Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 6.363
Filtrar
1.
Ann Plast Surg ; 90(2): 123-127, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36688854

RESUMO

INTRODUCTION: There is widespread recognition of the importance of assessment of patient satisfaction and well-being after breast reconstruction. However, few studies of fat grafting performed simultaneously with implant-based breast reconstruction (IBBR) have accounted for confounding factors, such as patient background and information bias. The aim of this study was to examine patient satisfaction and well-being using multivariate analysis of BREAST-Q scores in patients treated with IBBR combined with fat grafting. METHODS: Seventy-one consecutive patients who underwent IBBR with silicone breast implants were enrolled for a prospective cohort study. Among these patients, 56 responded to the BREAST-Q questionnaire, including 24 who underwent fat grafting at the same time as IBBR (FAT+ group) and 32 who underwent IBBR alone (FAT- group). The BREAST-Q questionnaire was completed 1 year after surgery. Statistical analysis was performed using descriptive and summary statistics to identify differences between the 2 groups. RESULTS: Logistic regression analysis showed that the FAT+ group was significantly more likely than the FAT- group to have satisfaction with breasts (P = 0.0201) and satisfaction with outcome (P = 0.0364). CONCLUSIONS: Multivariate analysis with consideration of confounding factors indicated that addition of fat grafting to IBBR improves outcomes of breast reconstruction. These results suggest that a minor surgical procedure of fat grafting can improve patient satisfaction and outcomes after breast reconstruction.


Assuntos
Implantes de Mama , Neoplasias da Mama , Mamoplastia , Humanos , Feminino , Mastectomia/métodos , Estudos Prospectivos , Mamoplastia/métodos , Satisfação do Paciente , Medidas de Resultados Relatados pelo Paciente , Análise Multivariada , Tecido Adiposo/transplante , Neoplasias da Mama/etiologia , Estudos Retrospectivos
2.
Plast Reconstr Surg ; 151(2): 207e-213e, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36696306

RESUMO

BACKGROUND: Anatomical implants continue to be a particularly useful tool in breast surgery, offering an excellent result for certain indications. However, to ensure fixation and prevent rotation, traditional alternatives have medium to high surface roughness and have been controversial in recent years. METHODS: A retrospective assessment of 122 prosthetic augmentation and reconstruction patients over a period of 5 years was conducted. Patients were treated with tabbed anatomical implants with a smooth surface and followed up for a period of 12 months. Demographics, complications, and patient satisfaction were captured. A subgroup of 101 patients were assessed with chest radiographs at 1-year follow-up. Technical recommendations are discussed. RESULTS: Primary breast augmentation, revision augmentation, augmentation-mastopexy, and breast reconstruction were the main indications for surgery. All implants were inserted through an inframammary incision and placed in the subpectoral space using dual-plane techniques, except in one mastectomy case. Rotation of the implants was radiographically observed in only two cases of revision augmentation. None of the 122 patients developed capsular contracture, seroma, rupture, infection, hematoma, or malposition following breast surgery. CONCLUSIONS: Smooth anatomical implants with a fixation system offer reliable and satisfactory results for patients with various diagnoses and indications. The tab system and the fixation technique are essential to provide long-term stability, which was verified by radiographs because of the radiopaque lines present in the device for that purpose. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Implante Mamário , Implantes de Mama , Neoplasias da Mama , Mamoplastia , Humanos , Feminino , Implantes de Mama/efeitos adversos , Implante Mamário/métodos , Estudos Retrospectivos , Mastectomia , Neoplasias da Mama/etiologia , Mamoplastia/métodos , Reoperação , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia
4.
BMJ Case Rep ; 16(1)2023 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-36593075

RESUMO

This case study highlights the rare complications of silicone breast implants, as well as the diagnostic limitations of imaging. The patient initially presented with leakage of bilateral breast implants as discovered by a positron emission tomography (PET)-computerized tomography (CT) scan performed as part of a workup for small bowel Langerhans cell sarcoma metastases. The imaging results of the PET-CT scan revealed increased activity bilaterally with an enhancing, irregular, heterogeneously enhancing mass in the right breast. Given the clinical suspicion for breast implant-associated anaplastic large cell lymphoma, further investigation including surgical excision was undertaken. What initially was a concern for a serious complication of long-standing breast implants, fortuitously turned out to be a benign but exuberant xanthogranulomatous inflammatory reactive process. We hope that our report will add to the literature of this rare phenomenon and highlight it as a differential diagnosis of a mass in association with breast implants.


