scholarly journals Implant Replacement or Removal: What Happens after Capsular Contracture? A German Study Examining Breast Implant Revision Surgery and Patient Choices in 946 Cases

Breast Care ◽  
2020 ◽  
pp. 1-8
Author(s):  
Shafreena Kühn ◽  
Mara Anna Georgijewitsch ◽  
Andrej Wehle ◽  
Moritz Billner ◽  
Lara Küenzlen ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Revision Surgery ◽  
Breast Implant ◽  
Capsular Contracture ◽  
Implant Removal ◽  
Single Center ◽  
Autologous Breast Reconstruction ◽  
Implant Placement ◽  
In Situ Implant

<b><i>Introduction:</i></b> Capsular contracture most often leads to implant revision surgery for aesthetic or reconstructive purposes. However, little is known about which operation is chosen when revision surgery has to be performed. We performed analysis of revision indications and performed revision surgery considering implant removal or replacement and additional surgical procedures. To our knowledge, this study presents the largest German single-center analysis regarding implant revision surgery after the onset of complications. <b><i>Methods:</i></b> Retrospective 10-year data analysis of a single-center population undergoing breast implant revision surgery. <b><i>Results:</i></b> Capsular contracture was the most frequent finding before reoperation, both removal and replacement (<i>p</i> &#x3c; 0.05). It was linked to longer duration of in situ implant placement (<i>p</i> &#x3c; 0.05) and more frequently in reconstructive patients (<i>p</i> &#x3c; 0.05). Implant replacement was performed more often before definite implant removal for reconstructive patients (<i>p</i> &#x3c; 0.05). Mean duration of in situ implant placement before definite removal was lower for reconstructive patients (<i>p</i> = 0.005). Overall reconstructive patients were older than aesthetic patients (<i>p</i> &#x3c; 0.05). After implant removal, 61.7% of aesthetic patients chose to undergo mastopexy, 54.7% of reconstructive patients opted for autologous breast reconstruction, and 25.4% did not choose an additional surgical procedure after implant removal. <b><i>Conclusion:</i></b> Significant differences are observed for reconstructive and aesthetic patients regarding indication leading to revision surgery, time of revision surgery, and the type of performed revision surgery itself. After implant removal, more than 60% of aesthetic patients undergo mastopexy, more than half of reconstructive patients choose autologous breast reconstruction, and over a quarter of patients choose no additional surgical procedures.

A Multicenter Analysis Examining Patients Undergoing Conversion of Implant-based Breast Reconstruction to Abdominally based Free Tissue Transfer

2018 ◽  
Vol 34 (09) ◽  
pp. 685-691 ◽  
Author(s):  
Ruya Zhao ◽  
Bao Tran ◽  
Andres Doval ◽  
Gloria Broadwater ◽  
Kate Buretta ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Breast Implant ◽  
Capsular Contracture ◽  
Free Tissue Transfer ◽  
Implant Removal ◽  
Implant Failure ◽  
Tissue Transfer ◽  
Institutional Review ◽  
Tissue Reconstruction ◽  
Multicenter Analysis

Background Breast implant placement is the most common method for postmastectomy reconstruction. For patients who develop complications associated with implant-based reconstruction, additional surgeries may be challenging. This study examined implant-based reconstruction failure in patients undergoing salvage with abdominal free tissue transfer. Methods We conducted an Institutional Review Board approved, multicenter retrospective study of patients with implant-based primary breast reconstruction followed by implant removal and subsequent abdominal free tissue transfer between 2006 and 2016. Patient demographics, treatment details, and complications were evaluated. Severity of implant failure was graded as either (1) not severe (delayed salvage reconstruction) or (2) severe (immediate salvage reconstruction). Results Between 2006 and 2016, 115 patients with 180 mastectomy defects underwent primary implant-based reconstruction with subsequent implant removal and abdominally based free tissue reconstruction. Of these, 68 were delayed and 47 were immediate salvage reconstruction. Factors leading to elective removal were capsular contracture, asymmetry, and implant malposition. Factors leading to obligatory removal were infection, delayed wound healing, and implant extrusion. Postmastectomy radiation was significantly associated with immediate salvage reconstruction (p < 0.001, odds ratio = 3.9) as were large volume implants (p = 0.06). Deep inferior epigastric perforator flaps comprised 78.3% of all abdominally based free tissue reconstructions, while muscle-sparing transverse rectus abdominus myocutaneous flaps comprised 18.3%. Overall flap failure rate was 2.6% (2.94% delayed and 2.13% immediate salvage reconstruction; p = 1.0). Conclusion Our findings suggest that abdominal free tissue transfer remains a safe and effective salvage modality for implant-based breast reconstruction failure. Patients with severe implant failure were more likely to have received radiation. Surgeons should remain cognizant of this during care of patients.

