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1.
Plast Reconstr Surg ; 146(2): 301-308, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740580

RESUMO

BACKGROUND: Infections are challenging complications of implant-based breast reconstruction and augmentation. They pose a clinical challenge, with significant economic implications. One proposed solution is implant irrigation at the time of placement. There is no consensus on the optimal irrigant solution. METHODS: The authors tested the relative efficacy of 10% povidone-iodine, Clorpactin, Prontosan, triple-antibiotic solution, or normal saline (negative control) against two strains each of methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis. Sterile, smooth silicone implant disks were immersed in irrigant solution, then incubated in suspensions of methicillin-resistant S. aureus or S. epidermidis overnight. The disks were rinsed and sonicated to displace adherent bacteria from the implant surface, and the displaced bacteria were quantified. Normalized values were calculated to characterize the relative efficacy of each irrigant. RESULTS: Povidone-iodine resulted in reductions of the bacterial load by a factor of 10 to 10 for all strains. Prontosan-treated smooth breast implant disks had a 10-fold reduction in bacterial counts for all but one methicillin-resistant S. aureus strain. In comparison to Prontosan, triple-antibiotic solution demonstrated a trend of greater reduction in methicillin-resistant S. aureus bacterial load and weaker activity against S. epidermidis strains. Clorpactin reduced the recovered colony-forming units for only a single strain of S. epidermidis. Povidone-iodine demonstrated the greatest efficacy against all four strains. However, Clorpactin, triple-antibiotic solution, and Prontosan demonstrated similar efficacies. CONCLUSIONS: Povidone-iodine was the most efficacious of the irrigants at reducing methicillin-resistant S. aureus and S. epidermidis contamination. Given the recent lifting of the U.S. Food and Drug Administration moratorium, larger clinical studies of povidone-iodine as a breast implant irrigant solution are warranted. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.


Assuntos
Anti-Infecciosos Locais/administração & dosagem , Biofilmes/efeitos dos fármacos , Implante Mamário/efeitos adversos , Implantes de Mama/microbiologia , Infecções Relacionadas à Prótese/prevenção & controle , Bacitracina/administração & dosagem , Benzenossulfonatos/administração & dosagem , Implante Mamário/instrumentação , Cefazolina/administração & dosagem , Combinação de Medicamentos , Gentamicinas/administração & dosagem , Humanos , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Povidona-Iodo/administração & dosagem , Infecções Relacionadas à Prótese/microbiologia , Soluções , Staphylococcus epidermidis/efeitos dos fármacos , Staphylococcus epidermidis/isolamento & purificação , Irrigação Terapêutica/métodos
3.
Plast Reconstr Surg ; 146(1): 30-37, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32590638

RESUMO

BACKGROUND: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) has entered the spotlight, as several high-profile media outlets have begun to relay the evolving science to the public. This study aimed to gauge the baseline knowledge and concern regarding BIA-ALCL among adult laywomen within the United States. METHODS: Mechanical Turk was used to survey 500 American women on self-reported demographics, prior experience with breast implants, and 11 questions regarding their knowledge and concern regarding BIA-ALCL. Responses were reviewed for quality control before study inclusion. RESULTS: Overall, 12 percent of respondents had received breast implants and 73 percent knew someone with implants; 13.6 percent of respondents (including 51.7 percent of respondents with implants) had previously heard of BIA-ALCL. After providing information about its risk, 58.4 percent of respondents were still willing to receive a reconstructive implant and 45.8 percent a cosmetic implant; 35.8 percent reported they would be less likely to receive an implant. Of the respondents with breast implants, 66.7 percent reported some degree of concern regarding BIA-ALCL and 35.0 percent are strongly considering removing their implants. Those who had heard of BIA-ALCL consumed information from several sources, predominantly health professionals or media/health care blogs. Different sources of information were not associated with a respondent's degree of concern. CONCLUSIONS: Only a minority of American women have heard of BIA-ALCL and understand its association with breast implants. As plastic surgeons who perform breast reconstruction, we can promote the spread of information through the popular media and health care blogs to address this growing concern, particularly among women with existing breast implants.


Assuntos
Implante Mamário/efeitos adversos , Implantes de Mama/efeitos adversos , Neoplasias da Mama/etiologia , Conhecimentos, Atitudes e Prática em Saúde , Linfoma Anaplásico de Células Grandes/etiologia , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Falha de Prótese/etiologia , Estados Unidos
4.
Acta Cir Bras ; 35(4): e202000407, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32555938

RESUMO

PURPOSE: To evaluate whether silicone foam implants have a different evolution pattern compared to conventional texture implants. METHODS: Fifty-eight female patients underwent surgery. They were divided into two groups (silicone foam - Lifesil® - and microtexturized silicone - Lifesil®). The evolution was analyzed in postoperative consultations, with physical examination, photographic documentation and filling in a satisfaction questionnaire, in the postoperative period of one month, four months, one year and then annually, up to a maximum of 3 years of follow-up. RESULTS: There were no statistically significant differences in presence of rippling, stretch marks, breast ptosis, capsular contracture and quality of scars. There was a higher rate of patients who were very satisfied with the outcome 360 days after surgery in the group receiving silicone foam implants (p = 0.036). CONCLUSION: In short time, silicone foam envelope implants proved to be as reliable as textured silicone envelope implants, making them an option for augmentation mammoplasty.