Assuntos
Doenças Mamárias , Implantes de Mama , Neoplasias da Mama , Linfoma Anaplásico de Células Grandes , Humanos , Feminino , Implantes de Mama/efeitos adversos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Géis de Silicone/efeitos adversos , Linfoma Anaplásico de Células Grandes/diagnóstico por imagem , Linfoma Anaplásico de Células Grandes/etiologia , Proliferação de Células , Inflamação/complicações , Neoplasias da Mama/cirurgia , Neoplasias da Mama/complicações
5.
J Plast Reconstr Aesthet Surg ; 76: 18-26, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36512998

RESUMO

BACKGROUND: Capsular contracture following post-mastectomy radiotherapy (PMRT) is commonly seen in patients undergoing implant-based immediate breast reconstruction (IBR). Further understanding of the underlying biology is needed for the development of preventive or therapeutic strategies. Therefore, we conducted a comparative study of gene expression patterns in capsular tissue from breast cancer patients who had received versus those who had not received PMRT after implant-based IBR. METHODS: Biopsies from irradiated and healthy non-irradiated capsular tissue were harvested during implant exchange following IBR. Biopsies from irradiated (n = 13) and non-irradiated (n = 12) capsules were compared using Affymetrix microarrays to identify the most differentially regulated genes. Further analysis using immunohistochemistry was performed in a subset of materials to compare the presence of T cells, B cells, and macrophages. RESULTS: Enrichment testing using Gene Ontology (GO) analysis revealed that the 227 most differentially expressed genes were mainly involved in an inflammatory response. Twenty-one GO biological processes were identified [p < 0.05, false discovery rate (FDR) < 5%], several with B-cell-associated inflammation. Cell-type Identification by Estimating Relative Subsets of RNA Transcripts (CIBERSORT) analysis identified macrophages as the most common inflammatory cell type in both groups, further supported by immunostaining of CD68. Radiation remarkably increased B-cell infiltration in the capsular region of biopsies, as quantified by immunostaining of CD20 (p = 0.016). CONCLUSIONS: Transcript analysis and immunohistochemistry revealed inflammatory responses in capsular biopsies regardless of radiotherapy. However, the radiation response specifically involved B-cell-associated inflammatory responses.


Assuntos
Implante Mamário , Implantes de Mama , Neoplasias da Mama , Mamoplastia , Humanos , Feminino , Neoplasias da Mama/genética , Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Mastectomia , Implantes de Mama/efeitos adversos , Radioterapia Adjuvante/efeitos adversos , Mamoplastia/efeitos adversos , Inflamação , Expressão Gênica
6.
J Plast Reconstr Aesthet Surg ; 76: 76-87, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36513014

RESUMO

BACKGROUND: Approximately 80% of patients undergoing total mastectomy in the US opt for implant-based breast reconstruction (IBBR). A two-stage reconstruction with tissue expander (TE) remains the most common technique. Since the implementation of ADMs, a prepectoral approach has gained popularity and is becoming the standard of care. Herein, we compared the surgical and postoperative outcomes of prepectoral versus subpectoral two-stage IBBR. METHODS: A retrospective chart review was performed between January 2011 and December 2020. We included female patients undergoing immediate two-stage IBBR. The primary outcomes of this study were to compare the 30-day morbidity and the overall rate of complications during the first and second stages of reconstruction, and to compare the time to initiate postmastectomy radiotherapy (PMRT). Propensity score matching was implemented. RESULTS: After matching, 154 reconstructions were analyzed, 77 in each group. The two matched groups exhibited comparable (p > 0.05) characteristics for all analyzed demographic and intraoperative independent variables. Reconstructions in the prepectoral group had a shortened median time for drain removal (13-days vs. 15-days, p = 0.001). The intraoperative expansion volumes were higher in the prepectoral group (300 ml versus 200 ml, p = 0.025). The 30-day morbidity and first- and second-stage complication rates were not significantly different between groups. The time to start postmastectomy radiation therapy (PMRT) was not significantly different between groups (134-days versus 126.5-days, p = 0.58). CONCLUSION: Prepectoral and subpectoral TE placement had comparable complication rates during the first and second stages of IBBR. Timing for TE-to-Implant exchange and initiation of PMRT were comparable between the two approaches.