Composite Breast Remodeling After Implant Removal by Tissue Recruitment and Loops Fixation With Power-Assisted Liposuction and Lipofilling (PALLL)

2021 ◽  
Author(s):  
Marwan H Abboud ◽  
Ayush K Kapila ◽  
Svetlana Bogaert ◽  
Nicolas M Abboud
Keyword(s):  
Breast Implant ◽  
Capsular Contracture ◽  
Patient Characteristics ◽  
Fat Grafting ◽  
Implant Removal ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Aesthetic Results ◽  
And Migration ◽  
The Aesthetic

Abstract Background An increasing number of women wish breast implant removal whilst maintaining an acceptable projection and form were possible. Objectives The authors propose a technique to remodel the breast after implant removal utilizing internal suture loops to project the breast, recruit abdominal and axillary tissue cranially and medially, and provide a matrix for lipofilling. Methods A prospective analysis was performed of consecutive patients undergoing implant extraction followed by power-assisted liposuction loops and lipofilling. Patient characteristics were measured. The aesthetic results were evaluated by 2 independent raters. Patient-reported satisfaction was measured by standardized questionnaires. Results Implants in 52 patients with an average age of 55 and body mass index of 23.7 were extracted followed by breast remodeling. A total of 73% of patients had implants for aesthetic reasons, 41% were smokers, and 43% of the reconstruction cases received radiotherapy. A total of 28% had implant extraction for rupture, 58% for capsular contracture, and 14% due to pain and migration. The average volume of the implants removed was 292 cc, followed by an average lipofilling of 223 cc, yielding a ratio of 0.76 to 1. The average tissue recruited by loops was 82.5 cc. Independent raters measured 79% of results as good, 13% as acceptable, and 8% as requiring improvement; 80% of patients were satisfied to very satisfied. Conclusions The authors propose implant extraction followed by power-assisted liposuction loops and lipofilling can provide footprint definition, sustained projection, and high patient satisfaction. Moreover, the recruitment of a vascularized adipo-cutaneous flap by loops allows a reduced ratio of fat grafting to implant volume. Level of Evidence: 4

scholarly journals Attachment distribution of pectoral muscle origins identified in dual-plane breast implant insertion

2020 ◽  
Vol 47 (2) ◽  
pp. 160-164
Author(s):  
Su Bong Nam ◽  
Kyung Ho Song ◽  
Jung Yeol Seo ◽  
June Seok Choi ◽  
Tae Seo Park ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Breast Implant ◽  
Pectoralis Major Muscle ◽  
Pectoral Muscle ◽  
Augmentation Mammoplasty ◽  
Dual Plane ◽  
Reconstruction Surgery ◽  
Additional Information ◽  
Implant Placement ◽  
The Right

Background Implant-based dual-plane augmentation mammoplasty requires accurate separation of the pectoralis major muscle (PMM) at its origins. The authors identified the PMM origins during breast reconstruction surgery with the goal of providing additional information on subpectoral implant insertion for reconstructive or aesthetic purposes.Methods This study was conducted on 67 patients who underwent breast reconstruction surgery at the breast center of our hospital between November 2016 and June 2018. In total, 34 left and 39 right hemithoraces were examined. The left and right hemithoraces were each divided into 15 zones to determine the percentage of PMM attachments in each zone. The distribution of PMM origins in each zone was examined to identify any statistically significant differences.Results There were no statistically significant differences in the origins of the PMM between the right and left hemithoraces. The percentage of attachments increased moving from the fourth to the sixth rib and from the lateral to the medial aspect.Conclusions The anatomical findings of this study could be used as a reference for accurate dissection of the origins of the PMM for the preparation of the subpectoral pocket for subpectoral implant placement.

