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Sample records for breast implantation

  1. Breast reconstruction - implants

    Science.gov (United States)

    Breast implants surgery; Mastectomy - breast reconstruction with implants; Breast cancer - breast reconstruction with implants ... to make reconstruction easier. If you will have breast reconstruction later, your surgeon will remove enough skin ...

  2. Risks of Breast Implants

    Science.gov (United States)

    ... Tissue Disease The FDA has not detected any association between silicone gel-filled breast implants and connective tissue disease, breast cancer, or reproductive problems. In order to rule out ...

  3. Delayed breast implant reconstruction

    DEFF Research Database (Denmark)

    Hvilsom, Gitte B.; Hölmich, Lisbet R.; Steding-Jessen, Marianne

    2012-01-01

    We evaluated the association between radiation therapy and severe capsular contracture or reoperation after 717 delayed breast implant reconstruction procedures (288 1- and 429 2-stage procedures) identified in the prospective database of the Danish Registry for Plastic Surgery of the Breast during...... reconstruction approaches other than implants should be seriously considered among women who have received radiation therapy....

  4. Delayed breast implant reconstruction

    DEFF Research Database (Denmark)

    Hvilsom, Gitte B.; Hölmich, Lisbet R.; Steding-Jessen, Marianne

    2011-01-01

    Studies of complications following reconstructive surgery with implants among women with breast cancer are needed. As the, to our knowledge, first prospective long-term study we evaluated the occurrence of complications following delayed breast reconstruction separately for one- and two-stage pro......Studies of complications following reconstructive surgery with implants among women with breast cancer are needed. As the, to our knowledge, first prospective long-term study we evaluated the occurrence of complications following delayed breast reconstruction separately for one- and two......-stage procedures. From the Danish Registry for Plastic Surgery of the Breast, which has prospectively registered data for women undergoing breast implantations since 1999, we identified 559 women without a history of radiation therapy undergoing 592 delayed breast reconstructions following breast cancer during...... the period 1999 to 2006; 239 one-stage procedures and 353 two-stage procedures. The postoperative course through November 2009 was evaluated by cumulative incidence adjusting for competing risks for the selected outcomes; hematoma, infection, seroma, implant rupture, severe capsular contracture (modified...

  5. Silicone Gel-Filled Breast Implants

    Science.gov (United States)

    ... Medical Procedures Implants and Prosthetics Breast Implants Silicone Gel-Filled Breast Implants Share Tweet Linkedin Pin it ... options Linkedin Pin it Email Print Description: Silicone gel-filled breast implants have a silicone outer shell ...

  6. Silicone breast implants: complications.

    Science.gov (United States)

    Iwuagwu, F C; Frame, J D

    1997-12-01

    Silicone breast implants have been used for augmentation mammoplasty for cosmetic purposes as well as for breast reconstruction following mastectomy for more than three decades. Though the use of the silicone gel filled variety has been banned in the USA except for special cases, they continue to be available elsewhere in the world including the UK. Despite the immense benefit they provide, their usage is associated with some complications. Most of these are related to the surgery and can be reduced by good surgical management. The major complications associated with their use is adverse capsular contracture, an outcome which can be very frustrating to manage. This article reviews the commonly reported complications and suggested management alternatives.

  7. Untreated silicone breast implant rupture.

    Science.gov (United States)

    Hölmich, Lisbet R; Vejborg, Ilse M; Conrad, Carsten; Sletting, Susanne; Høier-Madsen, Mimi; Fryzek, Jon P; McLaughlin, Joseph K; Kjøller, Kim; Wiik, Allan; Friis, Søren

    2004-07-01

    Implant rupture is a well-known complication of breast implant surgery that can pass unnoticed by both patient and physician. To date, no prospective study has addressed the possible health implications of silicone breast implant rupture. The aim of the present study was to evaluate whether untreated ruptures are associated with changes over time in magnetic resonance imaging findings, serologic markers, or self-reported breast symptoms. A baseline magnetic resonance imaging examination was performed in 1999 on 271 women who were randomly chosen from a larger cohort of women having cosmetic breast implants for a median period of 12 years (range, 3 to 25 years). A follow-up magnetic resonance imaging examination was carried out in 2001, excluding women who underwent explantation in the period between the two magnetic resonance imaging examinations (n = 44). On the basis of these examinations, the authors identified 64 women who had at least one ruptured implant at the first magnetic resonance imaging examination and, for comparison, all women who had intact implants at both examinations (n = 98). Magnetic resonance images from the two examinations were compared and changes in rupture configuration were evaluated. Comparisons were also made for self-reported breast symptoms occurring during the study period and for changes in serum values of antinuclear antibodies, rheumatoid factor, and cardiolipin antibodies immunoglobulin G and immunoglobulin M. The majority of the women with implant rupture had no visible magnetic resonance imaging changes of their ruptured implants. For 11 implants (11 percent) in 10 women, the authors observed progression of silicone seepage, either as a conversion from intracapsular into extracapsular rupture (n = 7), as progression of extra-capsular silicone (n = 3), or as increasing herniation of the silicone within the fibrous capsule (n = 1); however, in most cases, these changes were minor. Some changes could be ascribed to trauma, but

  8. Salvage of Infected Breast Implants

    Directory of Open Access Journals (Sweden)

    Joon Ho Song

    2017-11-01

    Full Text Available Background Implant-based breast reconstruction is being performed more frequently, and implants are associated with an increased risk of infection. We reviewed the clinical features of cases of implant infection and investigated the risk factors for breast device salvage failure. Methods We retrospectively analyzed 771 patients who underwent implant-based breast reconstruction between January 2010 and December 2016. Age, body mass index, chemotherapy history, radiation exposure, and smoking history were assessed as potential risk factors for postoperative infection. We also evaluated the presence and onset of infection symptoms, wound culture pathogens, and other complications, including seroma, hematoma, and mastectomy skin necrosis. Additionally, we examined the mastectomy type, the use of acellular dermal matrix, the presence of an underlying disease such as hypertension or diabetes, and axillary node dissection. Results The total infection rate was 4.99% (58 of 1,163 cases and the total salvage rate was 58.6% (34 of 58. The postoperative duration to closed suction drain removal was significantly different between the cellulitis and implant removal groups. Staphylococcus aureus infection was most frequently found, with methicillin resistance in 37.5% of the cases of explantation. Explantation after infection was performed more often in patients who had undergone 2-stage expander/implant reconstruction than in those who had undergone direct-to-implant reconstruction. Conclusions Preventing infection is essential in implant-based breast reconstruction. The high salvage rate argues against early implant removal. However, when infection is due to methicillin-resistant S. aureus and the patient’s clinical symptoms do not improve, surgeons should consider implant removal.

  9. Untreated silicone breast implant rupture

    DEFF Research Database (Denmark)

    Hölmich, Lisbet R; Vejborg, Ilse M; Conrad, Carsten

    2004-01-01

    were evaluated. Comparisons were also made for self-reported breast symptoms occurring during the study period and for changes in serum values of antinuclear antibodies, rheumatoid factor, and cardiolipin antibodies immunoglobulin G and immunoglobulin M. The majority of the women with implant rupture...... that implant rupture is a relatively harmless condition, which only rarely progresses and gives rise to notable symptoms. Even so, because of a small risk of silicone spread, the authors suggest that women with implant ruptures be followed clinically, if not operated on. Because implant ruptures often occur...

  10. A pictorial essay of breast implant imaging and implant complications.

    Science.gov (United States)

    Arslan, Gozde; Celik, Levent; Cubuk, Rahmi

    2016-01-01

    Nowadays as more breast conserving surgeries and mastectomies are being performed, more breast implants are being used. Follow-up of these patients is as important as treatment. We, radiologists should be aware of normal imaging appearance of implants during follow ups. We should also be aware of complications which we may encounter during controls. In our essay, we aim to show the normal and pathological appearence of implants by sharing ultrasound, mammography and MR images from our clinic. Breast, Implants, MRI, Rupture.

  11. Immediate Direct-To-Implant Breast Reconstruction Using Anatomical Implants

    Directory of Open Access Journals (Sweden)

    Sung-Eun Kim

    2014-09-01

    Full Text Available BackgroundIn 2012, a new anatomic breast implant of form-stable silicone gel was introduced onto the Korean market. The intended use of this implant is in the area of aesthetic breast surgery, and many reports are promising. Thus far, however, there have been no reports on the use of this implant for breast reconstruction in Korea. We used this breast implant in breast reconstruction surgery and report our early experience.MethodsFrom November 2012 to April 2013, the Natrelle Style 410 form-stable anatomically shaped cohesive silicone gel-filled breast implant was used in 31 breasts of 30 patients for implant breast reconstruction with an acellular dermal matrix. Patients were treated with skin-sparing mastectomies followed by immediate breast reconstruction.ResultsThe mean breast resection volume was 240 mL (range, 83-540 mL. The mean size of the breast implants was 217 mL (range, 125-395 mL. Breast shape outcomes were considered acceptable. Infection and skin thinning occurred in one patient each, and hematoma and seroma did not occur. Three cases of wound dehiscence occurred, one requiring surgical intervention, while the others healed with conservative treatment in one month. Rippling did not occur. So far, complications such as capsular contracture and malrotation of breast implant have not yet arisen.ConclusionsBy using anatomic breast implants in breast reconstruction, we achieved satisfactory results with aesthetics better than those obtained with round breast implants. Therefore, we concluded that the anatomical implant is suitable for breast reconstruction.

  12. Cutaneous Silicone Granuloma Mimicking Breast Cancer after Ruptured Breast Implant

    Directory of Open Access Journals (Sweden)

    Waseem Asim Ghulam El-Charnoubi

    2011-01-01

    Full Text Available Cutaneous manifestations due to migration of silicone from ruptured implants are rare. Migrated silicone with cutaneous involvement has been found in the chest wall, abdominal wall, and lower extremities. We describe a case of cutaneous silicone granuloma in the breast exhibiting unusual growth mimicking breast cancer after a ruptured implant.

  13. Silicone breast implants and connective tissue disease

    DEFF Research Database (Denmark)

    Lipworth, Loren; Holmich, Lisbet R; McLaughlin, Joseph K

    2011-01-01

    -analyses and critical reviews, which have demonstrated that cosmetic breast implants are not associated with a subsequent increased occurrence of individual CTDs or all CTDs combined, including fibromyalgia. Moreover, there is no credible evidence for the conjectured excess of "atypical" CTD among women with cosmetic...... CTD, has been extensively studied. We have reviewed the epidemiologic literature regarding an association between cosmetic breast implants and CTDs, with particular emphasis on results drawn from the most recent investigations, many of which are large cohort studies with long-term follow-up, as well...... breast implants, or of a rheumatic symptom profile unique to these women. No increased risk of CTDs is evident in women with extracapsular ruptures in two studies, which evaluated risk by implant rupture status, and no consistent association has been observed between silicone breast implants...

  14. Imaging of common breast implants and implant-related complications: A pictorial essay

    Directory of Open Access Journals (Sweden)

    Amisha T Shah

    2016-01-01

    Full Text Available The number of women undergoing breast implant procedures is increasing exponentially. It is, therefore, imperative for a radiologist to be familiar with the normal and abnormal imaging appearances of common breast implants. Diagnostic imaging studies such as mammography, ultrasonography, and magnetic resonance imaging are used to evaluate implant integrity, detect abnormalities of the implant and its surrounding capsule, and detect breast conditions unrelated to implants. Magnetic resonance imaging of silicone breast implants, with its high sensitivity and specificity for detecting implant rupture, is the most reliable modality to asses implant integrity. Whichever imaging modality is used, the overall aim of imaging breast implants is to provide the pertinent information about implant integrity, detect implant failures, and to detect breast conditions unrelated to the implants, such as cancer.

  15. Imaging of common breast implants and implant-related complications: A pictorial essay

    Science.gov (United States)

    Shah, Amisha T; Jankharia, Bijal B

    2016-01-01

    The number of women undergoing breast implant procedures is increasing exponentially. It is, therefore, imperative for a radiologist to be familiar with the normal and abnormal imaging appearances of common breast implants. Diagnostic imaging studies such as mammography, ultrasonography, and magnetic resonance imaging are used to evaluate implant integrity, detect abnormalities of the implant and its surrounding capsule, and detect breast conditions unrelated to implants. Magnetic resonance imaging of silicone breast implants, with its high sensitivity and specificity for detecting implant rupture, is the most reliable modality to asses implant integrity. Whichever imaging modality is used, the overall aim of imaging breast implants is to provide the pertinent information about implant integrity, detect implant failures, and to detect breast conditions unrelated to the implants, such as cancer. PMID:27413269

  16. Delayed breast reconstruction with implants after invasive breast cancer does not impair prognosis

    DEFF Research Database (Denmark)

    Holmich, L.R.; During, M.; Henriksen, T.F.

    2008-01-01

    We investigated if delayed breast implant reconstruction after breast cancer impairs prognosis. Using data from the Danish Breast Cancer Cooperative Group register, we identified all women......We investigated if delayed breast implant reconstruction after breast cancer impairs prognosis. Using data from the Danish Breast Cancer Cooperative Group register, we identified all women...

  17. The diagnosis of breast implant rupture

    DEFF Research Database (Denmark)

    Hölmich, Lisbet R; Vejborg, Ilse; Conrad, Carsten

    2005-01-01

    STUDY OBJECTIVE: The aim of this study was to evaluate the accuracy of Magnetic Resonance Imaging (MRI) as performed according to a strict study protocol in diagnosing rupture of silicone breast implants. MATERIAL AND METHODS: The study population consisted of 64 women with 118 implants, who had...... participated in either one or two study MRI examinations, aiming at determining the prevalence and incidence of silent implant rupture, respectively, and who subsequently underwent explantation. Implant rupture status was determined by four independent readers and a consensus diagnosis of either rupture...... (intracapsular or extracapsular), possible rupture or intact implant was then obtained. Strict predetermined rupture criteria were applied as described in this report and findings at surgery were abstracted in a standardised manner and results compared. RESULTS: At MRI, 66 implants were diagnosed as ruptured...

  18. Prepectoral Implant-Based Breast Reconstruction

    Directory of Open Access Journals (Sweden)

    Lyndsey Highton, BMBCh, MA, FRCS(Plast

    2017-09-01

    Conclusion:. Prepectoral implant placement with ADM cover is emerging as an alternative approach for IBR. This method facilitates breast reconstruction with a good cosmetic outcome for patients who want a quick recovery without potential compromise of pectoral muscle function and associated problems.

  19. Breast implants under siege: an historical commentary.

    Science.gov (United States)

    Fisher, J C; Brody, G S

    1992-01-01

    Despite 3 decades of rapidly expanding application of polydimethylsiloxane as a relatively safe implantable biomaterial, the American public is being told by a vocal minority that its use in the breast implant may be dangerous. Most of the furor has been generated by consumer advocates with support of a handful of scientists who have expressed opinions, not well supported by facts, about the risks of these devices. These anxieties have been fueled in the public's mind by a media more interested in sensationalism than disciplined reporting. The controversy has complicated the regulatory process and has become politicized in the halls of State Legislatures and Congress. Remarkably, this controversy has not involved the many other biomedical applications of silicone. How has this controversy gathered momentum? What role has the government played and how have the professional, scientific, corporate, and patient communities responded to public concern? This discussion places the breast implant battle into an historical perspective.

  20. Reconstructive breast implantation after mastectomy for breast cancer

    DEFF Research Database (Denmark)

    Henriksen, Trine F; Fryzek, Jon P; Hölmich, Lisbet R

    2005-01-01

    BACKGROUND: Clinical reports have raised concern about local complications following breast implantation used in reconstructive or cosmetic surgery, but there is a shortage of epidemiological studies in this area. OBJECTIVE: To assess in a prospective epidemiological manner the occurrence of shor...

  1. Capsular Contracture In Silicone Breast Implants: Insights From Rat Models

    Directory of Open Access Journals (Sweden)

    VILBERTO J. VIEIRA

    Full Text Available ABSTRACT Breast augmentation with silicone implants is one of the most common procedures performed by plastic surgeons around the world. Capsular contracture is a frequent complication in breast augmentation and reconstructive surgery, that requires invasive intervention. The inflammatory response to implanted mammary prostheses appears to be directly associated to capsular contracture. This review discusses the evidences from rat models studies, on the role of inflammation and fibrosis in capsular contraction and its relation to silicone breast implants surface.

  2. Permanent Breast Seed Implant Dosimetry Quality Assurance

    Energy Technology Data Exchange (ETDEWEB)

    Keller, Brian M., E-mail: Brian.Keller@sunnybrook.ca [Department of Medical Physics, Sunnybrook Health Sciences Center, Toronto, ON (Canada); Department of Radiation Oncology, University of Toronto, Sunnybrook Health Sciences Center, Toronto, ON (Canada); Ravi, Ananth [Department of Medical Physics, Sunnybrook Health Sciences Center, Toronto, ON (Canada); Sankreacha, Raxa [Carlo Fidani Regional Cancer Center, Mississauga, ON (Canada); Pignol, Jean-Philippe [Department of Radiation Oncology, University of Toronto, Sunnybrook Health Sciences Center, Toronto, ON (Canada)

    2012-05-01

    Purpose: A permanent breast seed implant is a novel method of accelerated partial breast irradiation for women with early-stage breast cancer. This article presents pre- and post-implant dosimetric data, relates these data to clinical outcomes, and makes recommendations for those interested in starting a program. Methods and Materials: A total of 95 consecutive patients were accrued into one of three clinical trials after breast-conserving surgery: a Phase I/II trial (67 patients with infiltrating ductal carcinoma); a Phase II registry trial (25 patients with infiltrating ductal carcinoma); or a multi-center Phase II trial for patients with ductal carcinoma in situ (3 patients). Contouring of the planning target volume (PTV) was done on a Pinnacle workstation and dosimetry calculations, including dose-volume histograms, were done using a Variseed planning computer. Results: The mean pre-implant PTV coverage for the V{sub 90}, V{sub 100}, V{sub 150}, and V{sub 200} were as follows: 98.8% {+-} 1.2% (range, 94.5-100%); 97.3% {+-} 2.1% (range, 90.3-99.9%), 68.8% {+-} 14.3% (range, 32.7-91.5%); and 27.8% {+-} 8.6% (range, 15.1-62.3%). The effect of seed motion was characterized by post-implant dosimetry performed immediately after the implantation (same day) and at 2 months after the implantation. The mean V{sub 100} changed from 85.6% to 88.4% (p = 0.004) and the mean V{sub 200} changed from 36.2% to 48.3% (p < 0.001). Skin toxicity was associated with maximum skin dose (p = 0.014). Conclusions: Preplanning dosimetry should aim for a V{sub 90} of approximately 100%, a V{sub 100} between 95% and 100%, and a V{sub 200} between 20% and 30%, as these numbers are associated with no local recurrences to date and good patient tolerance. In general, the target volume coverage improved over the duration of the seed therapy. The maximum skin dose, defined as the average dose over the hottest 1 Multiplication-Sign 1-cm{sup 2} surface area, should be limited to 90% of the

  3. Relative implant volume and sensibility alterations after breast augmentation.

    Science.gov (United States)

    Pitanguy, Ivo; Vaena, Michel; Radwanski, Henrique N; Nunes, Daniel; Vargas, André F

    2007-01-01

    Recent studies have provided diverging results regarding the factors that may affect sensibility after primary breast augmentation. Implant volume is believed to be an important factor, but the relation of implant size to breast volume has not been adequately addressed. In addition, the literature shows that a conflict exists when the periareolar and inframammary approaches are compared. This study aimed to refine the volumetric analysis comparing the implant and final breast size as well as the intrinsic association of these two factors with postoperative sensory alteration of the breast. A prospective study investigated patients who underwent aesthetic breast augmentation between June 2004 and October 2005 (i.e., a 16-month period) at the Ivo Pitanguy Institute. The sensibility in nine regions of the breast was tested before and after surgery using Semmes-Weinstein monofilaments. Breast sizers were used to compare the pre- and postoperative breast volumes. Statistical analysis of the data took into consideration the relative volume of the implant, the surgical approach, the presence of minor complications, the breast-feeding history, and the subjective evaluation of sensory changes in the patients. A total of 37 patients who underwent breast augmentation were examined preoperatively. The relative volume of the implant was found to be associated with sensibility alterations. No difference was found between the periareolar and inframammary incision approaches. Other factors such as previous breast-feeding, minor complications, and subjective alterations were not associated with sensory alterations. The study findings suggest that larger implants and smaller breasts show an increased association with postoperative sensory alterations of the breast. Plastic surgeons and their patients should be aware of this possibility. Implant volume should be considered together with breast size to avoid sensory complications, and this is summarized in the concept of relative

  4. Local complications after cosmetic breast implant surgery in Finland

    DEFF Research Database (Denmark)

    Kulmala, Ilona; McLaughlin, Joseph K; Pakkanen, Matti

    2004-01-01

    cosmetic silicone breast implants between 1968 and 2002. Patient records were abstracted, and additional information was gathered using a structured questionnaire that was mailed to 470 of the women in the cohort. Overall, 36% of the women had 1 or more diagnoses of postoperative complications...... implantation. Most of the women were satisfied with the implantation, but only 40% considered the preoperative information on possible risks related to implantation as sufficient. With respect to the occurrence of local complications following cosmetic breast implantation, the findings of this study...

  5. Bacterial biofilms and capsular contracture in patients with breast implants.

    Science.gov (United States)

    Rieger, U M; Mesina, J; Kalbermatten, D F; Haug, M; Frey, H P; Pico, R; Frei, R; Pierer, G; Lüscher, N J; Trampuz, A

    2013-05-01

    It has been hypothesized that bacterial biofilms on breast implants may cause chronic inflammation leading to capsular contracture. The association between bacterial biofilms of removed implants and capsular contracture was investigated. Breast implants explanted between 2006 and 2010 at five participating centres for plastic and reconstructive surgery were investigated by sonication. Bacterial cultures derived from sonication were correlated with patient, surgical and implant characteristics, and the degree of capsular contracture. The study included 121 breast implants from 84 patients, of which 119 originated from women and two from men undergoing gender reassignment. Some 50 breast prostheses were implanted for reconstruction, 48 for aesthetic reasons and 23 implants were used as temporary expander devices. The median indwelling time was 4·0 (range 0·1-32) years for permanent implants and 3 (range 1-6) months for temporary devices. Excluding nine implants with clinical signs of infection, sonication cultures were positive in 40 (45 per cent) of 89 permanent implants and in 12 (52 per cent) of 23 temporary devices. Analysis of permanent implants showed that a positive bacterial culture after sonication correlated with the degree of capsular contracture: Baker I, two of 11 implants; Baker II, two of ten; Baker III, nine of 23; and Baker IV, 27 of 45 (P contracture, indicating the potential causative role of bacterial biofilms in the pathogenesis of capsular contracture. NCT01138891 (http://www.clinicaltrials.gov). © 2013 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd.

  6. A Ballistics Examination of Firearm Injuries Involving Breast Implants.

    Science.gov (United States)

    Pannucci, Christopher J; Cyr, Adam J; Moores, Neal G; Young, Jason B; Szegedi, Martin

    2017-07-06

    This ballistics study examines whether saline breast implants can decrease tissue penetration in firearm injuries. We hypothesize that the fluid column within a saline breast implant can alter bullet velocity and/or bullet pattern of mushrooming. The two experimental groups included saline implants with 7.4 cm projection and a no implant group. The experimental design allowed the bullet to pass-through an implant and into ballistics gel (n = 10) or into ballistics gel without passage through an implant (n = 11). Shots that passed through an implant had 20.6% decreased penetration distance when compared to shots that did not pass-through an implant; this difference was statistically significant (31.9 cm vs. 40.2 cm, p ballistics gel penetration. © 2017 American Academy of Forensic Sciences.

  7. Breast implants and the risk of breast cancer: a meta-analysis of cohort studies

    NARCIS (Netherlands)

    Noels, Eline C.; Lapid, Oren; Lindeman, Jan H. N.; Bastiaannet, Esther

    2015-01-01

    The popularity of cosmetic breast augmentation and the incidence of breast cancer have been increasing worldwide. It has been hypothesized that the risk of breast cancer may be greater among patients who have undergone cosmetic breast implantation. The authors performed a meta-analysis of the

  8. Psychological characteristics of Danish women with cosmetic breast implants

    DEFF Research Database (Denmark)

    Lipworth, Loren; Kjøller, Kim; Hölmich, Lisbet R

    2009-01-01

    An excess of suicide among women with cosmetic breast implants compared with controls has consistently been reported in epidemiologic studies. We have evaluated psychological characteristics among 423 Danish women with cosmetic breast implants, compared with 414 controls. Odds ratios (OR) with 95......% confidence intervals (CI) for self-reported psychological symptoms were calculated using multiple logistic regression. Substantial excesses of all studied symptoms before implant surgery were reported among women with breast implants compared with women with other cosmetic surgery, whereas ORs for virtually......, the corresponding ORs for these 3 psychological symptoms after surgery were 0.9 (95% CI = 0.6-1.4), 1.0 (95% CI = 0.7-1.5), and 1.0 (95% CI = 0.6-1.5), respectively. In conclusion, women with cosmetic breast implants reported preoperative psychological symptoms indicative of depressive disorders substantially more...

  9. Mortality and suicide among Danish women with cosmetic breast implants

    DEFF Research Database (Denmark)

    Jacobsen, Poul Harboe; Hölmich, Lisbet R; McLaughlin, Joseph K

    2004-01-01

    BACKGROUND: Epidemiologic studies indicate that women with cosmetic breast implants have a significantly increased risk of suicide. Our objectives were to examine mortality among Danish women who underwent cosmetic breast implant surgery and to evaluate the baseline prevalence of psychopathological...... disorders as measured by admission to a psychiatric hospital among women seeking cosmetic surgery. METHODS: Cohort study of 2761 women who underwent cosmetic breast implant surgery at private clinics of plastic surgery or public hospitals, 7071 women who underwent breast reduction surgery at public...... hospitals, and 1736 women who attended private clinics for cosmetic surgery other than breast implantation, between 1973 and 1995. Causes of death through 1999 were identified through the Danish Mortality Files. Information on admission to psychiatric hospitals prior to cosmetic surgery was obtained from...

  10. Management of tuberous breast deformity with anatomic cohesive silicone gel breast implants.

    Science.gov (United States)

    Panchapakesan, Vivek; Brown, Mitchell H

    2009-01-01

    Tuberous breast deformity is a rare congenital condition that often requires surgical correction. Numerous surgical techniques have been described, reflecting the reconstructive challenge of this deformity. The anatomic cohesive gel breast implant is a powerful tool in both aesthetic and reconstructive breast surgery. In the authors' experience, its use in treating tuberous breast deformity has provided the opportunity for a single-stage approach, with very good results. The senior author has managed more than 50 cases of single-stage reconstruction for tuberous breast deformity using anatomic cohesive gel breast implants. His surgical technique is described with suggestions for achieving optimal results. Representative case examples are provided. The anatomic cohesive silicone gel breast implant is an excellent device for treating tuberous breast deformity. It often can be used as a single-stage correction of the deformity with very good results. The authors strongly advocate consideration of its use in tuberous breast deformity reconstruction.

  11. Study of the radiation effect in breast implants

    Energy Technology Data Exchange (ETDEWEB)

    Moreno T, L. R.; Ramirez R, A., E-mail: lumor2000@yahoo.com.mx [Universidad Autonoma Metropolitana, Unidad Azcapotzalco, Departamento de Ciencias Basicas, Av. San Pablo No. 180, Col. Reynosa Tamaulipas, 02200 Mexico D. F. (Mexico)

    2013-10-01

    This breast cancer is one of the most important death causes in women. Among the more frequently medical treatment for advanced breast cancer is the mastectomy. This situation leads to silicone implants as an esthetic option. There have been cases in patients with implants where cancer was frequently detected, in which a conventional radiotherapy is required. In this work is presented a study of the probable adverse effects caused by the application of high power X-rays (6-10 MV) to the silicone implants and to the surrounding tissues. In the research carried out at the clinic, none Bolus effect was detected in patients with implants. Our results prescribe that in the case of patients with implants and frequent breast cancer, the removal of implants is not necessary due radiotherapy works directly in the damaged tissues. (Author)

  12. Tissue Reinforcement in Implant-based Breast Reconstruction

    Directory of Open Access Journals (Sweden)

    Michael Scheflan, MD

    2014-08-01

    Conclusions: ADM-assisted implant-based breast reconstruction may improve aesthetic outcomes. However, appropriate patient selection, surgical technique, and postoperative management are critical for its success, including minimizing the risk of complications.

  13. The Clinical Implications of Poly Implant Prothèse Breast Implants: An Overview

    Directory of Open Access Journals (Sweden)

    Umar Wazir

    2015-01-01

    Full Text Available Mammary implants marketed by Poly Implant Prothèse (PIP were found to contain industrial grade silicone and this caused heightened anxiety and extensive publicity regarding their safety in humans. These implants were used in a large number of patients worldwide for augmentation or breast reconstruction. We reviewed articles identified by searches of Medline, PubMed, Embase, and Google Scholar databases up to May 2014 using the terms: "PIP", "Poly Implant Prothèse", "breast implants" and "augmentation mammoplasty" "siloxanes" or "silicone". In addition the websites of regulating bodies in Europe, USA, and Australia were searched for reports related to PIP mammary implants. PIP mammary implants are more likely to rupture than other implants and can cause adverse effects in the short to the medium term related to the symptoms of rupture such as pain, lumps in the breast and axilla and anxiety. Based on peer-reviewed published studies we have calculated an overall rupture rate of 14.5% (383/2,635 for PIP implants. However, there is no evidence that PIP implant rupture causes long-term adverse health effects in humans so far. Silicone lymphadenopathy represents a foreign body reaction and should be treated conservatively. The long-term adverse effects usually arise from inappropriate extensive surgery, such as axillary lymph node dissection or extensive resection of breast tissue due to silicone leakage.

  14. Anaplastic large cell lymphoma associated with breast implants

    Directory of Open Access Journals (Sweden)

    Vid Bajuk

    2017-02-01

    Full Text Available An increasing number of women worldwide decide for esthetic correction of breasts with silicone implants and post-cancer breast reconstruction with tissue expanders and silicone breast implants. It is estimated that more than 10 million women around the globe have them. Tere are approximately 200 known cases of patients with anaplastic large cell lymphoma (ALCL linked with silicone breast implants reported in medical literature. ALCL is a rare disease with an annual incidence of 0.1–0.3/100 000 women with breast silicone implants. In the presence of clinical signs, physician should also consider this rare form of ALCL in differential diagnosis. Patients are on average 50 years old. Long afer implantation surgery, the patient may experience breast swelling, pain and/or asymmetry. In diagnostics, ultrasound and cytological examination are required. During ultrasound examination fluid formation (seroma or solid tumor mass can be detected. Treatment is individualized. Due to tumor nature, implant resection and total capsulectomy are usually indicated; also, chemo- and radiotherapy might rarely be required. Five-year survival rate depends on tumor form and correlates well with clinical fndings of seroma or solid mass. In the more frequent form, seroma, fve-year survival rate is 100 %, while in the case of solid tumor mass fve-year survival rate is 75 %. The rarity of this disease makes it difficult to diagnose, but nevertheless, early detection and treatment are important for better recovery.

  15. CASE REPORT Breast cancer in a patient with silicone implants ...

    African Journals Online (AJOL)

    than in the breast mass. Breast cancer in a patient with silicone implants. R A Ahmed, MB ChB. Department of Radiology, Kalafong Hospital, University of Pretoria. CASE REPORT. Fig. 1. Inhomogeneous poorly outlined vascular mass in the left upper outer quadrant at two o'clock. Note the microcalcifications. This was the.

  16. Infection Prophylaxis for Breast Implant Surgery: Could We Do Better?

    Science.gov (United States)

    Henderson, Julia R.; Kandola, Sandhir; Hignett, Susan P.; Teasdale, Rebecca L.; Topps, Ashley R.; Pennick, Mandana; Hwang, Meiju; Barnes, Nicola

    2017-01-01

    Objective: Infective complications following breast implant surgery may result in implant removal. This causes patient distress and is costly to treat. A range of precautions is undertaken at the time of surgery to reduce infection, with varying levels of supporting evidence. This study aimed to determine how frequently and consistently infection prevention precautions are used during breast implant surgery. Methods: Multicenter observational study of surgical practice with real-time data collection during breast implant surgery. Results: From 7 NHS breast units, 121 implant procedures were assessed in 94 patients under the care of 22 consultant surgeons. The commonest procedure was immediate reconstruction (58%; 70/121). All patients were methicillin-resistant Staphylococcus aureus (but not methicillin-sensitive Staphylococcus aureus) screened. Antibiotics were given at surgery in all cases; 92% (85/94) received postoperative antibiotics. Other precautions included closed glove technique (67%; 63/94), door signs to reduce theater traffic (72%; 68/94), glove changing prior to implant handling (98%; 119/121), laminar air flow theaters (55%; 52/94), disposable drapes (94%; 88/94) and gowns (74%; 70/94), and cavity washing (89%; 108/121). Among the 14 consultants evaluated on more than 1 procedure (range, 2-22; median = 5), only 1 consistently used exactly the same precautions when siting an implant. Conclusion: Despite national guidance, infection prevention measures are not applied consistently during breast implant surgery, with variability between surgeons and within individual surgeon's practice. The introduction of an infection prevention checklist for all breast implant procedures could improve the reliability with which these precautions are undertaken. PMID:28663774

  17. Psychological characteristics of Danish women with cosmetic breast implants.

    Science.gov (United States)

    Lipworth, Loren; Kjøller, Kim; Hölmich, Lisbet R; Friis, Søren; Olsen, Jørgen H; McLaughlin, Joseph K

    2009-07-01

    An excess of suicide among women with cosmetic breast implants compared with controls has consistently been reported in epidemiologic studies. We have evaluated psychological characteristics among 423 Danish women with cosmetic breast implants, compared with 414 controls. Odds ratios (OR) with 95% confidence intervals (CI) for self-reported psychological symptoms were calculated using multiple logistic regression. Substantial excesses of all studied symptoms before implant surgery were reported among women with breast implants compared with women with other cosmetic surgery, whereas ORs for virtually all symptoms occurring after surgery were close to or below 1.0. In particular, ORs for treatment for depression, cognitive/depressive symptoms, and depression/low spirit before surgery were 4.6 (95% CI = 2.1-10.0), 3.9 (95% CI = 1.9-7.8), and 2.5 (95% CI = 1.1-5.5), respectively. In contrast, the corresponding ORs for these 3 psychological symptoms after surgery were 0.9 (95% CI = 0.6-1.4), 1.0 (95% CI = 0.7-1.5), and 1.0 (95% CI = 0.6-1.5), respectively. In conclusion, women with cosmetic breast implants reported preoperative psychological symptoms indicative of depressive disorders substantially more frequently than women with other cosmetic surgery. Future studies using standardized, validated psychiatric assessment tools are needed to determine whether this can explain the higher risk for suicide among a subset of women seeking cosmetic breast implants.

  18. Silicone Breast Implants: A Rare Cause of Pleural Effusion

    Directory of Open Access Journals (Sweden)

    Imam H. Shaik

    2015-01-01

    Full Text Available Pleural effusions are one of the rarest complications reported in patients with silicone gel filled breast implants. The silicone implants have potential to provoke chronic inflammation of pleura and subsequent pulmonary complications such as pleural effusion. Herein, we report a 44-year-old female who presented with left sided pleural effusion, six weeks after a silicone breast implantation surgery. The most common infectious, inflammatory, and malignant causes of pleural effusion were excluded with pleural fluid cytology and cultures. With recurrent effusion in the setting of recent surgery, the chemical reaction to silicone breast implants was sought and exploration was performed which revealed foreign body reaction (FBR to silicone material. The symptoms dramatically improved after the explantation.

  19. Cancer risk among Danish women with cosmetic breast implants

    DEFF Research Database (Denmark)

    Friis, Søren; Hölmich, Lisbet R; McLaughlin, Joseph K

    2006-01-01

    -up of our earlier cohort study of Danish women with cosmetic breast implants by 7 years, yielding 30 years of follow-up for women with longest implant duration. The study population consisted of women who underwent cosmetic breast implant surgery at private clinics of plastic surgery (n = 1,653) or public...... (range = 0-30 years). Women with breast implants experienced a reduced risk of breast cancer (SIR = 0.7; 95% CI = 0.5-1.0), and an increased risk of non-melanoma skin cancer (SIR = 2.1; 95% CI = 1.5-2.7). Stratification by age at implantation, calendar year at implantation and time since implantation...... showed no clear trends, however, the statistical precision was limited in these analyses. When excluding non-melanoma skin cancer, the SIR for cancer overall was 1.0 (95% CI = 0.8-1.2). With respect to other site-specific cancers, no significantly increased or decreased SIR were observed. Similar results...

  20. Objective Comparison of Commercially Available Breast Implant Devices.

    Science.gov (United States)

    Henderson, Peter W; Nash, David; Laskowski, Marta; Grant, Robert T

    2015-10-01

    Breast implants are frequently used for both cosmetic breast augmentation and breast reconstruction after mastectomy. Three companies currently offer FDA-approved breast implants (Allergan, Mentor, and Sientra), but their product offerings-including permanent breast implants, breast tissue expanders, sizers, and post-operative warranty-can be difficult to compare because of brand names and company-specific jargon. The ability to have a brand-agnostic understanding of all available options is important for both the surgical trainee as well as the surgeon in clinical practice. After a brief review of the history of breast implant devices, this review utilizes a unique conceptual framework based on variables such as fill material, shape, relative dimensions, and surface coating to facilitate a better understanding of the similarities and differences between the different company's offerings. Specifically, we identify which types of devices are offered by all three companies, those that are offered by only one company, those that have very limited product offerings, and those combinations that are not available at all. Finally, clinical implications are drawn from this framework that can be used by both cosmetic and reconstructive surgeons to counsel patients about all available options. Importantly, this project is entirely independent of any company's funding, support, or input. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  1. The double capsules in macro-textured breast implants.

    Science.gov (United States)

    Giot, Jean-Philippe; Paek, Laurence S; Nizard, Nathanael; El-Diwany, Mostafa; Gaboury, Louis A; Nelea, Monica; Bou-Merhi, Joseph S; Harris, Patrick G; Danino, Michel A

    2015-10-01

    Breast implants are amongst the most widely used types of permanent implants in modern medicine and have both aesthetic and reconstructive applications with excellent biocompatibility. The double capsule is a complication associated with textured prostheses that leads to implant displacement; however, its etiology has yet to be elucidated. In this study, 10 double capsules were sampled from breast expander implants for in-depth analysis; histologically, the inner capsular layer demonstrated highly organized collagen in sheets with delamination of fibers. At the prosthesis interface (PI) where the implant shell contacts the inner capsular layer, scanning electron microscopy (SEM) revealed a thin layer which mirrored the three-dimensional characteristics of the implant texture; the external surface of the inner capsular layer facing the intercapsular space (ICS) was flat. SEM examination of the inner capsule layer revealed both a large bacterial presence as well as biofilm deposition at the PI; a significantly lower quantity of bacteria and biofilm were found at the ICS interface. These findings suggest that the double capsule phenomenon's etiopathogenesis is of mechanical origin. Delamination of the periprosthetic capsule leads to the creation of the ICS; the maintained separation of the 2 layers subsequently alters the biostability of the macro-textured breast implant. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. Silicone implant incompatibility syndrome (SIIS) in a 57-year-old woman with unilateral silicone breast implant

    DEFF Research Database (Denmark)

    Schierbeck, Juliane; Davidsen, Jesper Rømhild; Grindsted Nielsen, Sanne

    2017-01-01

    implants can lead to different interstitial lung manifestations predominantly with granuloma evolvement, leading to the so-called silicone implant incompatibility syndrome (SIIS). This case describes a 57-year-old woman with multiple lung infiltrations and a left-sided breast implant. The implant had been...

  3. Prevalence of Rupture in Poly Implant Prothese Silicone Breast Implants, Recalled from the European Market in 2010

    NARCIS (Netherlands)

    Maijers, M.C.; Niessen, F.B.

    2012-01-01

    Background: Known complications of silicone breast implants are rupture and silicone leakage, complications that are related not only to generation and implant age but also to the manufacturer. Implants from the French manufacturer Poly Implant Prothèse showed more rupture than expected and were

  4. Microbial Load Analysis in Silicone Gel Breast Implants

    Directory of Open Access Journals (Sweden)

    Glaucia Cristina Mello Santos

    2010-06-01

    Full Text Available Silicone breast implants consist of biomaterials widely used in breast reconstitution surgeries or in mammary augmentation for esthetic reasons. A preliminary stage of the implant production process is vulcanization, which consists of heating the implant to 165±5°C for approximately 9 hours. The aim of this work was to evaluate the bioburden of silicone breast implants prior to the vulcanization process and the decline in bioburden due to this process, and to confirm the sterility of the gel contained in the membrane. Breast implant production stages were evaluated by microbial counting in different steps, according to the USP 32 methodology. To evaluation of decrease in microbial load, spores strips were introduced inside the implant, and after vulcanization cycles the strips were removed from the implant. The strips were transferred to tubes containing TSB, followed by incubation for 7 days at 30-35°C. The results obtained showed that the level of microbial contamination of gel implants is relatively low, and that vulcanization allowed for the inactivation of up to 108 spores. This study led us to the conclusion that vulcanization leaded to sterility of the gel inside the product. Thus, the final sterilizing process contributed to an increase in the Sterility Assurance Level 1. Keywords: Silicone. Breast implant. Sterilization. Dry heat. Vulcanization. Bioburden. RESUMO Análise da Carga Microbiana de Implantes Mamários de Silicone Os implantes mamários de silicone constituem-se em biomateriais que têm sido amplamente utilizados em cirurgias para reconstituição da mama ou para o aumento do tamanho da mama por motivos estéticos. Uma etapa preliminar do processo produtivo do implante é a vulcanização, que consiste no aquecimento do implante a 165±5°C por aproximadamente 9 horas. O objetivo deste estudo foi avaliar a carga microbiana dos implantes mamários de silicone antes do processo de vulcanização, o decaimento da carga

  5. [The use of implants in ptosis, hypertrophic and breast deformities].

    Science.gov (United States)

    Ohana, J; Karcenty, B; Mekouar, R; Amar, A

    2005-10-01

    Breast precise analysis, due to a partial or global diformity, total or minor tuberous breast allows an interesting appreciation of the skin and gland importance in breast modifications. This same analysis enables us to consider the ptosis and hypertrophies under a different angle. Thus, the relative proportions in between the various segments, their evolution in the time and especially the glandular distribution mode, sometimes leads to a different technical approach. To ensure a better glandular distribution, an important factor of the breast stability, the use of a mastopexy, which everyone knows the limits, appears under a new light and, more often than one thought, the use of a breast implant ensures homogeneity of consistency and a more long term result. Concerning the various skin modifications, their specific analysis permit to establish the type of incision used for a better-adapted scar result. The approach we suggest, (detailed analytic study of the breast, glandular distribution, relative proportion of the different breast levels and a more frequent use of an implant) which in any case should not be systematic, can obviously in certain situation optimize the quality of the result (long term projection and a better stability of the mammary shape).

