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2.
Plast Reconstr Surg ; 145(2): 240e-250e, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985610

RESUMO

BACKGROUND: Periprosthetic infections represent major complications in breast reconstruction, frequently leading to expander-implant loss. No consensus regarding a management algorithm for attempted salvage currently exists. This study assessed outcomes of the authors' salvage protocol using an antibiotic-impregnated polymethylmethacrylate implant with expander device exchange. METHODS: A retrospective chart review identified infected implant-based breast reconstruction cases treated between 2009 and 2017. Of 626 cases initially identified, a total of 62 cases had severe prosthetic infections, and underwent either prosthetic salvage (n = 45) or immediate explantation (n = 17). All the prosthetic salvage patients received intravenous antibiotics followed by surgical débridement, insertion of polymethylmethacrylate plates, device exchange, and postoperative antibiotics. After clinical resolution of infection, tissue expansion was performed, with the polymethylmethacrylate plates remaining in situ until exchanged for permanent implants. RESULTS: The authors' study demonstrated a primary infection clearance rate of 82.2 percent (n = 37). Compared to the traditional explantation group, a significantly higher percentage of the salvage patients completed final reconstruction (84.4 percent versus 35.3 percent; p < 0.001). Fewer patients abandoned reconstruction efforts after infection clearance (2.2 percent versus 58.8 percent; p < 0.001). The majority of cases (78.8 percent) that succeeded the salvage protocol ultimately received implant-based reconstruction; 62.5 percent that failed the salvage protocol still went on to receive autologous tissue reconstruction. CONCLUSIONS: Sustained local antibiotic delivery using polymethylmethacrylate implants and expander device exchange can successfully salvage an infected breast expander/implant. Compared with the traditional explantation approach, more patients complete final reconstruction. Other benefits include preserved skin envelope integrity and possibly improved long-term aesthetic outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Antibacterianos/administração & dosagem , Implante Mamário/efeitos adversos , Implantes de Mama/efeitos adversos , Polimetil Metacrilato/uso terapêutico , Infecções Relacionadas à Prótese/terapia , Terapia de Salvação/métodos , Expansão de Tecido/métodos , Adulto , Idoso , Terapia Combinada , Seguimentos , Humanos , Pessoa de Meia-Idade , Terapia de Salvação/instrumentação , Expansão de Tecido/instrumentação , Dispositivos para Expansão de Tecidos , Adulto Jovem
3.
Int J Radiat Oncol Biol Phys ; 106(3): 514-524, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31756414

RESUMO

PURPOSE: To compare single-stage direct-to-implant (DTI) immediate reconstruction to the commonly used 2-stages expander and implant (TE/I) or autologous reconstruction with focus on postmastectomy radiation therapy (PMRT) setting. METHODS AND MATERIALS: We reviewed the charts of 1,286 patients who underwent 1,814 breast reconstructions at our institution with and without PMRT from 1997 to 2017. Patients were divided into 6 groups according to type of reconstruction and PMRT status. Primary objective was reconstruction complications defined solely on surgical reintervention operative notes such as infection, skin necrosis, and fat necrosis across all groups. Implant-related complications such as capsular contracture, implant rupture or exposure, or implant failure were compared between TE/I and DTI. Kaplan-Meier estimates were used to calculate 5-year cumulative incidence of complications. The secondary objective was to compare the 3 reconstruction types in settings of immediate reconstruction followed by PMRT on multivariable analysis. RESULTS: Median follow-up was 5.8 years. Among 1286 patients, 41.1% (N = 529/1286) received PMRT. Among 1814 reconstructed breasts, autologous, single-stage, and TE/I represented 18.7%, 34.8%, and 46.2%, respectively. With no PMRT, the 5-year cumulative incidence of any reconstruction complication was 11.1%, 12.6%, and 19.5% for autologous, DTI, and TE/I reconstructions, respectively. The addition of PMRT resulted in 5-year cumulative incidence of 15.1%, 18.2%, and 36.8%, respectively. The multivariable analysis showed that DTI was associated with lesser complications compared with TE/I, whereas no significant difference was noted between DTI and autologous. CONCLUSIONS: Single-stage DTI reconstruction had significantly lower complication rates than TE/I with and without PMRT. Single-stage complication rates were not significantly different from autologous complication rates in PMRT settings. Single-stage reconstruction may offer a valuable option for patients receiving PMRT.


