Management of complication after breast augmentation with methacrylate.

INTRODUCTION: Several alloplastic biomaterials are available for injection to the breast, nevertheless not all of them are approved for biomedical use. Although in North America and Western Europe experience with synthetic biomaterials for breast augmentation is very limited, migratory streams might expose physicians worldwide to manage the related complications of these procedures. The aim of this study was to share with other surgeons the case of a patient presenting complications after breast augmentation with an unknown synthetic substance containing methacrylate. PRESENTATION OF CASE: A 33-years old Asian woman presented to our Institution with breast deformities, lumps and chest pain. The patient referred previous breast injection "with hospital fat" performed in China six years before. She was not aware about the details of the procedure, and language barriers limited communication. Clinical examination and ultrasounds revealed the irregular distribution of an unknown substance in both breasts. The material was surgically removed and replaced in the same session with polyurethane implants. Chemical analysis revealed the presence of methacrylate. DISCUSSION: With a growing demand for non-invasive cosmetic surgery, has been reported a growing population of untrained and unlicensed personnel performing cosmetic surgery in many countries where there are no laws that restrict the use of cosmetic procedures to physicians with appropriate training and with approved materials. Surgical removal of this substances can be extremely challenging and an open procedure with surgical debridement is recommended. CONCLUSION: Breast augmentation with non-absorbable biomaterials can lead to severe complications, in particular for patients intending to breastfeed.

A useful method to overcome the difficulties of applying silicone gel sheet on irregular surfaces.

To date, silicone gel and silicone occlusive plates are the most useful and effective treatment options for hypertrophic scars (surgical and traumatic). Use of silicone sheeting has also been demonstrated to be effective in the treatment of minor keloids in association with corticosteroid intralesional infiltration. In our practice, we encountered four problems: maceration, rashes, pruritus and infection. Not all patients are able to tolerate the cushion, especially children, and certain anatomical regions as the face and the upper chest are not easy to dress for obvious social, psychological and aesthetic reasons. In other anatomical regions, it is also difficult to obtain adequate compression and occlusion of the scar. To overcome such problems of applying silicone gel sheeting, we tested the use of liquid silicone gel (LSG) in the treatment of 18 linear hypertrophic scars (HS group) and 12 minor keloids (KS group) as an alternative to silicone gel sheeting or cushion. Objective parameters (volume, thickness and colour) and subjective symptoms such as pain and pruritus were examined. Evaluations were made when the therapy started and after 30, 90 and 180 days of follow-up. After 90 days of treatment with silicone gel alone (two applications daily), HS group showed a significant improvement in terms of volume decrease, reduced inflammation and redness and improved elasticity. In conclusion, on the basis of our clinical data, we find LSG to be a useful method to overcome the difficulties of applying silicone gel sheeting on irregular surface.