  6. Longitudinal Ultrasound Study of Breast Implant Rupture Over a Six-Year Interval.

    Science.gov (United States)

    Rochira, Dario; Cavalcanti, Pietro; Ottaviani, Antonio; Tambasco, Damiano

    2016-02-01

    Silicone gel-filled implants as opposed to saline-filled breast implants are the most commonly used breast implants in Europe, and this has recently also become the case in the United States. Modern implants have a multiple layer silicone shell and high to very high levels of cohesive silicone gel inside. Although breast magnetic resonance imaging is at present considered the gold standard imaging method for breast implant rupture detection, breast ultrasound (US) imaging is still the first-step investigation in Europe. The aim of this study was to verify whether or not the stepladder sign at US is still associated to intracapsular rupture among the last generation silicone breast implant. In this study, 156 patients presenting for breast augmentation, mastopexy with implants and breast reconstruction for a total number of 303 breast implants inserted were enrolled. A preoperative breast ultrasonography was performed, and patients underwent a routine US scan every 6 months for 24 months to evaluate the implant status. A final US evaluation 6 years after implantation was also performed. Stepladder signs were seen at 6 years in 170 implants (56%) of the examined implants at US scan, and only 2 implants showed signs of possible rupture because of severe distortion of the implant profile with or without external silicone collection. A third ruptured implant was detected at magnetic resonance imaging by the presence of breach of the shell at the posterior surface of the implant with small external silicon collection and was eventually confirmed at surgery. Therefore, the overall rupture rate found at the United States at 6 years was about 1% (3 of 303 implants). According to our findings, the stepladder sign at the United States is no longer associated to intracapsular rupture. Plastic surgeons, patients, and financial departments of hospitals would also be delighted to know that surgeons should not take patients back to theater for implant explantation when aging signs

  7. Correction of tuberous breast deformity: A retrospective study comparing lipofilling versus breast implant augmentation.

    Science.gov (United States)

    Brault, Nicolas; Stivala, Alessio; Guillier, David; Moris, Vivien; Revol, Marc; François, Caroline; Cristofari, Sarra

    2017-05-01

    Breast implants and, more recently, autologous fat grafting are the two most common treatments used to correct tuberous breast deformity (TBD). The post-surgical quality of life between the two techniques is not well demonstrated. This study aimed to compare satisfaction and health-related quality of life in patients affected by TBD between these two techniques. All TBD patients operated between January 2008 and May 2015 were retrospectively identified, and only those treated with implants or lipofilling were included. Satisfaction was evaluated at least 6 months after surgery with the postoperative Breast-Q® augmentation module. From January 2008 to May 2015, 62 patients were recruited in our study, and 37 patients were evaluated using a Breast-Q questionnaire after at least 6 months of follow-up. Breast implant-augmented patients were significantly more satisfied concerning the "satisfaction with breasts" module (p = 0.002) and the "satisfaction with outcome" module (p = 0.00008). A question-by-question analysis revealed several interesting and significant differences, showing higher scores in most of the questions in the breast implant group. Patients in the lipofilling group, interestingly, had a mean of 1.6 interventions compared to the mean 1.36 interventions in the implant group (p = 0.23). This reflects the need to perform more surgical sessions in the lipofilling group to achieve a satisfactory result. Our study demonstrated that tuberous breast correction with implants can achieve better satisfaction along with good outcomes than lipofilling usually does. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  8. Breast magnetic resonance imaging: tips for the diagnosis of silicone-induced granuloma of a breast implant capsule (SIGBIC).

    Science.gov (United States)

    de Faria Castro Fleury, Eduardo; Gianini, Ana Claudia; Ayres, Veronica; Ramalho, Luciana C; Seleti, Rodrigo Oliveira; Roveda, Decio

    2017-08-01

    Complications resulting from the placement of silicone breast implants are becoming more frequent in our clinical practice. This is due to the increase in breast aesthetic surgeries at the beginning of the century, where breast augmentation using silicone implants was the main intervention performed. Generally, studies that discuss the complications of breast implants are restricted to reports of intra- or extra-capsular ruptures, contractures and haematomas. Currently, much importance has been given to anaplastic large cell lymphoma (ALCL) as a more severe complication related to silicone implants. Recently, granuloma formation induced by silicone particle bleeding from intact breast implants has been described when the free silicone comes into contact with the fibrous capsule of the implant. Few studies have demonstrated the characteristics and diagnostic keys for this entity. The objective of this study is to present cases of SIGBIC diagnosed in our service and to discuss the main findings that allow its diagnosis. Teaching Points • Breast implants induce fibrous capsule formation at the periphery of the implant. • Gel bleeding is inherent in all types of silicone breast implants. • Gel bleeding induces silicone-induced granuloma of breast implants. • Main diagnostic tips: heterogeneous mass, black-drop sign and late enhancement.

  9. Long-term health status of Danish women with silicone breast implants

    DEFF Research Database (Denmark)

    Breiting, Vibeke B; Hölmich, Lisbet R; Brandt, Bodil

    2004-01-01

    autoantibodies. Self-reported use of psychotropic drugs was higher among women with breast implants than among either control group. The authors conclude that long-term cosmetic breast implantation may cause capsular contracture and breast pain but does not appear to be associated with other symptoms, diseases...

  10. The capsular hammock flap for correction of breast implant ptosis.

    Science.gov (United States)

    Wessels, Louis; Murphy, Siun; Merten, Steven

    2014-04-01

    A well-defined inframammary fold (IMF) is essential in providing an aesthetically pleasing and stable result in breast procedures. The position of the IMF on the chest wall determines the "footprint" of the breast, and hence the breast and chest aesthetic as a whole. Implant malposition is reported in the literature to occur in 5-8 % of primary breast augmentation patients. This occurs most commonly in a caudal direction, which is the most difficult problem to correct, as reported by Tebbett (Clin Plast Surg 28:425-434, 2001). Numerous surgical techniques to correct the malpositioned IMF have been described, including periosteal anchorage techniques as reported by Persichetti et al. (Ann Plast Surg 70:636-638, 2013), periareolar approaches that secure the IMF to the rib cage, and superiorly based capsular flaps. Here we describe a novel simple capsular flap technique using the lower anterior capsule, which is divided and formed into an inferiorly based flap and used as a "hammock" to re-establish the IMF and support the implant. As the capsule is made of a compact fibrous shell with a dense collagen network and excellent blood supply, using it as a flap to reposition and maintain the implant is ideal. Previous studies and tests have shown the reliability of capsule-based flap reconstruction due to the capsule's intrinsic strength and good vascularity, as shown by Rubino et al. (Ann Plast Surg 46:95-102, 2001). We describe our series of 12 primary breast augmentation patients with caudal implant malposition who underwent IMF reconstruction and implant repositioning with this technique. We explain our simple and repeatable technique that shows a stable and very durable result in repositioning the IMF and implant, with no recurrence of implant ptosis. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors

  11. The stable status evaluation for female breast implant surgery by calculating related physics parameters.

    Science.gov (United States)

    Sun, Shuh-Ping; Hsu, Ko-Wen; Chen, Jing-Shyr

    2008-05-01

    Cosmetic doctor utilizes the position, size and shapes of female's breast to judge whether the breast is under steady-state condition after breast implant plastic surgery. Since, doctor evaluates the breast condition with the subjective discrimination (such as vision, sense of touch) without using the objective physical parameters auxiliary. This study uses the 3D optics scanner editing 3D image to obtain full-scale 3D female breasts image. The CAD system converts the breast position, size and shapes, as the length of the curve between UBL (upper breast line) and NBL (nipple base line), the length of the curve between NBL and LBL (lower breast line), breast volume and breasts congruence rate. The stability after the breast implant plastic surgery is one of the important successful indexes of plastic surgery, so with the continuity analysis the breast curve length, volume and congruence rate can let the doctor really grasp the stability of the breast after plastic surgery.

  12. And the Breast is History: Issues Surrounding FDA Regulation of Silicone Breast Implants

    OpenAIRE

    Simme, Jodi L.

    1995-01-01

    The breast implant crisis has raised serious issues for women. On one hand, it is difficult to argue against giving women the right to choose, especially when the choice involves their own bodies. Restricting freedom in that realm is politically unpopular these days. On the other hand, women have been harmed by the lack of conclusive health information and by deceptive and coercive messages sent by media, implant manufacturers and plastic surgeons. For women to benefit from their right to cho...

  13. Implant Exposure after Immediate Reconstruction for Breast Cancer

    Directory of Open Access Journals (Sweden)

    Alfred Fitoussi

    2016-03-01

    Full Text Available Background: The technique most frequently employed for breast reconstruction, either immediate (IBR or delayed (DBR, is the insertion of a prosthesis. The placement of a foreign body always carries the risk, albeit small, of peri-prosthetic infection and exposure of the implant that necessitates its removal, signaling the temporary or permanent failure of the reconstruction.Methods: We retrospectively analyzed data of 738 consecutive patients immediate implant-only breast reconstructions between 1989 and 2005 in order to evaluate the contributing factors of failure.Results: Our statistical analysis identified 3 statistically significant risk factors of implant extrusion: irradiation (P = 0.01, post-operative chemotherapy (P = 0.03, and the use of non- Becker expanders (P = 0.02.Conclusions: It is important, especially for the multidisciplinary breast cancer team members, to be aware of these factors in order to make the optimal decision for immediate reconstruction after mastectomy and the suggested techniques. The patients should also be aware, as part of a shared medical decision, of the risks and their frequency before accepting IBR.

  14. What's really behind the attack on silicone breast implants.

    Science.gov (United States)

    Angell, M

    1996-09-09

    Millions of dollars are being awarded by injuries and a major company has been forced into bankruptcy because of litigation over silicone breast implants. Yet scientific research hasn't established a link between the implants and disease, notes Marcia Angell, executive editor of the New England Journal of Medicine. When she began studying the issue, this self-described feminist and liberal Democrat expected to uncover iniquities of big business and the implant manufacturers. Instead, she's written an indictment of the tort system, junk science, and the gullibility of the news media. Attorneys have twisted facts and played on the emotions of juries, with the consent of judges and often to the cheers of the press. Angell worries that it's now become politically correct to bash the scientific method in the name of diversity, multiculturalism, and feminism.

  15. The impact of cosmetic breast implants on breastfeeding: a systematic review and meta-analysis

    OpenAIRE

    Schiff, Michal; Algert, Charles S; Ampt, Amanda; Sywak, Mark S.; Roberts, Christine L

    2014-01-01

    Background Cosmetic breast augmentation (breast implants) is one of the most common plastic surgery procedures worldwide and uptake in high income countries has increased in the last two decades. Women need information about all associated outcomes in order to make an informed decision regarding whether to undergo cosmetic breast surgery. We conducted a systematic review to assess breastfeeding outcomes among women with breast implants compared to women without. Methods A systematic literatur...

  16. Correction of tuberous breast with small volume asymmetry by using a new adjustable implant.

    Science.gov (United States)

    Dessy, L A; Mazzocchi, M; Corrias, F; Sorvillo, V; Scuderi, N

    2013-04-01

    The tuberous breast syndrome is a rare anomaly of breast shape, which can be associated to volume breast asymmetry. We report our caseload in the correction of tuberous breasts with small volume asymmetry by using the Muti's technique associated to the implantation of a new adjustable implant. Purpose of the study is to evaluate the efficacy of treating tuberous breast deformity with two different types of implants (a textured round high profile cohesive I implant in the larger breast and a Spectra™ implant in the smaller breast). Since May 2008, patients affected by tuberous breast combined to small breast volume asymmetry were enrolled in a prospective study. After gland deformity correction, the adjustable implant was positioned in the smaller breast. A textured round implant was positioned in the contralateral breast. Standard pictures were taken before surgery and during follow-up visits over one year. A visual analogue scale (VAS) scale was used to evaluate patients' and external physicians' judgment. Standardized objective measurements of breast and chest were also taken. Statistical significance of any value variation was assessed with the Wilconxon's rank sum test. Eleven patients were treated with the proposed surgical approach. VAS scores from patients and external physicians were high. Deformity correction was obtained in all patients as evidenced by the significant modifications of objective measurements. No major late complications occurred. The new adjustable implant provides a reliable corrective option for hypoplastic tuberous breasts with small volume asymmetry. This device allows intra-operative modification of implant volume according to breast volume discrepancy. Although our findings are satisfying, a longer follow-up is required to evaluate long term results.

  17. Long-term safety and effectiveness of style 410 highly cohesive silicone breast implants

    DEFF Research Database (Denmark)

    Hedén, Per; Bronz, Giorgio; Elberg, Jens Jørgen

    2009-01-01

    Style 410 shaped gel breast implant before examination. The secondary end points included lactation, reproductive and breast disease history before and after implantation, and quality-of-life measurements and complications after implantation. RESULTS: The implant rupture rate was 1.7% a median of 8......BACKGROUND: In 2006, a single-center Swedish study demonstrated a low rupture rate and high patient satisfaction with the Style 410 shaped, form-stable gel implant. The current study aimed to validate the accuracy of the previously published results across multiple European sites. METHODS: A total...... than the preimplantation rates. Breast implantation surgery was considered advantageous by 91% of the subjects, demonstrating high patient satisfaction. CONCLUSIONS: The Style 410 anatomically shaped, form-stable gel breast implants demonstrated long-term safety and effectiveness....

  18. A feasibility study of magnetic resonance imaging of silicone breast implants in Finland

    DEFF Research Database (Denmark)

    Kulmala, Ilona; Boice, John D; McLaughlin, Joseph K

    2005-01-01

    Cosmetic breast implants have become increasingly popular throughout the world. However, there is insufficient knowledge about the frequency and severity of local complications such as rupture and capsular contracture. A pilot study of 25 Finnish women with 50 cosmetic breast implants was organized......-section of the different generations of implants in Finland, with implant ages varying from 4 months to 20 years. The average implant size was 215 mL, typical in Finnish cosmetic surgery. MR images were evaluated by two independent readers. The first reader diagnosed six implants with intracapsular rupture, while...

  19. Long-term health status of Danish women with silicone breast implants.

    Science.gov (United States)

    Breiting, Vibeke B; Hölmich, Lisbet R; Brandt, Bodil; Fryzek, Jon P; Wolthers, Mette S; Kjøller, Kim; McLaughlin, Joseph K; Wiik, Allan; Friis, Søren

    2004-07-01

    Long-term safety data are important in the evaluation of possible adverse health outcomes related to silicone breast implants. The authors evaluated long-term symptoms and conditions and medication use among 190 Danish women with cosmetic silicone breast implants compared with 186 women who had undergone breast reduction surgery and with 149 women from the general population. Breast implant and reduction surgeries were performed from 1973 to 1988 at one public hospital and one private plastic surgery clinic. Among women with breast implants, the average implantation time was 19 years, 60 percent (n = 114) had only one implantation, and 10 percent (n = 19) had undergone explantation before the time of study (1997 to 1998). The authors found no material differences in self-reported diseases or symptoms among study groups, except for breast pain, which was reported nearly three times as often by women with implants than by women with breast reduction (odds ratio, 2.8; 95 percent confidence interval, 1.4 to 5.3). Approximately 80 percent of women in each study group reported at least one symptom. No consistent differences were observed in the seroprevalences of antinuclear antibodies or other autoantibodies. Self-reported use of psychotropic drugs was higher among women with breast implants than among either control group. The authors conclude that long-term cosmetic breast implantation may cause capsular contracture and breast pain but does not appear to be associated with other symptoms, diseases, or autoimmune reactivity. The authors' finding of excess use of drugs for treatment of depression and anxiety among women with breast implants may warrant further investigation.

  20. Osteomyelitis of sternum and rib after breast prosthesis implantation: A rare or underestimated infection?

    Directory of Open Access Journals (Sweden)

    Piseth Seng

    2015-01-01

    Full Text Available Sternum and rib osteomyelitis complicated from breast implant infection is rare. We report a case of early sternum and rib osteomyelitis occurred during breast implant infection managed in an inter-regional referral center for bone/joint infections in the south of France.

  1. Correlation between MRI results and intraoperative findings in patients with silicone breast implants

    NARCIS (Netherlands)

    N. Lindenblatt (Nicole); K. El-Rabadi (Karem); T. Helbich (Thomas); H. Czembirek (Heinrich); M. Deutinger (Maria); H. Benditte-Klepetko (Heike)

    2014-01-01

    textabstractBackground:Silicone gel breast implants may silently rupture without detection. This has been the main reason for magnetic resonance imaging (MRI) of the augmented or reconstructed breast. The aim of the present study was to investigate the accuracy of MRI for implant rupture.

  2. Self-reported musculoskeletal symptoms among Danish women with cosmetic breast implants

    DEFF Research Database (Denmark)

    Kjøller, Kim; Hölmich, Lisbet Rosenkrantz; Fryzek, Jon P

    2004-01-01

    No epidemiological evidence of an association between silicone breast implants and connective tissue disease has been found. Based on case reports, it has been hypothesized that silicone breast implants may be associated with a unique rheumatic symptom cluster termed "atypical connective tissue d...

  3. Risk of pacemaker or implantable cardioverter defibrillator after radiotherapy for early-stage breast cancer in Denmark, 1982-2005

    DEFF Research Database (Denmark)

    Rehammar, Jens Christian; Johansen, Jens Brock; Jensen, Maj-Britt

    2017-01-01

    BACKGROUND AND PURPOSE: To examine the risk of cardiac conduction abnormalities or severe ventricular arrhythmias requiring implantation of a cardiac implantable electronic device (CIED), either a pacemaker or an implantable cardioverter-defibrillator, subsequent to breast cancer (BC) radiotherapy...

  4. Bacterial Biofilm Infection Detected in Breast Implant-Associated Anaplastic Large-Cell Lymphoma.

    Science.gov (United States)

    Hu, Honghua; Johani, Khalid; Almatroudi, Ahmad; Vickery, Karen; Van Natta, Bruce; Kadin, Marshall E; Brody, Garry; Clemens, Mark; Cheah, Chan Yoon; Lade, Stephen; Joshi, Preeti Avinash; Prince, H Miles; Deva, Anand K

    2016-06-01

    A recent association between breast implants and the development of anaplastic large-cell lymphoma (ALCL) has been observed. The purpose of this study was to identify whether bacterial biofilm is present in breast implant-associated ALCL and, if so, to compare the bacterial microbiome to nontumor capsule samples from breast implants with contracture. Twenty-six breast implant-associated ALCL samples were analyzed for the presence of biofilm by real-time quantitative polymerase chain reaction, next-generation sequencing, fluorescent in situ hybridization, and scanning electron microscopy, and compared to 62 nontumor capsule specimens. Both the breast implant-associated ALCL and nontumor capsule samples yielded high mean numbers of bacteria (breast implant-associated ALCL, 4.7 × 10 cells/mg of tissue; capsule, 4.9 × 10 cells/mg of tissue). Analysis of the microbiome in breast implant-associated ALCL specimens showed significant differences with species identified in nontumor capsule specimens. There was a significantly greater proportion of Ralstonia spp. present in ALCL specimens compared with nontumor capsule specimens (p associated with nontumor capsule specimens compared with breast implant-associated ALCL specimens (p Bacterial biofilm was visualized both on scanning electron microscopy and fluorescent in situ hybridization. This novel finding of bacterial biofilm and a distinct microbiome in breast implant-associated ALCL samples points to a possible infectious contributing cause. Breast implants are widely used in both reconstructive and aesthetic surgery, and strategies to reduce their contamination should be more widely studied and practiced. Risk, V.

  5. Correlation between MRI results and intraoperative findings in patients with silicone breast implants.

    Science.gov (United States)

    Lindenblatt, Nicole; El-Rabadi, Karem; Helbich, Thomas H; Czembirek, Heinrich; Deutinger, Maria; Benditte-Klepetko, Heike

    2014-01-01

    Silicone gel breast implants may silently rupture without detection. This has been the main reason for magnetic resonance imaging (MRI) of the augmented or reconstructed breast. The aim of the present study was to investigate the accuracy of MRI for implant rupture. Fifty consecutive patients with 85 silicone gel implants were included in the study. The mean age of the patients was 51 (range 21-72) years, with a mean duration of implantation of 3.8 (range 1-28) years. All patients underwent clinical examination and breast MRI. Intraoperative implant rupture was diagnosed by the operating surgeon. Nineteen of the 50 patients suffered from clinical symptoms. An implant rupture was diagnosed by MRI in 22 of 85 implants (26%). In seven of 17 removed implants (41%), the intraoperative diagnosis corresponded with the positive MRI result. However, only 57% of these patients were symptomatic. Ultrasound imaging of the harvested implants showed signs of interrupted inner layers of the implant despite integrity of the outer shell. By microsurgical separation of the different layers of the implant shell, we were able to reproduce this phenomenon and to produce signs of implant rupture on MRI. Our results show that rupture of only the inner layers of the implant shell with integrity of the outer shell leads to a misdiagnosis on MRI. Correlation with clinical symptoms and the specific wishes of the patient should guide the indication for implant removal.

  6. Saline-filled breast implant contamination with Curvularia species among women who underwent cosmetic breast augmentation.

    Science.gov (United States)

    Kainer, Marion A; Keshavarz, Homa; Jensen, Bette J; Arduino, Matthew J; Brandt, Mary E; Padhye, Arvind A; Jarvis, William R; Archibald, Lennox K

    2005-07-01

    During December 2000-July 2001, black sediment was noted in saline-filled silicone breast implants of women who had undergone revision surgery at facility A. Curvularia fungus was isolated from implant saline. To identify risk factors for contamination with Curvularia species, we performed case-control, retrospective cohort, and laboratory studies and conducted procedural reviews. A case patient was defined as any woman who underwent revision surgery at facility A between January 2000 and June 2001 and had black sediment in her implants. Five patients met the case definition. Contamination was associated with having had surgery performed in operating room (OR) 2 (4/88 vs. 1/140; P=.07) and a longer duration of surgery (PSurgery center infection control measures must include moisture control and balanced ventilation systems.

  7. Is Salvage of Recently Infected Breast Implant After Breast Augmentation or Reconstruction Possible? An Experimental Study.

    Science.gov (United States)

    Castus, P; Heymans, O; Melin, P; Renwart, L; Henrist, C; Hayton, E; Mordon, S; Leclère, F M

    2018-01-23

    The reinsertion of an infected implant when peri-prosthetic infection occurs early after breast augmentation or breast reconstruction remains controversial. In this experimental study, the authors tried to remove bacteria, and their biofilm, from the colonized surface of breast prostheses, without damaging their integrity. A total of 112 shell samples of silicone breast prostheses, smooth (SPSS) and textured (TPSS), were colonized by S. epidermidis (SE) or S. aureus (SA) strains, all able to produce biofilms. After 15 days, all the samples were removed from the contaminated culture broth and constituted 4 groups of 20 contaminated samples: SPSS/SE (group I), SPSS/SA (group II), TPSS/SE (group III), TPSS/SE (group IV). In another group-group SEM-, 16 colonized samples were used for documentation with scanning electron microscopy (SEM). The remaining 16 samples were used to test the limits of detection of the sterility test. All samples of groups I-IV and 8 samples of group SEM were « washed » with a smooth brush in a povidone-iodine bath and rinsed with saline solution. A subset of the washed samples was sent for SEM and the others were immersed in sterile broth and were incubated at 35 °C for 3 weeks (groups I-IV). Fifteen days after contamination, all the samples in groups I-IV were colonized. In the SEM group, SEM images attested to the presence of bacteria in biofilm attached to the shells. After cleaning, SEM did not reveal any bacteria and there was no visible alteration in the outer structure of the shell. Sterility tests performed after decontamination in groups I-IV remained negative for all the samples. Breast prostheses recently contaminated with Staphylococci, frequently involved in peri-prosthetic breast implant infection and capable of producing biofilms, can be efficiently decontaminated by the procedure used in this study. Our decontamination procedure did not alter the surface structure of the prostheses. This decontamination procedure

  8. Influence of breast composition and interseed attenuation in dose calculations for post-implant assessment of permanent breast {sup 103}Pd seed implant

    Energy Technology Data Exchange (ETDEWEB)

    Afsharpour, Hossein; Beaulieu, Luc [Departement de Radio-Oncologie et Centre de recherche en cancerologie de l' Universite Laval, Centre Hospitalier Universitaire de Quebec, 11 Cote du Palais, Quebec, QC G1R 2J6 (Canada); Pignol, Jean-Philippe; Keller, Brian [Department of Radiation Oncology, Sunnybrook and Women' s Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada); Carrier, Jean-Francois [Departement de Radiologie, Radio-Oncologie et Medecine Nucleaire, Hopital Notre-Dame de CHUM, 1560 Sherbrooke E, Montreal, QC H2L 4M1 (Canada); Reniers, Brigitte; Verhaegen, Frank, E-mail: beaulieu@phy.ulaval.c [Department of Radiation Oncology (MAASTRO), GROW, University Hospital Maastricht, Maastricht (Netherlands)

    2010-08-21

    The impact of tissue heterogeneity and interseed attenuation is studied in post-implant evaluation of five clinical permanent breast {sup 103}Pd seed implants using the Monte Carlo (MC) dose calculation method. Dose metrics for the target (PTV) as well as an organ at risk (skin) are used to visualize the differences between a TG43-like MC method and more accurate MC methods capable of considering the breast tissue heterogeneity as well as the interseed attenuation. PTV dose is reduced when using a breast tissue model instead of water in MC calculations while the dose to the skin is increased. Furthermore, we investigate the effect of varying the glandular/adipose proportion of the breast tissue on dose distributions. The dose to the PTV (skin) decreases (increases) with the increasing adipose proportion inside the breast. In a complete geometry and compared to a TG43-like situation, the average PTV D{sub 90} reduction varies from 3.9% in a glandular breast to 35.5% when the breast consists entirely of adipose. The skin D{sub 10} increases by 28.2% in an entirely adipose breast. The results of this work show the importance of an accurate and patient-dependent breast tissue model to be used in the dosimetry for this kind of low energy implant.

  9. Polyurethane foam-covered breast implants: a justified choice?

    Science.gov (United States)

    Scarpa, C; Borso, G F; Vindigni, V; Bassetto, F

    2015-01-01

    Even if the safety of the polyurethane prosthesis has been the subject of many studies and professional and public controversies. Nowadays, polyurethane covered implants are very popular in plastic surgery for the treatment of capsular contracture. We have identified 41 papers (1 is a communication of the FDA) by using search browsers such as Pubmed, Medline, and eMedicine. Eleven manuscripts have been used for an introduction, and the remaining thirty have been subdivided into three tables whose results have been summarized in three main chapters: (1) capsular formation and contracture, (2) complications, (3) biodegradation and cancer risk. (1) The polyurethanic capsule is a well defined foreign body reaction characterized by synovial metaplasia, a thin layer of disarranged collagen fibers and a high vascularization. These features make possible a "young" capsule and a low occurrence of capsular contracture even over a long period (10 years); (2) the polyurethane implants may be difficult to remove but there is no evidence that they cause an increase in the other complications; (3) there is no evidence of polyurethane related cancer in long-term studies (after 5 years). Polyurethane foam covered breast implants remain a valid choice for the treatment of capsular contracture even if it would be very useful to verify the ease of removal of the prosthesis and to continue investigations on biodegradation products.

  10. Breast reconstruction with anatomical implants: A review of indications and techniques based on current literature

    Directory of Open Access Journals (Sweden)

    Marco Gardani

    2017-09-01

    Full Text Available One important modality of breast cancer therapy is surgical treatment, which has become increasingly less mutilating over the last century. Breast reconstruction has become an integrated part of breast cancer treatment due to long-term psychosexual health factors and its importance for breast cancer survivors. Both autogenous tissue-based and implant-based reconstruction provides satisfactory reconstructive options due to better surgeon awareness of “the ideal breast size”, although each has its own advantages and disadvantages. An overview of the current options in breast reconstruction is presented in this article.

  11. The Relationship of Bacterial Biofilms and Capsular Contracture in Breast Implants

    Science.gov (United States)

    Ajdic, Dragana; Zoghbi, Yasmina; Gerth, David; Panthaki, Zubin J.; Thaller, Seth

    2016-01-01

    Capsular contracture is a common sequelae of implant-based breast augmentation. Despite its prevalence, the etiology of capsular contracture remains controversial. Numerous studies have identified microbial biofilms on various implantable materials, including breast implants. Furthermore, biofilms have been implicated in subclinical infections associated with other surgical implants. In this review, we discuss microbial biofilms as a potential etiology of capsular contracture. The review also outlines the key diagnostic modalities available to identify the possible infectious agents found in biofilm, as well as available preventative and treatment measures. PMID:26843099

  12. Inferior dermoglandular flap for autologous breast remodeling following explantation of breast implants in ptotic breasts: a case report and literature search

    Directory of Open Access Journals (Sweden)

    Umar Daraz Khan

    2015-04-01

    Full Text Available Explantation following aesthetic mammoplasty without implant replacement is quite uncommon and often leaves the patient worse off than prior to mammoplasty. A case is presented here in which patient's own tissue was used as an inferior dermoglandular flap for autologous breast remodeling. Inferior dermal flap has been described for breast reconstruction and simultaneous augmentation mammoplasty with mastopexy for prosthesis cover in the lower pole of the breast, but its use following explantation without implant replacement has not been described for breast remodeling and volume conservation.

  13. Multimodality Imaging-based Evaluation of Single-Lumen Silicone Breast Implants for Rupture.

    Science.gov (United States)

    Seiler, Stephen J; Sharma, Pooja B; Hayes, Jody C; Ganti, Ramapriya; Mootz, Ann R; Eads, Emily D; Teotia, Sumeet S; Evans, W Phil

    2017-01-01

    Breast implants are frequently encountered on breast imaging studies, and it is essential for any radiologist interpreting these studies to be able to correctly assess implant integrity. Ruptures of silicone gel-filled implants often occur without becoming clinically obvious and are incidentally detected at imaging. Early diagnosis of implant rupture is important because surgical removal of extracapsular silicone in the breast parenchyma and lymphatics is difficult. Conversely, misdiagnosis of rupture may prompt a patient to undergo unnecessary additional surgery to remove the implant. Mammography is the most common breast imaging examination performed and can readily depict extracapsular free silicone, although it is insensitive for detection of intracapsular implant rupture. Ultrasonography (US) can be used to assess the internal structure of the implant and may provide an economical method for initial implant assessment. Common US signs of intracapsular rupture include the "keyhole" or "noose" sign, subcapsular line sign, and "stepladder" sign; extracapsular silicone has a distinctive "snowstorm" or echogenic noise appearance. Magnetic resonance (MR) imaging is the most accurate and reliable means for assessment of implant rupture and is highly sensitive for detection of both intracapsular and extracapsular rupture. MR imaging findings of intracapsular rupture include the keyhole or noose sign, subcapsular line sign, and "linguine" sign, and silicone-selective MR imaging sequences are highly sensitive to small amounts of extracapsular silicone. ©RSNA, 2017.

  14. Adverse health outcomes in offspring of mothers with cosmetic breast implants : A review

    NARCIS (Netherlands)

    Kjoller, Kim; Friis, Soren; Lipworth, Loren; McLaughlin, Joseph K.; Olsen, Jorgen H.

    2007-01-01

    Background: To assess whether maternal cosmetic breast implants are associated with adverse health outcomes among offspring, the authors examined published findings of epidemiologic studies that addressed this hypothesis. Methods: Four epidemiologic studies, ail from Scandinavia, were identified.

  15. Immediate breast reconstruction with a myocutaneous latissimus dorsi flap and implant following skin-sparing salvage mastectomy after irradiation as part of breast-conserving therapy

    NARCIS (Netherlands)

    van Huizum, Martine A.; Hage, J. Joris; Rutgers, Emiel J.; Hoornweg, Marije J.

    2016-01-01

    Local relapse after breast-conserving therapy including whole breast irradiation is typically treated by salvage mastectomy. Immediate reconstruction by pedicled transfer of a latissimus dorsi flap in combination with implantation of a definitive prosthesis or temporary tissue expander following

  16. Radiotherapy for breast cancer is not associated with increased risk of cied implantation

    DEFF Research Database (Denmark)

    Johansen, J. B.; Rehammar, J. C.; Jorgensen, O. D.

    2015-01-01

    tests were calculated. Results: Among 18,308 women treated with radiotherapy for early-stage breast cancer, 179 women had a CIED implanted (166 pacemakers, 13 ICD) subsequent to radiotherapy, 90 in 9,315 left sided and 89 in 8,993 right sided breast cancers. Follow-up time was minimum 8 years...

  17. Prepectoral Implant-Based Breast Reconstruction and Postmastectomy Radiotherapy: Short-Term Outcomes

    Directory of Open Access Journals (Sweden)

    Steven Sigalove, MD

    2017-12-01

    Conclusions:. Immediate implant-based prepectoral breast reconstruction followed by PMRT appears to be well tolerated, with no excess risk of adverse outcomes, at least in the short term. Longer follow-up is needed to better understand the risk of PMRT in prepectorally reconstructed breasts.

  18. Primary anaplastic large cell lymphoma of the breast arising in reconstruction mammoplasty capsule of saline filled breast implant after radical mastectomy for breast cancer: an unusual case presentation

    Directory of Open Access Journals (Sweden)

    Sur Monalisa

    2009-04-01

    Full Text Available Abstract Background Primary non-Hodgkin lymphoma (NHL of the breast represents 0.04–0.5% of malignant lesions of the breast and accounts for 1.7–2.2% of extra-nodal NHL. Most primary cases are of B-cell phenotype and only rare cases are of T-cell phenotype. Anaplastic large cell lymphoma (ALCL is a rare T-cell lymphoma typically seen in children and young adults with the breast being one of the least common locations. There are a total of eleven cases of primary ALCL of the breast described in the literature. Eight of these cases occurred in proximity to breast implants, four in relation to silicone breast implant and three in relation to saline filled breast implant with three out of the eight implant related cases having previous history of breast cancer treated surgically. Adjuvant postoperative chemotherapy is given in only one case. Secondary hematological malignancies after breast cancer chemotherapy have been reported in literature. However in contrast to acute myeloid leukemia (AML, the association between lymphoma and administration of chemotherapy has never been clearly demonstrated. Case Presentation In this report we present a case of primary ALCL of the breast arising in reconstruction mamoplasty capsule of saline filled breast implant after radical mastectomy for infiltrating ductal carcinoma followed by postoperative chemotherapy twelve years ago. Conclusion Primary ALK negative ALCL arising at the site of saline filled breast implant is rare. It is still unclear whether chemotherapy and breast implantation increases risk of secondary hematological malignancies significantly. However, it is important to be aware of these complications and need for careful pathologic examination of tissue removed for implant related complications to make the correct diagnosis for further patient management and treatment. It is important to be aware of this entity at this site as it can be easily misdiagnosed on histologic grounds and to exclude

  19. Breast implant rupture and connective tissue disease: a review of the literature

    DEFF Research Database (Denmark)

    Hölmich, Lisbet Rosenkrantz; Lipworth, Loren; McLaughlin, Joseph K

    2007-01-01

    Large-scale epidemiologic studies to date have not found any credible association between silicone breast implants and either well-defined connective tissue diseases or undefined or atypical connective tissue diseases. It has been hypothesized that implant rupture could prompt an immunologic...... reaction giving rise to autoimmune or related diseases. In this article, the authors review the available literature on implant ruptures and connective tissue disease....

  20. Self-reported musculoskeletal symptoms among Danish women with cosmetic breast implants.

    Science.gov (United States)

    Kjøller, Kim; Hölmich, Lisbet Rosenkrantz; Fryzek, Jon P; Jacobsen, Poul Harboe; Friis, Søren; McLaughlin, Joseph K; Lipworth, Loren; Henriksen, Trine Foged; Høier-Madsen, Mimi; Wiik, Allan; Olsen, Jørgen H

    2004-01-01

    No epidemiological evidence of an association between silicone breast implants and connective tissue disease has been found. Based on case reports, it has been hypothesized that silicone breast implants may be associated with a unique rheumatic symptom cluster termed "atypical connective tissue disease." We have evaluated self-reported rheumatic symptoms among women who received breast implants between 1977 and 1997 at 2 private plastic surgery clinics in Denmark. Women with other cosmetic surgery, including breast reduction, as well as women from the general population, were identified as controls. No statistically significant differences in mild (odds ratio [OR] = 0.9; 95% confidence interval [CI] = 0.6-1.3), moderate (OR = 0.7; 95% CI = 0.4-1.2), or severe (OR = 1.1; 95% CI = 0.6-2.1) musculoskeletal symptoms were observed when women with breast implants were compared with women with other cosmetic surgery. Compared with women from the general population, women with breast implants were statistically significantly less likely to have mild or moderate musculoskeletal symptoms (OR = 0.5; 95% CI = 0.3-0.7 and OR = 0.3; 95% CI = 0.2-0.5, respectively); for severe symptoms the deficit was not statistically significant (OR = 0.7; 95% CI = 0.3-1.3). For individual symptom groups, there was no consistent pattern of reporting among women with implants. We did not find an excess of rheumatic symptoms or symptom clusters among women with breast implants. In fact, the occurrence of mild, moderate, and severe musculoskeletal symptoms was generally lower among women with implants compared with women with other cosmetic surgery and women in the general population.

  1. A Prospective Analysis of Dynamic Loss of Breast Projection in Tissue Expander-Implant Reconstruction

    Directory of Open Access Journals (Sweden)

    Lauren M Mioton

    2015-05-01

    Full Text Available BackgroundBreast projection is a critical element of breast reconstruction aesthetics, but little has been published regarding breast projection as the firm expander is changed to a softer implant. Quantitative data representing this loss in projection may enhance patient education and improve our management of patient expectations.MethodsFemale patients who were undergoing immediate tissue-expander breast reconstruction with the senior author were enrolled in this prospective study. Three-dimensional camera software was used for all patient photographs and data analysis. Projection was calculated as the distance between the chest wall and the point of maximal projection of the breast form. Values were calculated for final tissue expander expansion and at varying intervals 3, 6, and 12 months after implant placement.ResultsFourteen breasts from 12 patients were included in the final analysis. Twelve of the 14 breasts had a loss of projection at three months following the implant placement or beyond. The percentage of projection lost in these 12 breasts ranged from 6.30% to 43.4%, with an average loss of projection of 21.05%.ConclusionsThis study is the first prospective quantitative analysis of temporal changes in breast projection after expander-implant reconstruction. By prospectively capturing projection data with three-dimensional photographic software, we reveal a loss of projection in this population by three months post-implant exchange. These findings will not only aid in managing patient expectations, but our methodology provides a foundation for future objective studies of the breast form.

  2. Bilateral Breast Reconstruction with Extended Thoracodorsal Artery Perforator Propeller Flaps and Implants

    DEFF Research Database (Denmark)

    Gunnarsson, Gudjon L; Børsen-Koch, Mikkel; Nielsen, Henrik Toft

    2015-01-01

    (200-330), and the average implant size used was 350 cm(3) (195-650). We demonstrate how the extended thoracodorsal artery perforator propeller flap allows for a swift and reliable direct to implant bilateral total breast reconstruction in a simple setting and is a valuable adjunct to our armamentarium......We present our experience of bilateral total breast reconstruction using a double-sided extended thoracodorsal artery perforator propeller flap in a case series of 10 patients. Reconstruction was successfully achieved in all cases with few complications. The median time for surgery was 275 minutes...... of techniques for single-stage bilateral breast reconstruction....

  3. Variable presentation of anaplastic large-cell lymphoma in patients with breast implants.

    Science.gov (United States)

    Locke, Michelle B; Lofts, Julian

    2017-10-01

    Anaplastic large-cell lymphoma (ALCL) has recently been reported in women with breast implants. The incidence of breast implant-related ALCL is extremely rare and most surgeons would not expect to see this disease in their career. However, the senior author has had three women present to his practice with ALCL over a 2-year period. The three patients and their presentation were reviewed to establish the presenting complaint in each case of subsequently diagnosed ALCL. Literature was reviewed to establish appropriate treatment protocols for any subsequent patients. The average time between first implant placement and presentation with breast implant-associated ALCL was 13.3 years (range: 10-16 years) and age at presentation was 49 years (range: 45-53 years). Each presentation was somewhat different, being a palpable mass, a painless seroma and a painful seroma. Both patients with seroma underwent ultrasound-guided aspiration of fluid which confirmed ALCL. All patients underwent implant removal and complete capsulectomy. The patient with a mass at presentation initially declined adjuvant treatment but subsequently developed an ALCL-associated seroma and was treated with surgery and post-operative chemotherapy. Patients with breast implant-associated ALCL can present with different clinical signs and symptoms. Late seroma is a relatively common presentation of breast implant-associated ALCL. While firm guidelines for the management of breast implant-related ALCL are lacking, we suggest that any late seroma in the absence of infection should be managed with aspiration and cytological analysis of the fluid. © 2015 Royal Australasian College of Surgeons.

  4. Enhancing surface properties of breast implants by using electrospun silk fibroin.

    Science.gov (United States)

    Valencia-Lazcano, A A; Román-Doval, R; De La Cruz-Burelo, E; Millán-Casarrubias, E J; Rodríguez-Ortega, A

    2017-08-24

    In the present study, a new electrospun silk fibroin coating of silicone breast implants with improved biocompatibility and mechanical properties was obtained. Fibrous scaffolds were produced by electrospinning a solution containing silk fibroin, derived from Bombyx mori cocoons, and polyethylene oxide (PEO) to be used as a coating of breast implants. A randomly oriented structure of fibroin/PEO was electrospun on implants as assessed by SEM analysis, roughness measurements and ATR-FTIR spectroscopy. The scaffold showed 0.25 µm diameter fibres, 0.76 µm size superficial pores, arithmetic roughness of 0.632 ± 0.12 µm and texture aspect ratio of 0.893 ± 0.04. ATR-FTIR spectroscopy demonstrates the presence of PEO and fibroin in the coating. The mechanical characterisation of the implants before and after being coated with fibroin/PEO demonstrated that the fibroin/PEO scaffold contributes to the increase in the elastic modulus from 0.392 ± 0.02 to 0.560 ± 0.03 MPa and to a more elastic behaviour of the breast implants. Using the fibroin/PEO coating, human fibroblasts seeded on this matrix increased viability up to 30% compared to conventional breast implants. Electrospun silk fibroin could represent a clinically compatible, viable form to coat breast implants. Low cytotoxicity by the fibroin coating and its physico-chemical and mechanical properties may find application in improving breast implants biocompatibility. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2017. © 2017 Wiley Periodicals, Inc.

  5. The Story of : Pathologic Risk Factors in Breast Implant Surgery

    Directory of Open Access Journals (Sweden)

    Caroline A Yao

    2014-07-01

    Full Text Available Serratia marcescens (S. marcescens emerged as an opportunist in the setting of immunodeficiency in the 1970s, when serious infections occurred in San Francisco hospitals after USA. Navy experiments had aerosolized the bacteria to study biologic warfare. We investigate the risks of S. marcescens in San Franciscans who undergo mastectomy with implant reconstruction. From 2007 to 2011, the senior author took breast capsule cultures for all patients at the time of tissue expander exchange/explant. Of the 142 women who had reconstruction, 23 had positive cultures. Only the two patients who were positive for S. marcescens developed clinical infections that required explantation. Both had postoperative chemotherapy with transient neutropenia, and both had close ties to San Francisco. Clinical signs of infection emerged for both patients months after initial surgery, despite having previously well healed incisions. Other patients were culture positive for Pseudomonas, Proteus, Enterococcus and MRSA and did not develop require explant. While the link between San Francisco and S. marcescens is controversial, a patient's geography is a simple screening tool when considering postoperative risks, especially in the immunocompromised. Closer monitoring for neutropenia during chemotherapy, and a lower threshold to administer S. marcescens targeted antibiotics may be warranted in these patients.

  6. Chronic biofilm infection in breast implants is associated with an increased T-cell lymphocytic infiltrate: implications for breast implant-associated lymphoma.

    Science.gov (United States)

    Hu, Honghua; Jacombs, Anita; Vickery, Karen; Merten, Steven L; Pennington, David G; Deva, Anand K

    2015-02-01

    Biofilm infection of breast implants significantly potentiates capsular contracture. This study investigated whether chronic biofilm infection could promote T-cell hyperplasia. In the pig study, 12 textured and 12 smooth implants were inserted into three adult pigs. Implants were left in situ for a mean period of 8.75 months. In the human study, 57 capsules from patients with Baker grade IV contracture were collected prospectively over a 4-year period. Biofilm and surrounding lymphocytes were analyzed using culture, nucleic acid, and visualization techniques. In the pig study, all samples were positive for bacterial biofilm. There was a significant correlation between the bacterial numbers and grade of capsular contracture (p = 0.04). Quantitative real-time polymerase chain reaction showed that all lymphocytes were significantly more numerous on textured compared with smooth implants (p biofilm. Analysis of lymphocyte numbers showed a T-cell predominance (p biofilm infection around breast prostheses produces an increased T-cell response both in the pig and in humans. A possible link between bacterial biofilm and T-cell hyperplasia is significant in light of breast implant-associated anaplastic large-cell lymphoma. Risk, V.