Assuntos
Implante Mamário/efeitos adversos , Implantes de Mama/efeitos adversos , Neoplasias da Mama/radioterapia , Mamoplastia/efeitos adversos , Complicações Pós-Operatórias , Dispositivos para Expansão de Tecidos/efeitos adversos , Neoplasias da Mama/cirurgia , Feminino , Humanos , Incidência , Mamoplastia/métodos , Mamoplastia/estatística & dados numéricos , Pessoa de Meia-Idade , Necrose , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/epidemiologia , Radioterapia Adjuvante/efeitos adversos , Radioterapia Adjuvante/estatística & dados numéricos , Estudos Retrospectivos , Pele/patologia , Pele/efeitos da radiação , Fatores de Tempo
4.
Clin Nucl Med ; 45(1): 68-73, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31693606

RESUMO

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare malignancy with isolated case reports of FDG uptake on FDG PET/CT. We present 4 cases of pathology-confirmed BIA-ALCL to illustrate varying presentations and imaging features of this disease process. Breast implant-associated anaplastic large cell lymphoma presents most commonly approximately 10 years after implantation of textured silicone or saline breast implants. Patients may present with breast enlargement, peri-implant effusion, a palpable breast or axillary mass, lymphadenopathy, breast skin erythema, or pain. Diagnosis of BIA-ALCL may be confirmed by sampling of peri-implant fluid or biopsy of peri-implant masses or regional lymph nodes.


Assuntos
Implantes de Mama/efeitos adversos , Linfoma Anaplásico de Células Grandes/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Feminino , Fluordesoxiglucose F18 , Humanos , Linfoma Anaplásico de Células Grandes/etiologia , Pessoa de Meia-Idade , Compostos Radiofarmacêuticos , Ultrassonografia
8.
Isr Med Assoc J ; 21(8): 512-515, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31474008

RESUMO

BACKGROUND: Breast implant-associated anaplastic large cell lymphoma (ALCL) is a rare type of non-Hodgkin's lymphoma that is found around breast implants. ALCL was discovered only two decades ago. In Israel we currently have four diagnosed cases (as of 2018). Until recently, the estimated incidence was 1:300,000 women with breast implants, while recent reports range from 1:3817 to 1:30,000. OBJECTIVES: To determine the occurrence of breast implant-ALCL in Israel. METHODS: We conducted a retrospective analysis of the four patients diagnosed with ALCL in Israel. Cytology was confirmed and the clinical data was collected. Based on the estimated number of women with breast implants in Israel, a calculation of the true incidence was completed. RESULTS: The incidence in Israel is significantly higher than the older incidence reports indicate. We estimated that the lifetime prevalence of the disease is 4:60,000 women with a textured breast implant, or 1:15,000 women with a textured breast implant in Israel. CONCLUSIONS: ALCL is not common. We support the claim that the prevalence is significantly higher than what was initially described. This finding has clinical and medicolegal implications that should be addressed accordingly.


Assuntos
Implantes de Mama/efeitos adversos , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/epidemiologia , Linfoma Anaplásico de Células Grandes/diagnóstico , Linfoma Anaplásico de Células Grandes/epidemiologia , Adulto , Mama/cirurgia , Neoplasias da Mama/cirurgia , Remoção de Dispositivo , Feminino , Humanos , Israel/epidemiologia , Linfoma Anaplásico de Células Grandes/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos
13.
Rev. bras. cir. plást ; 34(3): 324-330, jul.-sep. 2019. ilus, tab
Artigo em Inglês, Português | LILACS | ID: biblio-1047147

RESUMO

Introdução: Ao longo dos últimos anos os benefícios das reconstruções imediatas se tornaram cada vez mais documentados na literatura e, hoje, o predomínio é pelas reconstruções imediatas. Nos últimos anos, o número de reconstruções com expansores e próteses tem aumentado. Métodos: Estudo retrospectivo entre 2013 e 2014. Foram incluídas as pacientes submetidas à mastectomia, seguida de reconstrução de mama, e assim separadas em dois grupos: 1 - submetida a reconstrução direta com prótese e 2 - expansor. Diversos dados foram avaliados. Resultados: Foram realizadas 138 reconstruções assim divididos: 57 com prótese e 81 com expansor-prótese. As complicações pós-operatórias não mostraram diferença entre os grupos. Radioterapia não teve influência nas complicações. Pacientes que fizeram reconstrução com prótese realizaram menos cirurgias (1,78 vs 2,54) e menos retornos pós-operatórios (8 vs 11,75). Conclusão: As reconstruções imediatas com prótese ou expansor apresentam baixas e semelhantes taxas de complicações pós-operatórias. Pacientes submetidas às reconstruções com prótese tiveram menor taxa de retorno e número de cirurgias para finalizar a reconstrução.