Assuntos
Implante Mamário/métodos , Implantes de Mama , Elastômeros de Silicone/uso terapêutico , Adulto , Mama/efeitos dos fármacos , Implante Mamário/efeitos adversos , Implantes de Mama/efeitos adversos , Feminino , Reação a Corpo Estranho/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Complicações Pós-Operatórias , Estudos Prospectivos , Reprodutibilidade dos Testes , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
5.
Plast Reconstr Surg ; 145(6): 1343-1353, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32459763

RESUMO

BACKGROUND: A growing number of transgender women present to plastic surgeons seeking breast augmentation. Despite some advocating their technical similarity, the authors have found substantially different planning and techniques are needed to obtain aesthetic results in transgender patients versus cosmetic breast augmentation. The authors sought to develop an approach for operative planning and technique to elucidate these differences and obtain consistent results. METHODS: All patients who underwent breast augmentation at the Johns Hopkins Center for Transgender Health were included in this study. Anthropometric assessments were obtained and comparative statistics between operative and nonoperative cohorts were calculated. Outcomes were analyzed and a patient-reported survey was performed to evaluate patient satisfaction. RESULTS: Fifty-nine consecutive transfemale patients presented for evaluation. Anthropometric measurements included base width (median, 15.0 ± 2.1 cm), notch-to-nipple distance (median, 22.0 cm), nipple-to-midline distance (median, 12.0 cm), areolar diameter (median, 3.5 ± 1.5 cm), and upper pole pinch (mean, 1.8 ± 1.1 cm). Thirty-six patients underwent augmentation mammaplasty. Postoperative complications (8.3 percent) included a minor hematoma and grade III capsular contracture in two patients. Patients were asked to complete a brief outcomes survey and reported an improvement in psychosocial well-being and high satisfaction rate (100 percent) with the overall cosmetic result. CONCLUSIONS: Transgender female patients represent a unique patient population requiring special consideration of anatomical differences in key planning decisions. The authors delineate the first systematic algorithm that addresses these differences, emphasizing maneuvers such as routine inframammary fold lowering. This can allow experienced augmentation surgeons to obtain excellent aesthetic and patient-reported outcomes in this population. As with cosmetic breast augmentation, patient satisfaction rates are high. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Implante Mamário/métodos , Disforia de Gênero/cirurgia , Planejamento de Assistência ao Paciente , Satisfação do Paciente , Cirurgia de Readequação Sexual/métodos , Adulto , Algoritmos , Implante Mamário/efeitos adversos , Implante Mamário/instrumentação , Implantes de Mama/efeitos adversos , Procedimentos Clínicos , Estética , Feminino , Seguimentos , Disforia de Gênero/psicologia , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Cirurgia de Readequação Sexual/efeitos adversos , Pessoas Transgênero/psicologia , Resultado do Tratamento , Adulto Jovem
6.
Plast Reconstr Surg ; 145(6): 1381-1387, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32459768

RESUMO

BACKGROUND: Device rupture is considered a major complication associated with breast implants. The U.S. Food and Drug Administration recommends magnetic resonance imaging (MRI) surveillance 3 years after implantation and then every 2 years, but adherence to these recommendations is poor. The authors identified current practice management for breast implant rupture surveillance by surveying practicing U.S. plastic surgeons. METHODS: An online survey of all active members of the American Society of Plastic Surgeons was performed. Questions analyzed imaging practice patterns related to breast implants. Logistic regression models were used to analyze determinants for radiographic imaging in breast implant patients. RESULTS: The survey had a response rate of 16.5 percent. For patients with breast implants, 37.7 percent of respondents recommended MRI at the recommended intervals. Fifty-five percent perform imaging only if there is a problem with the implant. Academic surgeons more frequently recommended MRI (56.3 percent and 39.3 percent; p = 0.0002). Surgeons with less than 5 years of experience are four times more likely to order MRI than surgeons with over 25 years' experience (60.8 percent and 28.1 percent; p < 0.0001). Furthermore, lower volume surgeons recommend significantly more MRI (45.2 percent and 27.3 percent; p = 0.001). Respondents are almost two times more likely to recommend MRI in reconstructive versus cosmetic patients (51.2 percent and 35.6 percent; p = 0.0004). CONCLUSIONS: MRI limitations include high costs, time commitments, and equipment constraints. Fewer than 40 percent of survey respondents suggest the recommended screening frequency to their patients; however, academic, low-volume, early-career surgeons are more likely to recommend MRI implant monitoring. Screening recommendations need to be evidence based and align with common practices to prevent undue system, provider, and patient burden.


