Silicone implant surface microtopography modulates inflammation and tissue repair in capsular fibrosis.

Excessive fibrous capsule formation around silicone mammary implants (SMI) involves immune reactions to silicone. Capsular fibrosis, a common SMI complication linked to host responses, worsens with specific implant topographies. Our study with 10 patients investigated intra- and inter-individually, reduced surface roughness effects on disease progression, wound responses, chronic inflammation, and capsular composition. The results illuminate the significant impact of surface roughness on acute inflammatory responses, fibrinogen accumulation, and the subsequent fibrotic cascade. The reduction of surface roughness to an average roughness of 4 µm emerges as a promising approach for mitigating detrimental immune reactions, promoting healthy wound healing, and curbing excessive fibrosis. The identified proteins adhering to rougher surfaces shed light on potential mediators of pro-inflammatory and pro-fibrotic processes, further emphasizing the need for meticulous consideration of surface design. The composition of the implant capsule and the discovery of intracapsular HSP60 expression highlight the intricate web of stress responses and immune activation that can impact long-term tissue outcomes.

Is It All about Surface Topography? An Intra-Individual Clinical Outcome Analysis of Two Different Implant Surfaces in Breast Reconstruction.

The most common long-term complication of silicone breast implants (SMI) remains capsular fibrosis. The etiology of this exaggerated implant encapsulation is multifactorial but primarily induced by the host response towards the foreign material silicone. Identified risk factors include specific implant topographies. Of note, breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) has only been observed in response to textured surface implants. We hypothesize that reduction of SMI surface roughness causes less host response and, hence, better cosmetic outcomes with fewer complications for the patient. A total of 7 patients received the routinely used CPX®4 breast expander (~60 µM Ra) and the novel SmoothSilk® (~4 µM Ra), fixed prepectoral with a titanized mesh pocket and randomized to the left or right breast after bilateral prophylactic NSME (nipple-sparing mastectomy). We aimed to compare the postoperative outcome regarding capsule thickness, seroma formation, rippling, implant dislocation as well as comfortability and practicability. Our analysis shows that surface roughness is an influential parameter in controlling fibrotic implant encapsulation. Compared intra-individually for the first time in patients, our data confirm an improved biocompatibility with minor capsule formation around SmoothSilk® implants with an average shell roughness of 4 µM and in addition an amplification of host response by titanized implant pockets.

Quantitative Proteomic Characterization of Foreign Body Response towards Silicone Breast Implants Identifies Chronological Disease-Relevant Biomarker Dynamics.

The etiology of exaggerated fibrous capsule formation around silicone mammary implants (SMI) is multifactorial but primarily induced by immune mechanisms towards the foreign material silicone. The aim of this work was to understand the disease progression from implant insertion and immediate tissue damage response reflected in (a) the acute wound proteome and (b) the adsorption of chronic inflammatory wound proteins at implant surfaces. An intraindividual relative quantitation TMT-liquid chromatography-tandem mass spectrometry approach was applied to the profile wound proteome formed around SMI in the first five days post-implantation. Compared to plasma, the acute wound profile resembled a more complex composition comprising plasma-derived and locally differentially expressed proteins (DEPs). DEPs were subjected to a functional enrichment analysis, which revealed the dysregulation of signaling pathways mainly involved in immediate inflammation response and ECM turnover. Moreover, we found time-course variations in protein enrichment immediately post-implantation, which were adsorbed to SMI surfaces after 6-8 months. Characterization of the expander-adhesive proteome by a label-free approach uncovered a long-term adsorbed acute wound and the fibrosis-associated proteome. Our findings propose a wound biomarker panel for the early detection and diagnosis of excessive fibrosis that could potentially broaden insights into the characteristics of fibrotic implant encapsulation.

Situación actual de los registros nacionales de implantes mamarios en países de la Federación Ibero Latinoamericana de Cirugía Plástica (FILACP) / Current situation of national breast implants registries in countries of the Ibero-Latin American Federation of Plastic Surgery (FILACP)

Desde que hicieron aparición los registros centralizados de implantes mamarios en varios países del mundo, la implantación y evolución de estos ha sido desigual. Desde el Comité de Registros de Implantes de Federación Ibero Latinoamericana de Cirugía Plástica (FILACP) lanzamos un estudio para conocer el estado actual de este tipo de bases de datos en los países de la Federación mediante una encuesta en línea.El cuestionario fue remitido de forma correcta por 20 de los 22 países de FILACP. Solamente 1 país (España) posee un registro nacional plenamente funcionante, mientras que 4 países más (20%) cuentan con sistemas de notificación de complicaciones o registros privados de los fabricantes de prótesis. En el 35% de los países no hay intención de poner ningún registro nacional en marcha.Exponemos también en el trabajo las peculiaridades de cada país. (AU)

Since the appearance of centralized registries of breast implants in several countries around the world, the implantation and use of each registry has been uneven. From the FILACP (Ibero Latin American Federation of Plastic Surgery) Implant Registrations Commi- ttee we launched a study to evaluate the current status of this type of databases. The study was carried out in the countries of the Federation and consisted of an online survey.It was answered by 20 of the 22 countries. Only 1 country (Spain) has a fully functional national registry, while 4 more countries (20%) have a compilation reporting systems or private registries of prosthesis manufactu- rers. In 35% of countries there is no intention to start any national registry.We also review in the work the aspects of the system in each country. (AU)

Primary High-Grade Angiosarcoma of the Breast in a Young Woman With Breast Implants: A Rare Case and a Review of Literature.