Introduction: The benefits of immediate reconstruction have been increasingly documented in the literature over the past few years. Today, with some exceptions, immediate reconstruction is the preferred surgical choice for breast cancer patients. In the recent years, the number of reconstructions using expanders and implants has increased. Methods: This retrospective study conducted between 2013 and 2014 included patients undergoing mastectomy followed by breast reconstruction, who were divided into direct implant reconstruction and expander treatment groups. Several variables were evaluated. Results: A total of 138 reconstructions (57 implants and 81 expander-implant) were performed. There were no intergroup differences in postoperative complications. Radiotherapy did not influence complications. Implant reconstruction patients underwent fewer surgeries (1.78 vs 2.54) and had fewer postoperative returns (8 vs 11.75). Conclusion: Immediate implant and expander-implant reconstruction approaches present low and similar postoperative complication rates. Patients undergoing implant reconstruction had a lower return rate and underwent fewer surgeries than those undergoing expander-implant reconstruction.


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , História do Século XXI , Complicações Pós-Operatórias , Mama , Estudos Retrospectivos , Mamoplastia , Implantes de Mama , Procedimentos Cirúrgicos Reconstrutivos , Complicações Pós-Operatórias/cirurgia , Mama/cirurgia , Mama/lesões , Mamoplastia/métodos , Implantes de Mama/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos
15.
Cir. plást. ibero-latinoam ; 45(3): 225-234, jul.-sept. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-184395

RESUMO

Introducción y Objetivo. El linfoma anaplásico de células grandes asociado a implantes mamarios es un subtipo de linfoma de células T periférico que se puede encontrar en la cápsula periprotésica, el fluido entre implante y cápsula en forma de seroma o en casos avanzados como enfermedad metastásica. Aportamos 4 casos clínicos de este tipo de linfoma diagnosticados en la provincia de Alicante, España, siendo de interés por ser escasa la incidencia reportada y pocos los trabajos científicos publicados a nivel nacional sobre esta patología. Material y método. Describimos estos 4 casos registrando: edad, antecedentes, indicación del implante, detalles de la cirugía previa, tipo de superficie y marca del implante, presentación clínica del cuadro y tratamiento administrado. Resultados. Dos casos correspondieron a cirugía estética y 2 a cirugía reconstructiva, la presentación clínica en 3 casos fue como seroma tardío y en 1 como linfadenopatía. Tres implantes eran de superficie texturizada y 1 de poliuretano. En todos los casos se realizó capsulectomía bilateral. Conclusiones. La aportación de nuestra serie contribuye a destacar la importancia de reportar los casos diagnosticados dada la escasa incidencia de la enfermedad y el reducido número de publicaciones sobre la misma en el ámbito iberolatinoamericano


Background and Objective. The anaplastic large cell lymphoma associated with breast implants is a subtype of peripheral T cell lymphoma that can be found in the periprosthetic capsule, the fluid between the implant and the capsule in the form of a seroma, or in advanced cases such as metastatic disease. We provide 4 clinical cases diagnosed in the province of Alicante, Spain, being of interest because of the low incidence reported and few published scientific papers nationwide. Methods. We describe these 4 clinical cases and recorded: age, history, implant indication, previous surgery details, implant type of surface and brand, clinical presentation of the pathology and treatment. Results. Two cases corresponded to cosmetic surgery and 2 to reconstructive surgery; clinical presentation in 3 cases was late seroma and lymphadenopathy in 1. Three implants had textured surface and one was of polyurethane. Bilateral capsulectomy was performed in all cases. Conclusions. The main contribution of our cases is to highlight the importance of informing about diagnosed cases, because of the rare incidence of the disease and the lack of publications about this theme in the Ibero-Latinamerican environment