Assuntos
Implante Mamário , Implantes de Mama , Neoplasias da Mama , Mamoplastia , Humanos , Feminino , Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Neoplasias da Mama/complicações , Implante Mamário/métodos , Implantes de Mama/efeitos adversos , Estudos Retrospectivos , Pontuação de Propensão , Mastectomia/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Mamoplastia/métodos , Morbidade
7.
Tissue Cell ; 80: 101999, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36527787

RESUMO

BACKGROUND: Capsular contracture may occur after rhinoplasty due to rejection of silicone implants by the immune system. Our previous high-throughput sequencing of RNA in nasal capsular contracture tissue revealed that FPR3 was significantly increased in grade IV capsular contracture tissue, compared with grade II. OBJECTIVE: This study aimed to elucidate the effect and specific mechanism of FPR3 on capsular formation and contracture following rhinoplasty. METHODS: Using the GeneMANIA Database, the genes involved with FPR3 expression were searched, and the Gene Ontology analysis was performed to annotate the biological functions of the aforementioned genes. The mRNA and protein expressions of related genes in fibroblasts and capsular contracture tissues were analyzed using quantitative real-time PCR, western blot, and immunohistochemical staining. CCK-8 was used to determine the viability of cells. The migration capacity of fibroblasts was assessed using a wound healing assay. ELISA was used to detect levels of IL-1ß, TNF-α, and IL-6. RESULTS: After rhinoplasty, the expression of FPR3 in the capsular tissue increased in proportion to the degree of contracture. By activating the PKA/Rap1/ERK1/2 axis, overexpression of FPR3 can significantly increase the cell viability of fibroblasts and promote their transformation into myofibroblasts. Moreover, FPR3 phosphorylates IκB to decrease NF-κB inhibition, thereby promoting the synthesis and release of the inflammatory cytokines IL-1ß, TNF-α, and IL-6. CONCLUSION: FPR3 is a crucial molecule that causes capsular development and contracture following rhinoplasty. In the future, local suppression of FPR3 may be an effective treatment for relieving capsular contracture.


Assuntos
Implantes de Mama , Contratura , Rinoplastia , Humanos , Implantes de Mama/efeitos adversos , NF-kappa B , Fator de Necrose Tumoral alfa/genética , Rinoplastia/efeitos adversos , Interleucina-6 , Sistema de Sinalização das MAP Quinases , Fibroblastos , Contratura/etiologia , Contratura/cirurgia
8.
Ann Surg Oncol ; 30(2): 1087-1097, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36496488

RESUMO

PURPOSE: In two-stage prosthetic breast reconstruction, autologous fat graft (AFG) is often conducted simultaneously with the second-stage operation, which is usually performed shortly after mastectomy. There is a paucity of studies evaluating whether conducting AFG early, with a relatively short interval from the primary operation, is oncologically safe. This study aimed to evaluate potential associations of AFG with breast cancer prognosis, focusing on its timing. METHODS: Patients with invasive breast cancer who underwent immediate two-stage prosthetic reconstruction following mastectomy between 2011 and 2016 were identified. They were categorized into two groups by whether AFG was performed during the second-stage operation. Cumulative incidence of oncologic events was compared between the two groups, after stratifying patients by the time interval between mastectomy and the second-stage operation (≤ 12 months vs. > 12 months). RESULTS: Of 267 cases that met the selection criteria, 203 underwent the second-stage operation within 12 months of mastectomy. AFG was performed for 112 cases and was not performed in 91 cases. The two groups showed similar baseline characteristics including tumor stage and adjuvant treatments. Compared with the control, AFG was associated with lower locoregional recurrence-free survival and disease-free survival, and this difference remained significant after adjusting for other variables including tumor stage. In the 64 cases undergoing the operation after 12 months following mastectomy, oncologic outcomes did not differ between the two groups. CONCLUSION: Our results suggest that AFG timing in relation to mastectomy may be associated with risks for breast cancer recurrence.