Assuntos
Implante Mamário/efeitos adversos , Implantes de Mama/efeitos adversos , Fidelidade a Diretrizes/estatística & dados numéricos , Contratura Capsular em Implantes/diagnóstico por imagem , Padrões de Prática Médica/estatística & dados numéricos , United States Food and Drug Administration/normas , Implante Mamário/instrumentação , Feminino , Fidelidade a Diretrizes/economia , Humanos , Contratura Capsular em Implantes/prevenção & controle , Imagem por Ressonância Magnética/economia , Imagem por Ressonância Magnética/normas , Imagem por Ressonância Magnética/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/economia , Padrões de Prática Médica/normas , Cirurgiões/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Fatores de Tempo , Estados Unidos
7.
Rinsho Shinkeigaku ; 60(5): 358-361, 2020 May 26.
Artigo em Japonês | MEDLINE | ID: mdl-32307393

RESUMO

A 69-year-old female developed subacute diplopia, right peripheral facial nerve palsy, bilateral upper and lower extremities dysesthesia and weakness 50 years after silicone injection for breast augmentation. Motor conduction study revealed prolonged distal latency and reduced amplitude in the median, ulnar, and peroneal nerves. Sensory conduction velocities were reduced in the median and ulnar nerves, and sensory potential in the sural nerve could not be recorded. While intravenous immunoglobulin therapy was ineffective, explantation of silicone breast implants improved her neurological symptoms. Histopathological study of axillary lymph node revealed foreign body granulomas and macrophages phagocyting silicone. The patient was diagnosed with human adjuvant disease presenting clinical features of Guillain-Barré syndrome. Human adjuvant disease should be considered in the patients with implants like silicone and neurological symptoms.


Assuntos
Implante Mamário/efeitos adversos , Implantes de Mama/efeitos adversos , Reação a Corpo Estranho/diagnóstico , Reação a Corpo Estranho/etiologia , Falha de Prótese , Géis de Silicone/efeitos adversos , Cirurgia Plástica/efeitos adversos , Idoso , Mama/cirurgia , Implante Mamário/métodos , Diagnóstico Diferencial , Feminino , Reação a Corpo Estranho/cirurgia , Síndrome de Guillain-Barré , Humanos , Cirurgia Plástica/métodos
8.
Plast Reconstr Surg ; 145(5): 898e-908e, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332523

RESUMO

BACKGROUND: Continued evolution of implant-based breast reconstruction involves immediate placement of the implant above the pectoralis muscle. The shift to prepectoral breast reconstruction is driven by goals of decreasing morbidity such as breast animation deformity, range-of-motion problems, and pain, and is made possible by improvements in mastectomy skin flap viability. To define clinical factors to guide patient selection for direct-to-implant prepectoral implant reconstruction, this study compares safety endpoints and risk factors between prepectoral and subpectoral direct-to-implant breast reconstruction cohorts. The authors hypothesized that prepectoral direct-to-implant breast reconstruction is a safe alternative to subpectoral direct-to-implant breast reconstruction. METHODS: Retrospective chart review identified patients who underwent prepectoral and subpectoral direct-to-implant breast reconstruction, performed by a team of five surgical oncologists and two plastic surgeons. Univariate analysis compared patient characteristics between cohorts. A penalized logistic regression model was constructed to identify relationships between postoperative complications and covariate risk factors. RESULTS: A cohort of 114 prepectoral direct-to-implant patients was compared with 142 subpectoral direct-to-implant patients. The results of the penalized regression model demonstrated equivalence in safety metrics between prepectoral direct-to-implant and subpectoral direct-to-implant breast reconstruction, including seroma (p = 0.0883), cancer recurrence (p = 0.876), explantation (p = 0.992), capsular contracture (p = 0.158), mastectomy skin flap necrosis (p = 0.769), infection (p = 0.523), hematoma (p = 0.228), and revision (p = 0.122). CONCLUSIONS: This study demonstrates that prepectoral direct-to-implant reconstruction is a safe alternative to subpectoral direct-to-implant reconstruction. Given the low morbidity and elimination of animation deformity, prepectoral direct-to-implant reconstruction should be considered when the mastectomy skin flap is robust. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Implante Mamário/efeitos adversos , Mastectomia/efeitos adversos , Recidiva Local de Neoplasia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Retalhos Cirúrgicos/transplante , Derme Acelular , Adulto , Mama/patologia , Mama/cirurgia , Implante Mamário/instrumentação , Implante Mamário/métodos , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Seguimentos , Humanos , Mastectomia/métodos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/prevenção & controle , Seleção de Pacientes , Músculos Peitorais/cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
9.
Plast Reconstr Surg ; 145(5): 917e-926e, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332528

