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1.
FP Essent ; 497: 27-36, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33021776

RESUMO

In 2018, breast augmentation was the most common cosmetic surgical procedure performed in the United States. It was the most commonly performed cosmetic surgical procedure in women ages 18 to 34 years. Silicone gel-filled implants are the most commonly used in the United States, followed by saline-filled implants. The most common approach to placement of implants is through an incision in the inframammary fold. The majority of implants are placed subglandularly, under the breast tissue but on top of the pectoralis muscle. Postoperative complications include lumps, asymmetry, leakage or deflation, capsular contracture, changes or loss of nipple and areolar sensation, seroma, hematoma, changes in breast shape, and infection. Long-term complications include infection, implant rupture, capsular contracture, and breast implant-associated anaplastic large cell lymphoma. Any patient who has undergone breast augmentation who presents with a breast lump or mass should be referred to a breast unit for evaluation. Lumps can indicate implant rupture, capsular contracture, seroma, hematoma, breast cancer, or infection. Studies have shown no association between silicone-filled breast implants and connective tissue disorders. Breast reconstruction after mastectomy frequently involves placement of implants. Autologous reconstruction remains another option. Various implants are approved by the Food and Drug Administration for buttock and calf augmentation.


Assuntos
Implantes de Mama , Neoplasias da Mama , Cirurgia Plástica , Adolescente , Adulto , Implantes de Mama/efeitos adversos , Feminino , Humanos , Mastectomia , Géis de Silicone , Estados Unidos , Adulto Jovem
2.
Acta Chir Plast ; 62(1-2): 50-52, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32911943

RESUMO

Some patients undergoing breast reconstruction with acellular dermal matrices (ADMs) develop postoperative erythema overlying their ADM grafts named red breast syndrome (RBS). To the best of our knowledge this entity has never been related to the use of a synthetic mesh. We present a case of a 61-year-old patient who underwent bilateral nipple-sparing prophylactic mastectomy because of BRCA-1 gene mutation. The patient was reconstructed with a direct-to-implant approach, and the implants were covered with a polyglycolic acid mesh. Twenty days after the reconstruction, she presented with a blanching erythema of both reconstructed breasts without signs of infection on the area covered by the mesh. The patient denied symptoms like fever or tenderness and presented with no clinical signs of infection. Her laboratory tests were within normal range. We decided to watch and wait. The patient continued strict controls in the outpatient setting. Gradually, the erythema begun to disappear and it resolved spontaneously. RBS has only been described with the use of ADMs, but since in this case the mesh was made of polyglycolic acid, we suggest RBS should be considered either with the use of biological or synthetic meshes. The importance of its differential diagnosis resides in distinguishing it from an infection.


Assuntos
Eritema/etiologia , Mamoplastia , Telas Cirúrgicas , Implante Mamário , Implantes de Mama/efeitos adversos , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mamoplastia/efeitos adversos , Mastectomia , Pessoa de Meia-Idade , Polietilenoglicóis , Telas Cirúrgicas/efeitos adversos
3.
BMC Infect Dis ; 20(1): 672, 2020 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-32938418

RESUMO

BACKGROUND: Mycobacterium jacuzzii (M. jacuzzii) was first isolated in 2003 by insertion of breast implants in Tel Aviv, Israel. In this case report, we describe our experience in detection of M. jacuzzii using phenotypic and genotypic test of wrist synovial sample. CASE PRESENTATION: A 73-year-old woman complained of pain and swelling in the right wrist for 4 months. Her body temperature was 37-38 °C, and symptoms, such as pain, swelling, and some movement limitation, were reported. Clinical laboratory parameters showed an elevated C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR), and white blood cells (WBC) count. The sequences of hsp65, rpoB, 16S rDNA, and sodA genes indicated very high homology to M. jacuzzii. CONCLUSION: We report a case of synovial infection caused by M. jacuzzii in a patient with severe wrist pain in Iran, who was treated with amikacin, levofloxacin, and ethambutol. The outcomes of treatment after 8 months were positive, and no recurrence of infection was reported in the patient.


