetic surgery demand were analyzed. RESULTS: The mean age of our population is 38.58 years (female-to-male ratio, 9:1). The mean body mass index is 27.50 (5.23). A total of 22.90% of the sample have smoking habits, 3.63% have alcohol addiction, 1.53% have drugs addiction, and 53.63% of the population have relevant comorbidities.The 56.68% of the patients have already undergone surgery. The conversion rate of our first consultations to surgery is 49.05%. The most requested operation is abdominoplasty (36.45%), followed by liposuction (22.90%), breast reduction (17.56%), mastopexy (14.79%), and rhinoplasty (7.63%). CONCLUSIONS: This topic is downplayed and seldom studied in the literature; our effort is to make patient profiling crucial and evidence-based in aesthetic surgery.

Prevalence of Psychiatric Disorders in Aesthetic Surgery.

PURPOSE: Our study aimed to characterize and objectify the prevalence of psychiatric disorders and the use of psychotropic drugs in patients interested in undergoing aesthetic surgery. The psychiatric profile of this population is particularly interesting and is related to self-perception and the general concept of beauty. METHODS: We conducted an observational, retrospective, and bicenter study of 2092 patients seen in plastic surgery departments. Data on general characteristics, pathology, psychiatric history (PH), use of psychotropic drugs, addictions, surgical requests, and surgical complications were recorded and analyzed. RESULTS: Based on our inclusion criteria, we selected 524 patients. The prevalence of psychiatric disorders was 32.25%. The prevalence of depressive disorders (19.27%), anxiety disorders (8.21%), and sleep-wake cycle disorders (7.06%) should be noted. Comparing the population with psychiatric history (PH+) and without psychiatric history (PH-), significant differences were found in patient ethnicity, addictions (tobacco, 37.50% vs 15.00%; drugs, 3.26% vs 0.59%), and comorbidities. In the 66.86% (n = 113) of PH+ patients, the plastic surgeon did not record the presence of psychiatric disorders in the medical record. DISCUSSION: This study offers a broad view of the prevalence and characteristics of psychiatric disorders and the use of psychotropic drugs among patients who want to undergo aesthetic surgery. The prevalence of psychiatric problems in the study population is higher than in the general population (32.25% vs 15.02%). CONCLUSIONS: Our results suggest that plastic surgeons should be properly trained to manage these patients. A multidisciplinary approach involving plastic surgeons, psychiatrists, and psychologists is advocated.

A Surgical Alternative in the Treatment of Hypopharyngeal Perforation.

Pharyngo-esophageal perforation is a rare, life-threatening complication of anterior cervical discectomy and fusion surgery with an incidence estimated to be between 0.2 and 1.51%. Early diagnosis and appropriate treatment of this complication is the key to reduce morbidity and mortality, as the main prognostic factor is the interval between the onset of the fistula, diagnosis and treatment. Conservative management has shown encouraging results in small and localized defects, whereas surgical approaches using flaps are to be considered for most of the cases. However, there is no clear consensus on the first choice of treatment in esophageal perforation. This case report presents the use of a supra-clavicular fascio-cutaneous pedicled propeller flap as a patch combined to primary repair of a hypopharyngeal perforation, 10 years after anterior cervical spine arthrodesis.

Para-prosthetic Leaks Following Mitral Valve Replacement: Case Analysis on a 20-year Period.

BACKGROUND: Mitral para-prosthetic leaks are rare but major complications of mitral heart valve replacements. When they must be re-operated, they are burdened with high mortality rates. We proposed to review our surgical experience in terms of approach and type of operation carried out. METHODS: Demographic, preoperative, intraoperative and postoperative characteristics of 34 patients benefited from a surgical treatment of mitral paravalvular leak, at the Brugmann University Hospital between 1996 and 2016, have been analysed retrospectively. We analysed the data to identify the risk factors of postoperative mortality. We then compared the data depending on the approach and the type of surgical treatment in order to compare the morbidity-mortality. RESULTS: The postoperative mortality rate was 11.7%. The presence of endocarditis and increase in lactate dehydrogenase were predictive factors of mortality. Cardiac complications and acute kidney failure were significantly more common in the decease population. Direct mitral paravalvular leak suturing was more frequently performed on early apparition, anterior and isolated leaks, whereas a mitral heart valve replacement was most often performed to cure active primary endocarditis. The incidence of complications and mortality rates were identical according to the approach and the type of operation performed. A mitral para-prosthetic leak recurrence was observed in 33% of the cases. CONCLUSION: Surgical treatment of mitral para-prosthetic leaks is accompanied by a high mortality rate. The operative strategy plays a major role and can influence the morbidity-mortality encountered in those patients.