RESUMO

BACKGROUND: Whether to irradiate the tissue expander before implant exchange or to defer irradiation until after exchange in immediate, two-stage expander/implant reconstruction remains uncertain. The authors evaluated the effects of irradiation timing on complication rates and patient-reported outcomes in patients undergoing immediate expander/implant reconstruction. METHODS: Immediate expander/implant reconstruction patients undergoing postmastectomy radiation therapy at 11 Mastectomy Reconstruction Outcomes Consortium sites with demographic, clinical, and complication data were analyzed. Patient-reported outcomes were assessed with BREAST-Q, Patient-Reported Outcomes Measurement Information System, and European Organisation for Research and Treatment of Cancer Breast Cancer-Specific Quality-of-Life Questionnaire surveys preoperatively and 2 years postoperatively. Survey scores and complication rates were analyzed using bivariate comparison and multivariable regressions. RESULTS: Of 317 patients who met inclusion criteria, 237 underwent postmastectomy radiation therapy before expander/implant exchange (before-exchange cohort), and 80 did so after exchange (after-exchange cohort). Timing of radiation had no significant effect on risks of overall complications (OR, 1.25; p = 0.46), major complications (OR, 1.18; p = 0.62), or reconstructive failure (OR, 0.72; p = 0.49). Similarly, radiation timing had no significant effect on 2-year patient-reported outcomes measured by the BREAST-Q or the European Organisation for Research and Treatment of Cancer survey. Outcomes measured by the Patient-Reported Outcomes Measurement Information System showed less anxiety, fatigue, and depression in the after-exchange group. Compared with preoperative assessments, 2-year patient-reported outcomes significantly declined in both cohorts for Satisfaction with Breasts, Physical Well-Being, and Sexual Well-Being, but improved for anxiety and depression. CONCLUSIONS: Radiation timing (before or after exchange) had no significant effect on complication risks or on most patient-reported outcomes in immediate expander/implant reconstruction. Although lower levels of anxiety, depression, and fatigue were observed in the after-exchange group, these differences may not be clinically significant. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.


Assuntos
Implante Mamário/efeitos adversos , Implantes de Mama/efeitos adversos , Neoplasias da Mama/terapia , Complicações Pós-Operatórias/epidemiologia , Dispositivos para Expansão de Tecidos/efeitos adversos , Expansão de Tecido/efeitos adversos , Adulto , Ansiedade/epidemiologia , Ansiedade/etiologia , Ansiedade/psicologia , Implante Mamário/instrumentação , Implante Mamário/métodos , Depressão/epidemiologia , Depressão/etiologia , Depressão/psicologia , Fadiga/epidemiologia , Fadiga/etiologia , Feminino , Humanos , Mastectomia/efeitos adversos , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/psicologia , Estudos Prospectivos , Qualidade de Vida , Radioterapia Adjuvante/efeitos adversos , Radioterapia Adjuvante/métodos , Fatores de Tempo , Tempo para o Tratamento , Expansão de Tecido/instrumentação
10.
An Bras Dermatol ; 95(3): 347-350, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32303432

RESUMO

Intravascular histiocytosis is a rare condition characterized by the aggregate of histiocytes within dilated dermal vessels. The diagnosis is mainly histophatological and immunohistochemical. We describe a case of a 55 year-old female patient presenting erythematous/purple patches on the breasts, back and limbs. She previously presented ductal carcinoma in the right breast in 2006 which was treated with mastectomy and proceeded to silicone breast implant in 2009. Clinical hypothesis was telangiectatic metastatic carcinoma. Histopathology showed vascular ectasia, thrombosis and recanalization of upper dermis small vessels. On immunohistochemistry, intravascular cells were CD 68+ and negative for estrogen and progesterone receptors, CK7, EMA and AE1/AE3 and endothelial cells were CD64+, leading to the diagnosis of intravascular histiocytosis.


Assuntos
Implante Mamário/efeitos adversos , Histiocitose/etiologia , Histiocitose/patologia , Silicones/efeitos adversos , Dermatopatias Vasculares/etiologia , Dermatopatias Vasculares/patologia , Dilatação Patológica , Feminino , Humanos , Imuno-Histoquímica , Pessoa de Meia-Idade , Trombose Venosa/etiologia , Trombose Venosa/patologia
11.
Arch Gynecol Obstet ; 301(4): 1037-1045, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32157414

RESUMO

PURPOSE: Little is known about the reason of high short-term complication rates after the subcutaneous placement of breast implants or expanders after mastectomy without biological matrices or synthetic meshes. This study aims to evaluate complications and their risk factors to develop guidelines for decreasing complication rates. METHODS: We included all cases of mastectomy followed by subcutaneous implant or expander placement between 06/2017 and 05/2018 (n = 92). Mean follow-up time was 12 months. RESULTS: Explantation occurred in 15 cases (16.3%). The surgeon's preference for moderate vs. radical subcutaneous tissue resection had a significant influence on explantation rates (p = 0.026), impaired wound healing or infection (requiring surgery) (p = 0.029, p = 0.003 respectively) and major complications (p = 0.018). Multivariate analysis revealed significant influence on complication rates for radical subcutaneous tissue resection (p up to 0.003), higher implant volume (p up to 0.023), higher drain volume during the last 24 h (p = 0.049), higher resection weight (p = 0.035) and incision type (p = 0.011). CONCLUSION: Based on the significant risk factors we suggest the following guidelines to decrease complication rates: favoring thicker skin envelopes after surgical preparation, using smaller implants, removing drains based on a low output volume during the last 24 h and no use of periareolar incision with extension medial or lateral. We should consider ADMs for subcutaneous one-stage reconstructions. The individual surgeon's preference of subcutaneous tissue resection is of highest relevance for short-term complications-this has to be part of internal team discussions and should be considered in future trials for comparable results.