Assuntos
Implantes de Mama/efeitos adversos , Infecções por Mycobacterium/diagnóstico , Mycobacterium/genética , Membrana Sinovial/microbiologia , Idoso , Amicacina/uso terapêutico , Antibacterianos/uso terapêutico , Sedimentação Sanguínea , Feminino , Humanos , Irã (Geográfico) , Contagem de Leucócitos , Mycobacterium/classificação , Mycobacterium/isolamento & purificação , Infecções por Mycobacterium/tratamento farmacológico , Infecções por Mycobacterium/microbiologia , Filogenia , RNA Ribossômico 16S/classificação , RNA Ribossômico 16S/metabolismo , Punho/microbiologia
4.
Arch Osteoporos ; 15(1): 149, 2020 09 22.
Artigo em Inglês | MEDLINE | ID: mdl-32964330

RESUMO

The effects of gluteal implants on bone mass remain unclear. Transgender women with ILS presented higher BMD in the hip compared with transgender women without implants, while no difference was observed in other sites. These results may be artifactual and suggest using spine/forearm sites for DXA in individuals with ILS. PURPOSE: The inappropriate use of industrial liquid silicone (ILS) injections for cosmetic purposes is practiced by some transgender women. The aim of this study was to evaluate the impact of gluteal ILS on femur BMD in transgender women. METHODS: A total of 46 trans women with and without ILS injection in the gluteal region were selected. All patients underwent clinical and hormonal evaluation, and bone mass was assessed by DXA. RESULTS: Bone mineral density (BMD) values were significantly higher in trans women with ILS (n = 23) in femoral neck and total femur when compared with trans women without implants (n = 23). Similar BMD was observed in other sites, such as lumbar spine and forearm. Good agreement was found in the evaluation of low BMD using spine/forearm or spine/femur in patients without implants (k = 0.744 and 1.000 for male and female reference database, respectively), but poor to fair index was found in patients with ILS implants (k = 0.330 and 0.646 for male and female reference database, respectively). CONCLUSIONS: In transgender women with ILS implants, poor to moderate agreement was found on BMD when comparing lumbar spine/femur DXA with an alternative site to the femur, depending on using male or female database. These results may be artifactual and suggest using spine/forearm sites for more accurate DXA assessments in trans women with ILS gluteal implants.


Assuntos
Densidade Óssea , Implantes de Mama , Pessoas Transgênero , Absorciometria de Fóton , Implantes de Mama/efeitos adversos , Feminino , Colo do Fêmur/diagnóstico por imagem , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Silicones
5.
Plast Reconstr Surg ; 146(3): 516-525, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32842102

RESUMO

BACKGROUND: Capsular contracture following breast augmentation is prone to recurrence with conventional surgical therapy. Adding acellular dermal matrix improves results but significantly increases operating time and cost. This study tested a new treatment algorithm that uses acellular dermal matrix selectively to optimize success rates while minimizing its drawbacks. METHODS: All patients surgically treated by the authors for Baker grade III/IV capsular contracture between 2007 and 2018 were included in this retrospective cohort study. Data were collected on patient, breast augmentation, capsular contracture, and surgical treatment characteristics, in addition to follow-up findings. Treatment success was defined as Baker grade II or better. RESULTS: One hundred eighty patients underwent 217 surgical treatments for capsular contracture. Conventional treatment was used in 185 cases and acellular dermal matrix in 32. Twenty-six patients were treated for a second occurrence and four were treated for a third. The average follow-up was 2.4 years. Conventional treatment was successful in 72.5 percent of first occurrences, 62.5 percent of second occurrences, and 50.0 percent of third occurrences. Acellular dermal matrix was successful in 96.9 percent of cases. The odds of failure were increased by bilateral capsular contracture (3.9 times) and previous treatment failure (3.5 times). When acellular dermal matrix was used selectively for bilateral capsular contracture or in unilateral cases with a previous treatment failure, the overall treatment success rate improved to 85.6 percent compared with 64.2 percent when this algorithm was not followed (p < 0.001). CONCLUSION: This study demonstrates that selective acellular dermal matrix use can increase success rate to over 85 percent in the overall treatment of capsular contracture, and to nearly 100 percent in individual cases.