Assuntos
Implante Mamário , Implantes de Mama , Neoplasias da Mama , Mamoplastia , Humanos , Feminino , Neoplasias da Mama/cirurgia , Neoplasias da Mama/patologia , Mastectomia/métodos , Recidiva Local de Neoplasia/patologia , Tecido Adiposo/patologia , Mamoplastia/efeitos adversos , Mamoplastia/métodos , Estudos Retrospectivos
9.
Ann Plast Surg ; 90(1): 19-26, 2023 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-36534096

RESUMO

BACKGROUND: The choice of implant shape (anatomic or round) is one of the most critical issues for breast augmentation. Determining whether there are differences in the postoperative breast morphology of the 2 implants is pivotal for surgical planning. This issue has been controversial and lacking in evidence. The aim of this study was to provide reference for implant selection by comparing breast morphology after dual-plane augmentation with anatomic and round implants using 3-dimensional scanning technology. METHODS: Patients with implant volume less than 300 mL who underwent transaxillary dual-plane augmentation were included in this study and were grouped according to implant shape. Three-dimensional scans were performed preoperatively and 6 months postoperatively. Postoperative breast height (BH), breast width (BW), BH of upper pole (BHUP), BH of lower pole (BHLP), breast projection (BP), BP of upper pole (BPUP), and BP of lower pole (BPLP) were measured separately, resulting in corresponding ratios (BH/BW, BHUP/BHLP, BP/BH, BPUP/BPLP). Breast volume, and the volumes of each pole (breast volume of upper pole [BVUP], breast volume of lower pole [BVLP]) and its ratio (BVUP/BVLP) were calculated. Correlation and regression analysis on the influencing factors of breast volume were performed. RESULTS: Thirty patients with anatomic implants and 26 with round implants were enrolled in this study. The mean volumes of anatomic and round implants were 260.5 ± 26.7 and 267.9 ± 21.7 mL (P = 0.192). The ratios of BH/BW in the 2 groups were 1.39 ± 0.12 and 1.37 ± 0.19, respectively (P = 0.582). The BHUP/BHLP values of 2 groups were 1.35 ± 0.22 and 1.41 ± 0.25 (P = 0.160). Two sets of BPUP/BPLP were 0.68 ± 0.19 and 0.73 ± 0.17 (P = 0.133). The ratios of BP/BH in the 2 groups were 0.39 ± 0.08 and 0.39 ± 0.06 (P = 0.830). The BVUP/BVLP ratios for both groups were 0.75 ± 0.11 and 0.77 ± 0.12 (P = 0.287). There was a volume loss rate of 13.3% ± 3.9% and 13.9% ± 5% (P = 0.489). The postoperative volume showed a positive correlation with both the preoperative volume and the implant volume. CONCLUSIONS: For patients with breast dysplasia undergoing transaxillary dual-plane augmentation with anatomic or round implants less than 300 mL, the difference in postoperative breast morphology is not obvious. Using these 2 shapes of implants results in a similar degree of volume loss.


Assuntos
Implante Mamário , Implantes de Mama , Mamoplastia , Humanos , Estudos Prospectivos , Implante Mamário/métodos , Mama/cirurgia , Mamoplastia/métodos
10.
Ann Plast Surg ; 90(1): 33-40, 2023 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-36534098