  7. Evaluation of the breast with implant using mammography, ultrasonography and magnetic resonance imaging; Avaliacao da mama com implante pelos diversos metodos de imagem: mamografia, ultra-sonografia e ressonancia magnetica

    Energy Technology Data Exchange (ETDEWEB)

    Louveira, Maria Helena; Castro, Iris Moura; Souza, Luis Ronan Marquez Ferreira de; Freitas, Andrea Goncalves de; Szejnfeld, Jacob; Kemp, Claudio [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil). Dept. de Diagnostico por Imagem]. E-mail: agracino@uol.com.br

    2003-07-01

    Breast implants have been frequently used for cosmetic and reconstructive reasons. As a consequence, a growing number of patients are looking for imaging methods to evaluate breast lesions hidden by implants, as well as to evaluate their integrity. Mammography is the most efficient method to screen breast cancer, but it is of limited use in the study of breasts with implants. It is often necessary the association of ultrasound and magnetic resonance imaging to evaluate breast lesions and implants alterations. Each imaging method is useful to evaluate these patients and recognize the information given by each one is very important for an early diagnosis of breast lesions and implant complications. (author)

  8. The diagnosis of silicone breast-implant rupture: clinical findings compared with findings at magnetic resonance imaging

    DEFF Research Database (Denmark)

    Hölmich, Lisbet Rosenkrantz; Fryzek, Jon P; Kjøller, Kim

    2005-01-01

    The objective was to evaluate the usefulness of clinical examination in the evaluation of breast-implant integrity, using the diagnosis at magnetic resonance imaging (MRI) as the "gold standard." Fifty-five women with 109 implants underwent a breast examination either just before or shortly after...... an MRI examination. Twenty-four of 109 implants were clinically diagnosed with possible rupture or rupture. Eighteen of the 24 implants were ruptured according to the MRI examination (75%). Eighty-five implants were clinically classified as intact, and 43 of these were actually ruptured at MRI (51...... to identify implant rupture, neither the sensitivity nor the specificity is acceptable....

  9. Immediate breast reconstruction with anatomical implants following mastectomy: The radiation perspective

    Energy Technology Data Exchange (ETDEWEB)

    Ben-David, Merav, E-mail: Merav.ben-david@sheba.health.gov.il [Radiation Oncology Unit, Chaim Sheba Medical Center, Ramat Gan (Israel); Sackler School of Medicine, Tel Aviv University, Tel Aviv (Israel); Granot, Hila [Radiation Oncology Unit, Chaim Sheba Medical Center, Ramat Gan (Israel); Gelernter, Ilana [Statistical Laboratory, School of Mathematics, Tel Aviv University, Tel Aviv (Israel); Scheflan, Michael [Department of Surgery, Assuta and Herzliya Medical Centers, Ramat Gan (Israel)

    2016-07-01

    Immediate implant-based breast reconstruction followed by postmastectomy radiation therapy (PMRT) is controversial because of the risk of compromised treatment plans and concerns regarding cosmetic outcomes. We evaluated the effects of immediate direct-to-implant breast reconstruction with anatomical implants on the quality of PMRT delivered by 3-dimensional conformal radiotherapy (3D-CRT). In this retrospective, single-institution study, patients who had undergone reconstruction with direct anatomic implant, performed by a single surgeon, received 3D-CRT between 2008 and 2013. For each patient, 2 plans (including or excluding internal mammary nodes [IMN]) were created and calculated. The primary end point was the dose distribution among reconstructed breasts, heart, lungs, and IMNs, and between right and left breasts. Of 29 consecutive patients, 11 received right-sided and 18 received left-sided PMRT to a total dose of 50 Gy. For plans excluding IMN coverage, mean D{sub mean} for right and left reconstructed breasts was 49.09 Gy (98.2% of the prescribed dose) and 48.51 Gy (97.0%), respectively. For plans including IMNs, mean D{sub mean} was 49.15 Gy (98.3%) for right and 48.46 Gy (96.9%) for left reconstructed breasts; the mean IMN D{sub mean} was 47.27 Gy (right) and 47.89 Gy (left). Heart D{sub mean} was below 1.56 Gy for all plans. Mean total lung volume receiving a dose of ≥ 20 Gy was 13.80% to 19.47%. PMRT can be delivered effectively and safely by 3D-CRT after direct-to-implant breast reconstruction with anatomical implants, even if patients require IMN treatment.

  10. Pilot Study of Association of Bacteria on Breast Implants with Capsular Contracture▿

    Science.gov (United States)

    Del Pozo, Jose L.; Tran, Nho V.; Petty, Paul M.; Johnson, Craig H.; Walsh, Molly F.; Bite, Uldis; Clay, Ricky P.; Mandrekar, Jayawant N.; Piper, Kerryl E.; Steckelberg, James M.; Patel, Robin

    2009-01-01

    Capsular contracture is the most common and frustrating complication in women who have undergone breast implantation. Its cause and, accordingly, treatment and prevention remain to be elucidated fully. The aim of this prospective observational pilot study was to test the hypothesis that the presence of bacteria on breast implants is associated with capsular contracture. We prospectively studied consecutive patients who underwent breast implant removal for reasons other than overt infection at the Mayo Clinic from February through September 2008. Removed breast implants were processed using a vortexing/sonication procedure and then subjected to semiquantitative culture. Twenty-seven of the 45 implants collected were removed due to significant capsular contracture, among which 9 (33%) had ≥20 CFU bacteria/10 ml sonicate fluid; 18 were removed for reasons other than significant capsular contracture, among which 1 (5%) had ≥20 CFU/10 ml sonicate fluid (P = 0.034). Propionibacterium species, coagulase-negative staphylococci, and Corynebacterium species were the microorganisms isolated. The results of this study demonstrate that there is a significant association between capsular contracture and the presence of bacteria on the implant. The role of these bacteria in the pathogenesis of capsular contracture deserves further study. PMID:19261794

  11. Correlation between MRI results and intraoperative findings in patients with silicone breast implants

    Directory of Open Access Journals (Sweden)

    Lindenblatt N

    2014-07-01

    Full Text Available Nicole Lindenblatt,1 Karem El-Rabadi,2 Thomas H Helbich,2 Heinrich Czembirek,3 Maria Deutinger,4 Heike Benditte-Klepetko5 1Division of Plastic and Hand Surgery, Department of Surgery, University Hospital Zurich, Zurich, Switzerland; 2Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna - General Hospital Vienna, 3Department of Radiology, Hospital Wiener Privatklinik, 4Department of Plastic and Reconstructive Surgery, Hospital Rudolfstiftung, Vienna, Austria; 5Department of Plastic and Reconstructive Surgery, Erasmus Medical Center, Rotterdam, the Netherlands Background: Silicone gel breast implants may silently rupture without detection. This has been the main reason for magnetic resonance imaging (MRI of the augmented or reconstructed breast. The aim of the present study was to investigate the accuracy of MRI for implant rupture. Methods: Fifty consecutive patients with 85 silicone gel implants were included in the study. The mean age of the patients was 51 (range 21–72 years, with a mean duration of implantation of 3.8 (range 1–28 years. All patients underwent clinical examination and breast MRI. Intraoperative implant rupture was diagnosed by the operating surgeon. Results: Nineteen of the 50 patients suffered from clinical symptoms. An implant rupture was diagnosed by MRI in 22 of 85 implants (26%. In seven of 17 removed implants (41%, the intraoperative diagnosis corresponded with the positive MRI result. However, only 57% of these patients were symptomatic. Ultrasound imaging of the harvested implants showed signs of interrupted inner layers of the implant despite integrity of the outer shell. By microsurgical separation of the different layers of the implant shell, we were able to reproduce this phenomenon and to produce signs of implant rupture on MRI. Conclusion: Our results show that rupture of only the inner layers of the implant shell with integrity of

  12. A simple method to inset and position polyurethane-covered breast implants.

    Science.gov (United States)

    Castello, Manuel Francisco; Han, Sheng; Silvestri, Alessandro; Grassetti, Luca; Torresetti, Matteo; Zhang, Yi Xin; Perdanasari, Aurelia Trisliana; Marcelli, Claudio; Gigliotti, Diego; Lazzeri, Davide

    2014-04-01

    Polyurethane-covered breast implants have been used increasingly for cosmetic and revision breast surgery. The incision for insertion should be of minimal length and the placement of these implants in the pocket can be more difficult than that of conventional implants because of the highly adherent textured surface of the polyurethane external layer that grasps the surrounding tissues. The use of a sterile plastic insertion sleeve that is open on both sides is suggested by the manufacturer to overcome the friction between the polyurethane implant and the skin and surrounding tissues. A new method to facilitate polyurethane implant insertion and adjustment in all cases of primary breast augmentation and revision surgery is presented. After the implant, which is in the sleeve, is located in the pocket, the plastic sleeve is filled with saline and antibiotics so the solution lubricates the surface around the implant. The sleeve is then twisted so that the solution is squeezed inside the pocket while the sleeve itself is pulled back and removed. Between 2010 and 2013, this method was used in 73 cases of primary augmentation and revision breast surgery without any complications. The method described here allows for easier removal of the plastic sleeve during polyurethane implant insertion without any complications or evidence of implant migration or rotation at follow-up. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

  13. The diagnosis of silicone breast-implant rupture: clinical findings compared with findings at magnetic resonance imaging

    DEFF Research Database (Denmark)

    Hölmich, Lisbet Rosenkrantz; Fryzek, Jon P; Kjøller, Kim

    2005-01-01

    The objective was to evaluate the usefulness of clinical examination in the evaluation of breast-implant integrity, using the diagnosis at magnetic resonance imaging (MRI) as the "gold standard." Fifty-five women with 109 implants underwent a breast examination either just before or shortly after...

  14. The Impact of Breast Implant Location on the Risk of Capsular Contraction

    DEFF Research Database (Denmark)

    Egeberg, Alexander; Sørensen, Jens Ahm

    2016-01-01

    developing CC with subglandular compared to submuscular placement of the breast implant. METHODS: A total of 1,283 studies were identified from December 2003 to December 2013 by PUBMED and MEDLINE searches and a manual search strategy. Two levels of screening resulted in 10 studies suitable for meta......-analysis, providing data on a total of 17,520 breast implants. All statistical calculations were performed with Review Manager (RevMan) version 5.2.7. RESULTS: Random-effect (RE) pooled relative risk (RR) and confidence intervals (CI) were calculated for capsular contraction. The risk of developing capsular....... CONCLUSION: This analysis demonstrated a more than 2-fold increase in the risk of capsular contraction with subglandular compared to submuscular breast implant location.Clinical Question: Risk....

  15. Silicone granuloma from ruptured breast implants as a cause of cervical lymphadenopathy.

    Science.gov (United States)

    Borghol, K; Gallagher, G; Skelly, B L

    2016-09-01

    A 56-year-old woman with a 10-year history of bilateral silicone breast implants presented to the ear, nose and throat outpatient clinic with a 2-month history of a right-sided neck lump. She was found to have a 1.3cm supraclavicular lymph node that gave the clinical impression of being reactive. Ultrasonography guided fine needle aspiration was inconclusive and initial review of subsequent computed tomography failed to identify a cause. This was followed by excisional biopsy of the lymph node, which revealed a silicone granuloma that was linked to a ruptured right-sided breast implant placed ten years previously. This case highlights the importance for otolaryngologists to consider silicone granuloma among the differential diagnoses of cervical lymphadenopathy in patients with a history of silicone breast implants. Recognising this differential diagnosis could avoid undue anxiety for patient and clinician regarding more serious pathology.

  16. The In Vivo Pericapsular Tissue Response to Modern Polyurethane Breast Implants.

    Science.gov (United States)

    Frame, James; Kamel, Dia; Olivan, Marcelo; Cintra, Henrique

    2015-10-01

    Polyurethane breast implants were first introduced by Ashley (Plast Reconstr Surg 45:421-424, 1970), with the intention of trying to reduce the high incidence of capsular contracture associated with smooth shelled, high gel bleed, silicone breast implants. The sterilization of the polyurethane foam in the early days was questionable. More recently, ethylene oxide (ETO)-sterilized polyurethane has been used in the manufacturing process and this has been shown to reduce the incidence of biofilm. The improved method of attachment of polyurethane onto the underlying high cohesive gel, barrier shell layered, silicone breast implants also encourages bio-integration. Polyurethane covered, cohesive gel, silicone implants have also been shown to reduce the incidence of other problems commonly associated with smooth or textured silicone implants, especially with reference to displacement, capsular contracture, seroma, reoperation, biofilm and implant rupture. Since the introduction of the conical polyurethane implant (Silimed, Brazil) into the United Kingdom in 2009 (Eurosurgical, UK), we have had the opportunity to review histology taken from the capsules of polyurethane implants in three women ranging from a few months to over 3 years after implantation. All implants had been inserted into virgin subfascial, extra-pectoral planes. The results add to the important previously described histological findings of Bassetto et al. (Aesthet Plast Surg 34:481-485, 2010). Five distinct layers are identified and reasons for the development of each layer are discussed. Breast capsule around polyurethane implants, in situ for fifteen and 20 years, has recently been obtained and analysed in Brazil, and the histology has been incorporated into this study. After 20 years, the polyurethane is almost undetectable and capsular contracture may appear. These findings contribute to our understanding of polyurethane implant safety, and give reasoning for a significant reduction in clinical

  17. Evaluation of the effects of silicone implants on the breast parenchyma.

    Science.gov (United States)

    Roxo, Ana Claudia Weck; Nahas, Fabio Xerfan; Bazi, Fernanda; de Castro, Claudio Cardoso; Aboudib, Jose Horacio; Marques, Ruy Garcia

    2015-11-01

    Despite being the cosmetic procedure most performed worldwide, there are still few objective measurements of postoperative volumetric analysis of breast augmentation available in the literature. The aim of this study was to evaluate volumetric changes in the breast parenchyma after the placement of silicone implants in the subglandular plane. Thirty-four women were randomly allocated to the intervention group (n = 24), who underwent breast augmentation in the subglandular plane, or to the control group (n = 10), who received no intervention. Volumetric magnetic resonance imaging was performed at inclusion, and after 6 and 12 months in all participants. The non-parametric Friedman's test was used for statistical analysis. There was a significant reduction in glandular volume (mean, 22%) at 12 months postoperatively in patients who underwent breast augmentation. Breast augmentation caused reduction in the volume of the breast parenchyma. 3 Therapeutic. © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

  18. Application of "CD−4" Theory for Determining the Width of Implant in Breast Augmentation

    Directory of Open Access Journals (Sweden)

    Jie Cai

    2015-01-01

    Full Text Available Background: The determination of the width of the implant is the first key step to select shape and volume of the implant in breast augmentation. The aim of this study was to introduce a new method to determine the width of the implant (W and explain the reasons to do so in details. Methods: From January 2006 to June 2014, the authors have found and applied "CD −4" theory to determine the width of breast implant (W in dual plane I or II breast augmentation cases through transaxillary or periareolar incision for 560 patients. "CD" is defined as the curved distance on skin from the midline of the sternal bone to the anterior axillary line (AAL on the lateral chest wall through the horizontal level on inferior mammary fold. W = CD − 4 (or 3.5 cm. Results: The 560 patients used both round and anatomic implants with W from 10.5 cm to 12.5 cm. Their CDs are from 14.5 cm to 17 cm. About 78% of the patients have got followed up from 1 month to 5 years postoperatively. Except for four patients who got unilateral capsular contractions, all the other patients are satisfied with their nature new breast shapes and volumes. Their new intermammary cleavages without bras are between 1 cm and 2.5 cm, and lateral borders of the breast are on the area of the AAL. Conclusions: W (width of the implant = CD − 4 (cm when doing dual plan I or II breast augmentation. For the very thin patient, 4 should be 3.5.

  19. Preoperative implant selection for unilateral breast reconstruction using 3D imaging with the Microsoft Kinect sensor.

    Science.gov (United States)

    Pöhlmann, Stefanie T L; Harkness, Elaine; Taylor, Christopher J; Gandhi, Ashu; Astley, Susan M

    2017-08-01

    This study aimed to investigate whether breast volume measured preoperatively using a Kinect 3D sensor could be used to determine the most appropriate implant size for reconstruction. Ten patients underwent 3D imaging before and after unilateral implant-based reconstruction. Imaging used seven configurations, varying patient pose and Kinect location, which were compared regarding suitability for volume measurement. Four methods of defining the breast boundary for automated volume calculation were compared, and repeatability assessed over five repetitions. The most repeatable breast boundary annotation used an ellipse to track the inframammary fold and a plane describing the chest wall (coefficient of repeatability: 70 ml). The most reproducible imaging position comparing pre- and postoperative volume measurement of the healthy breast was achieved for the sitting patient with elevated arms and Kinect centrally positioned (coefficient of repeatability: 141 ml). Optimal implant volume was calculated by correcting used implant volume by the observed postoperative asymmetry. It was possible to predict implant size using a linear model derived from preoperative volume measurement of the healthy breast (coefficient of determination R(2) = 0.78, standard error of prediction 120 ml). Mastectomy specimen weight and experienced surgeons' choice showed similar predictive ability (both: R(2) = 0.74, standard error: 141/142 ml). A leave one-out validation showed that in 61% of cases, 3D imaging could predict implant volume to within 10%; however for 17% of cases it was >30%. This technology has the potential to facilitate reconstruction surgery planning and implant procurement to maximise symmetry after unilateral reconstruction. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  20. Assessment of the implant geometry in fractionated interstitial HDR breast brachytherapy using an electromagnetic tracking system.

    Science.gov (United States)

    Kellermeier, Markus; Fietkau, Rainer; Strnad, Vratislav; Bert, Christoph

    During the partial-breast treatment course by interstitial brachytherapy, electromagnetic tracking (EMT) was applied to measure the implant geometry. Implant-geometry variation, choice of reference data, and three registration methods were assessed. The implant geometry was measured in 28 patients after catheter implantation (EMTbed), during CT imaging (EMTCT), and in each of up to n = 9 treatment fractions (EMTF(k), k = 1, 2,… n). EMTF(k) were registered to the planned implant reconstruction (CTplan) by using all dwell positions (DPs), the button centers, or three fiducial sensors on the patient's skin. Variation in implant geometry obtained from EMTF(k) was assessed for EMTbed, EMTCT, and CTplan. EMT was used to measure 3932 catheters. A duration of 6.5 ± 1.7 min was needed for each implant measurement (mean, 17 catheters) plus setup of the EMT system. Data registration based on the DP deviated significantly lower than registration on button centers or fiducial sensors. Within a registration group, there was a geometry in high-dose-rate interstitial brachytherapy breast treatments. EMTbed, EMTCT, and CTplan data can serve as reference for assessment of implant changes. Copyright © 2017 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  1. Versatility of Capsular Flaps in the Salvage of Exposed Breast Implants

    Directory of Open Access Journals (Sweden)

    Beniamino Brunetti, MD

    2015-03-01

    Full Text Available Summary: Breast implant exposure due to poor tissue coverage or previous irradiation represents a surgical challenge both in the reconstructive and aesthetic plastic surgery practice. In case of implant extrusion or incipient exposure, the commonly suggested strategies, such as targeted antibiotic therapy, drainage and lavage of the cavity, fistulectomy, and primary closure, may be ineffective leading the surgeon to an unwanted implant removal or to adopt more invasive flap coverage procedures. Breast implant capsule, in its physiological clinical behavior, can be considered as a new reliable source of tissue, which can be used in a wide range of clinical situations. In our hands, capsular flaps proved to be a versatile solution not only to treat breast contour deformities or inframammary fold malpositions but also to salvage exposed breast implants. In this scenario, the use of more invasive surgical techniques can be avoided or simply saved and delayed for future recurrences.(Plast Reconstr Surg Glob Open 2015;3:e340; doi:10.1097/GOX.0000000000000307; Published online 30 March 2015.

  2. Multisite Infection with Mycobacterium abscessus after Replacement of Breast Implants and Gluteal Lipofilling

    OpenAIRE

    Eva Rüegg; Alexandre Cheretakis; Ali Modarressi; Stephan Harbarth; Brigitte Pittet-Cuénod

    2015-01-01

    Introduction. Medical tourism for aesthetic surgery is popular. Nontuberculous mycobacteria (NTM) occasionally cause surgical-site infections. As NTM grow in biofilms, implantations of foreign bodies are at risk. Due to late manifestation, infections occur when patients are back home, where they must be managed properly. Case Report. A 39-year-old healthy female was referred for acute infection of the right gluteal area. Five months before, she had breast implants replacement, abdominal l...

  3. Breast-implant texturing associated with delamination of capsular layers: A histological analysis of the double capsule phenomenon.

    Science.gov (United States)

    Efanov, J I; Giot, J P; Fernandez, J; Danino, M A

    2017-06-01

    Macro-texturing of breast implants was developed with the double goal of improving implant stabilization within the breast cavity and decreasing the rate of capsular contractures. However, recent evidence suggests that double capsular formation, a potentially worrisome phenomenon associated with late seromas and biofilms, occurs with preponderance in macro-textured implants. Our objective was to analyze histologically different regions of double capsules to determine if they are more prone to mechanical movements. A prospective analysis including patients undergoing second-stage expander to definitive breast-implant reconstruction post-mastectomy was conducted after intraoperative identification of the double capsule phenomenon. Two samples were collected from each capsules around the implant, located centrally and laterally. The specimens were sent for histological analysis by the institution's pathologist. In total, 10 patients were identified intraoperatively with partial double capsule phenomenon. Among samples retrieved from the lateral aspect of the breast implant, all were associated with delamination and fractures in the collagen matrix of the double capsules. This phenomenon was not observed in any sample from the dome of the breast. Breast-implant macro-texturing plays an important role on delamination of capsules on lateral portions of the breast, which may have an etiologic role in double capsule formation. Manufacturing implants with macro-texturing on one side and smooth surface on the other could diminish mechanical shear forces responsible for these findings. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  4. [Radiological trap and oncological precautions in a patient who has undergone a permanent withdrawal of PIP breast implants].

    Science.gov (United States)

    Koutsomanis, A; Bruant-Rodier, C; Roedlich, M-N; Bretz-Grenier, M-F; Perrot, P; Bodin, F

    2015-12-01

    We report the case of a 57-year-old patient who presented radiological images similar to ruptured breast implants one year after the supposed withdrawal of the latter. This woman had benefited for the first time from cosmetic PIP breast implants in 2000. Early in 2014, she requested the removal of the implants without renewal because she was feeling pain and functional discomfort. A few months after the operation, she consulted for breast swelling in the upper pole of the breast. Radiological assessment showed liquid formations compatible with the presence of implants. At our request, the rereading of the MRI by the radiologist definitively concluded on a bilateral seroma within the persistent fibrous capsule. In the absence of symptoms, clinical monitoring had been decided. But at the recrudescence of anaplastic large cell lymphoma cases associated with breast implants, a cytological sampling was intended. In case of cytological abnormality or recurrence of the seroma, a surgical procedure should be performed. In conclusion, the removal of a breast implant without capsulectomy may result in the formation of a seroma whose images resemble those of an implant. It is always worthwhile to provide precise clinical data to the radiologist in order to help him to make informed interpretations. Every serous effusion in a breast lodge having contained a silicone implant must evoke the diagnosis of anaplastic large cell lymphoma. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  5. Two-Stage Latissimus Dorsi Flap with Implant for Unilateral Breast Reconstruction: Getting the Size Right

    Directory of Open Access Journals (Sweden)

    Jiajun Feng

    2016-03-01

    Full Text Available BackgroundThe aim of unilateral breast reconstruction after mastectomy is to craft a natural-looking breast with symmetry. The latissimus dorsi (LD flap with implant is an established technique for this purpose. However, it is challenging to obtain adequate volume and satisfactory aesthetic results using a one-stage operation when considering factors such as muscle atrophy, wound dehiscence and excessive scarring. The two-stage reconstruction addresses these difficulties by using a tissue expander to gradually enlarge the skin pocket which eventually holds an appropriately sized implant.MethodsWe analyzed nine patients who underwent unilateral two-stage LD reconstruction. In the first stage, an expander was placed along with the LD flap to reconstruct the mastectomy defect, followed by gradual tissue expansion to achieve overexpansion of the skin pocket. The final implant volume was determined by measuring the residual expander volume after aspirating the excess saline. Finally, the expander was replaced with the chosen implant.ResultsThe average volume of tissue expansion was 460 mL. The resultant expansion allowed an implant ranging in volume from 255 to 420 mL to be placed alongside the LD muscle. Seven patients scored less than six on the relative breast retraction assessment formula for breast symmetry, indicating excellent breast symmetry. The remaining two patients scored between six and eight, indicating good symmetry.ConclusionsThis approach allows the size of the eventual implant to be estimated after the skin pocket has healed completely and the LD muscle has undergone natural atrophy. Optimal reconstruction results were achieved using this approach.

  6. Innovative combination of therapeutic mammoplasty and expandable-implant breast augmentation for immediate partial breast reconstruction

    Directory of Open Access Journals (Sweden)

    A.M.H. Choo

    2016-01-01

    Conclusion: A “novel” oncoplastic technique herein termed “augmentation-therapeutic mastopexy” is described for partial breast reconstruction during the treatment of a patient with bilateral breast cancer. It enabled adequate treatment of her cancer while reshaping the breast and achieving the desired larger breast size. It should be considered in selected breast-conservation patients who wish to maintain or increase their breast size.

  7. A Simple and Practical Method for Setting Up a Criterion of Projection of Silicone Breast Implant After Simple Mastectomy.

    Science.gov (United States)

    Ishii, Naohiro; Ando, Jiro; Harao, Michiko; Takemae, Masaru; Kishi, Kazuo

    2017-01-01

    Objective: In breast reconstruction, decision of projection of silicone breast implant in tissue expander replacement is difficult because of the need to consider several parameters that cannot be expressed in accurate numerical form. The present study aimed at a quantitative analysis based on decreased projection of the reconstructed side compared with silicone breast implant projection and to develop a new method for simple and practical decision of silicone breast implant projection. Methods: Thirty-five patients who had mammary carcinoma and were treated with simple mastectomy, tissue expander insertion, and replacement with anatomical silicone breast implant from April 2013 to March 2016 were retrospectively identified. We recorded the projection of used silicone breast implant (Pi). The projections of reconstructed breast 6 months after silicone breast implant insertion (Pr) and that of the unaffected breast during silicone breast implant selection (Pu) were measured. The difference between Pi and Pr was defined as the revised numerical value (Rev). We investigated whether Rev significantly differed according to age, body mass index, or Pu and analyzed correlations between Rev and age, Pu, and body mass index. Results: Mean Rev in all patients was 1.2 ± 0.3 cm. Rev was significantly higher in patients with higher body mass index than in those with lower body mass index ( P < .01) and in patients with higher Pu than in those with lower Pu ( P < .01). Significant positive correlations of Rev with body mass index and Pu were found (β = .63, P < .01 and β = .67, P < .01, respectively). Conclusions: Rev was a simple, practical, and cost-effective concept. We believe that it is a useful indicator for deciding silicone breast implant projection.

  8. Shaped versus Round Implants for Breast Reconstruction: Indications and Outcomes

    Directory of Open Access Journals (Sweden)

    Maurice Y. Nahabedian, MD

    2014-03-01

    Conclusions: Both shaped and round silicone gel devices can result in natural aesthetic outcomes. Shaped devices are preferred for contouring the upper pole and for optimizing breast projection. Round devices are preferred when the upper pole is not deficient and the patient desires softer breasts. Longer follow-up studies will be necessary.

  9. Magnetic Resonance Imaging Screening Results Compared with Explantation Results in Poly Implant Prothese Silicone Breast Implants, Recalled from the European Market in 2010

    NARCIS (Netherlands)

    Maijers, M.C.; Niessen, F.B.; Veldhuizen, J.F.H.; Ritt, M.J.P.F.; Manoliu, R.A.

    2014-01-01

    BACKGROUND: In a prospective cohort study, the authors followed 112 women whose Poly Implant Prothèse silicone breast implants were recalled. Magnetic resonance imaging results and clinical consequences were previously published. The authors compared magnetic resonance imaging screening with

  10. Regulatory science of new technology: tendency of medical professionals' interests on silicone breast implants.

    Science.gov (United States)

    Nakazaki, Tomomichi; Ikeda, Koji; Iwasaki, Kiyotaka; Umezu, Mitsuo

    2016-09-01

    New technology related to artificial organs is most attractive for worldwide researchers. We believe they must contribute for the future patients against untreatable diseases. Regulatory science is a new science to establish 'social acceptance' of new technology into the clinical market as soon as possible. In the history of silicone breast implants, we could recognize risks many times; however, we missed such chances to prevent a subsequent crisis. We analyzed the trend of published literature related to silicone breast implants to review the medical professionals' interests on such risks. This trend showed, despite issues of a social acceptance of silicone breast implants in a few countries, other countries' medical professionals had no interest. Our hypothesis is 'medical professionals face the government and do not have contributed to re-establish the social acceptance of new technologies for patients'. Any technology does not have the complete evidence of safety, efficacy and quality, despite regulatory authorities' review and approval with clinical evidences. medical professionals need to conduct subsequently the epidemiological study, to take a meta-analysis periodically and to create/update the guidance for their patients under their professional ethics after the marketing of new technologies. We need to take seriously the 'lesson learned' from the history of silicone breast implants for all kind of new technologies existed in the present.

  11. Efficacy of Vancomycin-based Continuous Triple Antibiotic Irrigation in Immediate, Implant-based Breast Reconstruction

    Directory of Open Access Journals (Sweden)

    Lisa M. Hunsicker, MD, FACS

    2017-12-01

    Conclusions:. Continuous breast irrigation with a vancomycin-based triple antibiotic solution is a safe and effective accompaniment for immediate implant reconstruction. Use of intramuscular anesthetic injection for postoperative pain control allows the elastomeric infusion pump to be available for local tissue antibiotic irrigation.

  12. Evaluation of the severity of capsular contracture using elastography after breast implant reconstruction.

    Science.gov (United States)

    Sowa, Yoshihiro; Yokota, Isao; Itsukage, Sizu; Nakatsukasa, Katsuhiko; Sakaguchi, Koichi; Taguchi, Tetsuya; Numajiri, Toshiaki

    2017-01-01

    Capsular contracture around implants is a common complication after breast reconstruction. Strain elastography (STE) and shear-wave elastography (SWE) are noninvasive imaging techniques that can measure tissue stiffness and thickness of the capsule. The purposes of the study were to compare STE and SWE for measurement of capsular contracture after breast implant reconstruction using intra-class correlation coefficients (ICCs) and to investigate the correlation of these data with the Baker score, which is the most frequently used clinical staging scale for capsule contracture. The subjects were 20 patients (27 implants) who underwent breast reconstruction. The reproducibility of SWE (ICC: 0.878) was higher than that of STE (ICC: 0.724) for measurement of capsular contracture. The correlation coefficient between measurements with the two methods was low (r = 0.6788). The Baker score had a higher correlation with measurements with SWE (r = 0.8124) compared to those with STE (r = 0.6983). These results suggest that SWE is a better tool for assessment of the degree of capsule contracture surrounding implants after breast reconstruction.

  13. Risk of pacemaker or implantable cardioverter defibrillator after radiotherapy for early-stage breast cancer in Denmark, 1982-2005

    DEFF Research Database (Denmark)

    Rehammar, Jens Christian; Johansen, Jens Brock; Jensen, Maj-Britt

    2017-01-01

    BACKGROUND AND PURPOSE: To examine the risk of cardiac conduction abnormalities or severe ventricular arrhythmias requiring implantation of a cardiac implantable electronic device (CIED), either a pacemaker or an implantable cardioverter-defibrillator, subsequent to breast cancer (BC) radiotherapy....... CONCLUSIONS: BC RT as practiced in Denmark in 1982-2005 did not increase the risk of CIED implants. This indicates that RT for BC does not increase the risk of severe ventricular arrhythmias or cardiac conduction abnormalities....

  14. The clinical course of immediate breast implant reconstruction after breast cancer

    DEFF Research Database (Denmark)

    Hvilsom, Gitte B.; Friis, Søren; Frederiksen, Kirsten

    2011-01-01

    The number of women suitable for breast conserving treatment as well as immediate reconstruction after breast cancer has been increasing, and studies of complications hereafter are needed.......The number of women suitable for breast conserving treatment as well as immediate reconstruction after breast cancer has been increasing, and studies of complications hereafter are needed....

  15. Experimental total wrapping of breast implants with acellular dermal matrix: a preventive tool against capsular contracture in breast surgery?

    Science.gov (United States)

    Schmitz, Marweh; Bertram, Martin; Kneser, Ulrich; Keller, Andrea K; Horch, Raymund E

    2013-10-01

    Capsular contracture remains a hitherto unsolved complication after implantation of silicone gel-filled breast prostheses. Based on clinical and experimental data, the use of an acellular dermal matrix as a sheath around implants may lead to lesser capsular contracture acting as a proposed biological environment mimicking wound bed tissue. The aim of our study was to analyse the tissue reaction after implantation of silicone prosthesis with and without an envelope of acellular dermal matrix. Implantation of 60 silicone prostheses in the back of Lewis rats were carried out, randomly paired taking one rat from group A and one from group B. Group A included implants completely enveloped with xenogenic acellular dermis and group B undraped silicone implants. At 3, 6 and 12 weeks postoperatively, the samples were explanted and subjected to histological and immunohistochemical evaluation. A new myofibroblast tissue layer was identified in proximity to the implant in both groups. The thickness of the layer in group A was continuously thinner than in group B regarding the different explantation time points. Implants completely wrapped with acellular dermal matrix showed significantly lesser inflammatory signs at 3 and 12 weeks after implantation compared to controls. Cell proliferation after 12 weeks was significantly decreased in group A. The slight myofibroblast layer and reduced rate of inflammation and proliferation in the treatment group show a positive effect of total acellular dermal matrix envelope and hypothesise the decrease of capsular contracture in long-term periods. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  16. Cohort Study to Assess the Impact of Breast Implants on Breastfeeding.

    Science.gov (United States)

    Filiciani, Sandra; Siemienczuk, Guillermo F; Nardín, Juan M; Cappio, Bárbara; Albertengo, Andrés C; Nozzi, Guillermo; Caggioli, Matías

    2016-12-01

    The objective of this study was to evaluate the impact of breast implant surgery and its approaches on lactation by comparing women with and without breast implants at the time of childbirth. Between April of 2013 and July of 2014, in Rosario (Sanatorio de la Mujer and Centro Quirúrgico Rosario), Argentina, a prospective cohort study of women with and without breast implants was performed. Of a total of 3950 births that occurred during this period, 200 patients with similar anthropometric characteristics (maternal and newborn) were selected. Breastfeeding (exclusive or mixed) was compared with artificial feeding at 24 and 48 hours and 30 days in both groups, and the type of incision was also compared. Breastfeeding at 30 days showed a nonsignificant trend favoring the control group (OR, 7.39; 95 percent CI, 0.92 to 339.2). The percentage of women with implants who succeeded in establishing breastfeeding (exclusive or mixed) was very high (93 percent). In the control group, 99 percent of the women were breastfeeding at 30 days. In a comparison of the submammary and areola incision, breastfeeding showed odds ratios of 0.78 (95 percent CI, 0.33 to 1.87) at 24 hours, 1.10 (95 percent CI, 0.48 to 2.56) at 48 hours, and 0.18 (95 percent CI, 0.36 to 1.82) at 30 days. This study shows that most patients with breast implants were able to establish breastfeeding. However, there is a higher number of women without implants that established exclusive breastfeeding. No significant difference was found between the different surgical approaches. Therapeutic, II.

  17. SU-F-T-314: Estimation of Dose Distributions with Different Types of Breast Implants in Various Radiation Treatment Techniques for Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lee, M; Lee, S; Suh, T [Department of Biomedical Engineering, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of); Research Institute of Biomedical Engineering, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of); Jung, J [Department of Biomedical Engineering, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of); Research Institute of Biomedical Engineering, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of); Department of Radiation Oncology, College of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon (Korea, Republic of); Kim, S; Cho, Y; Lee, I [Department of Radiation Oncology, Gangnam Severance Hospital, Seoul (Korea, Republic of)

    2016-06-15

    Purpose: This study investigates the effects of different kinds and designs of commercialized breast implants on the dose distributions in breast cancer radiotherapy under a variety of conditions. Methods: The dose for the clinical conventional tangential irradiation, Intensity Modulated Radiation Therapy (IMRT), volumetric modulated arc therapy (VMAT) breast plans was measured using radiochromic films and stimulated luminescence dosimeter (OSLD). The radiochromic film was used as an integrating dosimeter, while the OSLDs were used for real-time dosimetry to isolate the contribution of dose from individual segment. The films were placed at various slices in the Rando phantom and between the body and breast surface OSLDs were used to measure skin dose at 18 positions spaced on the two (right/left) breast. The implant breast was placed on the left side and the phantom breast was remained on the right side. Each treatment technique was performed on different size of the breasts and different shape of the breast implant. The PTV dose was prescribed 50.4 Gy and V47.88≥95%. Results: In different shapes of the breast implant, because of the shadow formed extensive around the breast implant, dose variation was relatively higher that of prescribed dose. As the PTV was delineated on the whole breast, maximum 5% dose error and average 3% difference was observed averagely. VMAT techniques largely decrease the contiguous hot spot in the skin by an average of 25% compared with IMRT. The both IMRT and VMAT techniques resulted in lower doses to normal critical structures than tangential plans for nearly all dose analyzation. Conclusion: Compared to the other technique, IMRT reduced radiation dose exposure to normal tissues and maintained reasonable target homogeneity and for the same target coverage, VMAT can reduce the skin dose in all the regions of the body.

  18. Breast Implant-Associated Anaplastic Large Cell Lymphoma: A Systematic Review.

    Science.gov (United States)

    Leberfinger, Ashley N; Behar, Brittany J; Williams, Nicole C; Rakszawski, Kevin L; Potochny, John D; Mackay, Donald R; Ravnic, Dino J

    2017-12-01

    Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), a rare peripheral T-cell lymphoma, is increasing in incidence. However, many practitioners who treat patients with breast cancer are not aware of this disease. To assess how BIA-ALCL develops, its risk factors, diagnosis, and subsequent treatment and to disseminate information about this entity to the medical field. A literature review was performed in an academic medical setting. All review articles, case reports, original research articles, and any other articles relevant to BIA-ALCL were included. Data on BIA-ALCL, such as pathophysiology, patient demographics, presentation, diagnosis, treatment, and outcomes, were extracted. Particular focus was paid to age, time to onset, implant type, initial symptoms, treatment, and survival. The search was conducted in January 2017 for studies published in any year. After duplicates were excluded, 304 relevant articles were assessed, and 115 were included from the first documented case in August 1997 through January 2017. Thirty review articles, 44 case reports or series, 15 original research articles, and 26 "other" articles (eg, techniques, special topics, letters) were reviewed. A total of 93 cases have been reported in the literature, and with the addition of 2 unreported cases from the Penn State Health Milton S. Hershey Medical Center, 95 patients were included in this systematic review. Almost all documented BIA-ALCL cases have been associated with a textured device. The underlying mechanism is thought to be due to chronic inflammation from indolent infections, leading to malignant transformation of T cells that are anaplastic lymphoma kinase (ALK) negative and CD30 positive. The mean time to presentation is approximately 10 years after implant placement, with 55 of 83 (66%) patients initially seen with an isolated late-onset seroma and 7 of 83 (8%) with an isolated new breast mass. Ultrasonography with fluid aspiration can be used for diagnosis

  19. Numb chin syndrome as a manifestation of possible breast cancer metastasis around dental implants.

    Science.gov (United States)

    Orhan, Kaan; Bayndr, Hakan; Aksoy, Seçil; Seker, Basak Kusakci; Berberoğlu, Atilla; Ozan, Oğuz

    2011-05-01

    Numb chin syndrome, sometimes called numb lip syndrome, is an uncommon but well-recognized symptom in medical oncology. It may be a metastatic neurologic manifestation of malignancy, often with no clinically visible pathologic finding. The authors report a numb chin syndrome as a manifestation possible breast cancer metastasis around dental implants in a 69-year-old woman. The patient was presented with complaint of numbness in the lower jaw. Medical anamnesis revealed a metastatic breast carcinoma (CA). Radiographic imaging with conventional panoramic radiography and cone beam computed tomographic examination, revealed a moth-eaten shape, radiolucent, and radiopaque mixed appearance around the dental implants that was related with possible metastasis of the breast cancer. Numb chin syndrome is almost unknown within the dental and oral and maxillofacial community, despite being well reported in the medical literature. General dentists, oral medicine specialists, and oral and maxillofacial surgeons must be aware of this condition to consider metastatic cancer in patients with unexplained facial hypoesthesia. Moreover, although the development of metastatic lesions around implants is an uncommon pathologic finding, the examination of peri-implant lesion should be performed carefully considering the entire pathologic situations.

  20. Anaplastic Large-Cell Lymphoma Associated with Breast Implants: A Case Report of a Transgender Female.

    Science.gov (United States)

    Patzelt, Matej; Zarubova, Lucie; Klener, Pavel; Barta, Josef; Benkova, Kamila; Brandejsova, Adrianna; Trneny, Marek; Gürlich, Robert; Sukop, Andrej

    2017-11-03

    Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare peripheral T cell lymphoma. BIA-ALCL is a disease of the fibrous capsule surrounding the implant and occurs in patients after both breast reconstruction and augmentation. More than 300 cases have been reported so far, including two in a transgender patient. Here we describe BIA-ALCL presented with a mass in a transgender patient and the first case of BIA-ALCL in the Czech Republic. In 2007, a 33-year-old transgender male to female underwent bilateral breast augmentation as a part of his transformation to female. In June 2014, the patient developed a 5-cm tumorous mass in her left breast. Magnetic resonance imaging of the chest revealed a ruptured implant and a tumorous mass penetrating into the capsule and infiltrating the pectoral muscle. An R0 surgery was indicated-the implant, silicone gel and capsule were removed, and the tumorous mass was resected together with a part of the pectoral muscle. Histology revealed anaplastic large-cell lymphoma. The patient underwent standard staging procedures for lymphoma including a bone marrow trephine biopsy, which confirmed stage IE. The patient was treated with the standard chemotherapy for systemic ALCL-6 cycles of CHOP-21. The patient was tumor-free at the 2-year follow-up. BIA-ALCL has been reported mostly in women who received implants for either reconstructive or aesthetic augmentation. This is the third report of BIA-ALCL in a transgender person, the first in the Czech Republic. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  1. Novel rat model of methicillin-resistant Staphylococcus aureus-infected silicone breast implants: a study of biofilm pathogenesis.

    Science.gov (United States)

    Arad, Ehud; Navon-Venezia, Shiri; Gur, Eyal; Kuzmenko, Boris; Glick, Rivka; Frenkiel-Krispin, Daphna; Kramer, Eyal; Carmeli, Yehuda; Barnea, Yoav

    2013-02-01

    Clinical infection of breast implants occurs in 7 to 24 percent of breast reconstructions. It may persist over time in the form of biofilm without overt manifestation and is extremely difficult to eradicate. The authors' aim was to establish a novel model for biofilm infection of silicone breast implants in rats. Fifty-six rats underwent implantation of miniature silicone breast implants and/or methicillin-resistant Staphylococcus aureus (MRSA) bacteria. Group A received implants covered with MRSA biofilm. Group B received implants and free planktonic MRSA. Group C received free planktonic MRSA without implants. A control group received sterile implants without MRSA. Each group was divided to receive either saline or vancomycin injections between days 4 and 11. Clinical evaluation, bacterial counts, and scanning electron microscopy were performed. The mortality rate in group B (implants infected with free planktonic MRSA) was significantly higher than that in all other groups [37 percent versus groups A and D (0 percent) and group C (7 percent)]. Treatment with vancomycin lowered temperature in groups B and C (p < 0.05) and improved wound healing in group B (p < 0.01). Vancomycin treatment reduced wound bacterial counts in free planktonic MRSA groups B and C but had no significant effect on biofilm MRSA-infected group A. The model successfully induced persistent breast implant infection. Free planktonic MRSA produced in situ biofilm on silicone implants. Biofilm infection has milder manifestations than free planktonic MRSA infection, which has higher rates of systemic infections and death when compared with either isolated biofilm infection or free planktonic MRSA infection without implant. Vancomycin has limited effect against mature biofilm.