Assessing the Relationship between Anxiety and Revision Surgery following Autologous Breast Reconstruction

2019 ◽  
Vol 144 (1) ◽  
pp. 24-33 ◽  
Author(s):  
Jonah P. Orr ◽  
Amanda R. Sergesketter ◽  
Ronnie L. Shammas ◽  
Analise B. Thomas ◽  
Roger W. Cason ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Revision Surgery ◽  
Autologous Breast Reconstruction ◽  
The Relationship

scholarly journals Comprehensive Comparison Between Shaped Versus Round Implants for Breast Reconstruction: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 41 (1) ◽  
pp. 34-44 ◽  
Author(s):  
So-Eun Han ◽  
Kyeong-Tae Lee ◽  
Saik Bang
Keyword(s):  
Breast Reconstruction ◽  
Meta Analysis ◽  
Breast Implant ◽  
Capsular Contracture ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Relative Risks ◽  
Patient Reported ◽  
Aesthetic Results ◽  
Retrospective Cohort Studies

Abstract Background Prosthetic breast reconstruction has been gaining popularity and a variety of implant options are currently available. Therefore, it is important to evaluate the safety and efficacy of newly developed shaped implants compared with those of conventional round implants. To date, few studies have investigated the outcomes of breast reconstruction with shaped versus round implants. Objectives The present study aimed to comprehensively compare, via meta-analytic methodology, shaped and round breast implant reconstruction in terms of complication profiles and aesthetic satisfaction. Methods PubMed/MEDLINE, Ovid, and Cochrane databases were searched to identify relevant studies presenting the complication rates for shaped and round implant groups. The relative risks of the following complications between the groups were calculated: infection, seroma, capsular contracture, rupture, rippling, reconstruction failure, and implant exchange or removal. Outcomes of aesthetic satisfaction included aesthetic results and patient-reported outcomes. Results Meta-analysis of 8 retrospective cohort studies, representing 2490 cases of implant-based breast reconstruction, was performed. There were no significant differences in the risks of infection, seroma, capsular contracture, and reconstruction failure between the 2 groups. The risks of implant rupture and rippling were significantly reduced with shaped implants. In a subgroup analysis of shaped/textured and round/smooth implants, the risk of infection was significantly enhanced in the former, whereas incidences of other complications, including capsular contracture and reconstruction failure, were similar. Aesthetic satisfaction analysis of the 2 groups demonstrated similar outcome scores with favorable overall results. Conclusions Our results suggest that both shaped and round implants might provide favorable breast reconstruction outcomes with similarly low complication rates and aesthetic results. Level of Evidence: 4

Outcomes of Immediate Alloplastic Breast Reconstruction in Patients Receiving Post-Mastectomy Radiotherapy

2020 ◽  
pp. 229255032096964
Author(s):  
Stacy Fan ◽  
Hanny Chen ◽  
Aaron Grant ◽  
Tanya DeLyzer
Keyword(s):  
Breast Reconstruction ◽  
Revision Surgery ◽  
Capsular Contracture ◽  
Tissue Expander ◽  
Wound Dehiscence ◽  
Fisher Exact Test ◽  
Adjuvant Radiation ◽  
Complication Rates ◽  
Alloplastic Breast Reconstruction ◽  
Alloplastic Reconstruction

