scholarly journals Defining Double Capsules: A Clinical and Histological Study

2021 ◽  
Author(s):  
Aaron C Van Slyke ◽  
Janine M Roller ◽  
Reza Alaghehbandan ◽  
Nicholas J Carr
Keyword(s):  
Histological Study ◽  
Breast Implants ◽  
Descriptive Statistics ◽  
Fibrous Capsule ◽  
Level Of Evidence ◽  
Capsule Formation ◽  
Patient Demographics ◽  
Capsule Type ◽  
Synovial Metaplasia ◽  
Inflammatory Infiltrates

Abstract Background Macrotextured breast implants are associated with double capsules. There is little agreement as to what defines double capsules, how they present, and whether different degrees of double capsule exist. Objectives This study aimed to define double capsules and report an association between double-capsule type and degree of tissue adherence. Methods Consecutive aesthetic patients undergoing explantation of Biocell (Allergan, Inc., Irvine, CA) implants between May 2018 and November 2018 were included if they were found to have double capsules intraoperatively. Patient demographics, implant characteristics, explantation reason, implant adherence, and intraoperative findings were recorded. Both adherent and double capsules were histologically examined. Data were analyzed by descriptive statistics. Results Eleven patients had 22 Biocell implants explanted during the study period. The average explantation time was 8.0 years. Sixteen implants were found to have some degree of nonadherence, and all areas of nonadherence were associated with double-capsule formation. Double capsules were either partial or complete. The architecture of the inner layer of double capsules varied between an organized capsular layer and a thin area of nascent capsule. Histologically, all capsular specimens demonstrated an overall hypocellular fibrous capsule with scattered chronic inflammatory infiltrates. Synovial metaplasia was present in all capsule types and spaces/cracks in the capsule were disproportionately represented in partially adherent capsules. Conclusions This is the first study to identify a clinical and pathological correlation between double capsules and failed tissue adherence. Double capsules represent a spectrum of inner capsule formation ranging between nascent capsular tissue to a mature inner capsular layer. Level of Evidence: 4

Efficient reduction of fibrous capsule formation around silicone breast implants densely grafted with 2-methacryloyloxyethyl phosphorylcholine (MPC) polymers by heat-induced polymerization

2020 ◽  
Vol 8 (6) ◽  
pp. 1580-1591 ◽  
Author(s):  
Sunah Kang ◽  
Jungah Kim ◽  
Seulah Kim ◽  
Maierdanjiang Wufuer ◽  
Sohyun Park ◽  
...  
Keyword(s):  
Breast Implants ◽  
Pig Model ◽  
Fibrous Capsule ◽  
Capsule Formation ◽  
Silicone Breast Implants ◽  
Efficient Reduction ◽  
Fibrous Capsule Formation

This article presents the efficacy of heat-induced MPC-grafting against excessive fibrous capsule formation and related inflammation in tissues surrounding silicone breast implants inserted in a pig model.

scholarly journals High-strength and fibrous capsule–resistant zwitterionic elastomers

2021 ◽  
Vol 7 (1) ◽  
pp. eabc5442
Author(s):  
Dianyu Dong ◽  
Caroline Tsao ◽  
Hsiang-Chieh Hung ◽  
Fanglian Yao ◽  
Chenjue Tang ◽  
...  
Keyword(s):  
Mechanical Properties ◽  
Mechanical Strength ◽  
High Strength ◽  
Design Principles ◽  
Fibrous Capsule ◽  
High Mechanical Strength ◽  
Capsule Formation ◽  
Locking Mechanism ◽  
Fibrous Capsule Formation

The high mechanical strength and long-term resistance to the fibrous capsule formation are two major challenges for implantable materials. Unfortunately, these two distinct properties do not come together and instead compromise each other. Here, we report a unique class of materials by integrating two weak zwitterionic hydrogels into an elastomer-like high-strength pure zwitterionic hydrogel via a “swelling” and “locking” mechanism. These zwitterionic-elastomeric-networked (ZEN) hydrogels are further shown to efficaciously resist the fibrous capsule formation upon implantation in mice for up to 1 year. Such materials with both high mechanical properties and long-term fibrous capsule resistance have never been achieved before. This work not only demonstrates a class of durable and fibrous capsule–resistant materials but also provides design principles for zwitterionic elastomeric hydrogels.