RESUMO

BACKGROUND: Oncoplastic techniques, in conjunction with lumpectomy and adjuvant radiotherapy, have been demonstrated to achieve good aesthetic results and cancer outcomes in the treatment of patients with macromastia or significant ptosis. This study evaluated a series of patients undergoing breast conservation with concomitant oncoplastic-augmentation-mastopexy and a contralateral augmentation-mastopexy. METHODS: Patients undergoing lumpectomy for breast conservation were identified via a retrospective chart review. Inclusion criteria included patients with ptosis and preexisting breast implants or insufficient breast volume undergoing oncoplastic implant placement/exchange and mastopexy. Demographic characteristics, operative details, and complications were assessed. RESULTS: Thirty-four consecutive patients (64 breasts, 4 unilateral procedures) were included in the study. Average age was 51.4 years, average body mass index was 27, and 38.2% were smokers/former smokers. The average operative time was 2.5 hours. Furthermore, 38.2% of patients received chemotherapy, and 82.4% of patients received breast adjuvant radiotherapy. The average length of follow-up was 11.7 months. In the sample that received radiation, the capsular contracture rate was 25%, with a 7.1% contracture revision rate. For the entire group, a total of 8 patients (23.5%) underwent revisions for either positive margins (8.8%), capsular contracture (8.8%), implant loss (2.9%), or cosmetic concerns (2.9%). One patient developed a pulmonary embolism. CONCLUSIONS: Oncoplastic-augmentation-mastopexy is a safe technique with acceptable complication rates. This technique is best used for breast cancer patients with breast ptosis and a paucity of breast volume or preexisting implants who wish to pursue breast-conserving therapy. The revision rates are acceptable compared with single-stage cosmetic augmentation procedures as well as other oncoplastic techniques described in the literature, but patients must be clearly counseled on contracture risk.


Assuntos
Implante Mamário , Implantes de Mama , Neoplasias da Mama , Contratura , Mamoplastia , Humanos , Pessoa de Meia-Idade , Feminino , Estudos Retrospectivos , Mastectomia Segmentar/efeitos adversos , Mamoplastia/métodos , Implantes de Mama/efeitos adversos , Implante Mamário/métodos , Neoplasias da Mama/cirurgia , Complicações Pós-Operatórias/cirurgia , Contratura/cirurgia
12.
Clin Radiol ; 77(2): 79-87, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34579859

RESUMO

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare but emerging T-cell non-Hodgkin lymphoma. It has two distinct subtypes, "effusion-only" or "mass-forming" disease, arising around implants in patients with in situ or previous history of textured-surface breast implants. The clinical, histopathological and imaging features are unique and nuanced as compared to primary breast malignancy and other lymphoma categories. Prompt recognition and diagnosis triggers referral to appropriate BIA-ALCL centres and initiation of treatment, with potential for excellent prognosis. Definitive management of both subtypes involves implant and capsule removal; systemic therapy is reserved for mass-forming disease and advanced-stage disease. There have been recent crucial advances in the diagnostic pathway, with publication of national and international guidelines: from the UK Medicines Healthcare products Regulatory Agency (MHRA) Plastic, Reconstructive and Aesthetic Surgery Expert Advisory Group (PRASEAG), and the United States National Comprehensive Cancer Network (NCCN). This review provides a practical guide to the clinical work-up of BIA-ALCL, enabling optimisation of the diagnostic imaging pathway, with representative cases.


Assuntos
Implantes de Mama/efeitos adversos , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/etiologia , Diagnóstico por Imagem/métodos , Linfoma Anaplásico de Células Grandes/diagnóstico por imagem , Linfoma Anaplásico de Células Grandes/etiologia , Mama/diagnóstico por imagem , Feminino , Humanos , Prognóstico
13.
Aesthetic Plast Surg ; 46(1): 1-10, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34494126