Assuntos
Implante Mamário/efeitos adversos , Neoplasias da Mama/cirurgia , Mastectomia/métodos , Complicações Pós-Operatórias/etiologia , Tela Subcutânea/cirurgia , Implantes de Mama/efeitos adversos , Neoplasias da Mama/patologia , Estudos de Coortes , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos
12.
Plast Reconstr Surg ; 145(6): 1029e-1036e, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32195865

RESUMO

BACKGROUND: The objective of this study was to determine whether women with a history of radiation therapy before mastectomy experience a risk for postoperative complications and patient-reported outcomes similar to those of women undergoing postmastectomy radiation therapy in the setting of immediate implant reconstruction. METHODS: The cohort included patients undergoing immediate implant reconstruction at 11 centers across North America. Women were categorized into three groups: prior breast conservation therapy, postmastectomy radiation therapy, and no radiation therapy. Mixed effect logistic regressions were used to analyze the effects of radiation therapy status on complication rates and patient-reported outcomes. RESULTS: ONE THOUSAND FIVE HUNDRED NINETY-FOUR: patients were analyzed, including 84 women with prior breast conservation therapy, 329 women who underwent postmastectomy radiation therapy, and 1181 women with no history of radiation therapy. Compared with postmastectomy radiation therapy, breast conservation was associated with lower rates of all complications and major complications (OR, 0.65; 95 percent CI, 0.37 to 1.14; p = 0.13; and OR, 0.61; 95 percent CI, 0.33 to 1.13; p = 0.12). These differences were not statistically significant. Rates of reconstructive failure between the two cohorts were comparable. Before reconstruction, satisfaction with breasts was lowest for women with prior breast conservation therapy (p < 0.001). At 2 years postoperatively, satisfaction with breasts was lower for women with postmastectomy radiation therapy compared with breast conservation patients (p = 0.007). CONCLUSIONS: Higher postoperative complication rates were observed in women exposed to radiation therapy regardless of timing. Although women with prior breast conservation experienced greater satisfaction with their breasts and fewer complications when compared to women undergoing postmastectomy radiation therapy, there was a similar risk for reconstruction failure. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.


Assuntos
Implante Mamário/efeitos adversos , Neoplasias da Mama/terapia , Mastectomia Segmentar/efeitos adversos , Terapia Neoadjuvante/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Radioterapia Adjuvante/efeitos adversos , Adulto , Implante Mamário/instrumentação , Implantes de Mama/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , América do Norte/epidemiologia , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Fatores de Tempo , Falha de Tratamento
13.
Plast Reconstr Surg ; 145(4): 901-911, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32221199

RESUMO

BACKGROUND: Capsular contracture is a troublesome and distressing complication in mammaplasty or breast reconstruction involving a prosthesis. Previous studies have indicated that leukotriene antagonists effectively reverse capsular contracture. However, this treatment method lacks comprehensive support from evidence-based medicine and remains considerably controversial. In this study, a meta-analysis was conducted to evaluate the therapeutic and preventive effects of leukotriene antagonists on capsular contracture in patients after breast prosthesis implantation. METHODS: A comprehensive literature search was performed in English and Chinese databases. All clinical studies assessing the therapeutic and prophylactic effects of leukotriene antagonists on capsule contracture after breast prosthesis implantation were selected. Risk differences and 95 percent confidence intervals were applied as the final pooled statistics. RESULTS: A total of five eligible studies were included, involving 1710 breast prosthesis implantations. The final results indicated that leukotriene antagonists markedly inhibited capsular contracture formation, with statistical significance at 32.02 (p < 0.001) (pooled risk difference, 0.84; 95 percent CI, 0.79 to 0.89). In subgroup analysis, subgroups based on different leukotriene antagonists included the montelukast and zafirlukast groups, with significant pooled statistical levels of 19.34 (p < 0.001) and 79.48 (p < 0.001), respectively (montelukast: pooled risk difference, 0.83; 95 percent CI, 0.75 to 0.92; zafirlukast: pooled risk difference, 0.85; 95 percent CI, 0.83 to 0.87), indicating that both montelukast and zafirlukast were effective in inhibiting encapsulation. CONCLUSIONS: This meta-analysis demonstrated that leukotriene antagonists (montelukast and zafirlukast) have significant effects in treating and preventing capsular contracture. These medications should be administered in a reasonable and safe way. Further studies of clinical efficacy, duration, safety, and exact mechanism of leukotriene antagonists for periprosthetic capsular contracture are warranted.