Assuntos
Algoritmos , Implantes de Mama/efeitos adversos , Contratura Capsular em Implantes/cirurgia , Mamoplastia/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Falha de Tratamento , Resultado do Tratamento
6.
Medicine (Baltimore) ; 99(30): e21095, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791685

RESUMO

RATIONALE: Anaplastic large T-cell lymphoma (BI-ALCL) is a rare primitive lymphoma described in women with breast implant prostheses, which has been arousing interest in recent years due to its potentially high social impact. The difficult diagnosis associated with the high and increasing number of prosthetic implants worldwide has led to hypothesize an underestimation of the real impact of the disease among prosthesis-bearing women. The aim of this work is to search for specific radiological signs of disease linked to the chronic inflammatory pathogenetic mechanism. PATIENT CONCERNS: This work describes a case of BI-ALCL in an American woman with no personal or family history of cancer, who underwent breast augmentation for esthetic purposes at our Institute. After about 10 years of relative well-being, the patient returned to our Institute with clear evidence of breast asymmetry due to the increase in volume of the right breast which had progressively become larger over a period of 6 months. There was no evidence of palpable axillary lymph nodes or other noteworthy signs. DIAGNOSIS: The ultrasound and magnetic resonance (MR) tests indicated the presence of seroma with amorphous material in the exudate which was confirmed by indirect signs, visible in right breast mammography. Due to suspected cold seroma, an ultrasound-guided needle aspiration was performed for the cytological analysis of the effusion which highlighted the presence of a number of large-sized atypical cells with an irregular nucleus with CD30 immunoreactivity, leucocyte common antigen (CD45) compatible with the BI-ALCL diagnosis. INTERVENTIONS: In our case, a capsulectomy was performed because the disease was limited inside the capsule and periprosthetic seroma. The final histological examination confirmed the stage. LESSONS: The patient is being monitored and shows no signs of recurrence of disease >24 months after surgery. CONCLUSION: A diagnosis of BI-ALCL can be reached using new radiological indicators, such as fibrin, which is clearly visible by MR in the form of nonvascularized debris of amorphous material hypointense in all sequences, free flowing or adhered to the external surface of the prosthesis.


Assuntos
Implantes de Mama/efeitos adversos , Linfoma Anaplásico de Células Grandes/diagnóstico por imagem , Biópsia por Agulha , Diagnóstico Diferencial , Feminino , Humanos , Imuno-Histoquímica , Linfoma Anaplásico de Células Grandes/etiologia , Linfoma Anaplásico de Células Grandes/patologia , Imagem por Ressonância Magnética , Mamografia , Pessoa de Meia-Idade , Seroma/diagnóstico por imagem , Ultrassonografia Mamária
7.
Plast Reconstr Surg ; 146(2): 238-245, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740567