RESUMO

Currently there are limited implant-based options for cosmetic breast augmentation, and problems associated with those have been increasingly appreciated, most commonly capsular contracture, which occurs due to a chronic foreign body reaction against non-degradable implant materials such as silicone and polyurethane leading to scar tissue formation, pain, and deformity. The underlying biomechanical concepts with implants create a reciprocal stress-strain relationship with local tissue, whilst acting as a deforming force. This means that with time, as the implant continues to have an effect on surrounding tissue the implant and host's biomechanical properties diverge, making malposition, asymmetry, and other complications more likely. Research directed towards development of alternative therapies based on tissue engineering and regenerative medicine seeks to optimize new tissue formation through modulation of tissue progenitors and facilitating tissue regeneration. Scaffolds can guide the process of new tissue formation by providing both an implant surface and a three-dimensional space that promotes the development of a microenvironment that guides attachment, migration, proliferation, and differentiation of connective tissue progenitors. Important to scaffold design are the architecture, surface chemistry, mechanical properties, and biomaterial used. Scaffolds provide a void in which vascularization, new tissue formation, and remodelling can sequentially occur. They provide a conduit for delivery of the different cell types required for tissue regeneration into a graft site, facilitating their retention and distribution. Whilst recent research from a small number of groups is promising, there are still ongoing challenges to achieving clinical translation. This article summarizes the biomechanical principles of breast implants, how these impact outcomes, and progress in scaffold-guided tissue engineering approaches to cosmetic breast augmentation. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .


Assuntos
Implante Mamário , Implantes de Mama , Mamoplastia , Implante Mamário/efeitos adversos , Implante Mamário/métodos , Implantes de Mama/efeitos adversos , Humanos , Contratura Capsular em Implantes/cirurgia , Mamoplastia/métodos , Poliuretanos , Engenharia Tecidual , Resultado do Tratamento
14.
Handchir Mikrochir Plast Chir ; 54(6): 495-500, 2022 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-36513061

RESUMO

Rotation of an anatomical breast implant may require revisional surgery. High-resolution ultrasound can help determine the exact implant alignment. However, the directional markings of anatomical implants are implemented very inconsistently by manufacturers. Therefore, a definite diagnosis is often not possible without precise knowledge of the expected imaging. The aim of this work is a differentiation of the imaging of common implant brands in high-resolution ultrasound. Methods To simulate an authentic imaging, anatomical implants were viewed through abdominal skin thinned to 1.5-2 cm, which was obtained during a classic abdominoplasty. Implants from the companies Allergan, Eurosilicone, Mentor, Motiva, Nagor, Polytech and Sebbin were compared. The marking positions and dimensions were documented by ultrasound. Results Based on placement and shape, a clear allocation between alignment and manufacturer is basically possible among the implants used. The base plate and caudal markers could be clearly visualised for all brands. In Polytech implants, however, the visible structural change is limited to a very small central area. The visualisation of directional marks, base plate and implant shell also allow conclusions to be drawn about the manufacturer. In high-resolution ultrasound, a fast and reliable diagnosis of implant alignment is possible for all implants examined. Also it was possible to make a clear allocation between implant and manufacturer in this context. Flip over of the implant can also be reliably depicted. The cataloguing of the markings summarised here can be used to determine the exact alignment of the implant and thus provide diagnostic certainty, especially if the brand is unknown.


Assuntos
Implante Mamário , Implantes de Mama , Humanos , Géis de Silicone/química , Rotação , Implante Mamário/métodos , Ultrassonografia
16.
Breast ; 66: 332-341, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36502569

RESUMO

Shared strategies and correct information are essential to guide physicians in the management of such an uncommon disease as Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). A systematic review of the literature was performed to collect the most relevant evidence on BIA-ALCL reported cases. A panel of multidisciplinary experts discussed the scientific evidence on BIA-ALCL, and updated consensus recommendations were developed through the Delphi process. The lastest reported Italian incidence of BIA-ALCL is 3.5 per 100.000 implanted patients (95% CI, 1.36 to 5.78), and the disease counts over 1216 cases worldwide as of June 2022. The most common presentation symptom is a late onset seroma followed by a palpable breast mass. In the event of a suspicious case, ultrasound-guided fine-needle aspiration should be the first step in evaluation, followed by cytologic and immunohistochemical examination. In patients with confirmed diagnosis of BIA-ALCL confined to the capsule, the en-bloc capsulectomy should be performed, followed by immediate autologous reconstruction, while delayed reconstruction applies for disseminate disease or radically unresectable tumor. Nevertheless, a multidisciplinary team approach is essential for the correct management of this pathology.