Assuntos
Implante Mamário/efeitos adversos , Contratura Capsular em Implantes/prevenção & controle , Antagonistas de Leucotrienos/uso terapêutico , Acetatos/uso terapêutico , Adolescente , Adulto , Implantes de Mama/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Quinolinas/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Compostos de Tosil/uso terapêutico , Adulto Jovem
14.
Plast Reconstr Surg ; 145(4): 686e-696e, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32221195

RESUMO

BACKGROUND: The resurgence of prepectoral breast reconstruction has brought strict patient inclusion and exclusion criteria by numerous authors. This article provides an overview of a single surgeon's experience with 201 patients, 313 breasts using immediate, direct-to-implant prepectoral breast reconstruction. The article compares surgical outcomes of different patient cohorts to elucidate risk factors that may predispose patients toward developing complications. METHODS: A retrospective chart review was performed, identifying all patients who underwent prepectoral, direct-to-implant breast reconstruction from June of 2016 to June of 2018. RESULTS: A total of 201 patients representing 313 breasts were included. A midlateral incision was used in 157 breasts (50.2 percent), followed by a skin-reducing, Wise-pattern in 90 breasts (28.8 percent). Acellular dermal matrix was used in 243 breasts (77.6 percent), free nipple grafts were used in 39 breasts (12.5 percent), and postmastectomy radiation therapy was used in 58 breasts (18.5 percent). Complications requiring operative intervention occurred in 24 breasts (7.7 percent), and minor complications occurred in 23 breasts (7.3 percent). There were no significant differences in complication rates for (1) acellular dermal matrix use versus non-acellular dermal matrix use, (2) Wise-pattern versus other incision, or (3) postmastectomy radiotherapy (p > 0.05). CONCLUSIONS: This represents the largest single-surgeon, direct-to-implant prepectoral cohort in the literature. Surgical complications did not differ with acellular dermal matrix use, incision selection, and the use of postmastectomy radiation therapy. There may be an association between acellular dermal matrix use and major complications and radiotherapy with minor complications. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Implante Mamário/efeitos adversos , Implantes de Mama/efeitos adversos , Neoplasias da Mama/terapia , Retalhos de Tecido Biológico/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Derme Acelular/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Mama/patologia , Mama/efeitos da radiação , Mama/cirurgia , Implante Mamário/instrumentação , Implante Mamário/métodos , Neoplasias da Mama/patologia , Feminino , Retalhos de Tecido Biológico/transplante , Humanos , Mastectomia/efeitos adversos , Pessoa de Meia-Idade , Mamilos/transplante , Complicações Pós-Operatórias/etiologia , Radioterapia Adjuvante/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
16.
Cir. plást. ibero-latinoam ; 46(1): 25-36, ene.-mar. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-190855

RESUMO

INTRODUCCIÓN Y OBJETIVO: Desde 1995 en que se publicó la primera notificación que relacionaba el linfoma anaplásico de células grandes al hecho de portar implantes mamarios (LACG-AIM) han transcurrido más de 25 años y han sido publicados cientos de artículos. El presente trabajo tiene como objetivo realizar una revisión sistemática y analítica de los casos publicados, así como sintetizar el conocimiento actual sobre esta entidad y acercarlo al lector de habla hispana. MATERIAL Y MÉTODO: Realizamos una búsqueda sistemática en las bases de datos PubMed, ScienceDirect y SciELO así como en el buscador de Google Académico entre 1995 y octubre de 2019, que pretende revisar las características de los casos recogidos en la literatura en dicho periodo de tiempo. RESULTADOS: El número total de casos recogidos en la bibliografía analizada fue de 122. La información resultó heterogénea y mayoritariamente basada en notificaciones de casos. Cabe destacar la escasez de casos publicados desde países íbero-latinoamericanos. Exponemos los principales datos recogidos relativos a características del linfoma, sintomatología, diagnóstico, patogenia, estudios genéticos, mutaciones, tratamiento, pronóstico y supervivencia. CONCLUSIONES: Aunque el diagnóstico y tratamiento actual del LACG-AIM se encuentran bastante estandarizados, la incidencia real y la etiología de esta entidad necesitan de estudios más rigurosos. La falta de criterios comunes a la hora de recoger o notificar los casos hace difícil una recogida veraz y uniforme. Es necesaria la comunicación de cualquier incidente relacionado con las prótesis mamarias, tanto a los registros nacionales de implantes como a la comunidad científica, a fin de recopilar información de calidad como base para latoma de decisiones basadas en evidencia


