Experience of explantation of Trilucent breast implants.

On 6 June 2000, the Medical Devices Agency (MDA) recommended that all Trilucent (soya-bean-oil filled) breast implants should be removed. This accelerated a trend that had already begun in our unit. This study follows our previous report on a 3 year series of women with Trilucent breast implants. The aim was to present our operative findings at explantation, and to correlate them with the preoperative signs and symptoms, the postoperative complications and the details of the hospital stay. In total, 44 patients (82 implants) underwent explantation, of whom 34 were cosmetic cases and 10 were reconstructive. Five patients had their implants removed before the MDA announcement. Implant rippling was the most common problem reported (25%), followed by pain (18%), implant deflation (9.1%) and capsular contracture (4.5%). Free oil was seen around the implant in 15 cases; four of these presented with clinical deflation, and three with rippling. The remaining eight patients were asymptomatic. We conclude that these implants tend to bleed, as evidenced by the presence of free oil around the implant in 34% of patients. The absence of free oil in 73% of the patients who presented with rippling suggests that the leaking oil is often metabolised and absorbed. The findings of this study are significant for women in whom free oil was found around the implant during explantation, and for those who still have Trilucent implants in place, for whatever reason, in spite of the MDA recommendation.

Exogenous peptides presented by transporter associated with antigen processing (TAP)-deficient and TAP-competent cells: intracellular loading and kinetics of presentation.

This study investigates the differential capacity of TAP-deficient T2 cells, TAP-competent EBV cells, and immature and mature dendritic cells to present peptides to preformed CTL lines. It demonstrates that presentation of exogenous peptides involves peptide uptake and loading onto newly synthesized MHC class I molecules. This mechanism was best demonstrated for low affinity peptides in the presence of irrelevant peptides competing for HLA binding sites. Under these circumstances, inhibition of protein synthesis with cycloheximide or vesicular trafficking with brefeldin A significantly reduced the presentation of low affinity peptides. This was not restored by adding exogenous beta(2)-microglobulin to stabilize the MHC complex on the cell surface. In contrast, presentation of high affinity peptides was not sensitive to cycloheximide or brefeldin A, which suggests that different mechanisms may operate for presentation of high and low affinity peptides by TAP-competent cells. High affinity peptides can apparently compete with peptides in preloaded MHC class I molecules at the cell surface, whereas low affinity peptides require empty MHC molecules within cells. Accordingly, very high concentrations of exogenous low affinity peptides in conjunction with active MHC class I metabolism were required to allow successful presentation against a background of competing intracellular high affinity peptides in TAP-competent cells. These findings have implications for the design of peptide and protein-based vaccines.

Trilucent breast implants: a 3 year series.

The use of Trilucent breast implants in the UK dates back to 1995 and their introduction coincided with the medium-term effects of the silicone-implant controversy. We present a review of 3 years' experience of the Trilucent implant (1996-1998) during which 29 patients with a mean age of 39.4 years had a total of 50 implants. The aim of the study was to analyse the results in these patients in terms of complications, reoperation rate and patient satisfaction. Using a combination of retrospective chart analysis and postal survey, we found an incidence of implant deflation of 10% (5/50). The overall reoperation rate was 20% (10/50). The postal survey yielded a mean satisfaction score of 7.1 (on a scale of 0-10) from the 20 respondents out of the 29 patients (68.9%). In view of the high complication rate, we discontinued the use of Trilucent implants in advance of their withdrawal by the Medical Devices Agency (MDA) in March 1999. However, these findings may now be considered of added interest, particularly with regard to patients who are opting to keep their Trilucent implants despite the recommendation of the MDA in June 2000 that such implants should be removed.