  2. Accelerated partial breast irradiation using the strut-adjusted volume implant single-entry hybrid catheter in brachytherapy for breast cancer in the setting of breast augmentation.

    Science.gov (United States)

    Bloom, Elizabeth S; Kirsner, Steve; Mason, Bryan E; Nelson, Chris L; Hunt, Kelly K; Baumann, Donald P; Gifford, Kent A

    2011-01-01

    Accelerated partial breast irradiation (APBI) has gained popularity as an alternative to adjuvant whole breast irradiation; however, owing to limitations of delivery devices for brachytherapy, APBI has not been a suitable option for all the patients. This report evaluates APBI using the strut-adjusted volume implant (SAVI) single-entry catheter to deliver brachytherapy for breast cancer in the setting of an augmented breast. The patient previously had placed bilateral subpectoral saline implants; stereotactic core biopsy revealed estrogen receptor- and progesterone receptor-positive ductal carcinoma in situ of intermediate nuclear grade. The patient underwent needle-localized segmental mastectomy of her left breast; pathologic specimen revealed no residual malignancy. An SAVI 8-1 device was placed within the segmental resection cavity. Treatment consisted of 3.4 Gy delivered twice a day for 5 days for a total dose of 34 Gy. Treatments were delivered with a high-dose-rate (192)Ir remote afterloader. Conformance of the device to the lumpectomy cavity was excellent at 99.2%. Dosimetric values of percentage of the planning target volume for evaluation receiving 90% of the prescribed dose, percentage of the planning target volume for evaluation receiving 95% of the prescribed dose, volume receiving 150% of the prescribed dose, and volume receiving 200% of the prescribed dose were 97.1%, 94.6%, 22.7 cc, and 11.6 cc, respectively. Maximum skin dose was 115% of the prescribed dose. The patient tolerated treatment well with excellent cosmetic results, and limited acute and late toxicity at 8 weeks and 6 months, respectively. Breast augmentation should not be an exclusion criterion for the option of APBI. The SAVI single-entry catheter is another option to successfully complete APBI using brachytherapy for breast cancer in the setting of an augmented breast. Copyright © 2011 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  3. Natrelle round silicone breast implants: Core Study results at 10 years.

    Science.gov (United States)

    Spear, Scott L; Murphy, Diane K

    2014-06-01

    Allergan's Natrelle round silicone-filled breast implants were approved by the U.S. Food and Drug Administration in 2006 based on interim results from the Core Study; final 10-year study results are now available. Seven hundred fifteen subjects were implanted with smooth and Biocell textured Natrelle round silicone implants and attended clinic visits at 0 to 4 weeks, 6 months, 1 year, and annually through 10 years. Approximately one-third of subjects underwent magnetic resonance imaging at years 1, 3, 5, 7, and 9 to assess rupture. Complication rates showed modest increases over the previously published 6-year rates. The Kaplan-Meier capsular contracture rate was 18.9 percent for augmentation, 28.7 percent for revision-augmentation, and 24.6 percent for reconstruction. Among augmentation subjects, capsular contracture was significantly lower (p = 0.023) for submuscular (15.7 percent) versus subglandular (26.3 percent) placement. The overall rupture rate in the magnetic resonance imaging cohort was 13.0 percent for subjects and 7.7 percent for implants. By the end of the study, 81.8 percent of augmentation subjects still had an original implant in place. Using a five-point scale, 94.2 percent of augmentation, 83.8 percent of revision-augmentation, and 90.7 percent of reconstruction subjects reported being satisfied or definitely satisfied with their implants. Significant improvement over baseline was also seen in overall breast satisfaction and satisfaction with breast size, shape, feel, and how well they matched. The 10-year data from the Natrelle Core Study, which can guide surgeons and patients in decision-making, demonstrate safety and high levels of patient satisfaction. Therapeutic, III.

  4. Destiny rides again: the reappearance of silicone gel-filled breast implant toxicity.

    Science.gov (United States)

    Brawer, A E

    2017-09-01

    Background Twenty-five years ago attorneys representing ailing women in class action litigation against silicone breast implant manufacturers made the procedural error of defining silicone-induced toxicity in the courtroom before it was properly studied in the exam room. This aberrant methodology perverted the proper research process, rendered verification of any real disease elusive, and cemented the groundwork for a repeat public health crisis potentially affecting two million women in the USA who possess new silicone gel devices inserted over the past 10 years. Patients and methods Six women, previously well, aged 27 to 53 (mean 42), were recipients of the new generations of cohesive silicone gel-filled breast implants approved for general use by the Food and Drug Administration (FDA) since December of 2006. They averaged seven years of total implantation time, and none experienced implant rupture. Results All six became ill on average 3.5 years from the time of implantation. By seven years the women manifested multiple types of skin rashes, polyarthritis, fatigue, protracted AM stiffness, myalgias, headaches, photosensitivity, hair loss, paresthesias, tinnitus, lymphadenopathy, chest pain, cognitive dysfunction, dry eyes, skin pigment changes, itching, muscle twitching, dizziness, nausea, easy bruising, and odor and smell sensitivity. Three of the four who were explanted noted improvement and/or resolution of at least 50% of their total disease manifestations. Conclusions These six women are representative of over 70,000 other breast implant recipients who, over the past three years, have had their new silicone devices permanently removed because of alleged gel-induced toxicity. The recurrence of this public health crisis has been fueled by manufacturers' research fraud, FDA ineptness, faulty informed consent, patient abandonment, proprietary manufacturing secrecy, misleading advertising, physician indifference, aberrant research methodology, and lax

  5. Idiopathic pseudoaneurysm in a patient with breast implants

    DEFF Research Database (Denmark)

    Khorasani, Hoda; Eiberg, Jonas; Bigaard, Janne

    2016-01-01

    implant surgery. After clinical assessment, the patient underwent surgery with resection of the aneurysm and ligation of the arterial branch. No early postoperative complications were reported. Pseudoaneurysms in small vessels such as the IMA or its branches are not well described in the literature...

  6. Long-term cosmetic outcome after breast implantation

    DEFF Research Database (Denmark)

    Hölmich, Lisbet R; Breiting, Vibeke B; Fryzek, Jon P

    2007-01-01

    All women who underwent breast augmentation at 1 public and 1 private clinic in Denmark from 1973 to 1988, and available for follow-up, were invited to participate in a clinical study including a self-administered questionnaire, medical record abstraction, and a clinical examination. One hundred ...

  7. Polyurethane-Coated Breast Implants Revisited: A 30-Year Follow-Up

    Directory of Open Access Journals (Sweden)

    Nikki Castel

    2015-03-01

    Full Text Available BackgroundPolyurethane coating of breast implants has been shown to reduce capsular contracture in short-term follow-up studies. This 30-year study is the longest examination of the use of polyurethane-coated implants and their correlation with capsular contracture.MethodsThis study evaluates the senior surgeon's (F.D.P. experience with the use of polyurethane-coated implants in aesthetic breast augmentation in 382 patients over 30 years. Follow-up evaluations were conducted for six months after surgery. After the six-month follow-up period, 76 patients returned for reoperation. The gross findings, histology, and associated capsular contracture were noted at the time of explantation.ResultsNo patient during the six-month follow-up period demonstrated capsular contracture. For those who underwent reoperation for capsular contracture, Baker II/III contractures were noted nine to 10 years after surgery and Baker IV contractures were noted 12 to 21 years after surgery. None of the explanted implants had macroscopic evidence of polyurethane, which was only found during the first five years after surgery. The microscopic presence of polyurethane was noted in all capsules up to 30 years after the original operation.ConclusionsAn inverse correlation was found between the amount of polyurethane coating on the implant and the occurrence of capsular contracture. Increasingly severe capsular contracture was associated with a decreased amount of polyurethane coating on the surface of the implants. No contracture occurred in patients whose implants showed incomplete biodegradation of polyurethane, as indicated by the visible presence of polyurethane coating. We recommend research to find a non-toxic, non-biodegradable synthetic material as an alternative to polyurethane.

  8. Skin-reducing mastectomy and direct-to-implant reconstruction in giant phyllodes tumour of breast: case report

    Directory of Open Access Journals (Sweden)

    Francesco Ciancio

    2017-01-01

    Discussion and conclusion: In selected patients with large sized breasts (C-D cup and poor surface area of skin involved, a valid technique in the treatment of this pathology is the Skin-Reducing Mastectomy and immediate reconstruction with implants (DTI = direct to implant.

  9. Breast lift

    Science.gov (United States)

    Mastopexy; Breast lift with reduction; Breast lift with augmentation ... enlargement with implants) when they have a breast lift. ... it for medical reasons. Women usually have breast lifts to lift sagging, loose breasts. Pregnancy, breastfeeding, and ...

  10. Seed Placement in Permanent Breast Seed Implant Brachytherapy: Are Concerns Over Accuracy Valid?

    Energy Technology Data Exchange (ETDEWEB)

    Morton, Daniel, E-mail: dmorton@bccancer.bc.ca [Department of Medical Physics, BC Cancer Agency, Centre for the Southern Interior, Kelowna, British Columbia (Canada); Department of Physics and Astronomy, University of Victoria, Victoria, British Columbia (Canada); Hilts, Michelle [Department of Medical Physics, BC Cancer Agency, Centre for the Southern Interior, Kelowna, British Columbia (Canada); Department of Physics and Astronomy, University of Victoria, Victoria, British Columbia (Canada); Batchelar, Deidre [Department of Medical Physics, BC Cancer Agency, Centre for the Southern Interior, Kelowna, British Columbia (Canada); Crook, Juanita [Department of Radiation Oncology, BC Cancer Agency, Centre for the Southern Interior, Kelowna, British Columbia (Canada)

    2016-07-01

    Purpose: To evaluate seed placement accuracy in permanent breast seed implant brachytherapy (PBSI), to identify any systematic errors and evaluate their effect on dosimetry. Methods and Materials: Treatment plans and postimplant computed tomography scans for 20 PBSI patients were spatially registered and used to evaluate differences between planned and implanted seed positions, termed seed displacements. For each patient, the mean total and directional seed displacements were determined in both standard room coordinates and in needle coordinates relative to needle insertion angle. Seeds were labeled according to their proximity to the anatomy within the breast, to evaluate the influence of anatomic regions on seed placement. Dosimetry within an evaluative target volume (seroma + 5 mm), skin, breast, and ribs was evaluated to determine the impact of seed placement on the treatment. Results: The overall mean (±SD) difference between implanted and planned positions was 9 ± 5 mm for the aggregate seed population. No significant systematic directional displacements were observed for this whole population. However, for individual patients, systematic displacements were observed, implying that intrapatient offsets occur during the procedure. Mean displacements for seeds in the different anatomic areas were not found to be significantly different from the mean for the entire seed population. However, small directional trends were observed within the anatomy, potentially indicating some bias in the delivery. Despite observed differences between the planned and implanted seed positions, the median (range) V{sub 90} for the 20 patients was 97% (66%-100%), and acceptable dosimetry was achieved for critical structures. Conclusions: No significant trends or systematic errors were observed in the placement of seeds in PBSI, including seeds implanted directly into the seroma. Recorded seed displacements may be related to intrapatient setup adjustments. Despite observed seed

  11. Association between Enlarged Axillary Lymph Nodes and Silicone Breast Implant Ruptures seen on Magnetic Resonance Imaging.

    Science.gov (United States)

    Klang, Eyal; Amitai, Michal M; Raskin, Stephen; Rozendorn, Noa; Keddel, Nicholas; Pickovsky, Jana; Sklair-Levy, Miri

    2016-12-01

    Silicone breast augmentation is a common cosmetic surgery. Previous case reports demonstrated lymphadenopathy in the presence of implant ruptures. To investigate the association between enlarged axillary lymph nodes and silicone implant ruptures as seen on breast magnetic resonance imaging (MRI). Two groups were derived retrospectively from breast MRI reports in our institution for the period December 2011-May 2014. A search of our hospital records for "silicone" and "lymph node" was performed (group A), and the relationship between the presence of enlarged nodes and ruptures was evaluated. The prevalence of ruptures in the presence of nodes was calculated and the association between MRI imaging features and ruptures evaluated. A search for "silicone" and "implant rupture" was performed (group B) and, as for group A, the relationship between the presence of ruptures and nodes was evaluated and the prevalence of enlarged nodes in the presence of ruptures calculated. Group A comprised 45 women with enlarged nodes. Intracapsular ruptures were associated with nodes (P = 0.005), while extracapsular ruptures showed a trend of association with nodes (P = 0.08). The prevalence of ruptures in the presence of nodes was 31.4%. Nodes associated with ruptures showed a strong silicone signal (P = 0.008) and absent enhancement (P = 0.005). Group B comprised 73 women with ruptures. Enlarged nodes were associated with both intra- and extracapsular ruptures (P guide clinical decisions when either enlarged nodes or ruptures are encountered in patients with silicone implants. The association between silicone lymphadenopathy and implant rupture raises concerns regarding the role of rupture in silicone-induced systemic disease.

  12. Subcutaneous Implant-based Breast Reconstruction with Acellular Dermal Matrix/Mesh: A Systematic Review.

    Science.gov (United States)

    Salibian, Ara A; Frey, Jordan D; Choi, Mihye; Karp, Nolan S

    2016-11-01

    The availability of acellular dermal matrix (ADM) and synthetic mesh products has prompted plastic surgeons to revisit subcutaneous implant-based breast reconstruction. The literature is limited, however, with regards to evidence on patient selection, techniques, and outcomes. A systematic review of the Medline and Cochrane databases was performed for original studies reporting breast reconstruction with ADM or mesh, and subcutaneous implant placement. Studies were analyzed for level of evidence, inclusion/exclusion criteria for subcutaneous reconstruction, reconstruction characteristics, and outcomes. Six studies (186 reconstructions) were identified for review. The majority of studies (66.7%) were level IV evidence case series. Eighty percent of studies had contraindications for subcutaneous reconstruction, most commonly preoperative radiation, high body mass index, and active smoking. Forty percent of studies commenting on patient selection assessed mastectomy flap perfusion for subcutaneous reconstruction. Forty-five percent of reconstructions were direct-to-implant, 33.3% 2-stage, and 21.5% single-stage adjustable implant, with ADM utilized in 60.2% of reconstructions versus mesh. Pooled complication rates included: major infection 1.2%, seroma 2.9%, hematoma 2.3%, full nipple-areola complex necrosis 1.1%, partial nipple-areola complex necrosis 4.5%, major flap necrosis 1.8%, wound healing complication 2.3%, explantation 4.1%, and grade III/IV capsular contracture 1.2%. Pooled short-term complication rates in subcutaneous alloplastic breast reconstruction with ADM or mesh are low in preliminary studies with selective patient populations, though techniques and outcomes are variable across studies. Larger comparative studies and better-defined selection criteria and outcomes reporting are needed to develop appropriate indications for performing subcutaneous implant-based reconstruction.

  13. Capsular contracture by silicone breast implants: possible causes, biocompatibility, and prophylactic strategies

    Directory of Open Access Journals (Sweden)

    Steiert AE

    2013-12-01

    Full Text Available Andreas E Steiert, Maria Boyce, Heiko Sorg Department of Plastic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany Abstract: The most common implanted material in the human body consists of silicone. Breast augmentation and breast reconstruction using silicone-based implants are procedures frequently performed by reconstructive and aesthetic surgeons. A main complication of this procedure continues to be the development of capsular contracture (CC, displaying the result of a fibrotic foreign body reaction after the implantation of silicone. For many years, experimental and clinical trials have attempted to analyze the problem of its etiology, treatment, and prophylaxis. Different theories of CC formation are known; however, the reason why different individuals develop CC in days or a month, or only after years, is unknown. Therefore, we hypothesize that CC formation, might primarily be induced by immunological mechanisms along with other reasons. This article attempts to review CC formation, with special attention paid to immunological and inflammatory reasons, as well as actual prophylactic strategies. In this context, the word “biocompatibility” has been frequently used to describe the overall biological innocuousness of silicone in the respective studies, although without clear-cut definitions of this important feature. We have therefore developed a new five-point scale with distinct key points of biocompatibility. Hence, this article might provide the basis for ongoing discussion in this field to reduce single-publication definitions as well as increase the understanding of biocompatibility. Keywords: biofilm, foreign body reaction, breast augmentation, biocompatibility, fibrosis

  14. Radiologic images of an aggressive implant-associated fibromatosis of the breast and chest wall: case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Lourdes Alanis, MD, MPH

    2017-09-01

    Full Text Available Fibromatosis of the breast is a rare benign disease compromising <0.2% of all primary breast tumors. Although the chest wall is a common location, occurrences of implant-associated fibromatosis of the breast are extremely rare; only 33 cases have been reported. We present a case of a 42-year-old female who underwent breast augmentation with silicone breast implants, and 2 years later developed an aggressive implant-associated fibromatosis of the breast and chest wall. On imaging studies, the tumor mimicked breast carcinoma, and despite chemotherapy, the fibromatosis rapidly enlarged and was locally invasive requiring wide surgical excision. Unlike previously reported imaging findings, magnetic resonance imaging revealed an oval circumscribed mass with fringe-like internal architecture. We provide a review of the literature and discuss the imaging features of implant-associated fibromatosis of the breast.

  15. The Effect of Sterile Acellular Dermal Matrix Use on Complication Rates in Implant-Based Immediate Breast Reconstructions

    Directory of Open Access Journals (Sweden)

    Jun Ho Lee

    2016-11-01

    Full Text Available BackgroundThe use of acellular dermal matrix (ADM in implant-based immediate breast reconstruction has been increasing. The current ADMs available for breast reconstruction are offered as aseptic or sterile. No published studies have compared aseptic and sterile ADM in implant-based immediate breast reconstruction. The authors performed a retrospective study to evaluate the outcomes of aseptic versus sterile ADM in implant-based immediate breast reconstruction.MethodsImplant-based immediate breast reconstructions with ADM conducted between April 2013 and January 2016 were included. The patients were divided into 2 groups: the aseptic ADM (AlloDerm group and the sterile ADM (MegaDerm group. Archived records were reviewed for demographic data and postoperative complication types and frequencies. The complications included were infection, flap necrosis, capsular contracture, seroma, hematoma, and explantation for any cause.ResultsTwenty patients were reconstructed with aseptic ADM, and 68 patients with sterile ADM. Rates of infection (15.0% vs. 10.3%, flap necrosis (5.0% vs. 7.4%, capsular contracture (20.0% vs. 14.7%, seroma (10.0% vs. 14.7%, hematoma (0% vs. 1.5%, and explantation (10.0% vs. 8.8% were not significantly different in the 2 groups.ConclusionsSterile ADM did not provide better results regarding infectious complications than aseptic ADM in implant-based immediate breast reconstruction.

  16. Locally advanced breast implant associated anaplastic large cell lymphoma: A case report of successful treatment with radiation and chemotherapy

    Directory of Open Access Journals (Sweden)

    Christopher Fleighton Estes

    2015-02-01

    Full Text Available The development of breast implant associated anaplastic large cell lymphoma (ALCL is a rare phenomenon. A typical presentation is an effusion associated with a breast implant. Less commonly, disease can become more advanced locoregionally or distantly. The optimal treatment schema is a topic of debate: localized ALCL can potentially be cured with implant removal alone, while other cases in the literature, including those that are more advanced, have been treated with varying combinations of surgery, chemotherapy, and external beam radiotherapy. This is a case report of breast implant ALCL with pathologically proven lymph node involvement, the fifth such patient reported. Our patient experienced a favorable outcome with radiation therapy and chemotherapy.

  17. Acute Immunologic Reaction to Silicone Breast Implant after Mastectomy and Immediate Reconstruction: Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Massoome Najafi

    2014-08-01

    Full Text Available Background: Since the introduction of silicone based medical devices in to clinical practice, several reports appeared in the medical literature regarding their adverse effects. However, there are few reports of immunologic reactions to these implants.Case presentation: A case of systemic reaction to a breast implant inserted for immediate breast reconstruction in a breast cancer patient is presented. The patient developed fever and skin rash two months after the surgery. Investigations disclosed no infectious origin for the fever and a dramatic response to steroid therapy was observed.Conclusion: Immunologic reaction should be considered in case of systemic signs and symptoms after silicone breast implant placement as a rare complication. 

  18. Subcutaneously Placed Breast Implants after a Skin-Sparing Mastectomy: Do We Always Need ADM?

    Directory of Open Access Journals (Sweden)

    Apresh Singla, MBBS, MSc

    2017-07-01

    Full Text Available Background:. Immediate breast reconstruction is an acceptable treatment option after mastectomy for prophylaxis of early breast cancer. Different options exist for implant placement, incision technique, patient suitability, and institutional experience. This article is a case series exploring the feasibility and outcomes of patients undergoing immediate breast reconstruction using skin-sparing mastectomy without mesh or acellular dermal matrix (ADM and with a vertical inframammary incision. Methods:. A single-institution retrospective analysis was performed for all patients who underwent immediate single-stage reconstruction with subcutaneous silicon implants without ADM between 2009 and 2014 inclusive. Patient, operative and treatment variables were extracted. All patients with viable mastectomy skin flaps intraoperatively and at least 5 mm of subcutaneous tissue were eligible except for patients who were deemed too slim by the senior surgeon preoperatively and thus at risk of implant visibility or skin rippling. Results:. There were 26 patients (bilateral n = 12 and unilateral n = 14 eligible for analysis, with a median long-term follow-up of 51.5 months. The majority of complications were classified as minor affecting 46.2% of the cohort (n = 12. There were 20 episodes of complications overall. The most frequent episodes were contour defects (x = 5, minor seroma (x = 4, and malrotation and minor infection (x = 3. There was 1 episode of capsular contracture. Conclusion:. Skin-sparing mastectomy with immediate subcutaneous silicon implant reconstruction with a vertical incision and without the need for mesh or ADM is an acceptable and safe treatment option. Accurate patient selection and skin flap viability is the key to achieving optimal outcomes with this approach.

  19. The evaluation of contralateral breast's dose and shielding efficiency by breast size about breast implant patient for radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jong Wook; Woo, Heon; Jeong, Hyeon Hak; Kim, Kyeong Ah; Kim, Chan Yong; Yoo, Suk Hyun [Dept. of Radiation Oncology, Seoul National University Hospital, Seoul (Korea, Republic of)

    2014-12-15

    To evaluate the dose on a contralateral breast and the usefulness of shielding according to the distance between the contralateral breast and the side of the beam by breast size when patients who got breast implant receive radiation therapy. We equipped 200 cc, 300 cc, 400 cc, and 500 cc breast model on the human phantom (Rando-phantom), acquired CT images (philips 16channel, Netherlands) and established the radiation treatment plan, 180 cGy per day on the left breast (EclipseTM ver10.0.42, Varian Medical Systems, USA) by size. We set up each points, A, B, C, and D on the right(contralateral) breast model for measurement by size and by the distance from the beam and attached MOSFET at each points. The 6 MV, 10 MV and 15 MV X-ray were irradiated to the left(target) breast model and we measured exposure dose of contralateral breast model using MOSFET. Also, at the same condition, we acquired the dose value after shielding using only Pb 2 mm and bolus 3 mm under the Pb 2 mm together. As the breast model is bigger from 200 cc to 500 cc, The surface of the contralateral breast is closer to the beam. As a result, from 200 cc to 500 cc, on 180 cGy basis, the measurement value of the scattered ray inclined by 3.22-4.17% at A point, 4.06-6.22% at B point, 0.4-0.5% at C point, and was under 0.4% at D point. As the X-ray energy is higher, from 6 MV to 15 MV, on 180 cGy basis, the measurement value of the scattered ray inclined by 4.06-5% at A point, 2.85-4.94% at B point, 0.74-1.65% at C point, and was under 0.4% at D point. As using Pb 2 mm for shield, scattered ray declined by average 9.74% at A and B point, 2.8% at C point, and is under 1% at D point. As using Pb 2 mm and bolus together for shield, scattered ray declined by average 9.76% at A and B point, 2.2% at C point, and is under 1% at D point. Commonly, in case of patients who got breast implant, there is a distance difference by breast size between the contralateral breast and the side of beam. As the distance is

  20. [Advantages of the superior areolar approach for tuberous breast II and III correction with implants].

    Science.gov (United States)

    Servaes, M; Mahaudens, P; Sinna, R; Vanwijck, R; Denoel, C

    2011-08-01

    Tuberous breast is a mammary malformation that remains difficult to treat in most cases. It results from an abnormal development of the mammary base, mainly at the lower pole of the breast. The superficialis fascia is adherent to the dermis and deep plane. For type II and III of Grolleau's classification, we were confronted by some difficulties with inferior areolar approach as in Puckett's or Ribeiro's techniques. We had frequently an insufficient glandular volume at the inferior part of the breast and an early look of a "double bubble" deformity. We propose a technical modification to these procedures using a superior hemiareolar approach to place the implant. Associated with an incision of the deep part of the superficialis fascia, it provides a good-shaped lower pole of the breast by preserving glandular volume at this part and reduces the apparition of "double bubble". We operated on 14 types II-III tuberous breasts on nine female patients and had no significant complication. The mean follow-up is 36 months and the results were very satisfying for the patient and her surgeon. Copyright © 2010. Published by Elsevier SAS.

  1. Stealthy role of size-driven stresses in biomechanics of breast implants capsular contracture.

    Science.gov (United States)

    Fraldi, Massimiliano; Esposito, Luca; Cutolo, Arsenio; Carotenuto, Angelo Rosario; Adamo, Ciro; Molea, Guido

    2016-12-01

    Breast Capsular Contracture (BCC) is one of the adverse complications occurring with greater incidence in breast augmentation surgical procedures. Its formation can be interpreted as the conclusive result of the physiological process known as response to a foreign body. From a biochemical standpoint, the formation of the peri-prosthetic capsule is certainly a multifactorial process: many hypotheses concerning its etiology have been suggested in the literature and a number of related pharmacological protocols have been consequently proposed to clinically treat this pathology with the aim to prevent further complications and avoid future re-interventions. However, the vast majority of these theories seems to be only partially supported by clinical outcomes and thus a shared opinion on this matter is still absent among specialists. Within this framework, by starting from clinical observations which highlighted an unexpected correlation between histo-morphological features of fibrotic capsules and overall size of breast implants, the present study investigates the hypothesis that the biomechanical interaction between prosthesis and host tissue may play a crucial role in the biological processes governing the pathological phenomenon at hand. Therefore, to shed light on the underlying mechanisms which could trigger the breast capsular contracture, both simple analytical solutions, in which elasticity and growth are simultaneously taken into account, and more accurate geometrically faithful Finite Element-based numerical simulations have been exploited. The theoretical findings demonstrate that somehow counter-intuitive radial and hoop stress fields occur at the capsula-implant interface in a way such that their combined action, independently from other possible concurrent factors, results significantly amplified for small-size breast prostheses, localized stress peaks in these cases promoting detaching and rippling phenomena actually observed in BCC clinical

  2. Accelerated partial breast irradiation dosimetric criteria for the strut-adjusted volume implant.

    Science.gov (United States)

    Mooney, Karen E; Altman, Michael B; Edward, Sharbacha; Garcia-Ramirez, Jose; Thomas, Maria A; Zoberi, Imran; DeWees, Todd; Mullen, Daniel; Zoberi, Jacqueline E

    2016-01-01

    Current guidelines for high-dose-rate accelerated partial breast irradiation using single-entry implants are based on the National Surgical Adjuvant Breast and Bowel Project B-39/Radiation Therapy Oncology Group 0413 protocol, which assumed a balloon implant geometry. We have developed robust plan evaluation criteria specifically for the strut-adjusted volume implant (SAVI). Plan evaluation criteria were established using a "training data set" of 62 SAVI treatment plans and included the percentage volume of target receiving 90%, 95%, and 100% of the prescription dose (V90, V95, and V100), the absolute volume of target receiving 150% and 200% of prescription (V150 and V200), and the maximum doses to skin (Dskin max) and ribs (Drib max). "Ideal" and "expected" (routinely achievable) thresholds were determined for each criterion and compared to B-39 guidelines. A "test data set" collected from the next 25 patients was analyzed using the developed plan evaluation criteria. Ideal (expected) dosimetric thresholds established from the training data set were V90 ≥ 98% (95%), V95 ≥ 95% (92%), V100 ≥ 91% (88%), Dskin max skin sparing compared to B-39 guidelines. Copyright © 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  3. Modified Lower Pole Autologous Dermal Sling for Implant Reconstruction in Women Undergoing Immediate Breast Reconstruction after Mastectomy

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    Pankaj G. Roy

    2016-01-01

    Full Text Available Background. Autologous dermal sling with wise pattern skin reducing mastectomy allows one-stage implant reconstruction in women with large and ptotic breasts needing mastectomy for cancer or risk reduction. However, this technique is not suitable for women who lack ptosis and also carries risk of T-junction breakdown. Method. We have performed one-stage nipple sparing mastectomies with implant reconstruction in 5 women (8 breasts by modifying the autologous dermal sling approach. All these women had small to moderate breasts with no ptosis or pseudoptosis. Results. Three women had bilateral procedures, two underwent bilateral mastectomies simultaneously, and one had contralateral risk reduction surgery a year after the cancer side operation. All women underwent direct to implant reconstruction with implant volumes varying from 320 to 375 cc. There were no implant losses and only one required further surgery to excise the nipple for positive nipple shaves. A low complication rate was encountered in this series with good aesthetic outcome. Conclusion. The modified lower pole dermal sling allows direct to implant reconstruction in selected women with small to moderate sized breasts with minimal ptosis. The approach is safe and cost-effective and results in more natural reconstruction with preservation of nipple.

  4. Do textured breast implants decrease the rate of capsular contracture compared to smooth implants?

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    Ignacio Cifuentes

    2017-08-01

    Full Text Available Resumen El uso de implantes mamarios con propósitos estéticos y reconstructivos se ha convertido en uno de los procedimientos más comunes realizados por los cirujanos plásticos. Existen diversos modelos de implantes mamarios, los cuales difieren en su tamaño, relleno, forma y característica de la envoltura, pudiendo ser lisa o texturizada. La contractura capsular es una de las principales complicaciones del uso de implantes mamarios y se ha planteado que las prótesis texturizadas podrían disminuir la incidencia de contractura capsular. Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud a nivel mundial, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Identificamos cinco revisiones sistemáticas que en conjunto incluyen 15 estudios primarios, 13 de ellos correspondientes a ensayos aleatorizados pertinentes a la pregunta de interés. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos tablas de resumen de los resultados utilizando el método GRADE. Concluimos que el uso de prótesis mamaria texturizada probablemente disminuye el riesgo de contractura capsular, sin embargo, podría asociarse a un aumento en el riesgo de linfoma anaplásico de células grandes.

  5. Aesthetic outcomes of acellular dermal matrix in tissue expander/implant-based breast reconstruction.

    Science.gov (United States)

    Forsberg, Clay G; Kelly, David A; Wood, Benjamin C; Mastrangelo, Stephanie L; DeFranzo, Anthony J; Thompson, James T; David, Lisa R; Marks, Malcolm W

    2014-01-01

    Tissue expander and implant-based breast reconstruction after mastectomy is the most common method of breast reconstruction. Modifications of the traditional total submuscular reconstruction (TSR) have been made using acellular dermal matrix (ADM) to create an inferolateral sling and a more natural implant pocket for superior aesthetic results. The objective of this study was to assess aesthetic outcomes when using ADM in breast reconstruction. A retrospective chart review identified all patients who underwent implant-based breast reconstruction from 2005 to 2009 at our institution. Demographic information, complications, reoperations, and aesthetic outcome data were collected for all patients meeting inclusion criteria related to adequate follow-up and postoperative photographs. Five aesthetic outcomes were evaluated for all study patients by 18 blinded evaluators using postoperative photographs. Outcomes were scored on a scale of 1 to 5, with 5 representing the best possible aesthetic score. A total of 122 patients underwent 183 tissue expander-based reconstructions (ADM, n = 58; TSR, n = 125). The infection rate in patients with ADM was 16.2% compared to 5.9% in TSR patients, but this was not statistically significant (P = 0.09). Capsular contracture was more common in TSR patients (23.5%), compared to those with ADM (8.1%), P = 0.048. Aesthetic scores from the attending plastic surgeons were as follows: natural contour (ADM, 3.36; TSR, 3.02; P = 0.0001), symmetry of shape (ADM, 3.57; TSR, 3.27; P = 0.005), symmetry of size (ADM, 3.68; TSR, 3.42; P = 0.002), position on chest wall (ADM, 3.75; TSR, 3.45; P = 0.004), and overall aesthetic appearance (ADM, 3.56; TSR, 3.20; P = 0.0001). For all 5 aesthetic parameters evaluated, the ADM group scored significantly higher than the TSR group by 18 blinded evaluators. These consistent findings suggest that the use of ADM in breast reconstruction does confer a significant advantage in aesthetic outcomes for breast

  6. Goldilocks Mastectomy: A Safe Bridge to Implant-Based Breast Reconstruction in the Morbidly Obese.

    Science.gov (United States)

    Schwartz, Jean-Claude

    2017-06-01

    Reconstructive surgeons are encountering an increasing number of obese women requiring postmastectomy reconstruction. These patients are poor candidates for autologous and prosthetic-based reconstructions as they have a high rate of reconstructive failure, surgical complications, and poor aesthetic outcomes. We demonstrate here the utility of the previously described Goldilocks mastectomy with free nipple grafts as a safe bridge to second stage implant-based breast reconstruction. Ten consecutive morbidly (BMI > 40) or super obese (BMI>50) women underwent bilateral Goldilocks mastectomy with free nipple grafts followed by second stage subpectoral implant placement at least three months postoperatively. Patients were assessed for implant-related complications including malposition, capsular contracture, dehiscence, and extrusion. Ten postmastectomy reconstructions in patients with BMIs ranging from 37 to 50 with a mean BMI of 45 underwent bilateral Goldilocks mastectomy with free nipple grafts. Two patients had wound healing complications after Goldilocks mastectomy but were completely healed within 8 weeks. There were no instances of delayed wound healing or reconstructive failure after prosthetic placement. With at least 9 months of follow-up on all patients, no patient has had a capsular contracture, significant malposition, or other complication requiring reoperation. The obese patient poses a significant reconstructive challenge for which no reproducible approach has been described. Here, we present a 2-stage strategy: the previously described Goldilocks mastectomy with free nipple grafts followed by second stage subpectoral definitive implant placement. This is the first proposed description of a reliable strategy for postmastectomy reconstruction in the morbidly and super obese.

  7. Systemic Sclerosis and Silicone Breast Implant: A Case Report and Review of the Literature

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    Antonios Psarras

    2014-01-01

    Full Text Available Environmentally induced systemic sclerosis is a well-recognized condition, which is correlated with exposure to various chemical compounds or drugs. However, development of scleroderma-like disease after exposure to silicone has always been a controversial issue and, over time, it has triggered spirited debate whether there is a certain association or not. Herein, we report the case of a 35-year-old female who developed Raynaud’s phenomenon and, finally, systemic sclerosis shortly after silicone breast implantation surgery.

  8. Suction drains in esthetic breast implant exchange are associated with surgical site infections: A retrospective cohort study.

    Science.gov (United States)

    Hadad, Eran; Wiser, Itay; Rosenthal, Adaya; Landau, Geva; Ziv, Ella; Heller, Lior

    2017-11-01

    Surgical site infection (SSI) following esthetic breast implant exchange occurs in up to 2% of procedures. The effect of suction drains on SSI risk in these cases remains controversial. This study aimed to assess the SSI risk in the presence of suction drains after esthetic exchange of breast implants. This is a retrospective cohort study of patients undergoing esthetic breast implant exchange between 2012 and 2015. SSI was determined according to the definition of the Center for Disease Control and Prevention. Multivariate analysis using a logistic regression model to identify independent risk factors for SSI was performed. A total of 256 women (504 breasts) met the inclusion criteria and were included in the study. The mean age was 44 ± 11 years. The mean operative time was 93 ± 40 min. The mean implant age at the time of the exchange was 10.3 ± 6.5 years. Suction drains were used in 229 breasts (45.4%) and were removed after 6 ± 7 days. Twenty (4%) breasts were diagnosed with SSI, of which 17 had suction drains. Suction drain use and days until drain removal were associated with a higher risk of SSI (85.0% vs. 43.8%, p suction drains remained an independent risk factor for SSI after adjustment for age, smoking, and previous capsular contracture (OR = 10.66, CI 95% 2.42-46.82). Suction drain use in esthetic breast implant exchange is associated with an increased risk of SSI. Surgeons should carefully consider using suction drains in selected cases only. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  9. Radiological and echographic aspects of breasts with silicone implants; Aspectos radiologicos e ecograficos das mamas com protese de silicone

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    Pace Bauab, S. de [Instituto de Radiodiagnostico Rio Preto, Sao Jose do Rio Preto, SP (Brazil)

    1994-10-01

    The silicone prosthesis, its application in breast augmentation mammoplasty and the studies about its association with auto-immune diseases and cancer, are commented. The normal and the pathologic radiologic and echographic aspects of breasts with implants are discussed, concerning to the prosthesis itself and to the adjacent parenchyma. The validity of mammographic and ultrasound mammography in the detection of cancer and of alterations of the implants are emphasized and also the importance of exams of high technical quality.(author). 16 refs, 13 figs.

  10. Flow cytometry of ALK-negative anaplastic large cell lymphoma of breast implant-associated effusion and capsular tissue.

    Science.gov (United States)

    Wu, David; Allen, Camilla T; Fromm, Jonathan R

    2015-01-01

    Anaplastic large cell lymphoma (ALCL) of the breast capsule is a rare lymphoma involving capsular tissues and/or effusions associated with breast implants. While several studies have detailed the histological and immunohistochemical (IHC) features of these tumors, no study has yet described flow cytometry features of the neoplastic cells of this entity. Here, we report two cases from our institution in which multi-parametric flow cytometry was performed. The immunophenotype of ALCL in association with breast implant was evaluated by flow cytometry. We show that much like CD30+ tumor cells of classical Hodgkin lymphoma (CHL) and ALCL of non-breast implant tumors, the neoplastic cells of this entity can be readily identified by flow cytometry. The neoplastic cells of both cases were largely devoid of T-cell antigens, but had expression of weak CD15, strong CD30, and expression of CD40. These results are correlated with routine morphologic and IHC analysis, supporting the flow cytometry immunophenotype. Flow cytometry can aid in the diagnostic evaluation of effusions or tissue samples in association with breast implant/prostheses. © 2014 Clinical Cytometry Society.

  11. Cytological Diagnosis of Bilateral Breast Implant-Associated Lymphoma of the ALK-Negative Anaplastic Large-Cell Type. Clinical Implications of Peri-Implant Breast Seroma Cytological Reporting.

    Science.gov (United States)

    Granados, Rosario; Lumbreras, Eva M; Delgado, Manuel; Aramburu, José A; Tardío, Juan C

    2016-07-01

    The cytological examination of peri-prosthetic breast effusions allowed the diagnosis of bilateral breast-implant ALK-negative anaplastic large cell lymphoma (BI-ALCL) in the case reported. Ten years after reconstructive surgery with bilateral breast implants, a large unilateral seroma developed and was cytologically analyzed. The presence of CD30 and CD4-positive large-sized atypical lymphoid cells exhibiting horseshoe-shaped nuclei and a brisk mitotic activity rendered the diagnosis of BI-ALCL. Similar cells were seen in the peri-prosthetic fluid intraoperatively collected from the contralateral breast. Although initial histological analysis of the capsulectomy specimens showed unilateral tumor, the cytological findings prompted a more thorough tissue sampling, resulting in the diagnosis of bilateral disease. BI-ALCL usually follows an indolent clinical course; however, there are reported cases with an aggressive behavior. While the presence of bilateral disease is a putative risk factor for a bad prognosis, the small number of cases reported precludes a definitive assessment of this risk. Since most BI-ALCL present with late seromas, cytologic analysis of these effusions in women with breast implants should be mandatory. Cytology is a safe tool for diagnosis and follow-up of patients with breast implant-related late seromas, sometimes proven more sensitive than histological analysis. Complete bilateral capsulectomy and a detailed histological analysis should follow a cytological diagnosis of BI-ALCL in a breast effusion in order to avoid false negative diagnoses. Our case constitutes the first published report of a bilateral BI-ALCL diagnosed by cytology. Diagn. Cytopathol. 2016;44:623-627. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  12. Optimizing Safety, Predictability, and Aesthetics in Direct to Implant Immediate Breast Reconstruction: Evolution of Surgical Technique.

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    Kalus, Ram; Dixon Swartz, Jennifer; Metzger, Sarah Cristina

    2016-06-01

    Although immediate breast reconstruction with the insertion of a permanent prosthesis rather than a tissue expander (direct to implant [DTI]) has become gradually more preferred and requested by patients, the technique has yet to be fully embraced by most plastic surgeons, presumably due to concerns of patient safety and perceived higher complication and revision rates, despite not being supported by the literature. The authors review the senior author's protocol for patient selection and surgical technique in DTI reconstructions. A simple device is introduced which adds predictability and control in determining the inset suture line for the acellular dermal matrix and thus the position of the inframammary fold and lateral mammary fold, resulting in improved aesthetic outcomes, reduced complications, and reduced reoperation rates. A retrospective review of our one surgeon experience with 134 DTI breast reconstructions in 77 patients between 2006 and 2015 is presented. The series is further subdivided into 74 reconstructions in 43 patients in whom their reconstruction was performed before the use of a patented 2-dimensional (2-D) template, and 60 reconstructions in 34 patients in whom the template was used. The overall complication rate requiring reoperation in the first 54 reconstructions was 50% versus 15% in the last 84. Failure of the reconstruction, defined by explantation, occurred in 11 of 74 reconstructions (14.9%) before the use of 2-D templates, and in 5 of 60 reconstructions (8.3%) in which templates were used, representing a 44% reduction. The revision rate specifically for implant malposition dropped from 18.6% before the use of templates to 2.9% after the incorporation of templates. Fifty-three reconstructions in 33 patients (40%) had no complications and no reoperations, correctly described as "one and done." Direct to implant reconstruction can be technically more demanding and exacting than 2-stage expander/implant reconstructions. A review of this

  13. Multisite Infection with Mycobacterium abscessus after Replacement of Breast Implants and Gluteal Lipofilling.

    Science.gov (United States)

    Rüegg, Eva; Cheretakis, Alexandre; Modarressi, Ali; Harbarth, Stephan; Pittet-Cuénod, Brigitte

    2015-01-01

    Introduction. Medical tourism for aesthetic surgery is popular. Nontuberculous mycobacteria (NTM) occasionally cause surgical-site infections. As NTM grow in biofilms, implantations of foreign bodies are at risk. Due to late manifestation, infections occur when patients are back home, where they must be managed properly. Case Report. A 39-year-old healthy female was referred for acute infection of the right gluteal area. Five months before, she had breast implants replacement, abdominal liposuction, and gluteal lipofilling in Mexico. Three months postoperatively, implants were removed for NTM-infection in Switzerland. Adequate antibiotic treatment was stopped after seven days for drug-related hepatitis. At entrance, gluteal puncture for bacterial analysis was performed. MRI showed large subcutaneous collection. Debridement under general anaesthesia was followed by open wound management. Total antibiotic treatment was 20 weeks. Methods. Bacterial analysis of periprosthetic and gluteal liquids included Gram-stain plus acid-fast stain, and aerobic, anaerobic and mycobacterial cultures.  Results. In periprosthetic fluid, Mycobacterium abscessus, Propionibacterium, and Staphylococcus epidermidis were identified. The same M. abscessus strain was found gluteally. The gluteal wound healed within six weeks. At ten months' follow-up, gluteal asymmetry persists for deep scarring. Conclusion. This case presents major complications of multisite aesthetic surgery. Surgical-site infections in context of medical tourism need appropriate bacteriological investigations, considering potential NTM-infections.