BACKGROUND AND OBJECTIVE: In 1995, the first notification relating anaplastic large cell lymphoma (BIA-ALCL) and breast implants was established. Twenty four years later, hundreds of articles have been published about this topic. The aim of this study is to review the published cases and summarize the current knowledge about this entity bringing it closer to Hispanic readers. METHODS: A systematic review was performed in PubMed, ScienceDirect, SciELO and Google Scholar databases since 1995 to October 2019. RESULTS: A total number of 122 case reports were analyzed. The information collected was heterogeneous. The shortage of Ibero-Latinoamerican published cases was evidenced. Data elements abstracted included information about patient demographics, medical history, implant characteristics, presenting symptoms, diagnosis and staging, treatment, and patient outcomes. CONCLUSIONS: Despite diagnosis and current treatment to BIA-ALCL are fairly standardized, more rigorous studies are required to establish actual incidence and etiology. The lack of common criteria when collecting or reporting clinical cases makes difficult a truthful and uniform data collection. Communication of any incident related to breast implants, both to the national implant registries and to the scientific community, is necessary in order to gather quality information as a basis for evidence-based decision making


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Linfoma Anaplásico de Células Grandes/diagnóstico , Linfoma Anaplásico de Células Grandes/etiologia , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/etiologia , Implante Mamário/efeitos adversos , Imuno-Histoquímica , Biópsia
17.
Plast Reconstr Surg ; 145(3): 542e-551e, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32097311

RESUMO

BACKGROUND: Texturing processes have been designed to improve biocompatibility and mechanical anchoring of breast implants. However, a high degree of texturing has been associated with severe abnormalities. In this study, the authors aimed to determine whether implant surface topography could also affect physiology of asymptomatic capsules. METHODS: The authors collected topographic measurements from 17 different breast implant devices by interferometry and radiographic microtomography. Morphologic structures were analyzed statistically to obtain a robust breast implant surface classification. The authors obtained three topographic categories of textured implants (i.e., "peak and valleys," "open cavities," and "semiopened cavities") based on the cross-sectional aspects. The authors simultaneously collected 31 Baker grade I capsules, sorted them according to the new classification, established their molecular profile, and examined the tissue organization. RESULTS: Each of the categories showed distinct expression patterns of genes associated with the extracellular matrix (Timp and Mmp members) and inflammatory response (Saa1, Tnsf11, and Il8), despite originating from healthy capsules. In addition, slight variations were observed in the organization of capsular tissues at the histologic level. CONCLUSIONS: The authors combined a novel surface implant classification system and gene profiling analysis to show that implant surface topography is a bioactive cue that can trigger gene expression changes in surrounding tissue, even in Baker grade I capsules. The authors' new classification system avoids confusion regarding the word "texture," and could be transposed to implant ranges of every manufacturer. This new classification could prove useful in studies on potential links between specific texturizations and the incidence of certain breast-implant associated complications.


Assuntos
Implante Mamário/efeitos adversos , Implantes de Mama/efeitos adversos , Mama/imunologia , Contratura Capsular em Implantes/imunologia , Complicações Pós-Operatórias/imunologia , Adulto , Idoso , Doenças Assintomáticas , Biomarcadores/análise , Mama/diagnóstico por imagem , Mama/cirurgia , Implante Mamário/instrumentação , Matriz Extracelular/imunologia , Estudos de Viabilidade , Feminino , Perfilação da Expressão Gênica , Regulação da Expressão Gênica/imunologia , Humanos , Contratura Capsular em Implantes/diagnóstico , Contratura Capsular em Implantes/epidemiologia , Contratura Capsular em Implantes/genética , Incidência , Interferometria , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/genética , Géis de Silicone , Propriedades de Superfície , Microtomografia por Raio-X
18.
Plast Reconstr Surg ; 145(3): 619-627, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32097293

RESUMO

BACKGROUND: Prepectoral implant-based reconstruction reemerged as a viable approach following recent advances in reconstructive techniques and technology. To achieve successful outcomes, careful patient selection is critical. Obesity increases the risk of complications and has been suggested as a relative contraindication for prepectoral breast reconstruction. METHODS: Retrospective chart review of patients who underwent immediate two-stage implant-based reconstruction at the authors' institution was performed. Only women having a body mass index of 30 kg/m or greater were included. Patient demographics, operative details, and surgical outcomes of prepectoral and subpectoral reconstruction were compared. RESULTS: One hundred ten patients (189 breasts) who underwent prepectoral and 83 (147 breasts) who underwent subpectoral reconstruction were included. Complications were comparable between the two groups. Twelve devices (6.4 percent), including implants and tissue expanders, required explantation in the prepectoral group, and 12 devices (8.2 percent) required explantation in the subpectoral group (p =0.522). Final implant-based reconstruction was achieved in 180 breasts (95.2 percent) in the prepectoral group and 141 breasts (95.9 percent) in the subpectoral group. Regardless of type of reconstruction (prepectoral or subpectoral), for each point increase in body mass index, the odds of complications and device explantation increased by 3.4 percent and 8.6 percent, respectively; and the optimal cutoff to predict higher complications and explantation rates was a body mass index of 34.8 kg/m and 34.1 kg/m, respectively. CONCLUSIONS: Obesity increases complications and failure rates in a positive correlation; however, complications and final reconstruction rates are comparable between the prepectoral and subpectoral groups. The authors believe that obesity should not be a contraindication for prepectoral breast reconstruction but that care should be taken in patients with a body mass index above 35 kg/m. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Implante Mamário/efeitos adversos , Contraindicações de Procedimentos , Obesidade/complicações , Músculos Peitorais/transplante , Complicações Pós-Operatórias/epidemiologia , Adulto , Índice de Massa Corporal , Implante Mamário/instrumentação , Implante Mamário/métodos , Implantes de Mama/efeitos adversos , Remoção de Dispositivo/estatística & dados numéricos , Feminino , Humanos , Pessoa de Meia-Idade , Obesidade/diagnóstico , Seleção de Pacientes , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento
19.
Plast Reconstr Surg ; 145(3): 632-642, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32097297