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Linfoma Anaplásico de Células Grandes/complicações , Linfoma Anaplásico de Células Grandes/diagnóstico , Implantes de Mama/efeitos adversos , Neoplasias da Mama/diagnóstico por imagem , Mamoplastia/métodos , Espanha , Seroma/complicações , Seroma/patologia , Seroma/cirurgia , Linfadenopatia/complicações , Linfadenopatia/cirurgia , Estudos Retrospectivos , Imuno-Histoquímica
16.
Cir. plást. ibero-latinoam ; 45(3): 235-242, jul.-sept. 2019. ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-184396

RESUMO

El linfoma anaplásico de células gigantes asociado a implantes mamarios es una entidad extremadamente rara de la que, hasta enero de 2019, han sido diagnosticados 656 casos en 34 países con 17 muertes comunicadas. Se postula que su etiología es el resultado de una reacción a un cuerpo extraño como la prótesis y la inflamación crónica persistente que se deriva. Presentamos el primer caso de esta patología diagnosticado y tratado en la Región de Murcia, España. Se trata de una paciente con seroma crónico recidivante que aparece a los 5 años de la colocación de implantes mamarios tras diagnóstico y tratamiento por cáncer de mama. El diagnóstico definitivo se obtuvo en el estudio anatomopatológico e inmunohistoquímico de la cápsula periprotésica tras cirugía de retirada de implantes y capsulectomía completa bilateral. Se administró quimioterapia postoperatoria por recomendación del Comité de Tumores hospitalario


Breast implant-associated large cell anaplastic lymphoma is an extremely rare entity of which, until January 2019, 656 cases have been diagnosed in 34 countries with 17 reported deaths. It´s etiology is postulated as the result of a foreign body reaction to the implant and the resultant chronic and persistent inflammation. We present the first case of this pathology diagnosed and treated in the Region of Murcia, Spain. A patient with chronic relapsing seroma that appears 5 years after breast implant placement after diagnosis and treatment for breast cancer. The definitive diagnosis was obtained in the pathological and immunohistochemical study of the periprosthetic capsule after implant removal surgery and bilateral complete capsulectomy. Postoperative chemotherapy was administered on the recommendation of the hospital Tumor Committee


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Linfoma Anaplásico de Células Grandes/complicações , Linfoma Anaplásico de Células Grandes/diagnóstico por imagem , Implantes de Mama/efeitos adversos , Reação a Corpo Estranho/etiologia , Reação a Corpo Estranho/patologia , Linfoma Anaplásico de Células Grandes/tratamento farmacológico , Seroma/patologia
17.
Cir. plást. ibero-latinoam ; 45(3): 243-252, jul.-sept. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-184397

RESUMO

Presentamos un caso de linfoma anaplásico de células grandes asociado a implante mamario (LACG-AIM) que debutó como seroma periprotésico unilateral izquierdo de características acelulares en su estudio inicial. Esto limitó la determinación inmunohistoquímica de marcadores CD30 y cinasa del linfoma anaplásico (ALK) y su diagnóstico preoperatorio. La paciente fue intervenida quirúrgicamente realizándose retirada del implante y capsulectomía completa bilateral. El estudio anatomopatológico de la cápsula periprotésica izquierda mostró un linfoma anaplásico de células grandes. Dado que algunos casos de LACG-AIM pueden presentarse sin celularidad en el seroma periprotésico, limitando la efectividad de las determinaciones inmunohistoquímicas preoperatorias, en casos de alta sospecha clínica cabría plantearse un tratamiento quirúrgico de forma precoz que iniciase el tratamiento oncológico sin demora y aportase un diagnóstico definitivo


We present a case of breast implant associated anaplastic large cell lymphoma (BIA-ALCL) that debuted as a left unilateral periprosthetic seroma of acellular features in its initial study. This aspect limited the immunohistochemical determination of CD30 markers and anaplastic lymphoma kinase (ALK) and its preoperative diagnosis. Patient was operated performing implant removal and bilateral complete capsulectomy. The pathological study of the left periprosthetic capsule showed an anaplastic large cell lymphoma. Since some cases of BIA-ALCL can occur without cellularity in the periprosthetic seroma, limiting the effectiveness of preoperative immunohistochemical determinations, in cases of high clinical suspicion an early surgical treatment could be considered in order to begin the oncological treatment without delay and providing a definitive diagnosis