  14. Implant breast reconstruction followed by radiotherapy: Can helical tomotherapy become a standard irradiation treatment?

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    Massabeau, Carole, E-mail: cmassabeau@hotmail.com [Department of Radiation Oncology, Institut Curie, Paris (France); Fournier-Bidoz, Nathalie; Wakil, Georges; Castro Pena, Pablo; Viard, Romain; Zefkili, Sofia; Reyal, Fabien; Campana, Francois; Fourquet, Alain; Kirova, Youlia M. [Department of Radiation Oncology, Institut Curie, Paris (France)

    2012-01-01

    To evaluate the benefits and limitations of helical tomotherapy (HT) for loco-regional irradiation of patients after a mastectomy and immediate implant-based reconstruction. Ten breast cancer patients with retropectoral implants were randomly selected for this comparative study. Planning target volumes (PTVs) 1 (the volume between the skin and the implant, plus margin) and 2 (supraclavicular, infraclavicular, and internal mammary nodes, plus margin) were 50 Gy in 25 fractions using a standard technique and HT. The extracted dosimetric data were compared using a 2-tailed Wilcoxon matched-pair signed-rank test. Doses for PTV1 and PTV2 were significantly higher with HT (V95 of 98.91 and 97.91%, respectively) compared with the standard technique (77.46 and 72.91%, respectively). Similarly, the indexes of homogeneity were significantly greater with HT (p = 0.002). HT reduced ipsilateral lung volume that received {>=}20 Gy (16.7 vs. 35%), and bilateral lungs (p = 0.01) and neighboring organs received doses that remained well below tolerance levels. The heart volume, which received 25 Gy, was negligible with both techniques. HT can achieve full target coverage while decreasing high doses to the heart and ipsilateral lung. However, the low doses to normal tissue volumes need to be reduced in future studies.

  15. Multisite Infection with Mycobacterium abscessus after Replacement of Breast Implants and Gluteal Lipofilling

    Directory of Open Access Journals (Sweden)

    Eva Rüegg

    2015-01-01

    Full Text Available Introduction. Medical tourism for aesthetic surgery is popular. Nontuberculous mycobacteria (NTM occasionally cause surgical-site infections. As NTM grow in biofilms, implantations of foreign bodies are at risk. Due to late manifestation, infections occur when patients are back home, where they must be managed properly. Case Report. A 39-year-old healthy female was referred for acute infection of the right gluteal area. Five months before, she had breast implants replacement, abdominal liposuction, and gluteal lipofilling in Mexico. Three months postoperatively, implants were removed for NTM-infection in Switzerland. Adequate antibiotic treatment was stopped after seven days for drug-related hepatitis. At entrance, gluteal puncture for bacterial analysis was performed. MRI showed large subcutaneous collection. Debridement under general anaesthesia was followed by open wound management. Total antibiotic treatment was 20 weeks. Methods. Bacterial analysis of periprosthetic and gluteal liquids included Gram-stain plus acid-fast stain, and aerobic, anaerobic and mycobacterial cultures.  Results. In periprosthetic fluid, Mycobacterium abscessus, Propionibacterium, and Staphylococcus epidermidis were identified. The same M. abscessus strain was found gluteally. The gluteal wound healed within six weeks. At ten months’ follow-up, gluteal asymmetry persists for deep scarring. Conclusion. This case presents major complications of multisite aesthetic surgery. Surgical-site infections in context of medical tourism need appropriate bacteriological investigations, considering potential NTM-infections.

  16. The Poly Implant Prothèse breast prostheses scandal: Embodied risk and social suffering.

    Science.gov (United States)

    Greco, Cinzia

    2015-12-01

    This article examines the 2010 scandal surrounding the use and subsequent recall of adulterated Poly Implant Prothèse (PIP) silicone breast prostheses in France. It uses a mixed method approach that includes 12 interviews with French PIP prosthesis recipients, analyses of medical literature, policy documents of French and EU regulatory agencies, and an online forum for PIP recipients. These data are used to explain how the definition of "acceptable risk" in the silicone implants controversy of the 1990s in the US influenced the PIP scandal later on in France. Additionally, PIP recipients had an embodied experience of risk that clashed with the definition of risk used by authorities and some surgeons. The coverage of re-implantation was also defined at different policy levels, leading to variation in patients' suffering. The combination of fraud and lack of recognition from part of the medical system constitutes an example of social suffering for the patients involved. The PIP scandal is a useful case for analyzing the interconnection of embodied experience and professional and public policy definitions of medical risk through the concepts of moral economy and biological citizenship. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Three-dimensional imaging provides valuable clinical data to aid in unilateral tissue expander-implant breast reconstruction.

    Science.gov (United States)

    Tepper, Oren M; Karp, Nolan S; Small, Kevin; Unger, Jacob; Rudolph, Lauren; Pritchard, Ashley; Choi, Mihye

    2008-01-01

    The current approach to breast reconstruction remains largely subjective and is based on physical examination and visual-estimates of breast size. Thus, the overall success of breast reconstruction is limited by the inability of plastic surgeons to objectively assess breast volume and shape, which may result in suboptimal outcomes. A potential solution to this obstacle may be three-dimensional (3D) imaging, which can provide unique clinical data that was previously unattainable to plastic surgeons. The following study represents a prospective analysis of patient volunteers undergoing unilateral tissue expander (TE)-implant reconstruction by one of the two senior authors (MC, NSK). All patients underwent unilateral mastectomy with immediate or delayed insertion of a TE, followed by an exchange for a permanent silicone or saline implant. 3D scans were obtained during routine pre- and postoperative office visits. The 3D breast-volume calculations served as a guide for surgical management. Twelve patients have completed 3D-assisted unilateral breast reconstruction to date. These patients represent a wide range of body habitus and breast size/shape; 3D volume range from 136 to 518 cm(3). The mean baseline breast asymmetry in this group was 12.0 +/- 10.8%. Contralateral symmetry procedures were performed in eleven patients, consisting of the following: mastopexy (n = 6), augmentation (n = 1), mastopexy/augmentation (n = 2), and reduction mammoplasty (n = 2). Reconstruction was completed in a total number of 2 (n = 10) or 3 (n = 2) operations. Overall breast symmetry improved at the completion of reconstruction in the majority of patients, with an average postoperative symmetry of 95.1 +/- 4.4% (relative to 88% preoperatively). 3D imaging serves a valuable adjunct to TE-implant breast reconstruction. This technology provides volumetric data that can help guide breast reconstruction, such as in choosing the initial TE size, total volume of expansion, and final implant size

  18. Complications of Radiotherapy after Immediate Breast Reconstruction with Implant: Risk Factors and Management - Our Institute’s Experience

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    Heba G. El-Sheredy

    2016-01-01

    Full Text Available Background: Breast cancer is the most frequent malignant tumor in women worldwide. In recent years, defined reconstruction principles along with numerous surgical techniques with volume replacement have been published. Autologous breast reconstruction is more natural but leaves donor site morbidity. It provides the opportunity to restore the breast mound without the need for scars. This study aims to evaluate the complications of radiotherapy after immediate breast reconstruction with implants in breast cancer patients who submitted to skin sparing mastectomy and nipple sparing mastectomy by taking into consideration the risk factors and management at our institution. Methods: The current study prospectively included patients with invasive breast cancer admitted between January and June 2012 who were scheduled for skin sparing mastectomy or nipple sparing mastectomy and axillary dissection followed by immediate breast reconstruction with implant. Patients received adjuvant chemotherapy followed by conventional fractionated radiation. Complications were classified as either minor or major. The minor complications included capsular contracture (Baker 1-2, seroma, minor skin infection and skin dehiscence without exposure of the implant. Major complications included capsular contracture (Baker 3-4, severe infection and major wound dehiscence with implant exposure. Capsular contracture was scored according to the modified Baker classification. Results: The study included 38 patients. Of these, 28 had skin sparing mastectomy while 10 underwent nipple sparing mastectomy. The overall complication rate was 71%. We observed minor complications in 18 patients while 9 patients had major complications. Complications occurred with a median time of 13 months following radiotherapy completion. All minor complications were managed conservatively whereas all major complications required repeat surgery. No loco-regional recurrences occurred during the follow up

  19. Comparison of the Explantation Rate of Poly Implant Prothèse, Allergan, and Pérouse Silicone Breast Implants within the First Four Years after Reconstructive Surgery before the Poly Implant Prothèse Alert by the French Regulatory Authority

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    Alexandre Leduey

    2015-01-01

    Full Text Available Background. In March 2010, ANSM (Agence Nationale de Sécurité du Medicament, the French Medical Regulatory Authority, withdrew Poly Implant Prothèse (PIP breast implants from the market due to the use of non-medical-grade silicone gel. The aim of this study was to compare the removal rate (and reasons thereof of breast implants produced by different manufacturers before the ANSM alert. Materials and Methods. From October 2006 to January 2010, 652 women received 944 implants after breast cancer surgery at the Gustave Roussy Comprehensive Cancer Center, Paris (France. The complications and removal rates of the different implant brands used (PIP, Allergan, and Pérouse were evaluated and compared. Results. PIP implants represented 50.6% of the used implants, Allergan 33.4%, and Pérouse 16%. The main reasons for implant removal were patient dissatisfaction due to aesthetic problems (43.2%, infection (22.2%, and capsular contracture (13.6%. Two years after implantation, 82% of Pérouse implants, 79% of PIP, and 79% of Allergan were still in situ. There was no difference in removal rate among implant brands. Conclusion. Before the ANSM alert concerning the higher rupture rate of PIP breast implants, our implant removal rate did not predict PIP implant failure related to the use of nonapproved silicone gel.

  20. MRI screening for silicone breast implant rupture: accuracy, inter- and intraobserver variability using explantation results as reference standard

    Energy Technology Data Exchange (ETDEWEB)

    Maijers, M.C.; Ritt, M.J.P.F. [VU University Medical Centre, Department of Plastic, Reconstructive and Hand Surgery, De Boelelaan 1117, PO Box 7057, Amsterdam (Netherlands); Niessen, F.B. [VU University Medical Centre, Department of Plastic, Reconstructive and Hand Surgery, De Boelelaan 1117, PO Box 7057, Amsterdam (Netherlands); Jan van Goyen Clinic, Department of Plastic Surgery, Amsterdam (Netherlands); Veldhuizen, J.F.H. [MRI Centre, Amsterdam (Netherlands); Manoliu, R.A. [MRI Centre, Amsterdam (Netherlands); VU University Medical Centre, Department of Radiology, Amsterdam (Netherlands)

    2014-06-15

    The recall of Poly Implant Prothese (PIP) silicone breast implants in 2010 resulted in large numbers of asymptomatic women with implants who underwent magnetic resonance imaging (MRI) screening. This study's aim was to assess the accuracy and interobserver variability of MRI screening in the detection of rupture and extracapsular silicone leakage. A prospective study included 107 women with 214 PIP implants who underwent explantation preceded by MRI. In 2013, two radiologists blinded for previous MRI findings or outcome at surgery, independently re-evaluated all MRI examinations. A structured protocol described the MRI findings. The ex vivo findings served as reference standard. In 208 of the 214 explanted prostheses, radiologists agreed independently about the condition of the implants. In five of the six cases they disagreed (2.6 %), but subsequently reached consensus. A sensitivity of 93 %, specificity of 93 %, positive predictive value of 77 % and negative predictive value of 98 % was found. The interobserver agreement was excellent (kappa value of 0.92). MRI has a high accuracy in diagnosing rupture in silicone breast implants. Considering the high kappa value of interobserver agreement, MRI appears to be a consistent diagnostic test. A simple, uniform classification, may improve communication between radiologist and plastic surgeon. (orig.)

  1. Immediate breast reconstruction with a saline implant and AlloDerm, following removal of a Phyllodes tumor

    Directory of Open Access Journals (Sweden)

    Roller Michael D

    2011-03-01

    Full Text Available Abstract Background Phyllodes tumors are uncommon tumors of the breast that exhibit aggressive growth. While surgical management of the tumor has been reported, a single surgical approach with immediate breast reconstruction using AlloDerm has not been reported. Case presentation A 22-year-old woman presented with a 4 cm mass in the left breast upon initial examination. Although the initial needle biopsy report indicated a fibroadenoma, the final pathologic report revealed a 6.5 cm × 6.4 cm × 6.4 cm benign phyllodes tumor ex vivo. Treatment was a simple nipple-sparing mastectomy coupled with immediate breast reconstruction. After the mastectomy, a subpectoral pocket was created for a saline implant and AlloDerm was stitched to the pectoralis and serratus muscle in the lower-pole of the breast. Conclusions Saline implant with AlloDerm can be used for immediate breast reconstruction post-mastectomy for treatment of a phyllodes tumor.

  2. Implantes mamarios y mastopexía: colgajos mamarios laterales y mediales, una opción técnica Breast Implants and Mastopexy: lateral and Medial Breast Flaps, a Technical Option

    Directory of Open Access Journals (Sweden)

    R. Goulart Jr.

    2012-12-01

    Full Text Available La mastopexia asociada al uso de implantes mamarios es actualmente una de las prácticas más desafiantes en Cirugía Plástica; en ella, el cirujano tiene que utilizar al máximo sus capacidades y conocimientos para decidir con exactitud la mejor relación entre el tamaño ideal del implante y el exceso de piel a retirar. El objetivo de este artículo es presentar una técnica a base de colgajos mamarios laterales y mediales (CMLM para cirugía de mastopexia con implantes mamarios en busca de una mejor definición de la mama y de una mayor duración del resultado final. Esta técnica se crea en base a la circulación mamaria y en los excedentes de tejido al final de la cirugía utilizando la marcación en T. Los resultados inmediatos han sido muy satisfactorios en términos de definición de la forma mamaria, de la solidez de la nueva estructura glandular y de la protección del implante mamario. La duración a largo plazo aún debe ser evaluada. Creemos que se trata de una técnica fácil de ejecutar, que permite un resultado estético satisfactorio, proporciona una percepción de mayor seguridad en el posicionamiento del implante, aunque somos conscientes de que su sostenibilidad y duración a largo plazo aún necesitan tiempo para una mejor evaluación.The breast implant associated with mastopexy actually is one of most difficult plastic surgeries. In fact, it is a surgery where the surgeon has to use his higher capabilities and skills in order to decide with precision the best relationship between ideal sizes of the breast implant and skin excess. The purpose in this paper is to present a breast lateral and medial flaps technique for augmentation mastopexy surgery looking for a better breast design and resistance on the final result. The technique was created on breast circulation basis, skin excess and better definition and resistance about the aesthetical breast results in the augmentation mastopexy surgery utilizing the T scar technique

  3. Characteristics of women with cosmetic breast implants compared with women with other types of cosmetic surgery and population-based controls in Denmark.

    Science.gov (United States)

    Kjøller, Kim; Hölmich, Lisbet R; Fryzek, Jon P; Jacobsen, Poul Harboe; Friis, Søren; McLaughlin, Joseph K; Lipworth, Loren; Henriksen, Trine F; Jørgensen, Signe; Bittmann, Sven; Olsen, Jørgen H

    2003-01-01

    Herein the authors describe characteristics of women with breast implants compared with women with other types of cosmetic surgery as well as population controls. All women who acquired breast implants from 1977 to 1997 were identified from the files of two private plastic surgery clinics in Denmark. Patient characteristics were obtained through a self-administered questionnaire. The magnitude of differences between patient and control groups was estimated using odds ratios and 95% confidence intervals. Women with breast implants had a significantly lower body mass index and reported a two-fold greater incidence of current smoking compared with women from the general population and compared with women with other cosmetic surgery. Women with implants reported a greater number of full-term pregnancies and were less likely than controls to have had their first birth at age 30 years or older. Women with implants were not more likely than women in either control group to report a history of diseases, including connective tissue diseases, cancer, or depression before their implant surgery. Women with cosmetic breast implants differ from women with other forms of cosmetic surgery and from general population controls with respect to characteristics that may importantly influence health outcomes and that need to be addressed in future breast implant studies.

  4. Risk of pacemaker implantation subsequent to radiotherapy for early-stage breast cancer in Denmark, 1982-2005

    DEFF Research Database (Denmark)

    Rehammar, Jens Christian; Videbaek, L.; Brock Johansen, J.

    2015-01-01

    Introduction: Adjuvant radiotherapy reduces the risk of recurrence and death for early-stage breast cancer. However, dose to the heart should be considered since recent data suggest an increasing risk of ischemic heart disease with increasing dose to the heart. Conduction abnormalities have been...... reported after mediastinal radiation for Hodgkin's disease, but the risk of conduction disorders and arrhythmias does not appear to be increased subsequent to breast cancer radiotherapy. Such conduction abnormalities constitute a quite heterogenous group covering mild as well as severe disorders....... Objectives: The aim of this study was to examine the risk of severe conduction abnormalities evaluated by implantation of a pacemaker, subsequent to breast cancer radiotherapy. Methods: From the database of the Danish Breast Cancer Collaborative Group, we identified women treated with radiotherapy for early...

  5. Complex radiological diagnosis of a breast cancer at women after augmentation mammоplasty of silicone gel implants

    Directory of Open Access Journals (Sweden)

    T. A. Shumakova

    2014-01-01

    Full Text Available One of leading problems of mammology is early diagnostics of a breast cancer. The work purpose studying of opportunities of a complex of radiological research techniques in diagnostics of a breast cancer at women after augmentation mammoplasty silicone gel implants. By results of сomplex kliniko-radiological examination of 630 women aged from 18 till 72 years (middle age made 35 ± 0.43 years with 1260 implants the breast cancer was revealed at 7 (1.1 % patients. The invasive pro-current cancer with local widespread type of body height of tumoral knot is histologically diagnosed. Sensitivity and specificity of methods of radiodiagnosis in identification of a cancer of mammary glands at women after endoprosthesis replacement made mammography – 28.6 % and 66.1 %, ultrasonography – 71.4 % and 85.7 %, magnetic resonance imaging – 85.7 % and 98.2 %, respectively. Thus, complex application of radiology research techniques raises level of diagnostics of breast cancer at patients after augmentation mammoplasty silicone gel implants that allows to choose an adequate method of treatment.

  6. Effect of implant vs. tissue reconstruction on cancer specific survival varies by axillary lymph node status in breast cancer patients.

    Directory of Open Access Journals (Sweden)

    Qian Ouyang

    Full Text Available To compare the breast cancer-specific survival (BCSS between patients who underwent tissue or implant reconstruction after mastectomy.We used the database from Surveillance, Epidemiology, and End Results (SEER registries and compared the BCSS between patients who underwent tissue and implant reconstruction after mastectomy. Cox-regression models were fitted, adjusting for known clinicopathological features. The interaction between the reconstruction types (tissue/implant and nodal status (N-stage was investigated.A total of 6,426 patients with a median age of 50 years were included. With a median follow up of 100 months, the 10-year cumulative BCSS and non-BCSS were 85.1% and 95.4%, respectively. Patients who underwent tissue reconstruction had tumors with a higher T-stage, N-stage, and tumor grade and tended to be ER/PR-negative compared to those who received implant reconstruction. In univariate analysis, implant-reconstruction was associated with a 2.4% increase (P = 0.003 in the BCSS compared with tissue-reconstruction. After adjusting for significant risk factors of the BCSS (suggested by univariate analysis and stratifying based on the N-stage, there was only an association between the reconstruction type and the BCSS for the N2-3 patients (10-year BCSS of implant vs. tissue-reconstruction: 68.7% and 59.0%, P = 0.004. The 10-year BCSS rates of implant vs. tissue-reconstruction were 91.7% and 91.8% in N0 patients (P>0.05 and 84.5% and 84.4% in N1 patients (P>0.05, respectively.The implant (vs. tissue reconstruction after mastectomy was associated with an improved BCSS in N2-3 breast cancer patients but not in N0-1 patients. A well-designed, prospective study is needed to further confirm these findings.

  7. Interference of silicone breast implants on bioimpedance measurement of body fat.

    Science.gov (United States)

    Yamaguchi, Camila M; Faintuch, Joel; Silva, Maira M; Modolin, M; Hayashi, Silvia Y; Cecconello, I

    2012-08-01

    No study targeting the impact of silicone breast implants on body composition measured by bioimpedance analysis was identified. Aiming to clarify this question a prospective clinical study was designed. Adult candidates were submitted to conventional analysis at baseline and two months after the surgical intervention. In addition, unwrapped prostheses were positioned in the axillary cavity before operation and bioimpedance was measured, both with and without application of ultrasound gel for improved conductivity (sham implantation). Patients (N = 20) were young and healthy (26.8 ± 3.6 years old, BMI 22.1 ± 3.7 kg/m(2)). In comparison with preoperative results, sham procedures pointed out increased body fat and body resistance (13.2 ± 5.6 vs 13.6 ± 5.4 kg, P = 0.017 and 523 ± 54 vs 569 ± 53 Ω, P = 0.003, respectively). Two-month follow-up confirmed the same pattern after surgical intervention, with minor discrepancies (13.2 ± 5.6 vs 13.8 ± 5.7 kg, P = 0.011 and 523 ± 54 vs 549 ± 62 Ω, P = 0.032, respectively). BMI remained stable and did not correlate with bioimpedance changes. Silicone was recognized as adipose tissue. Difference in total body fat (approximately 600 g) was consistent with used amount. Copyright © 2012 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  8. The effect of post-mastectomy radiation therapy on breast implants: Unveiling biomaterial alterations with potential implications on capsular contracture

    Energy Technology Data Exchange (ETDEWEB)

    Ribuffo, Diego; Lo Torto, Federico [Department of Plastic Surgery, “Sapienza” University of Rome, Viale del Policlinico 155, 00166 Rome (Italy); Giannitelli, Sara M. [Tissue Engineering Unit, Department of Engineering, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 21, 00128 Rome (Italy); Urbini, Marco; Tortora, Luca [Surface Analysis Laboratory, Department of Mathematics and Physics, University “Roma Tre”, Via della Vasca Navale 84, 00146 Rome (Italy); INFN — National Institute of Nuclear Physics, Section of Roma Tre, Via della Vasca Navale 84, 00146 Rome (Italy); Mozetic, Pamela; Trombetta, Marcella [Tissue Engineering Unit, Department of Engineering, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 21, 00128 Rome (Italy); Basoli, Francesco; Licoccia, Silvia [Department of Chemical Science and Technologies, University of Rome “Tor Vergata”, Via della Ricerca Scientifica 1, 00173 Rome (Italy); Tombolini, Vincenzo [Department of Radiation Oncology, “Sapienza” University of Rome, Viale del Policlinico 155, 00166 Rome (Italy); Spencer-Lorillard Foundation, Viale Regina Elena 291, 00161 Rome (Italy); Cassese, Raffaele [Department of Radiation Oncology, “Sapienza” University of Rome, Viale del Policlinico 155, 00166 Rome (Italy); Scuderi, Nicolò [Department of Plastic Surgery, “Sapienza” University of Rome, Viale del Policlinico 155, 00166 Rome (Italy); and others

    2015-12-01

    Post-mastectomy breast reconstruction with expanders and implants is recognized as an integral part of breast cancer treatment. Its main complication is represented by capsular contracture, which leads to poor expansion, breast deformation, and pain, often requiring additional surgery. In such a scenario, the debate continues as to whether the second stage of breast reconstruction should be performed before or after post-mastectomy radiation therapy, in light of potential alterations induced by irradiation to silicone biomaterial. This work provides a novel, multi-technique approach to unveil the role of radiotherapy in biomaterial alterations, with potential involvement in capsular contracture. Following irradiation, implant shells underwent mechanical, chemical, and microstructural evaluation by means of tensile testing, Attenuated Total Reflectance Fourier Transform InfraRed spectroscopy (ATR/FTIR), Scanning Electron Microscopy (SEM), high resolution stylus profilometry, and Time of Flight Secondary Ion Mass Spectrometry (ToF-SIMS). Our findings are consistent with radiation-induced modifications of silicone that, although not detectable at the microscale, can be evidenced by more sophisticated nanoscale surface analyses. In light of these results, biomaterial irradiation cannot be ruled out as one of the possible co-factors underlying capsular contracture. - Highlights: • The debate continues whether to perform breast reconstruction before or after PMRT. • Radiation therapy may alter implant material, concurring to capsular contracture. • In this work, irradiated implants were investigated by a multi-technique approach. • Radiation-induced alterations could be evidenced by ATR/FTIR and ToF-SIMS. • Reported alteration might represent a co-factor underlying capsular contracture.

  9. The role of angiogenesis, inflammation and estrogen receptors in breast implant capsules development and remodeling.

    Science.gov (United States)

    Segreto, Francesco; Carotti, Simone; Marangi, Giovanni Francesco; Tosi, Daniele; Zingariello, Maria; Pendolino, Alfonso Luca; Sancillo, Laura; Morini, Sergio; Persichetti, Paolo

    2017-12-13

    Capsular contracture is the most common complication following breast implant placement. The multiple factors unbalancing the physiological response to the foreign body have not been fully elucidated. The aim of this study was to investigate the role of neo-angiogenesis, inflammation and estrogen receptors in peri-prosthetic tissue development and remodeling. The study enrolled 31 women who underwent expander substitution with definitive implant. Specimens were stained with hematoxylin/eosin, Masson trichrome, immunohistochemistry and immunofluorescence for alpha-smooth muscle actin, estrogen receptor-α (ER-α), estrogen receptor-β (ER-β), Collagen type I and III, CD31 (as a marker of neo-angiogenesis) and vascular endothelial growth factor (VEGF). Inflammatory infiltration was quantified and analyzed. Transmission electron microscopy was performed for ultrastructural evaluation. Myofibroblasts, mainly localized in the middle layer of capsular tissue, expressed VEGF, ER-α and ER-β. ER-β expression positively correlated with Collagen type I deposition (p= 0.025). Neo-angiogenesis was predominant in the middle layer. CD31 expression positively correlated with Collagen type I expression (p=0.009) and inflammatory infiltration grade (p= 0.004). The degree of inflammatory infiltration negatively correlated with the time from implantation (p = 0.022). The middle layer is key in the development and remodeling of capsular tissue. Myofibroblasts produce VEGF, that induces neo-angiogenesis. New vessels formation is also correlated to the inflammatory response. Collagen deposition is associated with ER-β expression and neo-angiogenesis. These findings may prelude to targeted pharmacologic therapies able to control such interactions, thus hampering the self-sustaining loop promoting the progression of physiologic fibrosis toward pathologic contracture. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier

  10. Expander/implant breast reconstruction before radiotherapy. Outcomes in a single-institute cohort

    Energy Technology Data Exchange (ETDEWEB)

    Aristei, C.; Palumbo, I. [Perugia Univ. (Italy). Radiation Oncology Section; Santa Maria della Misericordia Hospital, Perugia (Italy); Falcinelli, L.; Petitto, R.P.; Perrucci, E. [Santa Maria della Misericordia Hospital, Perugia (Italy). Radiation Oncology Div.; Bini, V. [Perugia Univ. (Italy). Dept. of Internal Medicine; Farneti, A. [Perugia Univ. (Italy). Radiation Oncology Section; Gori, S. [Santa Maria della Misericordia Hospital, Perugia (Italy). Medical Oncology Div.

    2012-12-15

    Background and purpose: Radiotherapy (RT) of reconstructed breasts was associated with major complications and poor cosmetic outcome. The present study assessed complication rates, the link between risk factors and prosthesis removal, as well as cosmetic outcomes. Patients and methods: From 1997 to 2009, 101 consecutive patients received RT after breast reconstruction because of risk factors for relapse (92) or because relapse had occurred (9). At RT, 90 patients had temporary tissue expanders and 11 had permanent implants. Twelve patients underwent neo-adjuvant chemotherapy; all patients received adjuvant chemo- and/or hormone therapy. Results: At a median follow-up of 50 months, late toxicities occurred in 28 patients: pain in 7, lymphedema in 6, G1 cutaneous toxicity in 5, and subcutaneous toxicity in 19 (2G1, 9G2, 7G3, 1G4), with more than one side effect in 12. In 8 patients the prosthesis ruptured (3), was displaced (3), was displaced and ruptured (1), or lost shape (1). Capsular contracture was classified in 89 patients as IA in 14, IB in 47, II in 10, III in 11, and IV in 7. Twelve prostheses (11.9%) were removed. The only significant factor for prosthesis removal was age (p = 0.007). Judgments of cosmetic results were available from 81 physicians and 84 patients. Outcome was excellent/good in 58/81 physician judgments and in 57/84 patient evaluations. Overall inter-rater agreement on outcome was good ({kappa}-value 0.64; 95% CI: 0.48-0.79). Conclusion: RT to reconstructed breasts was associated with low rates of late toxicity and prosthesis removal. Cosmetic outcomes were, on the whole, good to excellent. (orig.)

  11. Comparison of Outcomes with Tissue Expander, Immediate Implant, and Autologous Breast Reconstruction in Greater Than 1000 Nipple-Sparing Mastectomies.

    Science.gov (United States)

    Frey, Jordan D; Choi, Mihye; Salibian, Ara A; Karp, Nolan S

    2017-06-01

    Nipple-sparing mastectomy permits complete preservation of the nipple-areola complex with excellent aesthetic results and with oncologic safety similar to that associated with traditional mastectomy techniques. However, outcomes have not been directly compared for tissue expander-, immediate implant-, and autologous tissue-based breast reconstruction after nipple-sparing mastectomy. All patients undergoing nipple-sparing mastectomy from 2006 to June of 2016 were identified at a single institution. Demographics and outcomes were analyzed and compared among different types of breast reconstruction. A total of 1028 nipple-sparing mastectomies were performed. Of these, 533 (51.8 percent) were tissue expander-based, 263 (25.6 percent) were autologous tissue-based, and 232 (22.6 percent) were immediate implant-based reconstructions. Tissue expander-based reconstructions had significantly more minor cellulitis (p = 0.0002) but less complete nipple necrosis (p = 0.0126) and major mastectomy flap necrosis (p < 0.0001) compared with autologous tissue-based reconstructions. Compared to immediate implant-based reconstruction, tissue expander-based reconstructions had significantly more minor cellulitis (p = 0.0006) but less complete nipple necrosis (p = 0.0005) and major (p < 0.0001) and minor (p = 0.0028) mastectomy flap necrosis (p = 0.0059). Immediate implant-based reconstructions had significantly more minor cellulitis (p = 0.0051), minor mastectomy flap necrosis (p = 0.0425), and partial nipple necrosis (p = 0.0437) compared with autologous tissue-based reconstructions. Outcomes were otherwise equivalent among the three groups. Tissue expander, immediate implant, and autologous tissue breast reconstruction techniques may all be safely offered with nipple-sparing mastectomy. However, reconstructive complications appear to be greater with immediate implant- and autologous tissue-based techniques compared with tissue expander-based reconstruction. Therapeutic, III.

  12. Giant desmoid tumour of the thorax following latissimus dorsi and implant breast reconstruction: case report and review of the literature

    LENUS (Irish Health Repository)

    Collins, AM

    2017-03-01

    The case of a giant thoracic desmoid tumour in a 44-year-old woman, who presented two years following a breast reconstruction with a latissimus dorsi (LD) flap and implant, is reported. Clinical findings included a rapidly growing, painless mass. Computed tomography (CT) suggested skin and intercostal soft tissue invasion. The tumour was resected en bloc with the LD muscle, implant capsule and underlying rib segments. The resultant thoracic and abdominal wall defects were reconstructed with Dualmesh® and polypropylene meshes respectively. There was no evidence of recurrence at thirty-six months follow-up.

  13. RE: Prosthetic Breast Implant Rupture: Imaging-Pictorial Essay : Full Cooperation Between Surgeon and Radiologist: "The Best of Both Worlds".

    Science.gov (United States)

    Marcasciano, M; Conversi, A; Kaciulyte, J; Dessy, L A

    2017-12-01

    Cooperation between plastic surgeons and radiologists is fundamental when breast prosthesis rupture is suspected. We describe our experience managing the case of suspected implant rupture in a patient that underwent CT scan imaging for thoracic pain. Poor clinical information given to radiologists leads to wrong diagnosis: during surgery, both prostheses were checked revealing no signs of rupture. Full communication among different specialists involved in the multidisciplinary approach is always recommended, and an easy-to-use national breast implant register would allow a better management of patients' follow-up and eventual preoperative planning. Level of evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  14. Intraoperative instillation of ropivacaine during the placement of sub-muscular cosmetic breast implants: Is there a clinical benefit?

    Science.gov (United States)

    Picard, F; Niddam, J; De Runz, A; Chaouat, M; Mimoun, M; Boccara, D

    2017-10-09

    The sub-muscular placement of cosmetic breast implants leads to substantial pain due to the muscular distention. The aim of this study was to assess the efficiency of intraoperative ropivacaine instillation to reduce postoperative pain the day after surgery. We conducted a prospective, controlled, single-blinded study comparing the intraoperative instillation of 7.5mg of ropivacaine through Redon drains with the standard procedure in 72 patients undergoing sub-muscular cosmetic breast augmentation for the first time. Pain at the awakening on postoperative day 1 was 4.8 on a simple numeric pain scale in the treatment group and 5.1 in the control group (P>0.05). On postoperative day 3, pain at awakening was 3.7 in both groups (P>0.05), and on postoperative day 5, pain was 2.8 in the treatment group and 2.7 in the control group (P>0.05). Local instillation of ropivacaine in the implant pocket during surgery did not decrease postoperative pain on day 1, day 3 and day 5. From now on, we are able to tell to patients that the postoperative pain after sub-muscular cosmetic breast implants surgery is about 5/10 on postoperative day 1, 4/10 at day 3 and 3/10 at day 5. Level II. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  15. Axillary Lymphadenopathy: An Outstanding Presentation for Breast Implant-Associated ALK-Negative Anaplastic Large Cell Lymphoma.

    Science.gov (United States)

    Tardío, Juan C; Granados, Rosario

    2015-08-01

    Till date, there is only one reported case of breast implant-associated ALK-negative anaplastic large cell lymphoma (ALCL) with an axillary presentation that followed an aggressive behavior. We report the case of a 50-year-old female presenting with an axillary lymphadenopathy 8 years after breast prostheses implantation. Clinical examination, ultrasound, and magnetic resonance imaging detected no mammary lesions. The lymph node showed intrasinusoidal infiltration by large pleomorphic cells expressing CD30 and lacking ALK-immunoreactivity. Tumor staging was negative. Cells with identical features were found in the ipsilateral periprosthetic capsule. The patient was treated with CHOP and radiotherapy, and she is alive without evidence of disease after a 30-month follow-up. The diagnosis of an ALK-negative ALCL in an axillary lymph node of a patient with ipsilateral breast prosthesis and negative staging should prompt removal of the implant with capsulectomy, since the pathological study of this specimen allows the correct diagnosis with important prognostic implications. © The Author(s) 2015.

  16. Prophylactic Nipple-Sparing Mastectomy and Direct-to-Implant Reconstruction of the Large and Ptotic Breast

    DEFF Research Database (Denmark)

    Gunnarsson, Gudjon L; Bille, Camilla; Reitsma, Laurens C

    2017-01-01

    BACKGROUND: Nipple-sparing mastectomy with simultaneous hammock technique direct-to-implant reconstruction is increasingly offered to patients opting for risk-reducing mastectomy. Despite this promising method, patients with macromastia and ptotic breasts remain a challenging group to treat...... satisfactorily and more often end up undergoing a difficult corrective procedure and experience an unacceptably high rate of failed reconstruction. The authors examined whether targeted preshaping mastopexy/reduction could prepare these patients for a successful nipple-sparing mastectomy....../direct-to-implant reconstruction. METHODS: Patients seeking risk-reducing nipple-sparing mastectomy/direct-to-implant reconstruction at the authors' institutions deemed unfit for a one-stage procedure based on their previous experience were offered a targeted two-stage, risk-reducing mastopexy/reduction followed by a delayed...

  17. Cyclic volatile methylsiloxanes in human blood as markers for ruptured silicone gel-filled breast implants.

    Science.gov (United States)

    Rosendahl, Pia; Hippler, Joerg; Schmitz, Oliver J; Hoffmann, Oliver; Rusch, Peter

    2016-05-01

    The replacement of medical-grade silicone with industrial-grade silicone material in some silicone gel-filled breast implants (SBI) manufactured by Poly Implant Prothèse and Rofil Medical Nederland B.V., reported in 2010, which resulted in a higher rupture tendency of these SBI, demonstrates the need for non-invasive, sensitive monitoring and screening methods. Therefore a sensitive method based on large volume injection-gas chromatography coupled to mass spectrometry (LVI-GC/MS) was developed to determine octamethylcyclotetrasiloxane (D4), decamethylcyclopentasiloxane (D5), and dodecamethylcyclo-hexasiloxane (D6) in blood samples from women with intact (n = 13) and ruptured SBI (n = 11). With dichloromethane extraction, sample cooling during preparation, and analysis extraction efficiencies up to 100 % and limits of detection of 0.03-0.05 ng D4-D6/g blood were achieved. Blood samples from women with SBI were investigated. In contrast to women with intact SBI, in blood from women with ruptured SBI higher D4 and D6 concentrations up to 0.57 ng D4/g blood and 0.16 ng D6/g blood were detected. With concentrations above 0.18 D4 ng/blood and 0.10 ng D6/g blood as significant criteria for ruptured SBI, this developed analytical preoperative diagnostic method shows a significant increase of the recognition rate. Finally a higher precision (error rate 17%) than the commonly used clinical diagnostic method, mamma sonography (error rate 46%), was achieved.

  18. Incorporating three-dimensional ultrasound into permanent breast seed implant brachytherapy treatment planning.

    Science.gov (United States)

    Morton, Daniel; Batchelar, Deidre; Hilts, Michelle; Berrang, Tanya; Crook, Juanita

    Planning permanent breast seed implant (PBSI) brachytherapy using CT alone may reduce treatment accuracy because of differences in seroma visualization compared with ultrasound (US). This study evaluates dosimetric effects of seroma delineation in PBSI and the potential impact of incorporating three-dimensional (3D) US into PBSI treatment planning. Spatially coregistered CT and 3D US images from 10 patients were retrospectively analyzed to simulate the PBSI procedure. Seromas contoured on CT and US defined clinical target volumes, CTVCT and CTVUS, which were expanded to create planning target volumes (PTVs). PBSI plans were generated using PTVCT alone, and the resulting coverage to PTVUS was evaluated. To assess the potential impact of transferring to an US-guided procedure, the CT-based plans were centered on CTVUS. The volume encompassed by both PTVs was used to evaluate how 3D US can affect the planning procedure. Median (range) PTVCTV100 was 95.6% (93.3-97.3%), resulting in PTVUS coverage of 91.5% (80.5-97.9%). Centering plans on CTVUS decreased PTVCTV100 by a mean of 10 ± 8%, and increased PTVUSV100 by 5 ± 4%. The combined PTVs were a mean 9±6% larger than PTVCT. Acceptable dosimetry to the combined PTVs resulted in sufficient coverage to individual PTVs but with a mean 11 ± 24% increase to skin dose and 6 ± 8% increase in breast V200. Differences in seroma visualization have dosimetric effects in PBSI. CT-based plans can underdose US-defined volumes and may not adequately translate to an US-guided procedure. Implementing 3D US into planning can potentially compensate for differences in delineation. Copyright © 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  19. Clinical Significance of Accounting for Tissue Heterogeneity in Permanent Breast Seed Implant Brachytherapy Planning.

    Science.gov (United States)

    Mashouf, Shahram; Fleury, Emmanuelle; Lai, Priscilla; Merino, Tomas; Lechtman, Eli; Kiss, Alex; McCann, Claire; Pignol, Jean-Philippe

    2016-03-15

    The inhomogeneity correction factor (ICF) method provides heterogeneity correction for the fast calculation TG43 formalism in seed brachytherapy. This study compared ICF-corrected plans to their standard TG43 counterparts, looking at their capacity to assess inadequate coverage and/or risk of any skin toxicities for patients who received permanent breast seed implant (PBSI). Two-month postimplant computed tomography scans and plans of 140 PBSI patients were used to calculate dose distributions by using the TG43 and the ICF methods. Multiple dose-volume histogram (DVH) parameters of clinical target volume (CTV) and skin were extracted and compared for both ICF and TG43 dose distributions. Short-term (desquamation and erythema) and long-term (telangiectasia) skin toxicity data were available on 125 and 110 of the patients, respectively, at the time of the study. The predictive value of each DVH parameter of skin was evaluated using the area under the receiver operating characteristic (ROC) curve for each toxicity endpoint. Dose-volume histogram parameters of CTV, calculated using the ICF method, showed an overall decrease compared to TG43, whereas those of skin showed an increase, confirming previously reported findings of the impact of heterogeneity with low-energy sources. The ICF methodology enabled us to distinguish patients for whom the CTV V100 and V90 are up to 19% lower compared to TG43, which could present a risk of recurrence not detected when heterogeneity are not accounted for. The ICF method also led to an increase in the prediction of desquamation, erythema, and telangiectasia for 91% of skin DVH parameters studied. The ICF methodology has the advantage of distinguishing any inadequate dose coverage of CTV due to breast heterogeneity, which can be missed by TG43. Use of ICF correction also led to an increase in prediction accuracy of skin toxicities in most cases. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Is the shear wave sonographic elastography correlated with pain after breast augmentation with silicone implants an indication of inflammatory activity? A preliminary report

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    Paweł Rzymski

    2011-12-01

    Full Text Available Introduction: Formation of a capsule is a natural inflammatory response to a foreign body such as a breast implant.Breast capsular contracture is the most severe complication of implant surgery. Aim: To evaluate breast tissues and the periprosthetic reaction with sonoelastography. Material and methods: Nineteen patients aged 20-41 underwent breast augmentation with silicone-filled implants.Their 38 breasts were evaluated before surgery, and 7 and 14 days after surgery. Whole breast stiffness was measuredby applanation tonometry. Patients underwent shear wave elastography and Young’s moduli of breast tissues and theperiprosthetic capsule were estimated. During surgery patients underwent standard anaesthesia and were releasedhome 2 days later after removal of drainage. Each day, patients completed the pain visual analogue scale questionnaireseparately for left and right breasts. Results: Applanation tonometry did not correlate with any parameter. In shear wave elastography we observed statisticallysignificant changes in elasticity of all breast tissues with the highest values on day 7 after surgery and decreasingon day 14. The correlations between pain and capsule elasticity in lower quadrants measured were significantbetween days 4 and 10, whereas correlations of pain with applanation tonometry were insignificant. Glandular tissueelasticity in lower quadrants did not correlate with pain, whereas in upper quadrants there was a significant correlationon days 6-10. Fatty tissue, muscle and thoracic fascia elasticity did not correlate with breast pain. Breast implantvolume correlated with pain only shortly after surgery, but did not correlate with any sonoelastographic parameters. Conclusions: Breast pain correlates strongly with periprosthetic stiffness in elastography 4 to 10 days after breast augmentation,suggesting the possible role of an inflammatory reaction.

  1. Staphylococcus aureus and Staphylococcus epidermidis Virulence Strains as Causative Agents of Persistent Infections in Breast Implants.