RESUMO

BACKGROUND: Antifibrinolytic medications, such as tranexamic acid, have recently garnered increased attention. Despite its ability to mitigate intraoperative blood loss and need for blood transfusion, there remains a paucity of research in breast reconstruction. The authors investigate whether intravenous tranexamic acid safely reduces the risk of hematoma following implant-based breast reconstruction. METHODS: A single-center retrospective cohort study was performed to analyze all consecutive patients undergoing immediate two-stage implant-based breast reconstruction following mastectomy between 2015 and 2016. The incidence of postoperative hematomas and thromboembolic events among all patients was reviewed. The patients in the intervention group received 1000 mg of intravenous tranexamic acid before mastectomy incision and 1000 mg at the conclusion of the procedure. Fisher's exact test and the Mann-Whitney-Wilcoxon test were used. Multivariate logistic regression models were performed to study the impact of intravenous tranexamic acid after adjusting for possible confounders. RESULTS: A total of 868 consecutive breast reconstructions (499 women) were reviewed. Overall, 116 patients (217 breasts) received intravenous tranexamic acid, whereas 383 patients (651 breasts) did not. Patient characteristics and comorbidities were similar between the two the groups. Patients who received tranexamic acid were less likely to develop hematomas [n = 1 (0.46 percent)] than patients who did not [n = 19 (2.9 percent)] after controlling for age, hypertension, and type of reconstruction (prepectoral and subpectoral) (p = 0.018). Adverse effects of intravenous tranexamic acid, including thromboembolic phenomena were not observed. Multivariate analysis demonstrated that age and hypertension independently increase risk for hematoma. CONCLUSIONS: Intravenous tranexamic acid safely reduces risk of hematoma in implant-based breast reconstruction. Further prospective randomized studies are warranted to further corroborate these findings. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Implantes de Mama/efeitos adversos , Mama/irrigação sanguínea , Hematoma/prevenção & controle , Mamoplastia/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Tromboembolia/prevenção & controle , Ácido Tranexâmico/administração & dosagem , Adulto , Antifibrinolíticos/administração & dosagem , Neoplasias da Mama/cirurgia , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Hematoma/etiologia , Humanos , Injeções Intravenosas , Mastectomia , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Tromboembolia/etiologia , Resultado do Tratamento
8.
Plast Reconstr Surg ; 146(2): 255-267, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740572

RESUMO

BACKGROUND: The Poly Implant Prothèse incident and breast implant-associated anaplastic large cell lymphoma have pointed to the need for uniform registries for breast implants as key features to monitoring the outcomes of breast implant surgeries internationally. The purpose of this study was to identify and harmonize common data elements collected by breast implant registries across the International Collaboration of Breast Registry Activities (ICOBRA) global consortium. METHODS: The authors convened an international group of surgeons, consumers, nurses, registry experts, and regulators to review the data points. A modified Delphi approach was applied, to rate the importance of each point on a six-point Likert scale. RESULTS: Data points from six national breast implant registries were divided into categories: clinical, implant-related, patient-reported findings; operation details and implanting technique details; patient characteristics; unique device identifiers; unique patient identifiers; and clinical demographics. A total of 52 data points collected by over 33 percent of national registries were identified. After five rounds, 34 data points formed the final set with agreed definitions. The group recognized the critical importance of additional elements that are currently not uniformly collected (e.g., patient-reported outcomes and long-term data) and set out the process for the dynamic global set updates driven by evidence gaps. CONCLUSIONS: The authors defined internationally agreed on common data elements and definitions used in breast implant registries. This collaboration will allow data sets to be combined, enabling an effective global early warning system of implant-related problems and further work on data sets.


Assuntos
Implantes de Mama/efeitos adversos , Neoplasias da Mama/cirurgia , Consenso , Mamoplastia/efeitos adversos , Sistema de Registros , Congressos como Assunto , Feminino , Saúde Global , Humanos , Incidência , Linfoma Anaplásico de Células Grandes/epidemiologia , Linfoma Anaplásico de Células Grandes/etiologia
10.
Radiología (Madr., Ed. impr.) ; 62(4): 266-279, jul.-ago. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-194244

RESUMO

Los implantes mamarios se asocian a complicaciones frecuentes ampliamente conocidas y estudiadas como la rotura y la contractura capsular. Sin embargo, debido al número cada vez mayor de pacientes portadoras de implantes mamarios, podemos encontrarnos con patología más infrecuente como la presencia de seroma o infección tardía, adenopatías en la cadena mamaria interna, granulomas en la cápsula del implante -que en algunos casos pueden extenderse más allá de la cápsula fibrosa-, tumores desmoides asociados a los implantes y el linfoma anaplásico de células grandes asociado a implantes mamarios. El objetivo de este artículo es revisar las principales complicaciones infrecuentes asociadas a los implantes mamarios y sus hallazgos radiológicos en las diferentes técnicas. Es importante un correcto manejo de esta patología, principalmente del seroma tardío, para diagnosticar precozmente el linfoma anaplásico de células grandes por su mayor transcendencia