Assuntos
Implante Mamário , Implantes de Mama , Neoplasias da Mama , Linfoma Anaplásico de Células Grandes , Humanos , Feminino , Implantes de Mama/efeitos adversos , Linfoma Anaplásico de Células Grandes/diagnóstico , Linfoma Anaplásico de Células Grandes/etiologia , Linfoma Anaplásico de Células Grandes/terapia , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/etiologia , Neoplasias da Mama/terapia , Implante Mamário/efeitos adversos , Mama/patologia
17.
Medicine (Baltimore) ; 101(46): e31344, 2022 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-36401398

RESUMO

BACKGROUND: In prepectoral direct-to-implant breast reconstruction using the acellular dermal matrix (ADM)-assisted technique, breast volume asymmetry can occur. We hypothesized that ADM size influences implant size selection in prepectoral breast reconstruction with implant coverage using an ADM. We investigated factors influencing implant size selection and provide guidelines for surgeons. METHODS: A retrospective chart review was performed to identify all patients who underwent prepectoral direct-to-implant breast reconstruction between January 2017 and October 2020. We assessed patient characteristics, preoperative expected implant volume, ADM size, volume of implant used in surgery, and symmetry scale of aesthetic item scale (AIS) 6 months after surgery. We compared the symmetry score of AIS between a group in which the preoperative expected silicone implant size (ES) was used and a group in which a silicone implant of a smaller size than planned (SS) was used. RESULTS: Patient characteristics, including age, body mass index (BMI), and excised breast volume, were similar between the groups (P > .05). ADM size had a significant effect on implant size selection (odds ratio = 1.760, P < .01). The symmetry score of AIS was higher in the SS group. CONCLUSIONS: ADM size must be considered when selecting implant size in prepectoral direct-to-implant breast reconstruction using the ADM-assisted technique.


Assuntos
Derme Acelular , Implantes de Mama , Mamoplastia , Humanos , Estudos Retrospectivos , Mamoplastia/métodos , Silicones
18.
Ann Plast Surg ; 89(6): 679-683, 2022 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-36416700

RESUMO

BACKGROUND: In implant-based breast surgery, infections remain a clinically challenging complication. Surgeons often prophylactically address this risk by irrigating the implant at the time of placement. However, there remain few data on the ideal irrigant for gram-negative species. METHODS: The authors assessed the relative efficacy of 10% povidone-iodine, triple-antibiotic solution, Prontosan, Clorpactin, and normal saline (negative control) against 3 gram-negative bacterial backgrounds: Escherichia coli , Pseudomonas aeruginosa , and Proteus species. A laboratory-adapted strain and a clinical isolate were selected for each group of bacteria. Sterile, smooth implant discs were immersed in each irrigant solution and then incubated in suspensions of each bacterial strain overnight at 37°C. Each disc was then rinsed and sonicated to displace biofilm-forming bacteria from the implant surface. The displaced bacteria were enumerated by plating, and normalized values were calculated for the bacterial counts of each irrigant. RESULTS: Povidone-iodine resulted in the greatest reduction of bacterial load for all 6 strains by a factor of 10 1 to 10 6 . Prontosan had a lesser, yet significant reduction in all bacterial strains. Triple-antibiotic solution demonstrated the greatest reduction in one Proteus species strain, and Clorpactin reduced bacterial counts in only half of the bacterial strains. When comparing laboratory strains to clinical isolates, significant differences were seen in each bacterial species in at least 2 irrigant solutions. CONCLUSIONS: Povidone-iodine has been proven the most effective at reducing bacterial contamination of E. coli, P. aeruginosa , and Proteus species in both laboratory-adapted strains and clinical isolates. CLINICAL RELEVANCE: This study proves that povidone-iodine is the most effective at preventing gram-negative infections in breast implant surgery.