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    Daniela Chessa

    Full Text Available Staphylococcus epidermidis and Staphylococcus aureus are currently considered two of the most important pathogens in nosocomial infections associated with catheters and other medical implants and are also the main contaminants of medical instruments. However because these species of Staphylococcus are part of the normal bacterial flora of human skin and mucosal surfaces, it is difficult to discern when a microbial isolate is the cause of infection or is detected on samples as a consequence of contamination. Rapid identification of invasive strains of Staphylococcus infections is crucial for correctly diagnosing and treating infections. The aim of the present study was to identify specific genes to distinguish between invasive and contaminating S. epidermidis and S. aureus strains isolated on medical devices; the majority of our samples were collected from breast prostheses. As a first step, we compared the adhesion ability of these samples with their efficacy in forming biofilms; second, we explored whether it is possible to determine if isolated pathogens were more virulent compared with international controls. In addition, this work may provide additional information on these pathogens, which are traditionally considered harmful bacteria in humans, and may increase our knowledge of virulence factors for these types of infections.

  2. Evaluation of the rupture of silicone breast implants by mammography, ultrasonography and magnetic resonance imaging in asymptomatic patients: correlation with surgical findings

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    Anabel Medeiros Scaranelo

    Full Text Available CONTEXT: Different imaging methods can identify the integrity of breast implants and also the extent of possible silicone leakage. Mammography, ultrasonography and magnetic resonance imaging are often used to evaluate the integrity of breast implants, usually in patients that are symptomatic for rupture. A group of clinically asymptomatic patients was taken as a sample. These patients wanted to remove or change their breast implants for psychological or cosmetic reasons. OBJECTIVE: The purpose of this study was to compare the efficacy of mammography, sonography and magnetic resonance imaging in the detection of breast implant rupture in an asymptomatic population. TYPE OF STUDY: Prospective study. SETTING: Department of Diagnostic Imaging, Universidade de São Paulo, São Paulo, Brazil. METHODS: The participants were 44 asymptomatic patients who subsequently had implants surgically removed. Eighty-three implants were evaluated by both film-screen mammography and high-resolution sonography and 77 implants were evaluated by magnetic resonance imaging. The sensitivity and specificity of mammography, ultrasonography and magnetic resonance imaging were assessed using predetermined diagnostic criteria for implant rupture. All radiological signs were discussed and false positives and false negatives were retrospectively evaluated to identify the pitfalls in the investigations. RESULTS: The respective sensitivity and specificity of mammography were 20% and 89%; sonography, 30% and 81%; and magnetic resonance imaging, 64% and 77%. The differences between patients with breast implants for cosmetic and oncological reasons were discussed. CONCLUSIONS: Our experience suggests that magnetic resonance imaging seems to be the best imaging method on its own for the evaluation of rupturing among asymptomatic patients.

  3. Soft, Brown Rupture: Clinical Signs and Symptoms Associated with Ruptured PIP Breast Implants

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    Yvette Godwin, FRCS

    2014-11-01

    Conclusions: Preoperative signs can be predictive of PIP implant failure. Brown-stained implants are more prone to rupture. The presence of iodine in the gel suggests unacceptable permeability of the shell early in the implant’s life span. A noninvasive screening test to detect brown implants in situ could help identify implants at risk of failure in those who elect to keep their implants.

  4. The iBRA (implant breast reconstruction evaluation) study: protocol for a prospective multi-centre cohort study to inform the feasibility, design and conduct of a pragmatic randomised clinical trial comparing new techniques of implant-based breast reconstruction.

    Science.gov (United States)

    Potter, Shelley; Conroy, Elizabeth J; Williamson, Paula R; Thrush, Steven; Whisker, Lisa J; Skillman, Joanna M; Barnes, Nicola L P; Cutress, Ramsey I; Teasdale, Elizabeth M; Mills, Nicola; Mylvaganam, Senthurun; Branford, Olivier A; McEvoy, Katherina; Jain, Abhilash; Gardiner, Matthew D; Blazeby, Jane M; Holcombe, Christopher

    2016-01-01

    Implant-based breast reconstruction (IBBR) is the most commonly performed reconstructive procedure in the UK. The introduction of techniques to augment the subpectoral pocket has revolutionised the procedure, but there is a lack of high-quality outcome data to describe the safety or effectiveness of these techniques. Randomised controlled trials (RCTs) are the best way of comparing treatments, but surgical RCTs are challenging. The iBRA (implant breast reconstruction evaluation) study aims to determine the feasibility, design and conduct of a pragmatic RCT to examine the effectiveness of approaches to IBBR. The iBRA study is a trainee-led research collaborative project with four phases:Phase 1 - a national practice questionnaire (NPQ) to survey current practicePhase 2 - a multi-centre prospective cohort study of patients undergoing IBBR to evaluate the clinical and patient-reported outcomesPhase 3- an IBBR-RCT acceptability survey and qualitative work to explore patients' and surgeons' views of proposed trial designs and candidate outcomes.Phase 4 - phases 1 to 3 will inform the design and conduct of the future RCT All centres offering IBBR will be encouraged to participate by the breast and plastic surgical professional associations (Association of Breast Surgery and British Association of Plastic Reconstructive and Aesthetic Surgeons). Data collected will inform the feasibility of undertaking an RCT by defining current practice and exploring issues surrounding recruitment, selection of comparator arms, choice of primary outcome, sample size, selection criteria, trial conduct, methods of data collection and feasibility of using the trainee collaborative model to recruit patients and collect data. The preliminary work undertaken within the iBRA study will determine the feasibility, design and conduct of a definitive RCT in IBBR. It will work with the trainee collaborative to build capacity by creating an infrastructure of research-active breast and plastic surgeons

  5. Characteristics of Women Who Have Had Cosmetic Breast Implants That Could Be Associated with Increased Suicide Risk: A Systematic Review, Proposing a Suicide Prevention Model

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    Nikolaos Manoloudakis

    2015-03-01

    Full Text Available Literature indicates an increased risk of suicide among women who have had cosmetic breast implants. An explanatory model for this association has not been established. Some studies conclude that women with cosmetic breast implants demonstrate some characteristics that are associated with increased suicide risk while others support that the breast augmentation protects from suicide. A systematic review including data collection from January 1961 up to February 2014 was conducted. The results were incorporated to pre-existing suicide risk models of the general population. A modified suicide risk model was created for the female cosmetic augmentation mammaplasty candidate. A 2-3 times increased suicide risk among women that undergo cosmetic breast augmentation has been identified. Breast augmentation patients show some characteristics that are associated with increased suicide risk. The majority of women reported high postoperative satisfaction. Recent research indicates that the Autoimmune syndrome induced by adjuvants and fibromyalgia syndrome are associated with silicone implantation. A thorough surgical, medical and psycho-social (psychiatric, family, reproductive, and occupational history should be included in the preoperative assessment of women seeking to undergo cosmetic breast augmentation. Breast augmentation surgery can stimulate a systematic stress response and increase the risk of suicide. Each risk factor of suicide has poor predictive value when considered independently and can result in prediction errors. A clinical management model has been proposed considering the overlapping risk factors of women that undergo cosmetic breast augmentation with suicide.

  6. Characteristics of women who have had cosmetic breast implants that could be associated with increased suicide risk: a systematic review, proposing a suicide prevention model.

    Science.gov (United States)

    Manoloudakis, Nikolaos; Labiris, Georgios; Karakitsou, Nefeli; Kim, Jong B; Sheena, Yezen; Niakas, Dimitrios

    2015-03-01

    Literature indicates an increased risk of suicide among women who have had cosmetic breast implants. An explanatory model for this association has not been established. Some studies conclude that women with cosmetic breast implants demonstrate some characteristics that are associated with increased suicide risk while others support that the breast augmentation protects from suicide. A systematic review including data collection from January 1961 up to February 2014 was conducted. The results were incorporated to pre-existing suicide risk models of the general population. A modified suicide risk model was created for the female cosmetic augmentation mammaplasty candidate. A 2-3 times increased suicide risk among women that undergo cosmetic breast augmentation has been identified. Breast augmentation patients show some characteristics that are associated with increased suicide risk. The majority of women reported high postoperative satisfaction. Recent research indicates that the Autoimmune syndrome induced by adjuvants and fibromyalgia syndrome are associated with silicone implantation. A thorough surgical, medical and psycho-social (psychiatric, family, reproductive, and occupational) history should be included in the preoperative assessment of women seeking to undergo cosmetic breast augmentation. Breast augmentation surgery can stimulate a systematic stress response and increase the risk of suicide. Each risk factor of suicide has poor predictive value when considered independently and can result in prediction errors. A clinical management model has been proposed considering the overlapping risk factors of women that undergo cosmetic breast augmentation with suicide.

  7. The micropolyurethane foam-coated Diagon/Gel4Two implant in aesthetic and reconstructive breast surgery – 3-year results of an ongoing study

    Directory of Open Access Journals (Sweden)

    Brunnert, Klaus E.

    2015-12-01

    Full Text Available Background: Breast implants are worldwide in use since 1962. Initially there were some problems with capsular contracture and the palpability of the rim of the implant. In 1968 this led to the introduction of the micropolyurethane foam-coating and then in 1970 to the first micropolyurethane foam-coated implant by F.A. Ashley. As a result of additional technical refinements in manufacturing this new implant design significantly reduced complications i.e. capsular contracture and implant rotation. Methods: This study reports a single surgeon’s experience with aesthetic and reconstructive breast surgery, in primary and secondary cases with the sole use of micropolyurethane foam-coated Diagon/gel4Two implants, partly in combination with the additional use of synthetic meshes, acellular dermal matrices and lipofilling. The trial is a prospective, single center cohort study designed to demonstrate the safety and effectiveness of the new implant design in primary and secondary aesthetic and reconstructive breast surgery. The reported data provide an interim report of the implantations performed from November 2010 to December 2013.Results: 90 patients were admitted to the study with 152 implants. The majority of the implants (n=95, 62.5% were used in reoperative cases for either oncological (n=52, 34.2% or aesthetic reasons (n=43, 28.3%. The median age of the study cohort was 45 years; the median body mass index was 21; the median observation time is 41 months. There was a very low complication rate, both short term within 6 weeks after the implantation of the silicone gel implant and in the follow up in November 2015. There were no serious complications needing explantation, no capsular fibrosis or implant rotation or rupture so far. There were only 4 minor complications (1.97%. There was 1 local recurrence 4 years after skin and nipple sparing mastectomy.Conclusion: The micropolyurethane foam-coated Diagon/gel4Two implant is a very reliable silicone

  8. Management of Implant Exposure in One-Stage Breast Reconstruction Using Titanium-Coated Polypropylene Mesh: Sub-Mammary Intercostal Perforator Flap.

    Science.gov (United States)

    De Riggi, Michele Antonio; Rocco, Nicola; Gherardini, Giulio; Esposito, Emanuela; D'Aiuto, Massimiliano

    2016-12-01

    One-stage implant-based breast reconstruction using titanium-coated polypropylene mesh is a novel approach widely used in Europe. Complication rates in breast reconstruction with the use of titanium-coated meshes seem to be comparable to those in patients with implant-based breast reconstruction alone. However, the use of synthetic meshes in implant-based breast reconstructive surgery leads to new clinical scenarios with the need for the breast surgeon to face new complications. We present an innovative treatment of implant exposure in the absence of infection in patients who underwent nipple-sparing mastectomy and immediate breast reconstruction with silicone implants and titanium-coated polypropylene mesh by using a pedicled sub-mammary intercostal perforator flap. Four patients who experienced implant exposure without infection have been treated with the use of a sub-mammary intercostal perforator flap. Whole coverage of the exposed implant/mesh with a sub-mammary intercostal perforator flap was obtained in all cases. No post-operative complications have been observed, whereas a pleasant aesthetic result has been achieved. Patients' post-operative quality of life and satisfaction levels were measured by the European Organisation for Research and Treatment of Cancer breast cancer-specific quality of life QLQ-BR23 questionnaire and showed an average good satisfaction with the post-operative outcomes (mean QLQ-BR23 score 1.9). For the first time, a sub-mammary intercostal perforator flap has been used with the aim of treating implant exposures without removing the prosthesis even in the presence of synthetic meshes, when wound infection was excluded. Although tested on a small series, the sub-mammary intercostal perforator flap might represent a simple, versatile and cost-effective procedure for the management of implant exposure following nipple-sparing mastectomy and immediate reconstruction with silicone implants and synthetic meshes. It should be considered to

  9. The evolution of FDA policy on silicone breast implants: a case study of politics, bureaucracy, and business in the process of decision-making.

    Science.gov (United States)

    Palley, H A

    1995-01-01

    The central issue facing federal regulation of breast implants is that while such devices are not functionally necessary or needed for survival, the side effects may be harmful and have not been proven unharmful. The Medical Device Amendments of 1976 appear to require such evidence prior to the FDA permitting the unrestricted marketing of these devices. However, only recently have such requirements been imposed by the FDA. The author examines the FDA's decision-making process, particularly as applied to silicone breast implants, and the factors that appears to have affected such decisions. In pursuing this study, the activities of a number of interest-group actors, as well as congressional responses and the role of federal bureaucratic actors, were examined. In 1992, the FDA established a regulatory protocol that effectively withdrew most silicone breast implants from the market for the purpose of breast augmentation and allows for the monitoring of the impact of new implants on women's health. This increase concern for determining the safety of breast implants is due to a number of factors, which are examined in this article.

  10. Silicon and matrix macromolecules: new research opportunities for old diseases from analysis of potential mechanisms of breast implant toxicity.

    Science.gov (United States)

    Brawer, A E

    1998-07-01

    An understanding of the normal and essential integration of the element silicon in biosystems, as well as knowledge of its fundamental chemistry, are crucial to understanding its role in health and disease. Modern organosilicon chemistry, based in part on the artificial silicon-carbon bond, coincided with the emergence of the biomaterials and bioengineering fields fifty years ago, and was thought to be a fortunate coincidence according to conventional wisdom that high-molecular-weight polymeric siloxanes were chemically and biologically inert. These concepts have been challenged by reports of silicone migration and degradation following insertion of gel-filled breast implants, claims of a novel systemic illness appearing in many breast implant recipients, and investigations implicating varied and permeating immunotoxic mechanisms of disease causation by breast devices. The present study develops additional potential pathogenetic ideas based on alterations of cell biochemistry by silicon-containing compounds, and offers correlation of the patients' diverse clinical features with plausable disruption of basic biological processes. This in turn raises new questions concerning everyday environmental exposure, has broad implications for multiple other diseases, can provide alternative directions for future investigative research, and may contribute to the ongoing redefinition of immune dysfunction and inflammation.

  11. Evaluation of the perceptions and cosmetic satisfaction of breast cancer patients undergoing totally implantable vascular access device (TIVAD) placement.

    Science.gov (United States)

    Liberale, Gabriel; El Houkayem, Michel; Viste, Claire; Bouazza, Fikri; Moreau, Michel; El Nakadi, Issam; Veys, Isabelle

    2016-12-01

    Totally implantable vascular access devices (TIVADs) are widely used to administer chemotherapy to cancer patients. While great progress has been made with respect to breast surgical reconstruction to take into account both aesthetics and patients' perceptions of body integrity, these aspects have not been considered with regard to the impact of TIVAD. In order to address this practice gap, we have adapted our TIVAD implantation technique to improve cosmetic results. The aim of this study was to assess breast cancer patients' comfort level and aesthetic satisfaction with regard to TIVAD insertion. Patients with breast cancer admitted for chemotherapy at an outpatient clinic completed a previously validated survey evaluating three main domains: symptoms (pain, discomfort) related to the TIVAD itself in daily activity, information received before and during the surgical procedure, and cosmetic aspects regarding the port insertion site (scar, port, and catheter location). Between September 2010 and June 2011, 232 patients were evaluated. Cosmetic satisfaction with scar location was high (93.3 %). Information given to patients before and during the procedure had a major impact on both symptom perception in daily activity and on cosmetic satisfaction. Obtaining a more aesthetic scar by placing the TIVAD in the deltopectoral groove contributed to a high rate of cosmetic satisfaction. Furthermore, the relevance of information given to patients before and/or during surgery had a major impact on symptom perception. Therefore, we suggest including a pre-operative information session in the care pathway.

  12. Protocol for a systematic review and meta-analysis on the clinical outcomes and cost of deep inferior epigastric perforator (DIEP flap versus implants for breast reconstruction

    Directory of Open Access Journals (Sweden)

    Ankur Khajuria

    2017-11-01

    Full Text Available Abstract Background Mastectomy in the context of breast malignancy can have a profoundly negative impact on a woman’s self-image, impairing personal, sexual and social relationships. The deep inferior epigastric perforator (DIEP flap and implants are the two commonest reconstructive modalities that can potentially overcome this psychological trauma. The comparative data on clinical outcomes and costs of the two modalities is limited. We aim to synthesise the current evidence on DIEP versus implants to establish which is the superior technique for breast reconstruction, in terms of clinical outcomes and cost-effectiveness. Methods A comprehensive search will be undertaken of EMBASE, MEDLINE, Google Scholar, CENTRAL and Science citation index databases (1994 up to August 2017 to identify studies relevant for the review. Primary human studies evaluating clinical outcomes and cost of DIEP and implant-based reconstruction in context of breast malignancy will be included. Primary outcomes will be patient satisfaction and cosmetic outcome from patient-reported outcome measures (scores from validated tools, e.g. BREAST-Q tool, complications and cost-analysis. The secondary outcomes will be duration of surgery, number of surgical revisions, length of stay, availability of procedures and total number of clinic visits. Discussion This will be the first systematic review and meta-analysis in available literature comparing the clinical outcomes and cost-effectiveness of DIEP and implants for breast reconstruction. This review is expected to guide worldwide clinical practice for breast reconstruction. Systematic review registration PROSPERO CRD42017072557 .

  13. Stiffness, compliance, resilience, and creep deformation: understanding implant-soft tissue dynamics in the augmented breast: fundamentals based on materials science.

    Science.gov (United States)

    Vegas, Manuel R; Martin del Yerro, Jose L

    2013-10-01

    Postoperative tissue stretch deformities are among the possible complications in breast augmentation. These deformities are responsible for many potential risks such as bottoming-out deformity, breakdown of the inframammary fold, permanent tissue atrophy, sensory loss, and breast distortion (visible implant edges and traction rippling), among others. Although the elastic properties of the breast are a major concern for plastic surgeons, concepts such as stiffness, compliance, elasticity, and resilience have not been sufficiently defined or explored in the plastic surgery literature. Similar to any other material, living tissues are subject to the fundamentals of the mechanics of materials. Based on their experience with more than 5,000 breast augmentations, the authors explored the basic fundamentals of the mechanics of materials in search of a rational explanation for long-term results in breast augmentation and augmentation-mastopexy. A basic law of the mechanics of materials determines that when a material (e.g., breast) is loaded with a force (e.g., implant), it produces a stress that causes the material to deform (e.g., breast augmentation), and this behavior might be graphed in a theoretical material's stress-stress curve. This deformation will increase with time although the load (implant) remains constant, a concept termed "creep deformation." Because the breast, like all human tissues, is a viscoelastic material, the application of concepts such as elastic and plastic deformation, stiffness, compliance, resilience, and creep deformation can and should be applied to breast augmentation surgery. The authors have found that the principles of the mechanics of materials can provide plastic surgeons with some clues for a predictable, long-lasting good result in breast augmentation and augmentation-mastopexy. Future studies are needed to develop these concepts and evaluate how they might individually determine the mid- and long-term outcomes of augmented breasts.

  14. Evaluation of dental implants as a risk factor for the development of bisphosphonate-related osteonecrosis of the jaw in breast cancer patients.

    Science.gov (United States)

    Matsuo, Akira; Hamada, Hayato; Takahashi, Hidetoshi; Okamoto, Ayako; Kaise, Hiroshi; Chikazu, Daichi

    2016-09-01

    It remains unclear whether dental implants are a risk factor for the development of bisphosphonate-related osteonecrosis of the jaw (BRONJ). We retrospectively evaluated the status of dental implants in patients given intravenous bisphosphonates (BPs) in a breast cancer cohort to elucidate the risk for BRONJ at the implant site. We established a BRONJ oral monitoring program for 247 breast cancer patients given intravenous BP in our institution. The 3-year cumulative incidence rate was determined. The systemic and local risk factors of 44 patients who completed comprehensive oral examinations were evaluated by logistic regression analysis. The 3-year cumulative incidence rate of the 247 patients was 0.074 % (8/247, 95 % CI 0.0081-0.014). In the 44 orally examined patients, 6 (13.6 %: 6/44) had dental implants. Of these 6 patients, 1 developed BRONJ at the implant site. There were no significant differences in the age, total BP treatment period, number of residual teeth, time of regular oral monitoring, oral hygiene level, or dental implant insertion. Although a case of ONJ was identified, dental implants which were inserted before intravenous BP administration were not a risk factor for the development of ONJ in breast cancer patients.

  15. Combination of chemical suppression techniques for dual suppression of fat and silicone at diffusion-weighted MR imaging in women with breast implants

    Energy Technology Data Exchange (ETDEWEB)

    Koh, Dow-Mu; Hughes, J. [Royal Marsden Hospital, Department of Radiology, Sutton (United Kingdom); Blackledge, M.; Leach, M.O.; Collins, D.J. [Institute of Cancer Research, CR UK-EPSRC Cancer Imaging Centre, Sutton (United Kingdom); Burns, S. [Nuada 3T MRI Centre, London (United Kingdom); Stemmer, A.; Kiefer, B. [Siemens Healthcare, Erlangen (Germany)

    2012-12-15

    Silicone breast prostheses prove technically challenging when performing diffusion-weighted MR imaging in the breasts. We describe a combined fat and chemical suppression scheme to achieve dual suppression of fat and silicone, thereby improving the quality of diffusion-weighted images in women with breast implants. MR imaging was performed at 3.0 and 1.5 T in women with silicone breast implants using short-tau inversion recovery (STIR) fat-suppressed echo-planar (EPI) diffusion-weighted MR imaging (DWI) on its own and combined with the slice-select gradient-reversal (SSGR) technique. Imaging was performed using dedicated breast imaging coils. Complete suppression of the fat and silicone signal was possible at 3.0 T using EPI DWI with STIR and SSGR, evaluated with dedicated breast coils. However, a residual silicone signal was still perceptible at 1.5 T using this combined approach. Nevertheless, a further reduction in silicone signal at 1.5 T could be achieved by employing thinner slice partitions and the addition of the chemical-selective fat-suppression (CHESS) technique. DWI using combined STIR and SSGR chemical suppression techniques is feasible to eliminate or reduce silicone signal from prosthetic breast implants. (orig.)

  16. Breast reconstruction - natural tissue

    Science.gov (United States)

    ... muscle flap; TRAM; Latissimus muscle flap with a breast implant; DIEP flap; DIEAP flap; Gluteal free flap; Transverse upper gracilis flap; TUG; Mastectomy - breast reconstruction with natural tissue; Breast cancer - breast reconstruction ...

  17. Direct-to-Implant Breast Reconstruction without the Use of an Acellular Dermal Matrix Is Cost Effective and Oncologically Safe.

    Science.gov (United States)

    Serrurier, L Charles J; Rayne, Sarah; Venter, Marisse; Benn, Carol-Ann

    2017-04-01

    Direct-to-implant breast reconstruction is a predictable, reliable, and cost-effective reconstruction. Most units performing direct-to-implant reconstructions recommend the use of an acellular dermal matrix or a mesh to reinforce the lower pole of the breast reconstruction. Two hundred seventy-two consecutive patients with 488 immediate direct-to-implant breast reconstructions performed in a 34-month period are included in this group. Mean follow-up of this group is 35 months. Four hundred eight reconstructions were performed through a lazy-S mastectomy, and 80 were performed through a Wise pattern mastectomy. Two local recurrences occurred. Minor complications accounted for 5.5 percent (n = 27): seromas, 3.4 percent (n = 17); wound healing problems, 0.6 percent (n = 3); and grade 2 capsular contracture, 1.4 percent (n = 7). Major complications accounted for 4.3 percent (n = 21): infection, 0.8 percent (n = 4); prosthetic loss, 0.4 percent (n = 2); hematoma, 0.4 percent (n = 2); and wounds requiring débridement, 2 percent (n = 10). The additional cost of acellular dermal matrix is dependent on manufacturer and size, but increases the cost of the procedure by 35.5 to 47.7 percent. This reconstruction method compares very favorably with published data from other units as far as early and late complications and cosmetic outcome are concerned. It has a complication rate similar to that of reconstructions using an acellular dermal matrix and is more cost effective. Therapeutic, IV.

  18. TiLoop® Bra mesh used for immediate breast reconstruction: comparison of retropectoral and subcutaneous implant placement in a prospective single-institution series.

    Science.gov (United States)

    Casella, Donato; Bernini, Marco; Bencini, Lapo; Roselli, Jenny; Lacaria, Maria Teresa; Martellucci, Jacopo; Banfi, Roberto; Calabrese, Claudio; Orzalesi, Lorenzo

    2014-01-01

    Immediate implant reconstruction after a conservative mastectomy is an attractive option made easier by prosthetic devices. Titanized polypropylene meshes are used as a hammock to cover the lower lateral implant pole. We conducted a prospective nonrandomized single-institution study of reconstructions using titanium-coated meshes either in a standard muscular mesh pocket or in a complete subcutaneous approach. The complete subcutaneous approach means to wrap an implant with titanized mesh in order to position the implant subcutaneously and spare muscles. Between November 2011 and January 2014, we performed immediate implant breast reconstructions after conservative mastectomies using TiLoop® Bra, either with the standard retropectoral or with a prepectoral approach. Selection criteria included only women with normal Body Mass Index (BMI), no large and very ptotic breasts, no history of smoking, no diabetes, and no previous radiotherapy. We analyzed short-term outcomes of such procedures and compared the outcomes to evaluate implant losses and surgical complications. A total of 73 mastectomies were performed. Group 1 comprised 29 women, 5 bilateral procedures, 34 reconstructions, using the standard muscular mesh pocket. Group 2 comprised 34 women, 5 bilateral procedures, 39 reconstructions with the prepectoral subcutaneous technique. Baseline and oncologic characteristics were homogeneous between the two groups. After a median follow-up period of 13 and 12 months, respectively, no implant losses were recorded in group 1, and one implant loss was recorded in group 2. We registered three surgical complications in group 1 and two surgical complications in group 2. Titanium-coated polypropylene meshes, as a tool for immediate definitive implant breast reconstruction, resulted as safe and effective in a short-term analysis, both for a retropectoral and a totally subcutaneous implant placement. Long-term results are forthcoming. A strict selection is mandatory to

  19. A nationwide study of connective tissue disease and other rheumatic conditions among Danish women with long-term cosmetic breast implantation

    DEFF Research Database (Denmark)

    Fryzek, Jon P; Holmich, Lisbet; McLaughlin, Joseph K

    2007-01-01

    population-based cohort study of Danish women with cosmetic breast implants (n = 2761) and comparison groups of women with other types of cosmetic surgery (n = 8807). All women were followed from January 1977 through December 2001. Hospitalization and outpatient data for CTD and ill-defined and other...... (standardized rate ratio = 1.5; 95% confidence interval = 1.4 to 1.7) cohorts. In analyses of diagnoses validated by chart review, women with cosmetic breast implants compared with those having other types of plastic surgery or consultation for plastic surgery had no statistically significant excess for any...

  20. A single-centre, retrospective proof-of-concept review of salvage of infected or exposed implant breast reconstructions with explantation and one-stage free flap replacement.

    Science.gov (United States)

    Bramhall, Russell J; Hernan, Izaro; Harris, Paul A

    2017-10-18

    Implant-based breast reconstruction has relatively high complication rates. Removal of infected implants and immediate autologous reconstruction is a safe single-stage procedure that preserves the native breast skin envelope. A single-centre, retrospective proof-of-concept review of all salvage procedures performed for acute/chronic infected or exposed implant-based reconstructions by a single surgeon over a 6-year period. We present 13 cases of a particularly difficult subgroup of acute/chronic infection/extrusion over a 6-year period. All were successfully salvaged in a single procedure by implant removal and immediate free flap reconstruction with no significant complications. All patients had a change of pocket from subpectoral to subcutaneous and partial capsulectomies. Four patients had unilateral DIEP flaps for unilateral reconstruction, 3 bi-pedicle DIEP flaps for unilateral reconstruction, 2 bilateral TUG flaps for unilateral reconstruction, 3 bilateral DIEP flaps for bilateral reconstruction and 1 unilateral DIEP and implant for unilateral reconstruction. These patients are often slim with limited donor sites and pose technical challenges, often requiring double free flap reconstructions. Single-stage implant removal and autologous reconstruction preserves the breast skin envelope to maximise cosmesis in a single procedure. The introduction of healthy, well-vascularised tissue may also help treat the infection. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  1. Direct delayed breast reconstruction with TAP flap, implant and acellular dermal matrix (TAPIA)

    DEFF Research Database (Denmark)

    Børsen-Koch, Mikkel; Gunnarsson, Gudjon L; Udesen, Ann

    2015-01-01

    BACKGROUND: The latissimus dorsi (LD) flap is considered one of the working horses within the field of breast reconstruction and it offers several advantages. However, donor-site morbidity may pose a problem. This article describes a new and modified technique for delayed breast reconstruction co...... there is a learning curve, this simple modified technique does not demand any perforator or other vessel dissection. Any trained plastic surgeon should be able to adopt the technique into the growing armamentarium of breast reconstruction possibilities....

  2. One stage rescue procedure after capsular contracture of breast implants with autologous fat grafts collected by water assisted liposuction (“BEAULI Method”

    Directory of Open Access Journals (Sweden)

    Ueberreiter, Klaus

    2013-01-01

    Full Text Available With increasing number of patients with silicone implants for breast augmentation or reconstruction we are confronted with more and more cases of capsular contracture. Not every case is resolved by resection of the capsule and exchange of implants. Many patients rather bear the consequences of severe fibrosis than to have their implants removed. The one stage procedure of implant removal and lipofilling proved to be highly efficient with good to excellent results and high patient satisfaction. Between January 2008 and October 2012 a total of 64 patients (124 breasts with capsular fibrosis Baker III to IV were treated with autologous fat grafts collected with the body-jet by water-assisted liposuction (“BEAULI Method”. Magnetic resonance imaging (MRI of the breasts was performed in 5 patients preoperatively and 6 month postoperatively, a clinical examination and photo documentation of all patients was done on day 1 and after 4 weeks, 12 weeks and 6 months postoperatively. The procedure included implant removal and lipofilling of the subcutaneous and intramuscular space in a single procedure by means of the BEAULI Method. The average gross amount of grafted fat was 260 ml. The average drainage time was one day. The shape of the breast changed to a more natural and ptotic form. Negative side effects like oily cysts or infections were not observed. The time of the overall procedure including liposuction was 70±15 min. Reoccurring capsular contracture is one of the hazards in plastic surgery. Until now the treatment of choice after more than two failed implant changes combined with resection of the capsule is usually the final removal of implants with or without possible additional autologous tissue transfer (microvascular flaps. We could add a relatively simple and efficient procedure to resolve and improve those cases by autologous fat transfer using water-assisted liposuction and the BEAULI Method.

  3. The non-specific symptoms of breast implant-associated anaplastic large cell lymphoma resulting in delayed diagnosis: A case-based review

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    Reem Dina Jarjis

    2015-12-01

    Full Text Available Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL is a rare entity that has become known as a distinct clinical condition recently. In general, BIA-ALCL patients with a history of breast implants present with non-specific implant-related complications, resulting in delayed diagnosis and appropriate treatment because of the lack of awareness of BIA-ALCL. The cause and pathogenesis have still not been identified, and there are no evidence-based guidelines on how this condition should be detected, treated or followed up because of the rarity of available data. We present the first published Danish case of anaplastic lymphoma kinase negative BIA-ALCL, and review the current literature to raise awareness of and discuss management options for this rare clinical entity.

  4. Breast prothesis leakage and malignant changes of the breast.

    Science.gov (United States)

    Al-Lawati, Taha; Kutty, Rajyashree

    2009-04-01

    A breast implant is a prosthesis used to enhance the size of a woman's breasts. Silicon implants are most commonly used, but as with all surgical implants it has some complications. The question is whether it can induce breast cancer? During the last year, a case of reconstructed breast with prosthesis which leaked was presented. The aim of this report is to review current literature to evaluate whether there are reported correlations between breast cancer and breast implants. The conclusion derived from this report is that there is no available evidence directly correlating breast cancer to breast implants.

  5. Initial clinical experience with the Strut-Adjusted Volume Implant brachytherapy applicator for accelerated partial breast irradiation.

    Science.gov (United States)

    Yashar, Catheryn M; Blair, Sarah; Wallace, Anne; Scanderbeg, Dan

    2009-01-01

    Accelerated partial breast irradiation is becoming increasingly popular. The Cianna single-entry high-dose-rate applicator, Strut-Adjusted Volume Implant (SAVI, Cianna Medical, Aliso Viejo, CA), contains peripheral struts allowing greater planning flexibility for small-breasted women, technically easier insertion, and normal tissue exposure minimization. This study evaluates early clinical experience. Thirty patients treated with the SAVI with a median followup of 12 months were evaluated. The median age was 59.5. Tumor size averaged 0.9cm. Fifteen cancers were ductal carcinoma in situ (50%), 1 was invasive lobular (3.3%), 4 were tubular (6.7%), and the rest infiltrating ductal (40%). Most of them were estrogen receptor (ER) positive (90%). Nine women (30%) were premenopausal. Dosimetry was outstanding with median V90, V150, and V200 of 96.2%, 24.8, and 12.8cc. There were no symptomatic seromas, and one report of asymptomatic fat necrosis seen on mammogram at 1 year. In patients who had skin spacing of less than 1cm, the median skin dose was 245cGy/fraction. The median rib and lung dose per fraction for those patients with either structure less than 1cm was 340 and 255cGy (75% of prescribed dose), respectively. There have been no local recurrences to date. Early clinical experience with the SAVI demonstrates the ease of placement of a single-entry brachytherapy device combined with the increased dose modulation of interstitial brachytherapy. Dose to normal structures has remained exceedingly low. Almost half of evaluated patients were not candidates for other single-entry brachytherapy devices because of skin spacing or breast size, demonstrating an expansion of candidates for single-entry partial breast brachytherapy.

  6. Revisiting Triple Antibiotic Irrigation of Breast Implant Pockets: A Placebo-controlled Single Practice Cohort Study

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    James J. Drinane, BSci

    2013-10-01

    Conclusions: Triple antibiotic breast irrigation is not associated with a significant reduction in the incidence or severity of capsular contracture compared with sterile saline when high-quality surgical technique is used.

  7. Is Single-Stage Prosthetic Reconstruction Cost Effective? A Cost-Utility Analysis for the Use of Direct-to-Implant Breast Reconstruction Relative to Expander-Implant Reconstruction in Postmastectomy Patients.

    Science.gov (United States)

    Krishnan, Naveen M; Fischer, John P; Basta, Marten N; Nahabedian, Maurice Y

    2016-09-01

    Prosthetic breast reconstruction is most commonly performed using the two-stage (expander-implant) technique. However, with the advent of skin-sparing mastectomy and the use of acellular dermal matrices, one-stage prosthetic reconstruction has become more feasible. Prior studies have suggested that one-stage reconstruction has economic advantages relative to two-stage reconstruction despite a higher revision rate. This is the first cost-utility analysis to compare the cost and quality of life of both procedures to guide patient care. A comprehensive literature review was conducted using the MEDLINE, EMBASE, and Cochrane databases to include studies directly comparing matched patient cohorts undergoing single-stage or staged prosthetic reconstruction. Six studies were selected examining 791 direct-to-implant reconstructions and 1142 expander-implant reconstructions. Costs were derived adopting both patient and third-party payer perspectives. Utilities were derived by surveying an expert panel. Probabilities of clinically relevant complications were combined with cost and utility estimates to fit into a decision tree analysis. The overall complication rate was 35 percent for single-stage reconstruction and 34 percent for expander-implant reconstruction. The authors' baseline analysis using Medicare reimbursement revealed a cost decrease of $525.25 and a clinical benefit of 0.89 quality-adjusted life-year when performing single-stage reconstructions, yielding a negative incremental cost-utility ratio. When using national billing, the incremental cost-utility further decreased, indicating that direct-to-implant breast reconstruction was the dominant strategy. Sensitivity analysis confirmed the robustness of the authors' conclusions. Direct-to-implant breast reconstruction is the dominant strategy when used appropriately. Surgeons are encouraged to consider single-stage reconstruction when feasible in properly selected patients.

  8. Nipple-Sparing Mastectomy via an Inframammary Fold Incision with Implant-Based Reconstruction in Patients with Prior Cosmetic Breast Surgery.

    Science.gov (United States)

    Dent, Briar L; Cordeiro, Christina N; Small, Kevin; Clemons, Jessica A; Kessler, Evan G; Swistel, Alexander; Talmor, Mia

    2015-07-01

    Nipple-sparing mastectomy through an inframammary fold incision (NSM-IMF) with implant-based reconstruction (IBR) is a cosmetically preferable approach to breast cancer treatment in appropriate candidates. However, patients who have undergone prior cosmetic breast surgery (CBS) may be at increased risk for postoperative complications secondary to existing surgical scars. To assess whether prior CBS increases the risk of complications following NSM-IMF with IBR. A retrospective chart review was conducted for 398 NSM-IMFs with IBR performed between July 2006 and December 2013. CBS cases were identified. Outcomes were reviewed. Of 398 NSM-IMF cases, 41 had prior CBS: 24 augmentations, 12 reductions, three mastopexies, and two augmentation mastopexies. NSM-IMF was performed an average of 8 years following CBS. CBS cases had lower BMIs (P = .040), more breast tissue resected (P = .021), wider breast bases (P = .0002), more single-stage reconstructions (P Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

  9. [Late results in breast reconstruction by latissimus dorsi flap and prothesis implantation].

    Science.gov (United States)

    Berdah-Benjoar, Y; Masson, J; Revol, M; Servant, J-M

    2009-08-01

    Breast reconstruction by latissimus dorsi myocutaneous flap in combination with prosthesis has been used for 30 years. Short- and medium-term evaluation after this procedure is well described in the literature, but there have been few evaluations of the late course published until now. In our retrospective study, we included 47 patients who had a breast reconstruction according to this technique, with a minimal follow-up of five years and a maximal follow-up of 11 years. We found that one third of the patients complained about the subjective donor-site morbidity of the latissimus dorsi myocutaneous flap and 37% of the patients needed a late reoperation for prosthesis exchange. Evolution of the reconstructed breast is different compared to the healthy side and getting a long-term symmetry seems difficult.

  10. Accelerated Partial Breast Irradiation With Low-Dose-Rate Interstitial Implant Brachytherapy After Wide Local Excision: 12-Year Outcomes From a Prospective Trial

    Energy Technology Data Exchange (ETDEWEB)

    Hattangadi, Jona A. [Harvard Radiation Oncology Program, Boston, MA (United States); Powell, Simon N. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); MacDonald, Shannon M.; Mauceri, Thomas; Ancukiewicz, Marek [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); Freer, Phoebe [Department of Radiology, Massachusetts General Hospital, Boston, MA (United States); Lawenda, Brian [21st Century Oncology, Las Vegas, NV (United States); Alm El-Din, Mohamed A. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Department of Clinical Oncology, Tanta University Hospital, Tanta (Egypt); Gadd, Michele A.; Smith, Barbara L. [Department of Surgical Oncology, Massachusetts General Hospital, Boston, MA (United States); Taghian, Alphonse G., E-mail: ataghian@partners.org [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States)

    2012-07-01

    Purpose: To evaluate the long-term toxicity, cosmesis, and local control of accelerated partial breast irradiation with implant brachytherapy after wide local excision for Stage T1N0 breast cancer (BCa). Materials and Methods: Between 1997 and 2001, 50 patients with Stage T1N0M0 BCa were treated in a Phase I-II protocol using low-dose-rate accelerated partial breast irradiation with implant brachytherapy after wide local excision and lymph node surgery. The total dose was escalated in three groups: 50 Gy (n = 20), 55 Gy (n = 17), and 60 Gy (n = 13). Patient- and physician-assessed breast cosmesis, patient satisfaction, toxicity, mammographic abnormalities, repeat biopsies, and disease status were prospectively evaluated at each visit. Kendall's tau ({tau}{sub {beta}}) and logistic regression analyses were used to correlate outcomes with dose, implant volume, patient age, and systemic therapy. Results: The median follow-up period was 11.2 years (range, 4-14). The patient satisfaction rate was 67%, 67% reported good-excellent cosmesis, and 54% had moderate-severe fibrosis. Higher dose was correlated with worse cosmetic outcome ({tau}{sub {beta}} 0.6, p < .0001), lower patient satisfaction ({tau}{sub {beta}} 0.5, p < .001), and worse fibrosis ({tau}{sub {beta}} 0.4, p = .0024). Of the 50 patients, 35% had fat necrosis and 34% developed telangiectasias {>=}1 cm{sup 2}. Grade 3-4 late skin and subcutaneous toxicities were seen in 4 patients (9%) and 6 patients (13%), respectively, and both correlated with higher dose ({tau}{sub {beta}} 0.3-0.5, p {<=} .01). One patient had Grade 4 skin ulceration and fat necrosis requiring surgery. Mammographic abnormalities were seen in 32% of the patients, and 30% underwent repeat biopsy, of which 73% were benign. Six patients had ipsilateral breast recurrence: five elsewhere in the breast, and one at the implant site. One patient died of metastatic BCa after recurrence. The 12-year actuarial local control, recurrence

  11. Infectious complications in implant based breast surgery and implications for plastic surgeons [Infektiöse Komplikationen bei alloplastischen Brustoperationen und Implikationen für Plastische Chirurgen

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    Horch, Raymund E.