Primary angiosarcoma (AS) of the breast is an extremely unusual variant of breast malignancies, and its incidence is about 0.05% of all primary breast tumors. In this article, we present a rare case of a primary AS that developed in a young woman with breast implants. This case report emphasizes importance of early investigation for accurate diagnosis and proper management of the breast AS, along with a correlation of histopathologic, radiologic, and clinical findings.

Abordagem vertical do peitoral maior nas inclusões mamárias / Vertical approach to the pectoralis major in breast implant insertion

INTRODUÇÃO: O trabalho demonstra uma abordagem alternativa para ampliarmos a escolha do espaço retromuscular e evitarmos os efeitos indesejáveis nas inclusões de próteses mamárias neste plano. MÉTODOS: Foram avaliados 328 pacientes do sexo feminino, com idade entre 17 e 62 anos, com queixa de hipomastia e certo grau de ptose mamária bilateral. Todas as pacientes foram submetidas à inclusão de próteses bilaterais e incisão vertical no músculo peitoral maior. A avaliação foi realizada com um período mínimo de 6 meses. RESULTADOS: A tática cirúrgica de incisão vertical no músculo peitoral maior nos permitiu ampliar a indicação do espaço retromuscular nas cirurgias de inclusão de próteses de mamas, conseguindo alcançar com êxito o posicionamento adequado da prótese e do tecido mamário, evitando cicatrizes adicionais. CONCLUSÕES: A técnica mostrou-se eficaz na sua propositura, evitando cicatrizes e o efeito de dupla-bolha e ampliando a indicação do espaço retromuscular.

INTRODUCTION: This study demonstrates an alternative method to access the retromuscular space and avoid undesirable effects caused by breast implant insertion in this space. METHODS: We evaluated 328 female patients, aged 17 to 62 years, with complaints of micromastia and bilateral ptosis. All patients underwent insertion of bilateral implants using a vertical incision in the pectoralis major. Follow-up was performed for at least 6 months. RESULTS: The technique of vertical incision in the pectoralis major increases the options for access to the retromuscular space in breast implant insertion. This method successfully achieves appropriate positioning of the implant and avoids additional scars. CONCLUSIONS: The technique proved to be effective, avoiding scars and the double-bubble effect, and increases the options for access to the retromuscular space.

Augmentation Mastopexy with Implant and Autologous Tissue for Correction of Moderate/Severe Ptosis.

PURPOSE: Breast augmentation combined with mastopexy is associated with a significantly higher complication rate than augmentation alone. The combination of mastopexy and breast implants has revealed a moderate recurrence of breast ptosis in many patients particularly with use of medium to large implants. Ptosis is the "bottoming out" of the breast tissue with loss of the desired roundness, due to the ptosis of the breast implant and the mammary tissue. In this study, we hypothesize the need for careful planning and careful preoperative surgical execution to minimize this complication. PATIENTS AND METHODS: Between January 2007 and July 2011, augmentation mastopexy with implant and autologous tissue ("double implant") was performed for 25 patients with grade III mammary ptosis. All patients underwent inverted-T mastopexy with supramuscular moderately cohesive gel breast implant using an inferior-based flap of de-epitelialized dermoglandular tissue and a superior-based nipple-areola complex pedicle. RESULTS: An inferior-based flap of deepithelialized dermoglandular tissue was used to stabilize the implant and is projection. Breast lifting was performed through a strong anchorage to fascia and to muscle of second intercostal space, improving the profile of the breast. Results were analyzed, no breast ptosis recurrence was noted at 30-month follow-up. CONCLUSIONS: Our technique presents the challenge of determining the amount of excess skin to be removed after implantation to create symmetry and provide for skin tightening without compromising tissue vascularization.

Fibromatosis agresiva de la pared torácica asociada a implante mamario: a propósito de un caso / Aggressive fibromatosis of the chest wall associated to mammary implant: a case report

La fibromatosis agresiva es una lesión benigna, que comprende el 0,3% de todos los tumores sólidos. A pesar que la pared torácica es un lugar común, este tipo de tumor raramente se ha asociado con los implantes o tejido mamarios. Pocos casos se han descrito en conjunción con un implante de seno. Se presenta el caso de una paciente femenina de 27 años, quien le aparece esta patología dos años después de la colocación de implante mamario

The aggressive fibromatoses is a benign lesion, is not frequent, represent the 0.3% of the all solid tumors. The chest wall was considered a common place for tumors, but this type is rarely associated with the mammary implants. There are few cases reported in conjunction with a mammary implant. We presented a rare clinical case of a feminine patient of 27 years old, to whom apparition of this pathology two years after the collocation of mammary implant