RESUMO

BACKGROUND: Animation deformity is an undesirable outcome of subpectoral breast reconstruction that results in abnormal breast contraction with activity, breast pain, and increased implant visibility. Surgical correction requires implant removal and conversion of the reconstruction to a prepectoral plane. The authors present their institutional experience with their preferred surgical technique to treat this challenging problem and outline solutions for increased success in these patients. METHODS: A retrospective review was performed of all patients undergoing conversion of their subpectoral breast reconstruction to a prepectoral plane at the authors' institution. Patient demographics and surgical details were analyzed, and postoperative outcomes and morbidity were assessed. The effects of changing operative strategies on enhanced success are also reported. RESULTS: A total of 80 breast conversions were performed over a 2.5-year period. All patients demonstrated resolution of animation deformity at a mean follow-up of 15.2 months. Two reconstructions (2.5 percent) required an unplanned return to the operating room, and 11 reconstructions (13.8 percent) were treated for infection. Preconversion fat grafting and the use of acellular dermal matrix were both associated with a reduced incidence of postoperative asymmetry and capsular contracture (p < 0.05). There were no reconstructive failures associated with conversion to a prepectoral pocket. CONCLUSIONS: Treatment of animation deformity in the reconstructed patient can be safely performed by surgical conversion to a prepectoral plane. The use of acellular dermal matrix, and preconversion fat grafting, in appropriate patients can improve results. The authors promote this operative algorithm for all reconstructive patients experiencing symptomatic animation deformity with subpectoral breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Doenças Mamárias/cirurgia , Implante Mamário/efeitos adversos , Músculos Peitorais/transplante , Complicações Pós-Operatórias/cirurgia , Reoperação/métodos , Adulto , Mama/fisiopatologia , Mama/cirurgia , Doenças Mamárias/etiologia , Doenças Mamárias/fisiopatologia , Implante Mamário/instrumentação , Implante Mamário/métodos , Implantes de Mama/efeitos adversos , Remoção de Dispositivo , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Movimento , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Estudos Retrospectivos
20.
Plast Reconstr Surg ; 145(3): 701-710, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32097310

RESUMO

BACKGROUND: One of the most common complications of the use of foreign material, in both reconstructive and cosmetic breast surgery, is capsular contracture. Historically, research on capsular contracture has focused mainly on reducing bacterial contamination through antibiotic solutions. Only secondary studies have focused on pharmacological control of the inflammation process, with particular attention paid to the main inflammation pathway, the arachidonic acid cascade. An important role in the arachidonic acid cascade is played by the omega-3 fatty acids, which are found mainly in oily fish and food supplements. The goal of the present study was to investigate the effects of omega-3 supplements on capsule contraction. METHODS: Female C57BL/6 mice were implanted with custom-made silicone gel implants and divided into two groups. The treated group received omega-3 oil daily while the control group received water daily by gavage. After mice were euthanized, samples of capsules were collected to evaluate thickness and transforming growth factor (TGF)-ß expression. RESULTS: The results showed that capsules in the omega-3 group were thinner and more transparent than those found in the control group. In addition, a significant downregulation of the TGF-ß2 gene transcript was observed in the omega-3 group. CONCLUSIONS: Omega-3 supplementation seems to be effective in reducing the occurrence of capsular formation, mainly through inhibition of the TGF-ß pathway and impairment of collagen deposit. Omega-3 supplementation is a simple and promising method that could be used to prevent or at least reduce capsular contracture after silicone implant surgery.


Assuntos
Implante Mamário/efeitos adversos , Implantes de Mama/efeitos adversos , Suplementos Nutricionais , Ácidos Graxos Ômega-3/administração & dosagem , Contratura Capsular em Implantes/prevenção & controle , Administração Oral , Animais , Implante Mamário/instrumentação , Modelos Animais de Doenças , Feminino , Humanos , Contratura Capsular em Implantes/etiologia , Contratura Capsular em Implantes/patologia , Glândulas Mamárias Animais/efeitos dos fármacos , Glândulas Mamárias Animais/patologia , Glândulas Mamárias Animais/cirurgia , Camundongos , Camundongos Endogâmicos C57BL , Géis de Silicone/efeitos adversos
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