    2013-07-01

    Full Text Available [english] Implantation of breast prosthesis is still one of the most frequently performed breast reconstructing or contouring procedures. Infectious complications and capsular contracture are inherent problems that may have different causes which are not clearly defined yet in terms of pathophysiology. Recent findings showed bacterial contamination as a major cause of implant failure. Since this has direct implications for the surgical management we report on biofilm development on alloplastic breast prostheses, characteristics and effects after implantation of medical devices in general. This article gives a review of the current literature and discusses possible issues to solve the problem of infection after implantation of breast prosthesis. In conclusion the reinsertion of single-use devices should not be recommended and should be strictly avoided when a device related infection has occured. According to current knowledge contaminated implants should be removed, the infection then be cured and if necessary, a new prosthesis may be implanted after a regeneration period. Alternatively a change in therapy towards autologous tissue reconstruction should be considered if previous attempts with alloplastic prostheses have failed and if radiation therapy has worsened the local tissue situation in the recipient area.[german] Implantationen von Brust-Prothesen sind für Brustrekonstruktionen oder Konturierungen noch immer die am häufigsten durchgeführten Verfahren. Typische inhärente Probleme sind dabei neben infektiösen Komplikationen die Kapselkontrakturen, deren unterschiedliche Ursachen bezüglich der Pathophysiologie noch nicht eindeutig geklärt sind.Neuere Erkenntnisse weisen auf bakterielle Kontamination als eine der Hauptursachen von Implantatversagen hin. Da dies direkte Auswirkungen auf die chirurgische Behandlung hat, berichten wir über das Problem der Biofilmentwicklung auf alloplastischen Brustimplantaten sowie über deren Effekte

  12. Effects of Zafirlukast on the Capsular Fibrosis of Silicone Breast Implants

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    Emre Hocaoglu

    2014-06-01

    Methods: Forty-eight adult female Sprague-Dawley rats were divided into four groups. Smooth-surfaced, gel-filled prostheses were implanted in 36 rats. Group A: The day of the operation, 12 animals received Zafirlukast treatment for 14 weeks (oral gavage, once a day, 6 days a week, 4 mg/kg/day; Group B: 10 weeks after the operation, 12 animals received Zafirlukast treatment for 4 weeks; Group C: 12 animals were implanted but did not receive treatment; Group D: 12 animals did not have an operation, but for 14 weeks received oral gavage containing water instead of Zafirlukast. At the end of the 14 weeks, the implants with the surrounding capsules were extracted. Blind macroscopic inspectional evaluation of the capsules was performed, and microscopic capsular thickness measurements were made. Results: The mean capsular thickness was 0.033 mm (SD: 0.011 in Group A, and 0.089 mm (SD: 0.023 and 0.125 mm (SD: 0.025 in Groups B and C, respectively. Differences between Groups A and C and between Groups A and B were significant (p0.05. Similarly, Macroscopic Inspectional Fibrosis Scoring showed a significant difference between Groups A and C and a non-significant difference between Groups B and C. Conclusion: Daily prophylactic oral administration of Zafirlukast immediately after implantation significantly diminishes the development of fibrotic capsules around the silicone prostheses. [Arch Clin Exp Surg 2014; 3(3.000: 139-146

  13. Patient retention and replacement trends after saline breast implants: are deflations inflationary?

    Science.gov (United States)

    Stevens, W Grant; Pacella, Salvatore J; Hirsch, Elliot; Stoker, David A

    2009-01-01

    This study aimed to examine serial operative trends with patients who have experienced surgical implant deflation. In addition, the economic impact of deflation on practice caseload was analyzed. A retrospective review was conducted to examine patients who experienced deflation from 2000 to 2007. Patient demographics, implant data, and the presence of secondary (performed at explantation) or tertiary (performed later) procedures were examined. Financial information was tabulated to determine the economic multiplier effect (i.e. the expected value of revenue from secondary and tertiary procedures divided by explantation cost) of taking on deflation cases in a practice. For this study, 285 patients with an average age of 38.4 years were identified. The average time to explantation was 50 months. Slightly more than half of the patients (55%) had both implants replaced at the time of explantation, whereas 59% switched to silicone implants and 41% continued with saline implants. A larger implant was chosen by 54% of the patients (average increase, 82 ml), whereas 18% underwent secondary procedures at the time of explantation including mastopexy (n = 22), facial rejuvenation (n = 8), liposuction (n = 7), or a combination of the two (n = 8). Tertiary procedures were performed for 31% of the patients after their explantation/reimplantation (average time frame, 13 months). The tertiary procedures included replacement with silicone (33.7%), liposuction (24.7%), abdominoplasty (11.2%), facial rejuvenation (13.5%), or nonsurgical rejuvenation using Botox, Restylane, or laser procedure (33.7%). Economic multiplier analysis showed that the financial impact of revenue derived from implant deflation on downstream practice revenue is 1.02. At the time of explantation, replacement with silicone after saline deflation is common (59% of patients). In this study, patients who chose replacement with saline had a significant tendency to replace with silicone (33%) as a tertiary procedure

  14. Colocación transpectoral superior de implantes mamarios: Relevancia técnica y anatómica Superior transpectoral insertion of breast implants: Anatomical and technical relevance

    Directory of Open Access Journals (Sweden)

    G. Peña Cabús

    2008-12-01

    Full Text Available Los tres planos de colocación de implantes para aumento mamario tienen particularidades claramente identificables. Cada modificación anatómica y los elementos tisulares acompañantes establecen beneficios y efectos adversos que influyen sobre el resultado final. El presente estudio tiene como objetivo la comunicación temprana de los hallazgos clínicos obtenidos con la creación de una cavidad de implantación en diferentes condiciones, utilizando una combinación de planos y haciendo énfasis en un fundamento anatómico y funcional de gran relevancia. El mejor manejo de los implantes mamarios y de otros biomateriales es el mantenimiento de su integridad y el control de su comportamiento a largo plazo. De manera prospectiva valoramos la colocación de implantes mamarios en una cavidad que es subfascial en la porción caudal de la mama y retropectoral en la porción cefálica. El aislamiento de las rutas linfáticas suprafasciales proporciona un menor riesgo de contaminación del implante. La facilidad técnica se produce al no tener que desinsertar inferior y medialmente el músculo pectoral. En los 15 casos estudiados, no se produjo ningún desplazamiento cefálico de los implantes con la contracción pectoral. Hacemos también una revisión de la sustentación anatómica y funcional del nuevo plano de implantación utilizado. El resultado es una suma de beneficios y la prevención de un frecuente efecto adverso, con lo que cumplimos el objetivo final de reducir la morbilidad e incrementar la seguridad del procedimiento.The particular benefits and adverse effects of the three different planes for breast implant placement are widely known. The search for a safer implantation cavity led to a combination of two dissection planes with different anatomical components placed in continuity. Instead of supporting its value with statistics of good outcomes, emphasis is stressed in the functional and anatomical consequences of the proposed plane of

  15. MRI and MRS in patients with silicon implants of the breast; MRT und MRS nach Silikonaufbau der weiblichen Brust

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    Pfleiderer, B.; Heindel, W. [Muenster Univ. (Germany). Radiologische Klinik und Poliklinik

    2001-07-01

    This paper reviews the evaluation of the breast of women by MR-techniques after implantation with silicon gel protheses. The main topics are the diagnosis of implant defects such as extensive ''gel bleed'' and intra- and extracapsular ruptures. Moreover, the MR-detection of siliconomas (encapsulated silicone) and differentiation from malignomas as well as MR-features of chronic foreign body reactions are presented. ''Gel bleed'' is difficult to diagnose unambiguously by MRI alone. The ''linguini'' sign is the only reliable mans to diagnose intracapsular ruptures. The presence of silicone outside the implant capsule indicates extracapsular rupture. The MR-spectroscopic detection of silicone in the liver suggests after short implantation times and a normal MR scan the diagnosis ''gel bleed'', and after longer implantation times of more than 10 years and missing ''linguini'' sign the diagnosis of ruptures due to a dissolved shell of the implant. MRI, in comparison to other imaging modalities, has the highest specificity and sensitivity in the diagnosis of implant defects. Due to its high costs, however, MR is not suitable as a screening tool and should only be used in cases of sonographic suspected rupture or after radical mastectomy. In these cases MRI is the method of choice. (orig.) [German] In dieser Uebersicht wird die Evaluation der weiblichen Brust nach Aufbau mit Silikonmammaprothesen mittels MR-Techniken vorgestellt. Ein Schwerpunkt liegt dabei auf der Defektdiagnostik, d.h. dem Nachweis des so genannten ''Gelblutens'', der intra- und der extrakapsulaeren Ruptur. Daneben wird auf die MR-Detektion von Silikonomen (abgekapseltes Silikon) und deren Abgrenzung von einem Malignom eingegangen und das typische MR-Erscheinungsbild von chronischer Fremdkoerperreaktion vorgestellt. ''Gelbluten'' ist mittels MR-Bildgebung (MRT

  16. Tailoring through Technology: A Retrospective Review of a Single Surgeon's Experience with Implant-Based Breast Reconstruction before and after Implementation of Laser-Assisted Indocyanine Green Angiography.

    Science.gov (United States)

    Harless, Christin A; Jacobson, Steven R

    2016-05-01

    Reported complication rates of implant-based breast reconstruction in the literature exceed 50%, with mastectomy skin flap necrosis reported to occur in up to 25% of cases. Laser-assisted indocyanine green angiography (LA-ICGA) technology allows the surgeon to optimize preservation of the mastectomy skin flap while avoiding skin necrosis. The purpose of this study was to determine if outcomes of breast reconstruction are beneficially affected by using LA-ICGA. A total 269 consecutive women (467 breast reconstructions) undergoing implant-based breast reconstruction from 2008 to 2013 were examined. The complication rates of those who underwent reconstruction prior to the implementation of LA-ICGA were compared with those who were reconstructed after implementation of LA-ICGA. A total of 254 consecutive breast reconstructions were performed prior to implementation of LA-ICGA, and 213 breasts were reconstructed with the use of LA-ICGA. After implementation of LA-ICGA System, the rate of mastectomy skin flap necrosis decreased by 86% (6.7% versus 0.9%, p = 0.02). The overall complication rate prior to LA-ICGA was 13.8% compared with 6.6% with the use of LA-ICGA (p = 0.01). After LA-ICGA was incorporated, the percentage of patients undergoing single-stage reconstruction increased from 12% to 32% (p = <0.001). Implementation of LA-ICGA provides the surgeon with an objective assessment of mastectomy flap perfusion resulting in a trend toward overall reduction in complications as well as an 86% decrease in the rate of subsequent skin necrosis. The objective assessment of mastectomy flap perfusion allows the surgeon to tailor breast reconstruction intraoperatively, in real-time, adjusting for the individual patient's mastectomy flap perfusion. © 2016 Wiley Periodicals, Inc.

  17. Interobserver variations of target volume delineation and its impact on irradiated volume in accelerated partial breast irradiation with intraoperative interstitial breast implant

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    Ritu Raj Upreti

    2017-02-01

    Full Text Available Purpose: To investigate the interobserver variations in delineation of lumpectomy cavity (LC and clinical target volume (CTV, and its impact on irradiated volume in accelerated partial breast irradiation using intraoperative multicatheter brachytherapy. Material and methods : Delineation of LC and CTV was done by five radiation oncologists on planning computed tomography (CT scans of 20 patients with intraoperative interstitial breast implant. Cavity visualization index (CVI, four-point index ranging from (0 = poor to (3 = excellent was created and assigned by observers for each patient. In total, 200 contours for all observers and 100 treatment plans were evaluated. Spatial concordance (conformity index, CI common , and CIgen, average shift in the center of mass (COM, and ratio of maximum and minimum volumes (V max /V min of LC and CTV were quantified among all observers and statistically analyzed. Variation in active dwell positions (0.5 cm step for each catheter, total reference air kerma (TRAK, volume enclosed by prescription isodose (V100% among observers and its spatial concordance were analyzed. Results : The mean ± SD CI common of LC and CTV was 0.54 ± 0.09, and 0.58 ± 0.08, respectively. Conformity index tends to increase, shift in COM and V max /V min decrease significantly (p < 0.05, as CVI increased. Out of total 309 catheters, 29.8% catheters had no change, 29.8% and 17.5% catheters had variations of 1 and 2 dwell positions (0.5 cm and 1 cm, respectively. 9.3% catheters shown variations ≥ 10 dwell positions (5 cm. The mean ± SD CI common of V100% was 0.75 ± 0.11. The mean observed V max /V min of prescription isodose and TRAK was 1.18 (range, 1.03 to 1.56 and 1.11 (range, 1.03 to 1.35, respectively. Conclusions : Interobserver variability in delineation of target volume was found to be significantly related to CVI. Smaller variability was observed with excellent visualization of LC. Interobserver variations showed dosimetric

  18. Patient-Report Satisfaction and Health-Related Quality of Life in TiLOOP® Bra-Assisted or Implant-Based Breast Reconstruction Alone.

    Science.gov (United States)

    M, Dieterich; J, Angres; A, Stachs; A, Glass; T, Reimer; B, Gerber; J, Stubert

    2015-08-01

    Implant-based breast reconstructions (IBBR) using alternatives to acellular dermal matrixes are increasing. Data on complications are limited, and information concerning health-related quality of life (HR-QoL) following the use of these synthetic meshes do not exist. Between January 2006 and January 2013, patients undergoing immediate or delayed-immediate IBBR with or without titanium covered polypropylene mesh (TiLOOP® Bra) were investigated. HR-QoL was assessed using the validated self-reporting BREAST-Q questionnaire. Patient demographics and complications were evaluated retrospectively. Stepwise regression backward elimination analysis was performed to identify influential factors on each BREAST-Q domain. Of the 90 women, 42 had IBBR alone and 48 in combination with TiLOOP® Bra. The mean follow-up was 18 months in the TiLOOP® Bra and 17.5 months in the implant alone group (p = 0.827). The overall complication rate was 21.1 %, with 14.6 % in the TiLOOP® Bra and in 28.6 % in the implant alone group (p = 0.105). Capsular contraction rate was 4.4 % in the TiLOOP® Bra and 16.7 % in the implant alone group (p = 0.052). The analysis of the HR-QoL showed no significant differences between the groups. Surgeries prior to IBBR had a positive influence on HR-QoL. TiLOOP® Bra was associated with a negative effect on "satisfaction with breast" (β = -5.72; p < 0.001), as it was no longer observed for "satisfaction with outcome" and other domains.

  19. SU-D-207B-04: Morphological Features of MRI as a Correlate of Capsular Contracture in Breast Cancer Patients with Implant-Based Reconstructions

    Energy Technology Data Exchange (ETDEWEB)

    Tyagi, N; Sutton, E; Hunt, M; Apte, A; Zhang, J; Oh, J; Mechalakos, J; Mehrara, B; Matros, E; Ho, A [Mem Sloan-Kettering Cancer Ctr, New York, NY (United States)

    2016-06-15

    Purpose: Capsular contracture (CC) is a serious complication in patients receiving implant-based reconstruction for breast cancer. The goal of this study was to identify image-based correlates of CC using MRI imaging in breast cancer patients who received both MRI and clinical evaluation following reconstructive surgery. Methods: We analyzed a retrospective dataset of 50 patients who had both a diagnostic MR and a plastic surgeon’s evaluations of CC score (Baker’s score) within a six month period following mastectomy and reconstructive surgery. T2w sagittal MRIs (TR/TE = 3500/102 ms, slice thickness = 4 mm) were used for morphological shape features (roundness, eccentricity, solidity, extent and ratio-length) and histogram features (median, skewness and kurtosis) of the implant and the pectoralis muscle overlying the implant. Implant and pectoralis muscles were segmented in 3D using Computation Environment for Radiological Research (CERR) and shape and histogram features were calculated as a function of Baker’s score. Results: Shape features such as roundness and eccentricity were statistically significant in differentiating grade 1 and grade 2 (p = 0.009; p = 0.06) as well as grade 1 and grade 3 CC (p = 0.001; p = 0.006). Solidity and extent were statistically significant in differentiating grade 1 and grade 3 CC (p = 0.04; p = 0.04). Ratio-length was statistically significant in differentiating all grades of CC except grade 2 and grade 3 that showed borderline significance (p = 0.06). The muscle thickness, median intensity and kurtosis were significant in differentiating between grade 1 and grade 3 (p = 0.02), grade 1 and grade 2 (p = 0.03) and grade 1 and grade 3 (p = 0.01) respectively. Conclusion: Morphological shape features described on MR images were associated with the severity of CC. MRI may be important in objectively evaluating outcomes in breast cancer patients who undergo implant reconstruction.

  20. Immunotherapeutic Approach to Breast Cancer: The Anti-Tumor Effect of Anti-IL-6 Monoclonal Antibodies in Malignant Mammary Tumor Implanted-Mice.

    Science.gov (United States)

    Abou-Shousha, Seham A; Abdel-Mawla, Ashour Abdel-Mawla A S; Hassan, Safia M

    2016-01-01

    It has been established that suppression of apoptosis during carcinogenesis is the main cause of development and progression of breast cancer. Breast cancer patients have higher circulating levels of IL-6 protecting cancer cells from apoptosis and positively correlated with poor prognosis of the disease. The current work is carried out to fulfill one of our in vivo preclinical studies' for approaching a novel breast cancer immunotherapy through induction of tumor cell apoptosis. The study aims at investigating the potential of anti-IL-6 monoclonal antibodies (mAbs) to suppress IL-6 anti-apoptotic activities in tumor microenvironment of malignant mammary tumor implanted-mice. To achieve this goal, 4 groups of mice were used, group I: served as control, group II: mice implanted with Ehrlich ascites carcinoma cell lines (EAC), through intramuscular injection till tumor inoculation, group III: injected intratumorally with10 µl saline for 3 successive days, and group IV: mice were injected intratumorally one day after tumor inoculation with a dose of 1.5 mg / kg of recombinent anti-IL-6 monoclonal antibodies in10 µl saline for 3 successive days. Apoptosis was evaluated in tumor samples from anti-IL-6 treated tumor implanted mice and compared with controls. Levels of apoptosis in tumor tissue samples of tumor implanted mice treated with anti-IL-6 were significantly (P=0.009) higher than untreated ones. In conclusion, anti-IL-6 monoclonal antibodies have the potential to suppress the anti-apoptotic effect of interleukin-6 (IL-6) within the tumor microenvironment of tumor implanted in mice. Copyright© by the Egyptian Association of Immunologists.

  1. Demystifying trans-axillary augmentation/periareolar mastopexy: a novel, two-stage, single-operation approach to management of the contralateral breast in implant reconstruction.

    Science.gov (United States)

    Kropf, Nina; Cordeiro, Christina N; McCarthy, Colleen M; Cordeiro, Peter G

    2011-04-01

    Following unilateral tissue expander/implant reconstruction, combined augmentation/mastopexy of the contralateral breast may be performed in an attempt to improve breast symmetry. Combined augmentation/mastopexy can be a very difficult operation, even for the surgeon with substantial experience. To simplify the technical approach to this complex problem, the senior author (PGC) has developed a 'two-stage, single-operation' approach. The purpose of this study is to review the safety and efficacy of this approach to the contralateral breast in the setting of unilateral, implant-based reconstruction. A retrospective review of all combined trans-axillary augmentation/periareolar mastopexies performed from 1998 to 2007 was undertaken. Only patients who had a history of prior unilateral mastectomy and immediate expander placement were included. Photographic documentation of long-term aesthetic results was evaluated by two independent observers. In total, 26 combined, trans-axillary augmentation/periareolar mastopexies were performed in patients, who had initiated unilateral, postmastectomy, tissue expander/implant reconstruction on the contralateral side. No patient desired revisional surgery for inadequate ptosis correction or malpositioning of the nipple. A total of 69% of patients had a 'very good to excellent' overall aesthetic result. Of those patients who were deemed to have a 'good' aesthetic result, the development of a capsular contracture in the reconstructed breast detracted from the overall aesthetics. The two-stage, single-operation approach to unilateral augmentation/mastopexy described here can produce a good aesthetic result and allow for adequate oncologic follow-up. In particular, excellent results are seen in patients with grade I or II ptosis and good-quality skin preoperatively. Monitoring of the breast for cancer, using mammography, is still possible with this technique. Copyright © 2010 British Association of Plastic, Reconstructive and Aesthetic

  2. Revision breast and chest wall reconstruction in Poland and pectus excavatum following implant complication using free deep inferior epigastric perforator flap

    Directory of Open Access Journals (Sweden)

    Dimitrios Dionyssiou

    2015-01-01

    Full Text Available This study aims to present the case of a female patient with Poland′s syndrome and pectus excavatum deformity who underwent breast and chest wall reconstruction with a pre-shaped free deep inferior epigastric perforator flap. A 57-year-old female patient with Poland′s syndrome and pectus excavatum presented with a Baker III capsular contracture following a previously performed implant-based right breast reconstruction. After a chest and abdominal CT angiography, she was staged as 2A1 chest wall deformity according to Park′s classification and underwent implant removal and capsulectomy, followed by a pre-shaped free abdominal flap transfer, providing both breast reconstruction and chest wall deformity correction in a single stage operation. Post-operative course was uneventful, and the aesthetic result remains highly satisfactory 24 months after surgery. Deep inferior epigastric free flap represents an interesting reconstructive solution when treating Poland′s syndrome female patients with chest wall and breast deformities.

  3. Influencia de las cargas triboeléctricas y de la contaminación sintomática de los implantes Triboelectric charges and breast implant symptomatic contamination

    Directory of Open Access Journals (Sweden)

    G. Peña Cabús

    2007-12-01

    Full Text Available El hallazgo ocasional de energía estática importante en un implante mamario, generó una revisión sistemática de la información disponible al respecto que restableció una secuencia de eventos y conceptos de importancia, a nuestro juicio, en la práctica clínica Los implantes mamarios son elastómeros resultantes de la polimerización industrial que pueden generar cargas electrostáticas en su superficie. El efecto triboeléctrico puede mantener suficiente energía estática como para atraer partículas de material capaces de producir una contaminación periprotésica sintomática. El desconocer esta propiedad física puede llevar a una práctica clínica de riesgo al colocar implantes mamarios. Adicionalmente se revisa la microbiología involucrada en la formación capsular periprotésica sintomática y la infección por bacterias productoras de "biofilm".An incidental finding of static energy upon the surface of a breast implant, generated a systematic search that led to a link between triboelectric charges and symptomatic periprosthetic infection. Breast implants are industrial elastomers that may result with electrostatic charges on its surface. Its propper resistivity allows silicone to maintain enough static that atracts and adheres particulate matter to become surface contamination with periprosthetic tissue reaction. Recognition of this particular physical property and its clinical implications allows for safer conditions of practice. We review microbiology involved in periprosthetic capsular formation and infection by "biofilm" producer bacteria.

  4. Reconstrucción mamaria con expansor tisular e implante: Indicaciones y experiencia en 24 casos Breast reconstruction with tissue expander: Indications and experience in 24 cases

    Directory of Open Access Journals (Sweden)

    C. Gutiérrez Gómez

    2012-12-01

    Full Text Available En la actualidad, la reconstrucción mamaria forma parte integral del tratamiento del cáncer de mama; la selección de la paciente es crítica para obtener resultados satisfactorios. El presente trabajo recoge nuestra experiencia en reconstrucción mamaria con expansión tisular e implantes, haciendo hincapié en la selección de las pacientes candidatas a este método reconstructivo. Revisamos las reconstrucciones mamarias realizadas en un período comprendido entre los años 1998 y 2008 por la misma cirujana, analizando factores como tipo de mastectomía, edad, tiempo de la reconstrucción (inmediata o diferida, causa de la mastectomía, tipo de expansor y prótesis utilizados, complicaciones y satisfacción de las pacientes. En todas excepto en una, la reconstrucción se realizó en dos tiempos operatorios; durante el primero se hizo la colocación del expansor tisular y en el segundo, el cambio por la prótesis mamaria definitiva. Se realizaron un total de 24 reconstrucciones mamarias en 19 pacientes en el período de 10 años revisado, 14 unilaterales y 5 bilaterales. Las complicaciones presentadas en este grupo de pacientes fueron del 16,6 %. El seguimiento de las pacientes fue de 2 a 10 años. Solamente en 1 caso de cuadrantectomía, se realizó la reconstrucción de forma diferida por antecedente de radioterapia (4,1 %. En nuestra opinión, la reconstrucción mamaria con expansor tisular e implante es un procedimiento seguro, reproducible y con bajo índice de complicaciones, sin el inconveniente añadido de ocasionar morbilidad en el a área donante.Nowadays, breast reconstruction is part of breast carcinoma treatment; patient's selection plays an important role in satisfactory results. The present paper reports our experience in breast reconstruction with tissue expander/implant and emphasizes the importance of choosing the candidates for this method of reconstruction. We review the breast reconstructions realized in a 10 year period

  5. Silicone granuloma in acral skin in a patient with silicone-gel breast implants and systemic sclerosis.

    Science.gov (United States)

    Anderson, D R; Schwartz, J; Cottrill, C M; McClain, S A; Ross, J S; Magidson, J G; Klainer, A; Bisaccia, E

    1996-01-01

    A 68-year-old white woman was referred to us by her rheumatologist for possible participation in a clinical study of photopheresis for scleroderma. In February 1993, she noticed edema of her distal phalanges, Raynaud's phenomenon in both hands, flu-like symptoms, fatigue, intermittent diarrhea, abdominal pain, tearing in both eyes, dyspnea on exertion, dysphagia, and odynophagia. Bilateral silicone-gel breast implants had been placed 12 years before; 2 months before her present evaluation, they were removed and found to be ruptured. Physical examination revealed edema, limited to the fingers and hands bilaterally, and slight induration of the skin on the dorsum of both hands and distal forearms. The remainder of the physical examination was normal. According to our study protocol, a skin biopsy specimen from the dorsum of the right hand was taken, but all other laboratory investigations were refused. Histopathologic examination revealed multiple clear spaces of varying sizes in the dermis and multinucleated macrophages containing small refractile particles, characteristic of silicone granuloma (Figs. 1 and 2); however, the specimen showed no evidence of scleroderma. X-ray energy dispersive analysis by scanning electron-microscopy confirmed the presence of elemental silicon in the small refractile particles. The patient did not receive any treatment after her diagnosis and shortly thereafter, she was lost to follow-up.

  6. Adherence to best practice consensus guidelines for implant-based breast reconstruction: Results from the iBRA national practice questionnaire survey.

    Science.gov (United States)

    Mylvaganam, Senthurun; Conroy, Elizabeth J; Williamson, Paula R; Barnes, Nicola L P; Cutress, Ramsey I; Gardiner, Matthew D; Jain, Abhilash; Skillman, Joanna M; Thrush, Steven; Whisker, Lisa J; Blazeby, Jane M; Potter, Shelley; Holcombe, Christopher

    2018-02-07

    The 2008 National Mastectomy and Breast Reconstruction Audit demonstrated marked variation in the practice and outcomes of breast reconstruction in the UK. To standardise practice and improve outcomes for patients, the British professional associations developed best-practice guidelines with specific guidance for newer mesh-assisted implant-based techniques. We explored the degree of uptake of best-practice guidelines within units performing implant-based reconstruction (IBBR) as the first phase of the implant Breast Reconstruction Evaluation (iBRA) study. A questionnaire developed by the iBRA Steering Group was completed by trainee and consultant leads at breast and plastic surgical units across the UK. Simple summary statistics were calculated for each survey item to assess compliance with current best-practice guidelines. 81 units from 79 NHS Trusts completed the questionnaire. Marked variation was observed in adherence to guidelines, especially those relating to clinical governance and infection prevention strategies. Less than half (n = 28, 47%) of units obtained local clinical governance board approval prior to offering new mesh-based techniques and prospective audit of the clinical, cosmetic and patient-reported outcomes of surgery was infrequent. Most units screened for methicillin-resistant staphylococcus aureus prior to surgery but fewer than 1 in 3 screened for methicillin-sensitive strains. Laminar-flow theatres (recommended for IBBR) were not widely-available with less than 1 in 5 units having regular access. Peri-operative antibiotics were widely-used, but the type and duration were highly-variable. The iBRA national practice questionnaire has demonstrated variation in reported practice and adherence to IBBR guidelines. High-quality evidence is urgently required to inform best practice. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

  7. Accelerated partial-breast irradiation with interstitial implants. Analysis of factors affecting cosmetic outcome

    Energy Technology Data Exchange (ETDEWEB)

    Ott, Oliver J.; Lotter, Michael; Fietkau, Rainer; Strnad, Vratislav [University Hospital Erlangen (Germany). Dept. of Radiation Oncology

    2009-03-15

    Purpose: To analyze patient-, disease-, and treatment-related factors for their impact on cosmetic outcome (CO) after interstitial multicatheter accelerated partial-breast irradiation (APBI). Patients and Methods: Between April 2001 and January 2005, 171 patients with early breast cancer were recruited in Erlangen for this subanalysis of the German-Austrian APBI phase II-trial. 58% (99/171) of the patients received pulsed-dose-rate (PDR), and 42% (72/171) high-dose-rate (HDR) brachytherapy. Prescribed reference dose for HDR brachytherapy was 32 Gy in eight fractions of 4 Gy, twice daily. Prescribed reference dose in PDR brachytherapy was 49.8 Gy in 83 consecutive fractions of 0.6 Gy each hour. Total treatment time was 3-4 days. Endpoint of this evaluation was the CO, graded as excellent, good, fair, or poor. Patients were divided in two groups with an excellent (n = 102) or nonexcellent (n = 69) cosmetic result. Various factors were analyzed for their impact on excellent CO. Results: The median follow-up time was 52 months (range: 21-91 months). Cosmetic results were rated as excellent in 59.6% (102/171), good in 29.8% (51/171), fair in 9.9% (17/171), and poor in 0.6% (1/171). The initial cosmetic status was significantly worse for the nonexcellent CO group (p = 0.000). The percentage of patients who received PDR brachytherapy APBI was higher in the nonexcellent CO group (68.1% vs. 51%; p = 0.026). Acute toxicity was higher in the nonexcellent CO group (24.6% vs. 12.7%; p = 0.045). Furthermore, the presence of any late toxicity was found to be associated with a worse cosmetic result (65.2% vs. 18.6%; p = 0.000). In detail, the appearance of skin hyperpigmentation (p = 0.034), breast tissue fibrosis (p = 0.000), and telangiectasia (p = 0.000) had a negative impact on CO. Conclusion: The initial, surgery-associated cosmetic status, brachytherapy modality, and the presence of acute and late toxicities were found to have an impact on overall CO. Our data have proven

  8. Implant contraception.

    Science.gov (United States)

    Meckstroth, K R; Darney, P D

    2001-12-01

    The experience of 6 million Norplant users has led to several more advanced implants. Implanon is a single-rod implant system containing a low androgenic progestin and requires 1 to 2 minutes for insertion and removal. Like other implants, Implanon prevents pregnancy by changing the character of the cervical mucus and interfering with luteal function. Unlike Norplant, though, Implanon is designed to prevent ovulation for the full duration of use. Implant contraception has several advantages over other types of contraception including high efficacy, minimal required maintenance, absence of estrogen, and rapid return of fertility after discontinuation. Implants can be a good choice for adolescents; women with hypertension, diabetes, anemia, endometriosis, or other medical problems; and women who are breast-feeding. Irregular bleeding is the most common adverse effect of implants and can be treated with several medication regimens. Preinsertion counseling, however, is the most important factor in ensuring satisfaction with implants. Unfortunately, no implant system is currently available in the United States since August 2000, but Implanon is expected to reach the U.S. market within the next 2 years.

  9. Variation in the provision and practice of implant-based breast reconstruction in the UK: Results from the iBRA national practice questionnaire.

    Science.gov (United States)

    Mylvaganam, Senthurun; Conroy, Elizabeth; Williamson, Paula R; Barnes, Nicola L P; Cutress, Ramsey I; Gardiner, Matthew D; Jain, Abhilash; Skillman, Joanna M; Thrush, Steven; Whisker, Lisa J; Blazeby, Jane M; Potter, Shelley; Holcombe, Christopher

    2017-10-01

    The introduction of biological and synthetic meshes has revolutionised the practice of implant-based breast reconstruction (IBBR) but evidence for effectiveness is lacking. The iBRA (implant Breast Reconstruction evAluation) study is a national trainee-led project that aims to explore the practice and outcomes of IBBR to inform the design of a future trial. We report the results of the iBRA National Practice Questionnaire (NPQ) which aimed to comprehensively describe the provision and practice of IBBR across the UK. A questionnaire investigating local practice and service provision of IBBR developed by the iBRA Steering Group was completed by trainee and consultant leads at breast and plastic surgical units across the UK. Summary data for each survey item were calculated and variation between centres and overall provision of care examined. 81 units within 79 NHS-hospitals completed the questionnaire. Units offered a range of reconstructive techniques, with IBBR accounting for 70% (IQR:50-80%) of participating units' immediate procedures. Units on average were staffed by 2.5 breast surgeons (IQR:2.0-3.0) and 2.0 plastic surgeons (IQR:1.0-3.0) performing 35 IBBR cases per year (IQR:20-50). Variation was demonstrated in the provision of novel different techniques for IBBR especially the use of biological (n = 62) and synthetic (n = 25) meshes and in patient selection for these procedures. The iBRA-NPQ has demonstrated marked variation in the provision and practice of IBBR in the UK. The prospective audit phase of the iBRA study will determine the safety and effectiveness of different approaches to IBBR and allow evidence-based best practice to be explored. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  10. Impact of delayed implant and DIEP flap breast reconstruction on body image and sexual satisfaction: a prospective follow-up study.

    Science.gov (United States)

    Gopie, Jessica P; ter Kuile, Moniek M; Timman, Reinier; Mureau, Marc A M; Tibben, Aad

    2014-01-01

    Prospective studies regarding the psychosexual impact after different types of breast reconstruction (BR) are scarce. The impact of either implant or deep inferior epigastric artery perforator (DIEP) flap BR on body image and sexual relationship satisfaction was investigated in time. At baseline, 98 women opting for delayed implant or DIEP flap BR after mastectomy for breast cancer completed a survey. The majority was followed up at 6 months (96%) and 20 months (86%) postoperatively. Questionnaires included the body image scale, Dutch Relationship Questionnaire, Short Form - 36 Health Survey and the Impact of Event Scale. Mixed modeling analyses indicated that preoperative body image improved significantly after 20 months (p body image was related to a better general mental health (p = 0.02), less cancer distress (p Body image and sexual relationship satisfaction significantly improved after BR, and this was not related to the BR type. Psychosexual consequences from previous cancer treatment may interfere. Lower general mental health, higher cancer distress, less partner relationship satisfaction or receiving hormonal therapy can negatively affect body image or sexual relationship satisfaction. Copyright © 2013 John Wiley & Sons, Ltd.

  11. Early Postoperative Outcomes in Breast Conservation Surgery Versus Simple Mastectomy with Implant Reconstruction: A NSQIP Analysis of 11,645 Patients.

    Science.gov (United States)

    Pyfer, Bryan; Chatterjee, Abhishek; Chen, Lilian; Nigriny, John; Czerniecki, Brian; Tchou, Julia; Fisher, Carla

    2016-01-01

    Little has been studied that compares early postoperative outcomes between breast conservation surgery (BCS) and simple mastectomy with implant reconstruction (SM). Our goal was to utilize a large-volume database to compare such outcomes in women with early stage breast cancer. The National Surgery Quality Improvement Program (NSQIP) database was searched for patients who underwent partial or complete mastectomy between 2009 and 2012. Exclusion criteria eliminated potential confounding factors. We compared preoperative comorbidities and postoperative complication rates between each treatment group by Chi square and two-sample t tests; we also determined the odds ratios for the likelihood of adverse events in a number of categories. A total of 11,645 patients met the study criteria: 9571 underwent BCS and 2074 underwent SM with implant reconstruction. The baseline characteristics of the two groups showed significant differences for age (61.7 years in BCS, 53.5 years in SM), body mass index (29.6 kg/m(2) in BCS, 27.0 kg/m(2) in SM), and rates of hypertension (47.0 % in BCS, 25.6 % in SM), coronary artery disease (1.3 % in BCS, 0.6 % in SM), chronic obstructive pulmonary disease (2.4 % in BCS, 1.0 % in SM), and diabetes (11.7 % in BCS, 5.9 % in SM). Statistical analysis between each treatment modality revealed that the SM with implant group had significantly higher total complication (5.5 vs. 2.1 % in BCS), wound (2.8 vs. 1.4 % in BCS), infection (1.9 vs. 0.4 % in BCS), and bleeding (0.2 vs. 0.05 % in BCS) rates than the BCS group. BCS has fewer overall early postoperative wound, infectious, and bleeding complications despite a significantly higher rate of preexisting risk factors.

  12. Cochlear Implants

    Science.gov (United States)

    ... implant procedure Welcome to the Food and Drug Administration (FDA) website on cochlear implants. Cochlear implants are electronic hearing devices. Doctors implant cochlear implants into people ...

  13. Economic analysis and review of the literature on implant-based breast reconstruction with and without the use of the acellular dermal matrix.

    Science.gov (United States)

    Bank, Jonathan; Phillips, Nicole A; Park, Julie E; Song, David H

    2013-12-01

    Use of the acellular dermal matrix (ADM) in two-stage implant-based breast reconstruction has been widely adopted. Despite an increasing focus on health care costs, few reports have addressed the financial implications of ADM use. This study sought to examine the costs of the two-stage technique with and without ADM, concentrating on the direct variable costs of patient care during the expansion process. A retrospective review of a prospectively maintained database was conducted. Data were collected on 132 cases resulting in a second-stage exchange for a permanent implant. The findings showed that AlloDerm was used in 61 reconstructions and Strattice in 23 reconstructions. The primary outcome was the number of fills required to achieve the final expander fill volume. The cost of subsequent patient encounters for expansion was estimated using institutional cost data. The number of fills required to achieve the final volume was higher in the non-ADM group (6.5 ± 1.7) than in the ADM group (3.6 ± 1.4) (p 0.05). The difference was significant in the larger fill volumes (>500 ml; 8.3 vs. 3.7; p Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  14. Iridium-192 implants for primary breast cancer: experience with placement at the time of wide local excision

    Energy Technology Data Exchange (ETDEWEB)

    McCormick, B.; Wesson, M.F.; Cox, L.; Osborne, M.P.; Petrek, J.A.; Kinne, D.W.

    1988-09-01

    An Ir-192 boost is a technique frequently used to deliver an additional dose of radiation therapy to the tumor bed following breast conserving surgery and combined with external beam radiation therapy to the entire breast for patients with early breast cancer. Traditionally these catheters are placed following completion of 4500-5000 cGy, as a separate procedure. This paper described a Pilot Study identifying placement of the catheters at the time of primary wide local excision, or re-excision in 52 patients. The key to the success of this technique is the achievement of complete hemostasis in the primary cavity, the presence of the radiation oncologist during the surgical procedure itself, and closure of the wound prior to placement of the catheters. Details of the technique, and preliminary patient results are presented.

  15. Cochlear implant

    Science.gov (United States)

    Hearing loss - cochlear implant; Sensorineural - cochlear; Deaf - cochlear; Deafness - cochlear ... of the cochlear implant. WHO USES A COCHLEAR IMPLANT? Cochlear implants allow deaf people to receive and process ...

  16. Avaliação da biocompatibilidade de implantes mamários de silicone esterilizados por calor seco e pelo óxido de etileno Biocompatibility assessment of silicone gel breast implants sterilized by dry-heat and by ethylene oxide

    Directory of Open Access Journals (Sweden)

    Janice Campos de Azevedo

    2006-06-01

    Full Text Available Os implantes mamários de silicone têm sido empregados, tanto nas cirurgias de aumento de mama, quanto na reconstrução do tecido mamário. A segurança biológica deste tipo de implante deve ser garantida, pois, em função da esterilização estes materiais, podem sofrer alterações oriundas dos processos esterilizantes por comprometimento da estrutura química dos polímeros. O objetivo deste trabalho consistiu na avaliação da biocompatibilidade de implantes mamários preenchidos com gel de silicone, de superfície lisa e texturizada submetidos à esterilização por calor seco e óxido de etileno. Empregou-se, para tanto, método in vitro, avaliando a citotoxicidade pelo método de captura do vermelho neutro, utilizando a linhagem celular NCTC clone 929. Os resultados obtidos demonstraram não haver comprometimento da biocompatibilidade dos biomateriais submetidos aos dois processos (calor seco e óxido de etileno, assim como comprovaram a eficácia de ambos na esterilização dos implantes.Silicone breast implants have been widely used for mammary augmentation and reconstruction surgery. Biological safety of these implants can be altered by sterilization methods. This study consisted of the biocompatibility assessment of smooth and textured silicone gel breast implants sterilized by dry-heat and ethylene oxide through cell viability, employing neutral red uptake method. The NCTC clone 929 cell were employed and the results showed no cytotoxicity of implants after both sterilization processes.

  17. Preliminary simulation of implants breast through the accelerated partial irradiation technique: coverage rates and homogeneity; Simulacion previa de implates de mama mediante la tecnica de irradiacion parcial acelerada: indices de cubrimiento y homegeneidad

    Energy Technology Data Exchange (ETDEWEB)

    Moral Sanchez, S. C.; Paula Carranza, B. de; Erzibengoa, M.; Bragado Alvarez, L.; Guisasola Berasetegui, A.

    2013-07-01

    In this work we present and evaluate the process of pre-simulation we have drawn up when it comes to treatments of accelerated partial irradiation of breast. Previous simulation that we will allow you to have greater control over the location of catheters with respect to the area to radiate. The goodness of this procedure is evaluated through representative quality indexes of the implant. (Author)

  18. A radiobiological investigation on dose and dose rate for permanent implant brachytherapy of breast using I125 or P103d sources.

    Science.gov (United States)

    Baltas, Dimos; Lymperopoulou, Georgia; Löffler, Edgar; Mavroidis, Panayiotis

    2010-06-01

    The present report addresses the question of what could be the appropriate dose and dose rate for I125 and P103d permanent seed implants for breast cancer as monotherapy for early stage breast cancer. This is addressed by employing a radiobiological methodology, which is based on the linear quadratic model, to identify a biologically effective dose (BED) to the prescription point of the brachytherapy implant, which would produce equivalent cell killing (or same cell survival) when compared to a specified external radiotherapy scheme. In the present analysis, the tumor and normal tissue BED ratios of brachytherapy and external radiotherapy are examined for different combinations of tumor proliferation constant (K), α/β ratios, initial dose rate (R0), and reference external radiotherapy scheme (50 or 60 Gy in 2 Gy per fraction). The results of the radiobiological analysis are compared against other reports and clinical protocols in order to examine possible opportunities of improvement. The analysis indicates that physical doses of approximately 100-110 Gy delivered with an initial dose rate of around 0.05Gyh-1 and 78-80 Gy delivered at 0.135Gyh-1 for I125 and P103d permanent implants, respectively, are equivalent to 50 Gy external beam radiotherapy (EBRT) in 2 Gy per fraction. Similarly, for physical doses of approximately 115-127 Gy delivered with an initial dose rate of around 0.059Gyh-1 and 92 Gy delivered at 0.157Gyh-1 for I125 and P103d, respectively, are equivalent to 60 Gy EBRT in 2 Gy per fraction. It is shown that the initial dose rate required to produce isoeffective tumor response with 50 or 60 Gy EBRT in 2 Gy per fraction increases as the repopulation factor K increases, even though repopulation is also considered in EBRT. Also, the initial dose rate increases as the value of the α/β ratio decreases. The impact of the different α/β ratios on the ratio of the tumor BEDs is significantly large for both the I125 and P103d implants with the deviation

  19. SU-E-J-215: Towards MR-Only Image Guided Identification of Calcifications and Brachytherapy Seeds: Application to Prostate and Breast LDR Implant Dosimetry

    Energy Technology Data Exchange (ETDEWEB)

    Elzibak, A; Fatemi-Ardekani, A; Soliman, A; Mashouf, S; Safigholi, H; Ravi, A; Morton, G; Song, WY [Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada); Han, D [Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada); University of California, San Diego, La Jolla, CA (United States)

    2015-06-15

    Purpose: To identify and analyze the appearance of calcifications and brachytherapy seeds on magnitude and phase MRI images and to investigate whether they can be distinguished from each other on corrected phase images for application to prostate and breast low dose rate (LDR) implant dosimetry. Methods: An agar-based gel phantom containing two LDR brachytherapy seeds (Advantage Pd-103, IsoAid, 0.8mm diameter, 4.5mm length) and two spherical calcifications (large: 7mm diameter and small: 4mm diameter) was constructed and imaged on a 3T Philips MR scanner using a 16-channel head coil and a susceptibility weighted imaging (SWI) sequence (2mm slices, 320mm FOV, TR/ TE= 26.5/5.3ms, 15 degree flip angle). The phase images were unwrapped and corrected using a 32×32, 2D Hanning high pass filter to remove background phase noise. Appearance of the seeds and calcifications was assessed visually and quantitatively using Osirix (http://www.osirix-viewer.com/). Results: As expected, calcifications and brachytherapy seeds appeared dark (hypointense) relative to the surrounding gel on the magnitude MRI images. The diameter of each seed without the surrounding artifact was measured to be 0.1 cm on the magnitude image, while diameters of 0.79 and 0.37 cm were measured for the larger and smaller calcifications, respectively. On the corrected phase images, the brachytherapy seeds and the calcifications appeared bright (hyperintense). The diameter of the seeds was larger on the phase images (0.17 cm) likely due to the dipole effect. Conclusion: MRI has the best soft tissue contrast for accurate organ delineation leading to most accurate implant dosimetry. This work demonstrated that phase images can potentially be useful in identifying brachytherapy seeds and calcifications in the prostate and breast due to their bright appearance, which helps in their visualization and quantification for accurate dosimetry using MR-only. Future work includes optimizing phase filters to best identify

  20. TU-AB-201-11: A Novel Theoretical Framework for MRI-Only Image Guided LDR Prostate and Breast Brachytherapy Implant Dosimetry

    Energy Technology Data Exchange (ETDEWEB)

    Soliman, A; Elzibak, A; Fatemi, A; Safigholi, H; Ravi, A; Morton, G; Song, W [Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario (Canada); Han, D [Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario (Canada); University of California, San Diego, La Jolla, CA (United States)

    2015-06-15

    Purpose: To propose a novel framework for accurate model-based dose calculations using only MR images for LDR prostate and breast seed implant brachytherapy. Methods: Model-based dose calculation methodologies recommended by TG-186 require further knowledge about specific tissue composition, which is challenging with MRI. However, relying on MRI-only for implant dosimetry would reduce the soft tissue delineation uncertainty, costs, and uncertainties associated with multi-modality registration and fusion processes. We propose a novel framework to address this problem using quantitative MRI acquisitions and reconstruction techniques. The framework includes three steps: (1) Identify the locations of seeds(2) Identify the presence (or absence) of calcification(s)(3) Quantify the water and fat content in the underlying tissueSteps (1) and (2) consider the sources that limit patient dosimetry, particularly the inter-seed attenuation and the calcified regions; while step (3) targets the quantification of the tissue composition to consider the heterogeneities in the medium. Our preliminary work has shown that the seeds and the calcifications can be identified with MRI using both the magnitude and the phase images. By employing susceptibility-weighted imaging with specific post-processing techniques, the phase images can be further explored to distinguish the seeds from the calcifications. Absolute quantification of tissue, water, and fat content is feasible and was previously demonstrated in phantoms and in-vivo applications, particularly for brain diseases. The approach relies on the proportionality of the MR signal to the number of protons in an image volume. By employing appropriate correction algorithms for T1 - and T2*-related biases, B1 transmit and receive field inhomogeneities, absolute water/fat content can be determined. Results: By considering calcification and interseed attenuation, and through the knowledge of water and fat mass density, accurate patient

  1. Magnetic resonance imaging of breast prostheses

    African Journals Online (AJOL)

    G5

    by silicone gel and when the silicone gel separates the elastomer shell from the sur- rounding fibrous breast capsule. Introduction. Breast implantation using prostheses is becoming a common plastic surgical proce- dure in this country. In the USA between 1 and 2 million women have had breast implantation procedures.1.

