Construction of mammographic findings simulators to study the interference of silicone implants in the diagnosis of breast cancer

Introduction: Breast cancer is the most prevalent malignant neoplasm among women, presenting itself, in 99% of cases, in females. Augmentation mammoplasty is the most performed aesthetic surgical intervention in the world. Objective: This study aims to improve the search for biomaterials compatible with mammographic findings suggestive of malignancy, to further study the interference of silicone implants in mammography exams. Methods: To make the simulators of mammographic findings, a bibliographic study of possible biomaterials that presented compatibility with the breast tissue and with possible neoplastic findings was carried out. The validation process of the simulators made in this work was carried out in two stages. Results: The result found was a density variation between 2.54 and 2.57 (dimensionless unit). For the second plate, the individual optical density of each material was analyzed. The results found for fiberglass ranged between 1.95 and 2.63. For chicken eggshells between 0.59 and 0.80. For the glycerin suppository, values between 1.43 and 2.29 were found. And for plastic PVC film 1.78 to 2.53. Conclusion: Given the above, it is observed that the first plate as a whole is compatible with mammographic studies. However, on the second plate, when the materials were analyzed separately, it was observed that fiberglass and plastic PVC film were the closest to compatibility with the commercial phantom, being compatible materials to simulate breast neoplasms in possible further studies.

Tumor Remnant After Silicone Implant en Block Capsulectomy: The Magnetic Resonance Role

Recently, there has been an increase in surgeries to treat silicone implants complications. These procedures are generally related to diseased fibrous capsules, whose most common clinical manifestation is capsular contracture. Other frequently found presentations are intracapsular collection and local inflammatory signs. The causes of these complications are not well established. Some reports associate them with the implant texture, gel bleeding, silicone-induced granuloma, and infectious processes. Although rare, there is an association with malignant neoplasia in the literature, where Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is the most severe complication. Patients often do not perform a Magnetic Resonance (MRI) scan for the explant surgical programming.The accuracy of MRI to assess fibrous capsule tumor remnants depends on the surgical time. The ideal time for the evaluation is up to 72 hours after the surgical time when the repair tissue starts to appear. Up to 2-3 weeks after surgery, MRI can provide information regarding the presence of a residual tumor. After this period, the presence of scar tissue impairs the analysis. This short report discusses the role of MRI in the evaluation of residual fibrous capsules in the postoperative period.

Iatrogenic intrathoracic encapsulated siliconoma from a ruptured breast implant

Our patient was a 57-year-old woman with a history of bilateral retropectoral silicone breast augmentation and axillary hyperhidrosis who underwent a bilateral thoracic sympathectomy via video-assisted thoracoscopic surgery by a surgeon at an outside hospital approximately 20 years ago. The left side required an open thoracotomy. Shortly after the surgery, she developed a left-sided Baker 4 capsular contracture and the left implant was noted to be ruptured. Both implants were exchanged. Several years later the patient began to experience progressive fatigue. Work-up revealed a left lung nodule and she underwent a biopsy that confirmed silicone granulomas. It was hypothesised that at the time of her initial thoracotomy the implant was violated resulting in silicone spillage into the thoracic cavity. The patient was referred to our institution for advanced management of her intrathoracic silicosis. The patient underwent bilateral removal of her silicone implants, total capsulectomy and needle-localised removal of her left thoracic silicone masses. She had an uneventful postoperative course with resolution of her fatigue.

Complication after Aquafilling® gel-mediated augmentation mammoplasty—galactocele formation in a lactating woman: a case report and review of literature

Augmentation mammoplasty using hydrogel fillers such as polyacrylamide gel (PAAG) or Aquafilling® has been performed commonly in some countries as an alternative to breast augmentation with saline or silicone implants. However, the safety of this procedure remains controversial, and many complications associated with the use of large-volume hydrogel injection have been reported in recent years. We present the case of a 33-year-old woman with a history of bilateral Aquafilling® injection augmentation mammoplasty who presented with an enlarged left breast while breastfeeding. Based on the clinical presentation and ultrasound findings, the patient underwent surgical incision as abscess formation caused by infection of the filler material could not be ruled out with certainty. Surgery revealed a galactocele with drainage of large amounts of milky fluid. Remaining filler material was removed as thoroughly as possible, and vacuum assisted wound dressing was performed. Galactocele formation in lactating women is a known complication after injection of hydrogel. Hence, it is important to be familiar with this uncommon but possibly severe complication in order to make an accurate diagnosis and initiate adequate treatment. To that end, it is recommended that patients who underwent Aquafilling® injection for breast augmentation should avoid lactation and that women intending to breastfeed should not undergo augmentation mammoplasty with injection of Aquafilling®.Level of Evidence: Level V, risk / prognostic study

Functionalization of Silicone Surface with Drugs and Polymers for Regulation of Capsular Contracture

Breast reconstruction is achieved using silicone implants, which are currently associated with major complications. Several strategies have been considered to overcome the existing limitations as well as to improve their performance. Recently, surface modification has proved to be an effective clinical approach to prevent bacterial adhesion, reduce capsular thickness, prevent foreign body reactions, and reduce other implant-associated problems. This review article summarizes the ongoing strategies for the surface modification of silicone implants in breast reconstruction applications. The article mostly discusses two broad categories of surface modification: drug-mediated and polymer-based. Different kinds of drugs have been applied with silicone that are associated with breast reconstruction. Initially, this article discusses studies related to drugs immobilized on silicone implants, focusing on drug-loading methods and their effects on capsule contracture. Moreover, the pharmacological action of drugs on fibroblast cells is considered in this section. Next, the polymeric modification of the silicone surface is introduced, and we discuss its role in reducing capsule thickness at the cellular and biological levels. The polymeric modification techniques, their chemistry, and their physical properties are described in detail. Notably, polymer activities on macrophages and inflammation are also briefly discussed. Each of the reviewed articles is summarized, highlighting their discussion of capsular thickness, foreign body reactions, and bacterial attachment. The aim of this review is to provide the main points of some research articles regarding the surface modification of silicon, which can lead to a decrease in capsular thickness and provides better patient compliance.

Implants versus Lipograft – Analysis of Long-Term Results after Congenital Breast Asymmetry Procedure

Congenital breast asymmetry represents a particular challenge to the classical techniques of plastic surgery due to a young group of patients. This study compares traditional breast augmentation using silicone implants to the more innovative lipograft technique regarding long-term results. To achieve this, we not only captured subjective parameters like satisfaction with outcome and symmetry, but also objective parameters such as breast volume and anthropometric measurements. Objective examination was performed manually and by using the Vectra® H2 photogrammetry scanning system. Patients who underwent implant augmentation and lipograft both showed no significant differences in patient´s satisfaction with surgical outcome (p = 0.55) and symmetry (p = 0.69). Furthermore, a breast symmetry of 93 % in both groups was reported. Likewise, no statistically significant volume difference between left and right breast was observed in both groups (p<0.41). However, on average, lipograft patients needed 1.3 procedures more until the desired result was achieved. In contrast, patients treated with implant-based breast augmentation usually need several implant changes during their life. In conclusion, both methods should be considered for patients with congenital breast asymmetry.