Assuntos
Humanos , Feminino , Adulto , Linfoma Anaplásico de Células Grandes/diagnóstico , Linfoma Anaplásico de Células Grandes/patologia , Implantes de Mama/efeitos adversos , Imuno-Histoquímica , Liberação de Cirurgia/métodos , Seroma/cirurgia , Seroma/diagnóstico por imagem , Seroma/patologia , Diagnóstico Diferencial , Neoplasias da Mama/diagnóstico por imagem , Ultrassonografia Mamária , Biópsia com Agulha de Grande Calibre/instrumentação , Implante Mamário/instrumentação
19.
Internist (Berl) ; 60(10): 1102-1105, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31451847

RESUMO

A 46-year-old immunosuppressed patient presented with a breast implant-associated infection 10 years after breast augmentation in Southeast Asia. No pathogen was identified in the initial conventional microbiological workup. Subsequently, infection with Mycobacterium abscessus-a nontuberculous mycobacteria-was diagnosed using a special culture technique. Increased rates of such infections are reported after cosmetic surgery in foreign countries, presumably due to inoculation with these ubiquitous pathogens. This case highlights the fact that the differential diagnosis and thus the microbiological workup should be extended in cases without initial pathogen detection.


Assuntos
Implantes de Mama/efeitos adversos , Corpos Estranhos/microbiologia , Mastodinia/etiologia , Infecções por Micobactéria não Tuberculosa/diagnóstico , Micobactérias não Tuberculosas/isolamento & purificação , Infecções Relacionadas à Prótese/microbiologia , Infecção da Ferida Cirúrgica/microbiologia , Implantes de Mama/microbiologia , Febre/etiologia , Humanos , Hospedeiro Imunocomprometido , Pessoa de Meia-Idade , Infecções por Micobactéria não Tuberculosa/microbiologia
20.
Plast Reconstr Surg ; 144(3): 360e-368e, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31461001

RESUMO

BACKGROUND: Surgical-site infection is a major concern in prosthetic-based breast reconstruction. Thirty-day postoperative readmission rates are a common quality metric, but little is known about readmission rates for later infections. METHODS: Using the 2013 to 2014 Nationwide Readmissions Database, the authors identified breast cancer patients undergoing breast reconstruction with implants and tissue expanders who had an infectious readmission. The authors used univariate and multivariate logistic regression models to identify predictors of infectious readmission and explantation within the early (0 to 30 days) and late (31 to 90 days) postoperative periods. RESULTS: In the weighted sample, the authors identified 18,338 patients undergoing prosthetic-based breast reconstruction. The overall infectious readmission rate was 4.1 percent (n = 759): 49.3 percent occurred early and 50.7 percent occurred late. Of the infectious readmissions, 39.5 percent required explantation, 55.1 percent of which occurred during a late infectious readmission. Seventy-five percent of these infectious readmissions and explantations occurred within 49 days of initial surgery. Median annual household income less than $40,000 (p = 0.035), diabetes (p = 0.038), and obesity (p = 0.004) were independent predictors of infectious readmission. Diabetes (p = 0.049) and hypertension (p = 0.011) were independent predictors of early readmission. Median annual household income less than $40,000 (p = 0.049), obesity (p = 0.006), and increasing length of stay during the index procedure (p = 0.028) were independent predictors of late readmission. No statistically significant independent predictors for explantation were identified. CONCLUSIONS: Traditional 30-day readmission rates are not an adequate quality metric for breast reconstruction given the number of late postoperative readmissions, many of which lead to explantation. Early and late infectious readmissions have different predictors. Interventions targeting these predictors may decrease the number of readmissions, thus reducing cost and improving quality. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Assuntos
Implante Mamário/efeitos adversos , Neoplasias da Mama/cirurgia , Readmissão do Paciente/estatística & dados numéricos , Infecção da Ferida Cirúrgica/epidemiologia , Adulto , Idoso , Implante Mamário/instrumentação , Implantes de Mama/efeitos adversos , Estudos de Coortes , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Humanos , Masculino , Mastectomia/efeitos adversos , Pessoa de Meia-Idade , Fatores de Risco , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/terapia , Fatores de Tempo , Dispositivos para Expansão de Tecidos/efeitos adversos
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