scholarly journals Granzyme B Is a Biomarker for Suspicion of Malignant Seromas Around Breast Implants

2020 ◽  
Author(s):  
Marshall E Kadin ◽  
John Morgan ◽  
Haiying Xu ◽  
Caroline Glicksman ◽  
David Sieber ◽  
...  
Keyword(s):  
Early Detection ◽  
Tumor Cells ◽  
Breast Implant ◽  
Granzyme B ◽  
Breast Implants ◽  
Large Cell ◽  
Target Cells ◽  
Cytotoxic Lymphocytes ◽  
Tumor Cell Death ◽  
Level Of Evidence

Abstract Background Granzyme B (GrB) is a serine protease secreted, along with pore-forming perforin, by cytotoxic lymphocytes to mediate apoptosis in target cells. GrB has been detected in tumor cells associated with systemic and breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) but its potential use for detection of early BIA-ALCL has not been fully investigated. Objectives Prompted by the increased incidence of BIA-ALCL, the aim of this study was to assess GrB as a new biomarker to detect early disease in malignant seromas and to better understand the nature of the neoplastic cell. Methods A Human XL Cytokine Discovery Magnetic Luminex 45-plex Fixed Panel Performance Assay was used to compare cytokine levels in cell culture supernatants of BIA-ALCL and other T-cell lymphomas, as well as malignant and benign seromas surrounding breast implants. Immunohistochemistry was employed to localize GrB to cells in seromas and capsular infiltrates. Results Differences in GrB concentrations between malignant and benign seromas were significant (P < 0.001). GrB was found in and around apoptotic tumor cells, suggesting that the protease may be involved in tumor cell death. Conclusions GrB is a useful marker for early detection of malignant seromas and to identify tumor cells in seromas and capsular infiltrates. Because there is an overlap between the lowest concentrations of soluble GrB in malignant seromas and the highest concentrations of GrB in benign seromas, it is recommended that GrB be used only as part of a panel of biomarkers for the screening and early detection of BIA-ALCL. Level of Evidence: 5

UNDERSTANDING REAL-WORLD BIOLOGIC MAINTENANCE DOSING PATTERNS AMONG PEDIATRIC ULCERATIVE COLITIS AND CROHN’S DISEASE PATIENTS

2021 ◽  
Vol 27 (Supplement_1) ◽  
pp. S23-S23
Author(s):  
Wallace Crandall ◽  
Richard Colletti ◽  
Wendy Komocsar ◽  
Chunyan Liu ◽  
Jennifer Dotson ◽  
...  
Keyword(s):  
Maintenance Dose ◽  
Pediatric Patients ◽  
Descriptive Statistics ◽  
Patient Demographics ◽  
Baseline Visit ◽  
The Us ◽  
Inflammatory Bowel ◽  
Using Data ◽  
Term Maintenance

Abstract Objectives To assess the initial and long-term maintenance dosing of biologic medications in pediatric UC and CD patients, using data in the ICN registry. Methods Pediatric patients (2–17 years) in the US who were diagnosed with UC or CD between June 1, 2013 and December 31, 2019, who, after enrollment in the ICN registry, initiated a biologic (adalimumab, infliximab, certolizumab, golimumab, ustekinumab, vedolizumab, and natalizumab) and were actively followed for at least 12 months after first maintenance dose were included in this study. Descriptive statistics of baseline patient demographics were summarized for the overall Inflammatory Bowel Disease (IBD) patient population and separately for UC and CD. Biologic maintenance dosage was calculated for UC and CD patients who had data for both dose and weight for each biologic at the baseline visit (first maintenance dose), 1-year and 3-year time points. Results A total of 1,887 pediatric IBD patients (UC=350; CD=1,537) were included in this study. Patients had a mean age at diagnosis of 12.9 years (UC=13.1; CD=12.9), 57.1% were male (UC=48.9%; CD=59.0%), and 80.6% were White (UC=79.8%; CD=80.8%) (Table 1). Infliximab (77.0%) was the most commonly prescribed biologic for UC, followed by adalimumab (12.4%), vedolizumab (10.1%), certolizumab (0.3%), and ustekinumab (0.3%). Similarly, infliximab (80.6%) was the most commonly prescribed biologic for CD, followed by adalimumab (16.5%), vedolizumab (1.6%), ustekinumab (1.2%), and certolizumab (0.1%) (Table 2). At first maintenance dose, UC patients on infliximab were receiving a mean dose of 10.5mg/kg/8wk, patients on adalimumab (weight <40kg) were receiving a mean dose of 1.3mg/kg/2wk, patients on adalimumab (weight≥40kg) were receiving a mean dose of 0.8mg/kg/2wk, and patients on vedolizumab were receiving a mean dose of 6.9mg/kg/8wks. Mean dose of infliximab among UC patients increased from 10.5mg/kg/8wk at first maintenance dose to 11.8mg/kg/8wk at 1-year from first maintenance dose. At the first maintenance dose, CD patients on infliximab were receiving a mean dose of 8.1mg/kg/8wk, patients on adalimumab (weight <40kg) were receiving a mean dose of 1.1mg/kg/2wk, patients on adalimumab (weight ≥40kg) were receiving a mean dose of 0.8mg/kg/2wk, patients receiving vedolizumab were receiving a mean dose of 10.5mg/kg/8wks. Mean dose of infliximab among CD patients increased from 8.1mg/kg/8wk at first maintenance dose to 9.6mg/kg/8wk at 1-year from first maintenance dose. Conclusion These results highlight the biologic maintenance dose changes among pediatric UC and CD patients. TNF inhibitors remain the most commonly used class of biologic, but the doses being used are double the standard dosing guidelines. There is little evidence of dose reduction over time among pediatric UC and CD patients in the ICN registry.