Breast implants are associated with well-known common complications that have been widely studied, such as rupture and capsular contraction. However, the increasingly growing number of patients with breast implants has led to the increased likelihood of coming across less common complications; these include seromas or late infection; adenopathies in the internal mammary chain; granulomas in the capsule of the implant, which in some cases can extend beyond the fibrous capsule; desmoid tumors associated with the implants; and breast implant-associated large cell anaplastic lymphoma. This article aims to review the main uncommon complications associated with breast implants and to describe and illustrate their findings in different imaging techniques. Proper management of these complications is important; this is especially true of late seroma and the diagnosis of breast implant-associated large cell anaplastic lymphoma for their repercussions


Assuntos
Humanos , Implantes de Mama/efeitos adversos , Contratura Capsular em Implantes/complicações , Contratura Capsular em Implantes/diagnóstico por imagem , Seroma/diagnóstico por imagem , Linfoma Anaplásico de Células Grandes/diagnóstico por imagem , Linfoma Anaplásico de Células Grandes/cirurgia , Espectroscopia de Ressonância Magnética , Linfadenopatia/diagnóstico por imagem
11.
Medicine (Baltimore) ; 99(27): e21134, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629748

RESUMO

Implant ruptures may be diagnosed by physical examination, ultrasound (US), and magnetic resonance imaging (MRI). The absence of standard guidelines to approach to implant ruptures may cause unnecessary surgical revisions in the absence of radiological confirmation of prosthetic damages.The purpose of this study was to analyze the diagnostic procedures applied to patients with suspected prosthetic rupture and surgeon choices to perform a revision or to plan a clinical and radiological follow-up.We conducted a retrospective study on 62 women submitted to revision surgery due to radiological diagnosis of suspected implant rupture, following mastectomy or aesthetic reconstruction, and admitted to a Plastic Surgery Department between 2008 and 2018.Seventy-three implants, believed to be ruptured, were explanted. One-third of these were intact and unnecessarily explanted. US associated with MRI evaluation resulted in the most helpful diagnostical method.A standardized clinical and radiological approach is essential to manage breast implant ruptures successfully. An innovative protocol is proposed in order to: ensure the appropriate management of implant ruptures and prevent unnecessary surgical revisions; reduce the risk of claims for medical malpractice in cases of unsatisfactory final aesthetic results or worse than before.


Assuntos
Implantes de Mama/efeitos adversos , Comportamento de Escolha/fisiologia , Mastectomia/efeitos adversos , Cirurgia Plástica/efeitos adversos , Feminino , Hospitalização , Humanos , Responsabilidade Legal/economia , Imagem por Ressonância Magnética/métodos , Imperícia/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Ruptura/complicações , Ruptura/diagnóstico por imagem , Ruptura/cirurgia , Cirurgiões/psicologia , Ultrassonografia/métodos
12.
Acta Med Hist Adriat ; 18(1): 165-176, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32638606

RESUMO

The authors have provided an in-depth review of the history of saline and silicone gel-filled breast implants. In the history of medicine, no devices have been more scrutinized and thoroughly studied than breast implants. Although we as plastic surgeons recognize and appreciate the benefits that our patients derive from these devices, society as a whole continues to remain skeptical. The reasons for this are complex and multifactorial but appear to be fueled by the media, oppositional organizations, and several trial lawyers. Prior to 1990, when the silicone gel implant controversy began, there were only eight indexed publications that dealt with the issue of silicone gel breast implants. Since 1990, there have been more than 500 indexed publications dealing with silicone gel implants. At the time of the moratorium in 1992, we as plastic surgeons did not have a leg to stand on because there was a paucity of scientific evidence to support our observations that silicone breast implants were safe and effective devices.