Assuntos
Implante Mamário , Implantes de Mama , Humanos , Povidona-Iodo/farmacologia , Escherichia coli , Antibacterianos
19.
Ann Plast Surg ; 89(6): 694-702, 2022 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-36416706

RESUMO

OBJECTIVE: The aim of the study is to determine rates of overall complications and failure of prepectoral breast reconstruction between various types of acellular dermal matrices (ADMs). BACKGROUND: Implant-based breast reconstruction is the most common reconstructive technique after mastectomy in the United States. Traditionally, the reconstruction has been performed in the subpectoral plane; however, there has been an emerging interest in prepectoral reconstruction using ADM. Human (hADM), porcine (pADM), and bovine (bADM) ADMs are available for use, but little is known about the benefits and complication profiles of each for prepectoral breast reconstruction. METHODS: Studies examining complications after the use of ADM for prepectoral breast reconstruction were identified using MEDLINE, Embase, the Cochrane Library, LILACS, and the Web of Science from January 2010 to August 2021. Titles and abstracts of 1838 studies were screened, followed by full-text screening of 355 articles. Thirty-three studies were found to meet inclusion criteria. RESULTS: From the 33 studies, 6046 prepectoral reconstructions were examined. Implant loss was comparable across the different types of ADM (pADM, 4.0%; hADM, 4.0%; bADM, 3.7%). Bovine ADM had the highest rate of capsular contracture (6.1%), infection (9.0%), skin flap necrosis (8.3%), dehiscence (5.4%), and hematoma (6.1%) when compared with both hADM and pADM. Human ADM had the highest rate of postoperative seroma (5.3%), followed by pADM (4.6%) and bADM (4.5%). CONCLUSIONS: Among the prepectoral breast reconstruction studies using hADM, pADM, or bADM included in our analysis, complication profiles were similar. Bovine ADM had the highest proportion of breast complications in the following categories: capsular contracture, infection rate, skin flap necrosis, dehiscence, and hematoma. Implant loss was comparable across the cohorts. Overall, prepectoral breast reconstruction using ADM leads to relatively low complication rates with the highest rates within the bADM cohort.


Assuntos
Derme Acelular , Implantes de Mama , Neoplasias da Mama , Contratura , Mamoplastia , Humanos , Bovinos , Animais , Suínos , Estados Unidos , Feminino , Mastectomia/métodos , Neoplasias da Mama/cirurgia , Mamoplastia/métodos , Complicações Pós-Operatórias/epidemiologia , Hematoma , Necrose
20.
Ann Plast Surg ; 89(5): 492-499, 2022 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-36279573

RESUMO

BACKGROUND: Acute pain after mastectomy is increased with concurrent breast reconstruction. One postulated advantage of prepectoral breast reconstruction is less postoperative pain; however, no comparisons to partial submuscular reconstruction have been made to date. Here, we examined the postoperative pain experienced between patients with prepectoral and subpectoral breast reconstruction after mastectomy. METHODS: We performed a retrospective chart review of all patients undergoing immediate breast reconstruction with tissue expanders from 2012 to 2019 by a single plastic surgeon. Patient demographics, surgical details, and anesthetic techniques were evaluated, and our primary outcome compared postoperative opioid usage between prepectoral and subpectoral reconstructions. Our secondary outcome compared pain scores between techniques. RESULTS: A total of 211 subpectoral and 117 prepectoral reconstruction patients were included for analysis. Patients with subpectoral reconstructions had higher postoperative opioid usage (80.0 vs 45.0 oral morphine equivalents, P < 0.001). Subpectoral patients also recorded higher maximum pain scores compared with prepectoral reconstructions while admitted (7 of 10 vs 5 of 10, P < 0.004). Multivariable linear regression suggests that mastectomy type and subpectoral reconstruction were significant contributors to postoperative opioid use (P < 0.05). CONCLUSIONS: Prepectoral breast reconstruction was associated with less postoperative opioid consumption and lower postoperative pain scores as compared with subpectoral reconstruction, when controlling for other surgical and anesthesia factors. Future randomized controlled trials are warranted to study how postoperative pain and chronic pain are influenced by the location of prosthesis placement in implant-based postmastectomy breast reconstruction.


Assuntos
Implante Mamário , Implantes de Mama , Neoplasias da Mama , Mamoplastia , Humanos , Feminino , Mastectomia/métodos , Implante Mamário/métodos , Analgésicos Opioides/uso terapêutico , Neoplasias da Mama/cirurgia , Estudos Retrospectivos , Mamoplastia/métodos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Derivados da Morfina
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...