Case 15.7

2014 ◽  
pp. 740-740
Author(s):  
Christine U. Lee ◽  
James F. Glockner
Keyword(s):  
Capsular Contracture ◽  
Breast Implants ◽  
Fat Suppression ◽  
Fibrous Capsule ◽  
Water Suppression ◽  
Left Figure

65-year-old woman with bilateral breast implants placed 25 years ago presents with increasing capsular contracture Axial (Figure 15.7.1) and bilateral sagittal (right, Figure 15.7.2A; left, Figure 15.7.2B) IR images with fat suppression and selective water suppression demonstrate silicone outside of the fibrous capsule bilaterally. Intracapsular rupture of both implants is indicated by the teardrop signs and subcapsular line signs in both breasts....

Breast Implant-Associated Anaplastic Large Cell Lymphoma in Australia: A Longitudinal Study of Implant and Other Related Risk Factors

2019 ◽  
Vol 40 (8) ◽  
pp. 838-846 ◽  
Author(s):  
Anna Loch-Wilkinson ◽  
Kenneth J Beath ◽  
Mark R Magnusson ◽  
Rodney Cooter ◽  
Karen Shaw ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Anaplastic Large Cell Lymphoma ◽  
Cell Lymphoma ◽  
Early Stage ◽  
Breast Implant ◽  
Breast Implants ◽  
Large Cell ◽  
Regulatory Action ◽  
Level Of Evidence ◽  
Large Cell Lymphoma

Abstract Background Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an emerging cancer that has been linked to the use of textured devices. The recent increase in number and frequency of cases has led to worldwide regulatory action. Objectives The authors aimed to longitudinally study BIA-ALCL in Australia since the index case was first reported in 2007. Methods Confirmed historical cases were collected and then prospectively analyzed from October 2015 to May 2019. Clinical and implant exposure data were determined and compared with company sales data for 4 devices to generate implant-specific risk. Results A total 104 cases of BIA-ALCL were diagnosed in Australia with exposure to 149 unique breast implants. The mean age of patients was 48.2 years (range, 22.4-78.5 years). They had an average time from implantation to diagnosis of 6.8 years. A total 51.7% of implants utilized in this cohort were Allergan Biocell devices. The indication for implant usage was for primary cosmetic augmentation in 70%, post-breast cancer reconstruction in 23%, and following weight loss/pregnancy in 7%. The majority of women presented with early (stage 1) disease (87.5%). The risk for developing BIA-ALCL ranged from 1 in 1947 sales (95% confidence interval = 1199-3406) for Silimed Polyurethane devices to 1 in 36,730 (95% confidence interval = 12,568-178,107) for Siltex imprinted textured devices. Conclusions Implants with higher surface area/texture seem to be more associated with BIA-ALCL in Australia. Recent regulatory action to suspend, cancel, or recall some of these higher risk devices is supported by these findings. Level of Evidence: 2

Prioritisation of catheterised patients for elective bladder outflow obstruction surgery in the current coronavirus disease 2019 era to reduce catheter-associated morbidity