Assuntos
Implantes de Mama/história , Qualidade de Produtos para o Consumidor , Desenho de Prótese/história , Géis de Silicone/história , Implantes de Mama/efeitos adversos , Feminino , História do Século XX , História do Século XXI , Humanos , Géis de Silicone/efeitos adversos , Cirurgia Plástica/história
13.
PLoS One ; 15(6): e0235050, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32589678

RESUMO

OBJECTIVE: To evaluate the sensitivity (S) of BMRI to detect silicone gel bleeding in a prospective observational study, including consecutive patients referred for BMRI scan. METHODS: From January 2017 to March 2018, we evaluated patients with breast implants referred for BMRI in a prospective observational study. For SIGBIC diagnosis, we adopted three new original imaging features: black drop signal; T2* hyper signal mass; and delayed contrast enhancement, considered as irrevocable signs to detect gel bleeding (GB). Histology confirmed the presence of a silicone corpuscle in breast implant capsular specimens. The accuracy of BMRI SIGBIC findings to predict GB was determined. We also compared SIGBIC diagnosis criteria to those features proposed by the BI-RADS léxicon, considered as equivocal findings. RESULTS: 208 patients had SIGBIC diagnosis at BMRI, and the histology confirmed GB in all cases. There were no false-positive results. Compared to the BI-RADS equivocal findings (S = 0.74), SIGBIC criteria had better sensitivity for GB diagnosis. CONCLUSION: SIGBIC diagnosis has high sensitivity to predict GB by the three irrevocable BMRI features described by the authors. We suppose GB is underdiagnosed in clinical practice by BI-RADS features. TRIAL CERTIFICATION: Study protocol: Plataforma Brasil CAAE: 77215317.0.0000.0072.


Assuntos
Implantes de Mama/efeitos adversos , Mama , Granuloma de Corpo Estranho/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Géis de Silicone/efeitos adversos , Adulto , Idoso , Mama/diagnóstico por imagem , Mama/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade
14.
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
15.
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
16.
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
17.
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
18.
Ann Thorac Surg ; 110(4): e275-e277, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32289299

RESUMO

We describe a case of a 16-year-old patient who underwent right pneumonectomy for pulmonary vein atresia and developed postpneumonectomy syndrome. She had an 800-cm3 saline-filled silicone tissue expander placed in the right hemithorax with resolution of her postpneumonectomy syndrome. However, 2 years later, she developed fevers, night sweats, and arthralgias. Her medical workup was negative for vasculitis, inflammatory bowel disease, and infectious etiologies. She underwent tissue expander removal, resulting in resolution of her symptoms. This report describes a case of an inflammatory state created by a tissue expander placed for postpneumonectomy syndrome.


Assuntos
Implantes de Mama/efeitos adversos , Inflamação/etiologia , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Dispositivos para Expansão de Tecidos/efeitos adversos , Adolescente , Feminino , Humanos , Síndrome
19.
Handchir Mikrochir Plast Chir ; 52(2): 67-74, 2020 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-32259859

RESUMO

Elective surgeries, especially aesthetic operations in plastic surgery, require surgeons to provide a holistic and comprehensive explanation of possible procedural risks and long-term consequences. Recently, the use of breast implants for aesthetic breast augmentation or breast reconstruction after tumour resection has gained public attention as the numbers of patients with rare breast implant-associated diseases have been rising worldwide, while the aetiopathogenesis remains unclear. BIA-ALCL was classified as a lymphatic neoplasm by the World Health Organization in 2016. Meanwhile, almost 800 cases have been documented, especially in patients that received textured implants. This malignant disease has led to a great level of uncertainty and scepticism in patients and the public. Hence, it is a central task of plastic surgeons to understand this rare disease, to recognise it at an early stage and help those affected by clear recommendations for action. The following manuscript summarises current approaches for diagnosis and treatment.


Assuntos
Implante Mamário , Implantes de Mama/efeitos adversos , Neoplasias da Mama/cirurgia , Linfoma Anaplásico de Células Grandes , Mamoplastia , Humanos
20.
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
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