Background: Immediate alloplastic breast reconstruction is traditionally avoided in patients who require post-mastectomy radiation therapy (PMRT). However, a subset of patients who undergo alloplastic reconstruction may unpredictably require adjuvant radiation. The purpose of this study was to compare outcomes and complications in patients at our institution who had undergone immediate alloplastic breast reconstruction and received PMRT to either the permanent implant or temporary tissue expander. Materials and Methods: A retrospective cohort study was performed looking at patients who underwent immediate alloplastic breast reconstruction over a 10-year period (2009-2019) at our regional breast centre. All patients who underwent immediate alloplastic breast reconstruction and had PMRT were included in the study. Major (wound dehiscence with device exposure, or reconstructive failure) and minor (infection, capsular contracture, revision surgery) complication rates between those patients receiving radiation to a tissue expander versus implant were compared using Fisher exact test ( P < .05). Results: Six-hundred ninety-two patients were identified, and 43 patients met inclusion criteria. Of this group, 29 received PMRT to implants and 14 received PMRT to tissue expanders. Complication rates were similar between groups for superficial wound infection (3.4% vs 7.1%), periprosthetic infection (3.4% vs 7.1%), capsular contracture (41.4% vs 21.4%), revision surgery for aesthetics (41.4% vs 21.4%), wound dehiscence and device exposure (3.4% vs 21.3%), and reconstructive failure (10.3% vs 6.7%). Total complication rates were similar between groups (51.7% vs 42.9%). Discussion: Overall 6.4% of patients who underwent immediate alloplastic breast reconstruction required PMRT over a 10-year period. Complication rates for infection, capsular contracture, revision surgery, wound dehiscence and device exposure, and reconstructive failure were similar between both groups. Total complication rates were similar between groups. This information will help to inform decision-making regarding immediate alloplastic reconstruction and expected complications when PMRT is needed.

scholarly journals Periprosthetic Fluid Analysis in the Diagnosis of Breast Implant Infections Using Cell Count and Differential

2020 ◽  
Vol 2 (3) ◽  
Author(s):  
Christopher N Stewart ◽  
Bill B Liu ◽  
Eugene E Zheng ◽  
Sue-Mi C Tuttle
Keyword(s):  
Breast Reconstruction ◽  
Cell Count ◽  
Clinical Decision Making ◽  
Breast Implant ◽  
Capsular Contracture ◽  
Accurate Diagnosis ◽  
Level Of Evidence ◽  
Fluid Analysis ◽  
Neutrophil Percentage ◽  
Periprosthetic Fluid

Abstract Background One of the most devastating complications following implant-based breast reconstruction is periprosthetic infection. Making a prompt and accurate diagnosis has been a challenge as plastic surgeons are limited by nonspecific systemic markers of infection, clinical examination findings, or imaging modalities. Objectives The aim of this study is to evaluate the use of periprosthetic fluid using cell count and differential as an aid in the diagnosis of infection. Methods This is a retrospective chart review. The authors selected patients who underwent breast reconstruction and had periprosthetic fluid analysis during the previous 10 years based on CPT 89051 (cell count and differential, body fluid). Only patients with clinical concerns for infection were included (cellulitis, fever, etc.); all others were excluded. Results A total of 54 samples were included in the study. Twenty-seven samples were associated with periprosthetic breast infections based on positive cultures or intraoperative findings consistent with infection. On fluid analysis, those with infection had a significantly higher neutrophil percentage (84.2% vs 19.3%, P &lt; 0.0001). A cutoff value of 77% neutrophils had a sensitivity of 89% and a specificity of 93% in diagnosing infection. Delayed treatment in patients with high neutrophil percentage was associated with poorer outcomes. Lastly, there was a strong correlation between higher neutrophil percentage and increased rate of capsular contracture. Conclusions Early and accurate diagnosis of periprosthetic breast infections can lead to earlier treatment and potentially improved the outcomes. Aspiration and analysis of periprosthetic fluid for neutrophil percentage can be a reliable method to guide clinical decision making. Level of Evidence: 3

scholarly journals BellaGel breast implant: 6-Year results of a prospective cohort study

2020 ◽  
Vol 47 (3) ◽  
pp. 235-241
Author(s):  
Joon Seok Oh ◽  
Jae Hoon Jeong ◽  
Yujin Myung ◽  
Jeongseok Oh ◽  
Shin Hyeok Kang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Clinical Study ◽  
Breast Reconstruction ◽  
Breast Implant ◽  
Capsular Contracture ◽  
Breast Implants ◽  
Asian Women ◽  
Safety And Efficacy ◽  
Implant Rupture ◽  
Cohesive Silicone Gel