2020 ◽  
pp. 205141582096403
Author(s):  
Angela Kit Ying Lam ◽  
Kathie Wong ◽  
Tharani Nitkunan
Keyword(s):  
Median Time ◽  
Waiting Times ◽  
Waiting List ◽  
Transurethral Resection Of Prostate ◽  
Outflow Obstruction ◽  
Level Of Evidence ◽  
Bladder Outflow Obstruction ◽  
Patient Demographics ◽  
Accident And Emergency ◽  
Included Patient

Objectives: This study aimed to audit the waiting times for a transurethral resection of prostate (TURP) at our institution, and to evaluate the extent of catheter-associated morbidity in this population. Methods: This was a retrospective closed-loop audit, with cycle one between 1 January 2018 and 31 December 2018 and cycle two between 1 October 2019 and 29 February 2020. Data collected included patient demographics, catheter status, catheter-associated presentations to accident and emergency (A&E), admissions and waiting times for TURP. The waiting-list form now has a catheter box, and a goal of 30 days from waitlisting to operation was set for those catheterised. Results: In cycle 1, 36% of the 181 patients were catheterised, and waited a median of 119 days (interquartile range (IQR) 59–163 days) for their TURP, while those not catheterised waited a median of 118 days (IQR 57.75–188.25 days). Catheterised patients presented to A&E 93 times, resulting in 13 admissions, compared to two presentations and zero admissions for those not catheterised. The median time from catheter insertion to first A&E attendance was 20 days (IQR 2–101 days). In cycle 2, 33% of the 55 patients were catheterised, with the median waiting-list time falling to 32 days (IQR 22–46 days) in those catheterised and 33 days (IQR 20–49 days) in those not catheterised. All 11 A&E attendances were from catheterised patients, with no admissions. The median time from insertion to first A&E attendance was nine days (IQR 4–40 days). Eighty-eight per cent of the waiting-list forms had appropriately ticked the catheter box. Conclusion: Our study shows that catheterised patients awaiting a TURP are more likely to have complications necessitating A&E attendance. Prioritisation of these patients on the waiting list for bladder outflow obstruction surgery may help to reduce catheter-associated morbidity. Level of evidence: Level 2c.

Single Staged Mastopexy With Autologous Fat Grafting: An Alternative to Augmentation Mastopexy With Implants

2019 ◽  
Author(s):  
Jules Walters ◽  
Lynn Bourn ◽  
Oren Tessler ◽  
Charles Patterson ◽  
Kamran Khoobehi
Keyword(s):  
Surgical Site Infections ◽  
Breast Implants ◽  
Fat Grafting ◽  
Level Of Evidence ◽  
Breast Ptosis ◽  
Autologous Fat ◽  
Ptotic Breast ◽  
The Mean ◽  
To Receive ◽  
Augmentation Mastopexy

Abstract Background Improving the ptotic breast with mastopexy and restoring upper pole fullness with augmentation continues to be a challenging issue for plastic surgeons. Autologous fat grating (AFG) for shaping and contouring of implant augmented breasts has shown positive outcomes with few complications. Objectives The objective of this study was to evaluate our experience with combined mastopexy and fat grafting for women with existing breast ptosis who prefer not to receive prosthetic breast implants but do desire volume enhancement. Methods A retrospective review of patients undergoing a single staged mastopexy with AFG, from 2006 to 2017, was performed. Inclusion criteria were women with breast ptosis or tuberous breasts desiring improved breast shape and volume. Patients were excluded if they were undergoing implant removal before the procedure. Clinical aesthetic outcomes were assessed by fellow plastic surgeons according to the Telemark Breast Scoring system. Results A total of 284 breasts, in 140 women, underwent a single staged mastopexy with AFG. The mean amount of fat grafted per breast was 299.4 mL (range, 50-710 mL). There were no surgical site infections, hematomas, or seromas. There were 3 major and 8 minor (0.06%) postoperative breast complications. A total of 13 plastic surgeons, of the 183 invited (7.1%), completed the breast outcomes survey. Regarding each category, there was significant improvement (P ≤ 0.0001) in upper pole fullness, ptosis, overall aesthetics, and symmetry postoperatively. Conclusion AFG combined with mastopexy is not associated with significant postoperative complications and results in excellent breast aesthetic outcomes. Level of Evidence: 4

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