Background This is the first clinical study conducted among Asian women using breast implants manufactured by an Asian company. Four-year data regarding the safety and efficacy of BellaGel breast implants have already been published, and we now report 6-year data.Methods This study was designed to take place over 10 years. It included 103 patients who underwent breast reconstruction or augmentation using BellaGel breast implants. The rates of implant rupture and capsular contracture were measured and analyzed to evaluate the effectiveness of the breast implant.Results At patients’ 6-year postoperative visits, the implant rupture and capsular contracture rates were 1.15% and 2.30%, respectively. The implant rupture rate was 3.77% among reconstruction cases and 0% among augmentation cases. The capsular contracture rate was 5.66% among reconstruction cases and 0.83% among augmentation cases.Conclusions The 6-year data from this planned 10-year study suggest that the BellaGel cohesive silicone gel-filled breast implant is an effective and safe medical device that can be used in breast reconstruction and augmentation.

scholarly journals How to Optimize Prepectoral Breast Reconstruction

2020 ◽  
Vol 40 (Supplement_2) ◽  
pp. S22-S28
Author(s):  
Francis D Graziano ◽  
Peter W Henderson ◽  
Jordan Jacobs ◽  
C Andrew Salzberg ◽  
Hani Sbitany
Keyword(s):  
Breast Reconstruction ◽  
Breast Implant ◽  
Capsular Contracture ◽  
Skin Flap ◽  
Soft Tissue Coverage ◽  
Precise Control ◽  
Postmastectomy Radiation ◽  
Added Benefit ◽  
Postmastectomy Radiation Therapy ◽  
Dermal Matrices

Abstract Prepectoral breast reconstruction has become a popular method of postmastectomy breast reconstruction due to its numerous benefits in properly selected patients. Prepectoral reconstruction, as compared with retropectoral position, offers the advantage of leaving the pectoralis muscle undisturbed and in its original anatomic position, resulting in significantly decreased acute and chronic pain, improved upper extremity strength and range of motion, and avoidance of animation deformity. The use of acellular dermal matrices (ADMs) allows for precise control of the breast pocket, resulting in aesthetic outcomes and high patient satisfaction. ADMs have the added benefit of reducing capsular contracture, especially in the setting of postmastectomy radiation therapy. Although prepectoral breast reconstruction is effective, the breast implant is placed closer to the skin flap with less vascularized soft tissue coverage. Therefore, optimizing outcomes in prepectoral breast reconstruction requires careful patient selection, intraoperative mastectomy flap evaluation, and perioperative surgical algorithms specific to prepectoral reconstruction.

scholarly journals Punctual Breast Implant Rupture following Lipofilling: Only a Myth?

Breast Care ◽  
2020 ◽  
pp. 1-4
Author(s):  
Andres Rivera ◽  
Carlota González-Pozega ◽  
Gorka Ibarra ◽  
Borja Fernandez-Ibarburu ◽  
Ángela García-Ruano ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Breast Implant ◽  
Capsular Contracture ◽  
Clinical Signs ◽  
Fat Graft ◽  
Implant Rupture ◽  
Fat Deposits ◽  
Autologous Fat Graft ◽  
Clinical Chart ◽  
Breast Implant Rupture

<b><i>Background:</i></b> Lipofilling techniques are widespread in clinical practice as a complement to breast reconstruction, despite posing some risk. Punctual implant rupture following a fat transfer is one of the possible complications, which has not been properly reported yet and is probably being underdiagnosed. The aim of this paper is to report key facts for appropriate diagnosis of this clinical chart.<i></i><b><i>Case Report:</i></b><i></i>We present the case of a 47-year-old woman with a bilateral prosthetic breast reconstruction who was treated with autologous fat graft for upper pole enhancing and scar improvement. The patient developed an early unilateral breast capsular contracture after the fat graft procedure, with normal radiological exploration. Surgical findings showed intraprosthetic fat deposits and a punctual implant rupture. <b><i>Conclusions:</i></b> Punctual breast implant rupture is a possible complication of lipofilling that is usually not suspected at first consultation and might be underdiagnosed based on radiological findings, so investigating clinical signs should necessarily be a prerequisite to diagnosis.

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