  2. Tumor bed-to-skin distance using accelerated partial-breast irradiation with the strut-adjusted volume implant device.

    Science.gov (United States)

    Fisher, Brandon; Daugherty, Larry; Shaikh, Talha; Reiff, Jay; Perlingiero, Dan; Alite, Fiori; Brady, Luther; Komarnicky, Lydia

    2012-01-01

    Because of the risk of skin toxicity with single dwell position, single-lumen brachytherapy devices are sometimes contraindicated for tumor cavities 5-7mm from the skin surface. We discuss the use of multicatheter device to treat patients with tumor bed-to-skin distances brachytherapy: 77 single-lumen and 40 multicatheter devices. A subset of 12 patients treated with SAVI(®) had bed-to-skin spacing Skin dose was measured dosimetrically, with skin constraints skin toxicities of Grades 1-2, all of which resolved by 6 months. The cosmetic outcome was good to excellent at followup. Multicatheter devices permit well-tolerated accelerated partial-breast irradiation in patients with tumor cavities near the skin surface for which the single-lumen device may not be appropriate. Published by Elsevier Inc.

  3. Partial breast irradiation: high dose rate per-operative brachytherapy technique using the MammoSite; Irradiation partielle du sein: technique de curietherapie de haut debit de dose apres l'implantation peroperatoire du dispositif MammoSite

    Energy Technology Data Exchange (ETDEWEB)

    Belkacemi, Y.; Poupon, L.; Castellanos, M.E.; Villette, S.; Lartigau, E. [Centre de Lutte Contre le Cancer Oscar-Lambret, Dept. de Radiotherapie, 59 - Lille (France); Chauvet, M.P.; Giard, S. [Centre de Lutte Contre le Cancer Oscar-Lambret, Dept. de Chirurgie Senologique, 59 - Lille (France); Bonodeau, F. [de Lutte Contre le Cancer Oscar-Lambret, Dept. de Radiologie, 59 - Lille (France); Cabaret, V. [de Lutte Contre le Cancer Oscar-Lambret, Dept. d' Anatomopathologie, 59 - Lille (France)

    2003-11-01

    In the conservative management of breast cancer, radiation therapy delivering 45 to 50 Gy to the whole breast, in 4.5 to 5 weeks, followed by a booster dose of 10 to 20 Gy is the standard of care. Based on the numerous studies which have reported that the local recurrences occurs within and surrounding the primary tumor site and in order to decrease the treatment duration and its morbidity, partial breast irradiation using several techniques has been developed. Partial irradiation may be considered as an alternative local adjuvant treatment for selected patients with favorable prognostic factors. Using external beam radiation therapy, the 3D-conformal technique is appropriate to deliver the whole dose to a limited volume. In UK, an intraoperative technique using a miniature beam of low energy of X-ray (50 kV) has been developed (Targit). Milan's team have developed an intraoperative electrons beam radiotherapy using a dedicated linear accelerator in the operative room. In USA and Canada the MammoSite has been advised for clinical use in per-operative brachytherapy of the breast. These two last techniques are currently compared in phase III randomized studies to the standard whole breast irradiation followed by a tumour bed booster dose. In this review we will focus on the MammoSite technique and will describe the per-operative implantation procedure. radiological controls ad dosimetric aspects. (author)

  4. SU-F-BRA-14: Optimization of Dosimetric Guidelines for Accelerated Partial Breast Irradiation (APBI) Using the Strut-Adjusted Volume Implant (SAVI)

    Energy Technology Data Exchange (ETDEWEB)

    Mooney, K; Altman, M; Garcia-Ramirez, J; Thomas, M; Zoberi, I; Mullen, D; DeWees, T; Esthappan, J [Washington University School of Medicine, St. Louis, MO (United States)

    2015-06-15

    Purpose: Treatment planning guidelines for accelerated partial breast irradiation (ABPI) using the strut-adjusted volume implant (SAVI) are inconsistent between the manufacturer and NSABP B-39/RTOG 0413 protocol. Furthermore neither set of guidelines accounts for different applicator sizes. The purpose of this work is to establish guidelines specific to the SAVI that are based on clinically achievable dose distributions. Methods: Sixty-two consecutive patients were implanted with a SAVI and prescribed to receive 34 Gy in 10 fractions twice daily using high dose-rate (HDR) Ir-192 brachytherapy. The target (PTV-EVAL) was defined per NSABP. The treatments were planned and evaluated using a combination of dosimetric planning goals provided by the NSABP, the manufacturer, and our prior clinical experience. Parameters evaluated included maximum doses to skin and ribs, and volumes of PTV-EVAL receiving 90%, 95%, 100%, 150%, and 200% of the prescription (V90, etc). All target parameters were evaluated for correlation with device size using the Pearson correlation coefficient. Revised dosimetric guidelines for target coverage and heterogeneity were determined from this population. Results: Revised guidelines for minimum target coverage (ideal in parentheses): V90≥95%(97%), V95≥90%(95%), V100≥88%(91%). The only dosimetric parameters that were significantly correlated (p<0.05) with device size were V150 and V200. Heterogeneity criteria were revised for the 6–1 Mini/6-1 applicators to V150≤30cc and V200≤15cc, and unchanged for the other sizes. Re-evaluation of patient plans showed 90% (56/62) met the revised minimum guidelines and 76% (47/62) met the ideal guidelines. All and 56/62 patients met our institutional guidelines for maximum skin and rib dose, respectively. Conclusions: We have optimized dosimetric guidelines for the SAVI applicators, and found that implementation of these revised guidelines for SAVI treatment planning yielded target coverage exceeding

  5. Improvement of registration accuracy in accelerated partial breast irradiation using the point-based rigid-body registration algorithm for patients with implanted fiducial markers

    Energy Technology Data Exchange (ETDEWEB)

    Inoue, Minoru; Yoshimura, Michio, E-mail: myossy@kuhp.kyoto-u.ac.jp; Sato, Sayaka; Nakamura, Mitsuhiro; Yamada, Masahiro; Hirata, Kimiko; Ogura, Masakazu; Hiraoka, Masahiro [Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto 606-8507 (Japan); Sasaki, Makoto; Fujimoto, Takahiro [Division of Clinical Radiology Service, Kyoto University Hospital, Kyoto 606-8507 (Japan)

    2015-04-15

    Purpose: To investigate image-registration errors when using fiducial markers with a manual method and the point-based rigid-body registration (PRBR) algorithm in accelerated partial breast irradiation (APBI) patients, with accompanying fiducial deviations. Methods: Twenty-two consecutive patients were enrolled in a prospective trial examining 10-fraction APBI. Titanium clips were implanted intraoperatively around the seroma in all patients. For image-registration, the positions of the clips in daily kV x-ray images were matched to those in the planning digitally reconstructed radiographs. Fiducial and gravity registration errors (FREs and GREs, respectively), representing resulting misalignments of the edge and center of the target, respectively, were compared between the manual and algorithm-based methods. Results: In total, 218 fractions were evaluated. Although the mean FRE/GRE values for the manual and algorithm-based methods were within 3 mm (2.3/1.7 and 1.3/0.4 mm, respectively), the percentages of fractions where FRE/GRE exceeded 3 mm using the manual and algorithm-based methods were 18.8%/7.3% and 0%/0%, respectively. Manual registration resulted in 18.6% of patients with fractions of FRE/GRE exceeding 5 mm. The patients with larger clip deviation had significantly more fractions showing large FRE/GRE using manual registration. Conclusions: For image-registration using fiducial markers in APBI, the manual registration results in more fractions with considerable registration error due to loss of fiducial objectivity resulting from their deviation. The authors recommend the PRBR algorithm as a safe and effective strategy for accurate, image-guided registration and PTV margin reduction.

  6. Augmentation Mammaplasty Using Implants: A Review

    Directory of Open Access Journals (Sweden)

    Susumu Takayanagi

    2012-09-01

    Full Text Available One of the techniques for augmentation mammaplasty is the procedure using implants. Eventhough this technique has been used for many years, there are still several controversial issuesto be discussed and overcome for patient safety. In this review article, capsular contracture,leak or rupture of the implants, possible systemic disease, relation with breast cancer, andrecent problems with Poly Implant Prothese implants are described and discussed.

  7. TiLoop® Bra mesh used for immediate breast reconstruction: comparison of retropectoral and subcutaneous implant placement in a prospective single-institution series

    OpenAIRE

    Casella, Donato; Bernini, Marco; Bencini, Lapo; Roselli, Jenny; Lacaria, Maria Teresa; Martellucci, Jacopo; Banfi, Roberto; Calabrese, Claudio; Orzalesi, Lorenzo

    2014-01-01

    Background Immediate implant reconstruction after a conservative mastectomy is an attractive option made easier by prosthetic devices. Titanized polypropylene meshes are used as a hammock to cover the lower lateral implant pole. We conducted a prospective nonrandomized single-institution study of reconstructions using titanium-coated meshes either in a standard muscular mesh pocket or in a complete subcutaneous approach. The complete subcutaneous approach means to wrap an implant with titaniz...

  8. Breast Imaging after Breast Augmentation with Autologous Tissues

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Kyu Won; Seo, Bo Kyung; Shim, Eddeum; Song, Sung Eun; Cho, Kyu Ran [Dept. of Radiology, Korea University Anam Hospital, Seoul (Korea, Republic of); Yoon, Eul Sik [Korea University Ansan Hospital, Ansan (Korea, Republic of); Woo, Ok Hee [Dept. of Radiology, Korea University Guro Hospital, Seoul (Korea, Republic of)

    2012-06-15

    The use of autologous tissue transfer for breast augmentation is an alternative to using foreign implant materials. The benefits of this method are the removal of unwanted fat from other body parts, no risk of implant rupture, and the same feel as real breast tissue. However, sometimes there is a dilemma about whether or not to biopsy for calcifications or masses detected after the procedure is completed. The purpose of this study is to illustrate the procedures of breast augmentation with autologous tissues, the imaging features of various complications, and the role of imaging in the diagnosis and management of complications and hidden breast diseases.

  9. Gossypiboma after Breast Augmentation

    Directory of Open Access Journals (Sweden)

    Kira Lundin

    2013-01-01

    Full Text Available A 39-year-old woman was referred for removal of cosmetic breast implants and related siliconoma. After an exchange of breast implants at a private clinic a year previously, she had asymmetry of the right breast, persistent pain, and a generally unacceptable cosmetic result. An MRI had shown a well-defined area with spots of silicone-like material at the upper pole of the right breast. Surgical removal of presumed silicone-imbibed breast tissue was undertaken, and surprisingly a gossypiboma was found in its place, which had not been identified on the MRI. Gossypiboma is the condition of an accidentally retained surgical sponge. This complication is also known as a textiloma, gauzoma, or muslinoma and is well described in other surgical specialties. However, it is extremely rare after plastic surgery, and this case illustrates the need for continued attention to the surgical count of sponges and instruments.

  10. Experimental model of capsular contracture in silicone implants

    Directory of Open Access Journals (Sweden)

    Bastos Érika Malheiros

    2003-01-01

    Full Text Available The breast implant procedure is one of the most performed into Plastic Surgery and the contracture that occurs the capsule formed around the breast implants one of most frequent complication. We describe here one experimental model of capsule contracture in rats.

  11. Simvastatin Reduces Capsular Fibrosis around Silicone Implants.

    Science.gov (United States)

    Chung, Kyu Jin; Park, Ki Rin; Lee, Jun Ho; Kim, Tae Gon; Kim, Yong-Ha

    2016-08-01

    Capsular fibrosis and contracture occurs in most breast reconstruction patients who undergo radiotherapy, and there is no definitive solution for its prevention. Simvastatin was effective at reducing fibrosis in various models. Peri-implant capsular formation is the result of tissue fibrosis development in irradiated breasts. The purpose of this study was to examine the effect of simvastatin on peri-implant fibrosis in rats. Eighteen male Sprague-Dawley rats were allocated to an experimental group (9 rats, 18 implants) or a control group (9 rats, 18 implants). Two hemispherical silicone implants, 10 mm in diameter, were inserted in subpanniculus pockets in each rat. The next day, 10-Gy of radiation from a clinical accelerator was targeted at the implants. Simvastatin (15 mg/kg/day) was administered by oral gavage in the experimental group, while animals in the control group received water. At 12 weeks post-implantation, peri-implant capsules were harvested and examined histologically and by real-time polymerase chain reaction. The average capsular thickness was 371.2 μm in the simvastatin group and 491.2 μm in the control group. The fibrosis ratio was significantly different, with 32.33% in the simvastatin group and 58.44% in the control group (P simvastatin group compared to the control group (P simvastatin reduces radiation-induced capsular fibrosis around silicone implants in rats. This finding offers an alternative therapeutic strategy for reducing capsular fibrosis and contracture after implant-based breast reconstruction.

  12. [Diagnosing and treating tuberous breast deformity].

    Science.gov (United States)

    Nielsen, Lea Juul; Jensen, Lisa Toft

    2017-01-23

    Tuberous breast deformity is a relatively rare breast anomaly, manifesting during puberty. Patients usually complain of small breasts, asymmetry or dissatisfaction with the shape of the breast. Objectively, patients present with reduced breast base, displaced inframammary fold, hypoplasia, asymmetry, ptosis and areola herniation. The surgical options are multiple, and either one- or two-stage procedures can be planned, using expanders, implants, "unfurling", lipografting or a combination of these. Surgical treatment leads to a high degree of patient satisfaction and low complication rates.

  13. [Tuberous breast: Current concept].

    Science.gov (United States)

    Ellart, J; Chaput, B; Grolleau, J-L

    2016-10-01

    Tuberous breast deformity is a congenital breast anomaly with different clinical signs. The most consistent sign is the constricting ring at the base of the breast. There is deficiency in the horizontal and/or vertical dimensions of the breast and often herniation of breast parenchyma toward the nipple-areola complex with areola enlargement. Breast asymmetry is frequently associated. This anomaly occurs only in females, during breast development at puberty. The incidence is unknown because of minor forms more difficult to diagnose. This deformity produces psychological morbidity and encourages the patients to consult. In 1999, Grolleau publishes a classification with three types of tuberous breast deformity. The goals of the surgical treatment are the expansion of the constricted base, the redistribution of volume, the correction of areolar size and of herniated subareolar breast tissue. In type II and III, the simple use of breast implant involves the "memory" of the previous inframammary fold line. To avoid this complication, it is necessary to make a glandular rearrangement with parenchymal flaps like Puckett and Ribeiro. It is a real challenge for the plastic surgeon who must reshape the breast and obtain a symmetry of volume. It would be delusive to think all types of tuberous breast can be corrected with the same one-step technique. It is often necessary to plan several surgeries and patient must always be informed about the strategy. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  14. Bilateral Poly Implant Prothèse Implant Rupture: An Uncommon Presentation

    Directory of Open Access Journals (Sweden)

    Peter Mallon

    2013-07-01

    Full Text Available Summary: A woman in her 50s underwent delayed bilateral Poly Implant Prothèse implant reconstruction following mastectomy for breast cancer. Symptoms of implant rupture developed 43 months after surgery with an erythematous rash on her trunk. The rash then spread to her reconstructed breast mounds. Initial ultrasound scan and magnetic resonance imaging were normal; however, subsequent magnetic resonance imaging demonstrated left implant rupture only. In theater, following removal of both implants, both were found to be ruptured. The rash on her trunk resolved within 3 weeks in the postoperative period. Chemical analyses of silicone in both implants confirmed a nonauthorized silicone source; in addition, the chemical structure was significantly different between the left and right implant, perhaps explaining the variation in presentation.

  15. Breast reconstruction with an expander prosthesis following mastectomy does not cause additional persistent pain

    DEFF Research Database (Denmark)

    Klit, Anders; Mejdahl, Mathias Kvist; Gärtner, Rune

    2013-01-01

    Few studies have examined the prevalence of persistent pain after breast reconstruction with an implant after tissue expansion in comparison to mastectomy without breast reconstruction. Our primary objective was to evaluate the prevalence of persistent pain after breast reconstruction with a subp......Few studies have examined the prevalence of persistent pain after breast reconstruction with an implant after tissue expansion in comparison to mastectomy without breast reconstruction. Our primary objective was to evaluate the prevalence of persistent pain after breast reconstruction...

  16. Conical polyurethane implants: an uplifting augmentation.

    Science.gov (United States)

    Georgeu, Garrick A; Frame, James D; Frame, James D

    2013-11-01

    Polyurethane-coated conical implants were introduced by Silimed (US distributor: Sientra, Santa Barbara, California) in 2008 and offer an alternative to round or anatomically shaped implants. By their design and volume distribution, they naturally create central volume and give a reasonable fullness to the upper pole while lifting some ptotic breasts, thus avoiding the need for classical mastopexy. The authors discuss the advantages of conical implants as an alternative to conventional silicone implants for women with breast ptosis. In the 2-year period between December 2010 and December 2012, a consecutive series of 302 women underwent implant-based breast surgery procedures (236 primary augmentations, 59 revisions, and 7 mastopexy-augmentations) with conical polyurethane devices. Implant volumes ranged from 225 to 560 cc, with low- to medium-profile devices predominating. No extra-high-profile implants were used. Only 1 patient had a drain inserted on completion of a revision augmentation. There were no infections (0%) and no wound dehiscence (0%). Four cases required reoperation (1.3%). Patient satisfaction scores were universally high (average, 9.94/10). There have been no capsular contractures to date, but follow-up is short. The modern conical, polyurethane implant has many advantages over the conventional round or anatomically shaped implants and offers patients an ideal compromise between volume, natural upper pole fullness, and a lift without mastopexy scars.

  17. Morphea on the breast and pregnancy

    African Journals Online (AJOL)

    abp

    2013-09-18

    Sep 18, 2013 ... breast implants, trauma, and external beam radiation for the treatment of breast cancer. None of these factors was found in our patient. To our knowledge, the pregnancy has never been reported as predisposing factor of the localization of morphea on the breast. The underlying etiology of morphea is ...

  18. A rare case of silicone mammary implant infection by Streptomyces spp. in a patient with breast reconstruction after mastectomy: taxonomic characterization using molecular techniques

    DEFF Research Database (Denmark)

    Manteca, Angel; Pelaez, Ana Isabel; del Mar Garcia-Suarez, Maria

    2009-01-01

    A Streptomyces sp. isolated from a patient who had had breast reconstruction after a mastectomy was identified at the species level by comparative sequence analysis of 16S ribosomal DNA (rDNA) and the hypervariable alpha-region of the 16S rDNA.......A Streptomyces sp. isolated from a patient who had had breast reconstruction after a mastectomy was identified at the species level by comparative sequence analysis of 16S ribosomal DNA (rDNA) and the hypervariable alpha-region of the 16S rDNA....

  19. Implantable contraception.

    Science.gov (United States)

    Meckstroth, K R; Darney, P D

    2000-12-01

    Although levonorgestrel contraceptive implants have been available for over 15 years, innovations have only recently led to a wider choice. These new implants offer easier insertion and removal and other advantages depending on the type of progestin. Implants prevent pregnancy by several mechanisms, including inhibition of ovulation and luteal function and alteration of cervical mucus and the endometrium. The high efficacy and ease of maintenance make implants an ideal contraceptive for many women, including adolescents, a population that uses implants infrequently but reports high satisfaction. Implants are appropriate for women who are breastfeeding, who have contraindications to estrogen, or who have diseases such as diabetes, hypertension, sickle cell anemia, or an HIV infection because implants have few metabolic or hematologic effects. Long-term use has not been associated with a decrease in BMD and generally leads to increased blood levels and iron stores. Women who wish to space their pregnancies appreciate the nearly immediate onset of action with insertion and the rapid termination of all effects with removal. All types of implants lead to menstrual changes and other side effects in some women. Adverse effects that occur in implant users more than the general population include headaches and acne. Women must be thoroughly counseled regarding the potential for menstrual alteration, side effects, and sexually transmitted infections if they do not use condoms. Despite their initial high cost, implants are a cost-effective method over several years, even when discontinued before the life of the implant.

  20. Sci—Fri PM: Topics — 02: Evaluation of Dosimetric Variations in Partial Breast Seed Implant (PBSI) due to Patient Arm Position (Up vs. Down)

    Energy Technology Data Exchange (ETDEWEB)

    Watt, E [Department of Physics and Astronomy, University of Calgary, Calgary, AB (Canada); Tom Baker Cancer Centre, Calgary, AB (Canada); Long, K [Tom Baker Cancer Centre, Calgary, AB (Canada); Husain, S [Tom Baker Cancer Centre, Calgary, AB (Canada); Department of Oncology, University of Calgary, Calgary, AB (Canada); Meyer, T [Department of Physics and Astronomy, University of Calgary, Calgary, AB (Canada); Tom Baker Cancer Centre, Calgary, AB (Canada); Department of Oncology, University of Calgary, Calgary, AB (Canada)

    2014-08-15

    The planning for PBSI is done with the patient's ipsilateral arm raised, however, anatomical changes and variations are unavoidable as the patient resumes her daily activities, potentially resulting in significant deviations in implant geometry from the treatment plan. This study aims to quantify the impact of the ipsilateral arm position on the geometry and dosimetry of the implant at eight weeks, evaluated on post-plans using the MIM Symphony™ software (MIM Software, Cleveland, OH). The average dose metrics for the three patients treated at the TBCC thus far using rigid fusion and contour transfer for the arms up position were 76% for the CTV V100, 61% for the PTV V100, and 37% for the PTV V200; and for the arms down position 81% for the CTV V100, 64% for the PTV V100, and 42% for the PTV V200. Qualitative analysis of the post-implant CT for one of the three patients showed poor agreement between the seroma contour transferred from the pre-implant CT and the seroma visible on the post-implant CT. To obtain a clinically accurate plan for that patient, contour modifications were used, yielding improved dose metric averages for the arms-up position for all three patients of 87% for the CTV V100, 68% for the PTV V100, and 39% for the PTV V200. Overall, the data available shows that dosimetric parameters increase with the patient's arm down, both in terms of coverage and in terms of the hot spot, and accrual of more patients may confirm this in a larger population.

  1. Dental Implant Surgery

    Science.gov (United States)

    ... to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, and is ... to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, and is ...

  2. Breast lump

    Science.gov (United States)

    ... removed with surgery. Breast infections are treated with antibiotics. If you are diagnosed with breast cancer , you will discuss your options carefully and thoroughly with your provider. Alternative Names Breast mass Images Female breast Breast lumps ...

  3. Transaxillary Endoscopic Breast Augmentation

    Directory of Open Access Journals (Sweden)

    Hyung-Bo Sim

    2014-09-01

    Full Text Available The axillary technique is the most popular approach to breast augmentation among Korean women. Transaxillary breast augmentation is now conducted with sharp electrocautery dissection under direct endoscopic vision throughout the entire process. The aims of this method are clear: both a bloodless pocket and a sharp non-traumatic dissection. Round textured or anatomical cohesive gel implants have been used to make predictable well-defined inframammary creases because textured surface implants demonstrated a better stability attributable to tissue adherence compared with smooth surface implants. The axillary endoscopic technique has greatly evolved, and now the surgical results are comparable to those with the inframammary approach. The author feels that this technique is an excellent choice for young patients with an indistinct or absent inframammary fold, who do not want a scar in the aesthetic unit of their chest.

  4. Double breast contour in primary aesthetic breast augmentation: incidence, prevention and treatment.

    Science.gov (United States)

    Médard de Chardon, Victor; Balaguer, Thierry; Chignon-Sicard, Bérengère; Lebreton, Elisabeth

    2010-04-01

    The goal of this study was to define the incidence of double breast contour in primary aesthetic breast augmentation and to analyze its risk factors. An independent plastic surgeon analyzed the data of 200 patients who had a primary aesthetic breast augmentation with silicone gel implant and with a minimum 12-month follow-up. All patients had pre and postoperative standardized photography. Mastopexy-augmentations, breast reconstructions, breast malformations (tuberous breasts and Poland syndrome), and patients with incomplete data were excluded from the study. Assessment was achieved using an original standardized evaluation form (preoperative breast morphology, surgical options, postoperative aesthetic results). Patients were also asked to complete an exhaustive satisfaction form. A double breast contour was assessed clinically using Massiha's classification. The mean follow-up was 36 months. The double breast contour incidence was 7%. All of them were type I (the so called waterfall deformity). There was no type II (double inframammary crease). They were minor for 6.5% and major for 0.5%. They were related to a preoperative breast ptosis, subpectoral placement, and implant upper malposition. The rate of the type I was 10.5% of submuscular augmentation and 15% of preoperative breast ptosis. A double breast contour was primitive for 6% and secondary for 1% (pregnancy and breast-feeding postaugmentation). It was bilateral for 4.5% (3 cases of upper malposition, 1 case of medial malposition, 2 cases of pregnancy with breast-feeding postaugmentation and 1 patient refused a mastopexy-augmentation). It was unilateral for 2.5% related to a preoperative breast asymmetry with ptosis asymmetry and skin quality asymmetry. The satisfaction rate in the group "double contour" (14 patients) was 85.7% (vs. 91.9%). One patient had revision surgery (upper malposition). These types of deformities are fundamentally different with consideration on their clinical aspects

  5. Which breast is the best? Successful autologous or alloplastic breast reconstruction: patient-reported quality-of-life outcomes.

    Science.gov (United States)

    Eltahir, Yassir; Werners, Lisanne L C H; Dreise, Marieke M; Zeijlmans van Emmichoven, Ingeborg A; Werker, Paul M N; de Bock, Geertruida H

    2015-01-01

    Breast reconstruction is an appropriate option offered to women who are diagnosed with breast cancer or gene mutations. It may be accomplished with implants or autologous procedures. This cross-sectional study evaluated the satisfaction and quality of life in addition to complications and secondary corrections in women after successful autologous or alloplastic (implant) breast reconstruction. Women were included after successful breast reconstruction. The BREAST-Q instrument and standardized questionnaires on depression, recurrence concerns, and anxiety were sent by mail to the participants. In addition, data were collected on complications and secondary corrections. Multiple regression analysis and chi-square tests were applied to evaluate differences between the autologous breast reconstruction group (n = 47) and the implant breast reconstruction group (n = 45). Women with a successful autologous reconstruction were significantly more satisfied with their reconstructed breasts than women with successful alloplastic breast reconstruction as measured with the BREAST-Q satisfaction with breasts module (p = 0.023). More women with an autologous breast reconstruction required secondary correction than women with an implant breast reconstruction (p = 0.012). Other findings did not differ between the two groups. Autologous breast reconstruction leads to more satisfaction than does implant breast reconstruction, notwithstanding that women with an autologous breast reconstruction more often required a secondary correction. The study found no ideal breast reconstruction suitable for all patients. However, this study may inform patients and medical teams in making decisions about breast reconstruction. This pilot study indicated several questions that we plan to further investigate in a larger prospective study. Therapeutic, III.

  6. About Implantable Contraception

    Science.gov (United States)

    ... Helping Your Child Deal With Death About Implantable Contraception KidsHealth > For Parents > About Implantable Contraception Print A ... How Much Does It Cost? What Is Implantable Contraception? Implantable contraception (often called the birth control implant) ...

  7. Augmented reality for breast imaging.

    Science.gov (United States)

    Rancati, Alberto; Angrigiani, Claudio; Nava, Maurizio B; Catanuto, Giuseppe; Rocco, Nicola; Ventrice, Fernando; Dorr, Julio

    2018-02-21

    Augmented reality (AR) enables the superimposition of virtual reality reconstructions onto clinical images of a real patient, in real time. This allows visualization of internal structures through overlying tissues, thereby providing a virtual transparency vision of surgical anatomy. AR has been applied to neurosurgery, which utilizes a relatively fixed space, frames, and bony references; the application of AR facilitates the relationship between virtual and real data. Augmented Breast imaging (ABI) is described. Breast MRI studies for breast implant patients with seroma were performed using a Siemens 3T system with a body coil and a four-channel bilateral phased-array breast coil as the transmitter and receiver, respectively. The contrast agent used was (CA) gadolinium (Gd) injection (0.1 mmol/kg at 2 ml/s) by a programmable power injector. Dicom formated images data from 10 MRI cases of breast implant seroma and 10 MRI cases with T1-2 N0 M0 breast cancer, were imported and transformed into Augmented reality images. Augmented breast imaging (ABI) demonstrated stereoscopic depth perception, focal point convergence, 3D cursor use, and joystick fly-through. Augmented breast imaging (ABI) to the breast can improve clinical outcomes, giving an enhanced view of the structures to work on. It should be further studied to determine its utility in clinical practice.

  8. Breast Pain

    Science.gov (United States)

    ... result in the development of breast cysts. Breast trauma, prior breast surgery or other factors localized to the breast can lead to breast pain. Breast pain may also start outside the breast — in the chest wall, muscles, joints or heart, for example — and ...

  9. SU-E-T-209: Comparison of Plan Quality Between Arm Avoidance (AA) Vs. Non Arm Avoidance VMAT Planning Techniques for Breast Cancer Patients with Bilateral Implant Reconstructions Receiving Postmastectomy Radiation

    Energy Technology Data Exchange (ETDEWEB)

    Kuo, L; Ballangrud, A; Ho, A; Mechalakos, J; Li, G; Hong, L [Memorial Sloan Kettering Cancer Center, New York, NY (United States)

    2015-06-15

    Purpose: Breast cancer patients with bilateral implant reconstructions who require postmastectomy radiotherapy can pose unique treatment planning challenges. The use of VMAT may provide advantages over conventional tangent or multi-beam IMRT techniques. Moreover, daily setup uncertainly of the arm position, however, could have significant impact on accurate dose delivery. This study compares the plan qualities between non-AA and AA VMAT techniques. Methods: Three breast cancer patients receiving left chest wall and regional nodal irradiation with bilateral implant reconstructions were studied. PTV included chest wall and IMNs (PTV-CW), and supraclavicular and axillary lymph nodes (PTV-SCV). For each patient, one non-AA VMAT plan (VMAT-S) with 4 partial arcs encompassing the ipsilateral arm and three AA VMAT plans where no arcs were entering or existing through the ipsilateral arm were generated. VMAT-AA1 uses 2 arcs for PTV-CW and 2 arcs for PTV-SCV. VMAT-AA2 used two static fields for PTV-SCV with 2 arcs for PTV-CW. VMAT-AA3 used 2 narrow arcs for PTV-CW and 2 long arcs for all PTVs. Prescription dose (PD) was 50 Gy (25 fractions). All plans were normalized to have 95% of PD to 95 % of PTV. PTV dose inhomogeneity and dose to the heart, left lung, right thyroid dose and left humerus were evaluated. Results: For VMAT-S, VMAT-AA1, VMAT-AA2 and VMAT-AA3, respectively, the average and standard deviation (in Gy unless specified otherwise) of PTV D05 are 54.7±0.9, 55.9±0.4, 56.7±0.7 and 55.7±0.4; mean Heart dose: 7.1±0.7, 7.2±0.8, 7.3±0.9 and 6.9±1.0; left lung V20Gy (in %): 28.1±1.0, 28.8+2.2, 32.2±4.1 and 27.8±2.0; mean right thyroid dose: 8.1±0.6, 5.1±2.1, 2.1±0.4 and 5.0±2.0; mean left humerus dose: 20.0±4.4,15.6±4.4, 15.2±8.2 and 15.3±4.6. Conclusion: AA VMAT can produce acceptable clinical plans while eliminating dosimetric impact related to arm setup uncertainty. These data require validation in larger planning studies prior to routine clinical

  10. Fibroadenoma - breast

    Science.gov (United States)

    ... fibroadenoma; Breast lump - noncancerous; Breast lump - benign References Hacker NF, Friedlander ML. Breast disease: a gynecologic perspective. In: Hacker NF, Gambone JC, Hobel CJ, eds. Hacker and ...

  11. Dual-Energy CT for Evaluation of Intra- and Extracapsular Silicone Implant Rupture

    Directory of Open Access Journals (Sweden)

    Katrina N. Glazebrook

    2016-01-01

    Full Text Available Silicone implants are commonly used for both breast augmentation and breast reconstruction. With aging of the implant, the silicone envelope may become weak or may rupture. The technique of choice for evaluation of implant integrity is breast MRI; however this may be contraindicated in some patients or the cost may be prohibitive. Dual-energy CT allows determination of density and atomic number of tissue and can provide material composition information. We present a case of extracapsular implant rupture with MRI and dual-energy CT imaging and surgical correlation.

  12. Penile Implants

    Science.gov (United States)

    ... men with erectile dysfunction (ED) to get an erection. Penile implants are typically recommended after other treatments for ... the scrotum, and two inflatable cylinders inside the penis. To achieve an erection, you pump the fluid from the reservoir into ...

  13. Cochlear Implants

    Science.gov (United States)

    ... the skin. An implant does not restore normal hearing. It can help a person understand speech. Children and adults can benefit from them. National Institute on Deafness and Other Communication Disorders

  14. Is tail vein injection a relevant breast cancer lung metastasis model?

    National Research Council Canada - National Science Library

    Rashid, Omar M; Nagahashi, Masayuki; Ramachandran, Suburamaniam; Dumur, Catherine I; Schaum, Julia C; Yamada, Akimitsu; Aoyagi, Tomoyoshi; Milstien, Sheldon; Spiegel, Sarah; Takabe, Kazuaki

    2013-01-01

    TWO MOST COMMONLY USED ANIMAL MODELS FOR STUDYING BREAST CANCER LUNG METASTASIS ARE: lung metastasis after orthotopic implantation of cells into the mammary gland, and lung implantations produced after tail vein (TV) injection of cells...

  15. Cochlear implant by adult

    OpenAIRE

    Kratochvílová, Tereza

    2011-01-01

    Bachelor thesis "The cochlear implant in an adult deaf" deals primarily with the cochlear implant. The most extensive part of the thesis talks about this topic, which also talks about the development and design of cochlear implants, explains the difference between cochlear implantation and tribal implantation and describes operation of implant and the subsequent setting of the implant. This section is also dedicated to binaural cochlear implantation, myths of cochlear implants and problems wh...

  16. Medication-Related Osteonecrosis of the Jaw Around Dental Implants: Implant Surgery-Triggered or Implant Presence-Triggered Osteonecrosis?

    Science.gov (United States)

    Giovannacci, Ilaria; Meleti, Marco; Manfredi, Maddalena; Mortellaro, Carmen; Greco Lucchina, Alberta; Bonanini, Mauro; Vescovi, Paolo

    2016-05-01

    Dentoalveolar surgery including tooth extractions and dental implants placement is considered the major risk factor for developing medication-related osteonecrosis of the jaw (MRONJ).In this study, a patient series of MRONJ around dental implants were carefully analyzed to describe the findings and to assess the possible risk factors. Fifteen patients with peri-implant bone osteonecrosis were selected out of a group of 250 patients (6%). Patients were divided into 2 groups according to the temporal relationship. Group 1 (G1)-necrosis immediately after implant placement (from 2 to 10 months) and defined as "implant surgery-triggered" MRONJ. Group 2-necrosis distant (from 1 to 15 years) from implant placement and defined as "implant presence-triggered" MRONJ. Epidemiological and pharmacological variables were recorded as well as specific data about osteonecrosis and dental implants. G1 included 6 patients: 5 (83.4%) treated with oral bisphosphonates (BPs) for osteoporosis and 1 (16.6%) with intravenous BPs for breast cancer. Mean duration of BP therapy (BPT) was 83.7 months. G2 included 9 patients: 8 patients (88.89%) treated with intravenous BPs for malignant disease and 1 (11.11%) with oral BPs for osteoporosis. Data confirms that not only surgical insertion of dental implants is a potential risk factor for the development of osteonecrosis but also the presence itself of the implant into the bone can be associated with this disease. Therefore, it is necessary to inform of the increased risk for MRONJ also the patients who have already osteointegrated implants and are going to start the BPT.The risk is lower for patients receiving oral BPs but it exists and seems to be higher if the implant is located in the posterior areas, if the duration of BPT is more than 3 years and if the patient is under corticosteroid therapy.

  17. Breast reconstruction following amputation for cancer

    Directory of Open Access Journals (Sweden)

    Višnjić Milan

    2009-01-01

    Full Text Available Background/Aim. Today, breast reconstruction is a widely accepted method in the treatment of breast cancer after modified radical mastectomy. Reconstruction methods are associated with an acceptable number of complications and reconstruction favorably impacts quality of life. The aim of the study was to present our experience in breast reconstruction. Methods. We presented here a four-year experience with 84 patients with breast reconstruction after modified radical mastectomy. Results. Implant reconstructions were most common, 44 (52.3%, with primary reconstruction in 31(70.4% and secondary in 13 (29.5% women. Lattisimus dorsi flap (LDF and implant were utilized in 32 (38% of the patients, with primary reconstruction in 24 (75% and secondary in 8 (25% women. Transversal rectus abdominis myocutaneous (TRAM flap was rarely used - just in 8 (9.5% patients and only for secondary breast reconstruction. Postoperatively, some early complications such as hematoma, seroma, infections and partial flap necrosis were observed in 10 (11.9% patients. Late complications, such as implant rejection, hypertrophic scarring and hernias at the flap elevation site, were noted in 10 (11.9% cases. Implant loss occurred in 5 (5.9% cases. All the complications were successfully managed, and patients rated their reconstruction as follows: excellent, 49 (59% cases; very good, 20 (24%, and good, 14 (16.8%. In one case, disease progression was observed 6 months after the primary breast reconstruction. Conclusion. Breast reconstruction is an acceptable method in the treatment of breast cancer in patients in the need for or with already performed mastectomy. The choice of reconstruction approach depends on the breast volume, patient's wish and experience of surgical team. Our results suggest the advantage of breast reconstruction with LDF with implant, since the technique is safe, complications relatively rare and easily manageable, and the results are excellent or very good

  18. Today in breast augmentation

    Directory of Open Access Journals (Sweden)

    Juan Manuel Calderón

    2016-02-01

    Full Text Available Breast augmentation is one of the most commonly performed procedures worldwide among aesthetic reconstructive surgeries. Among the indications for performing the procedure are primary and secondary alterations related to breasts shape and volume. During the initial assessment, emphasis should be placed in the anamnesis and physical examination, allowing to define target sizing and realistic expectations to prospectively determine the possible postoperative satisfaction rates. There are several methods used to select the appropriate implants that have become more accurate with time and with the use of technology. Although there are multiple materials developed, to this moment silicone implants continue to be the ones most used worldwide with low complication rates depending on each patient and on the technique used. It is considered as one of the aesthetic reconstructive surgeries with the highest degree of acceptance among the general population who undergo this type of procedures.

  19. The evolving breast reconstruction

    DEFF Research Database (Denmark)

    Thomsen, Jørn Bo; Gunnarsson, Gudjon Leifur

    2014-01-01

    The aim of this editorial is to give an update on the use of the propeller thoracodorsal artery perforator flap (TAP/TDAP-flap) within the field of breast reconstruction. The TAP-flap can be dissected by a combined use of a monopolar cautery and a scalpel. Microsurgical instruments are generally...... not needed. The propeller TAP-flap can be designed in different ways, three of these have been published: (I) an oblique upwards design; (II) a horizontal design; (III) an oblique downward design. The latissimus dorsi-flap is a good and reliable option for breast reconstruction, but has been criticized...... for morbidity and complications. The TAP-flap does not seem to impair the function of the shoulder or arm and the morbidity appears to be scarce. However, an implant is often needed in combination with the TAP-flap, which results in implant related morbidity over time. The TAP-flap seems to be a promising tool...

  20. Review: implants.

    Science.gov (United States)

    Ashton, P; Blandford, D L; Pearson, P A; Jaffe, G J; Martin, D F; Nussenblatt, R B

    1994-01-01

    An implantable sustained release device has been developed to treat chronic disorders of the eye. The device, consisting of a central core of drug encased in layers of permeable and impermeable polymers, can be implanted subconjunctivally or intravitreally. This technique was used to develop a ganciclovir device which, when implanted into the vitreous, maintains therapeutic vitreous levels of drug for 8 months. Initial studies in patients with cytomegalovirus (CMV) retinitis indicate that this treatment may offer better control of the disease and fewer side effects than existing therapies. Cyclosporine A devices were prepared for the treatment of uveitis. Early data suggests that these devices maintain therapeutic levels in the vitreous for approximately 3 years. Work on efficacy and toxicity is continuing. Although clinical applications of these devices are likely to be restricted to diseases requiring chronic drug therapy, they can be used to investigate optimal delivery rates. Subconjunctivally implanted devices releasing 5-FU for 12 days maintained filters in cynomolgus monkeys for 3 months. Similar devices maintained low intraocular pressure in 75% of high risk filter patients.

  1. Surgical treatment of breast cancer in previously augmented patients.

    Science.gov (United States)

    Karanas, Yvonne L; Leong, Darren S; Da Lio, Andrew; Waldron, Kathleen; Watson, James P; Chang, Helena; Shaw, William W

    2003-03-01

    The incidence of breast cancer is increasing each year. Concomitantly, cosmetic breast augmentation has become the second most often performed cosmetic surgical procedure. As the augmented patient population ages, an increasing number of breast cancer cases among previously augmented women can be anticipated. The surgical treatment of these patients is controversial, with several questions remaining unanswered. Is breast conservation therapy feasible in this patient population and can these patients retain their implants? A retrospective review of all breast cancer patients with a history of previous augmentation mammaplasty who were treated at the Revlon/UCLA Breast Center between 1991 and 2001 was performed. During the study period, 58 patients were treated. Thirty patients (52 percent) were treated with a modified radical mastectomy with implant removal. Twenty-eight patients (48 percent) underwent breast conservation therapy, which consisted of lumpectomy, axillary lymph node dissection, and radiotherapy. Twenty-two of the patients who underwent breast conservation therapy initially retained their implants. Eleven of those 22 patients (50 percent) ultimately required completion mastectomies with implant removal because of implant complications (two patients), local recurrences (five patients), or the inability to obtain negative margins (four patients). Nine additional patients experienced complications resulting from their implants, including contracture, erosion, pain, and rupture. The data illustrate that breast conservation therapy with maintenance of the implant is not ideal for the majority of augmented patients. Breast conservation therapy with explantation and mastopexy might be appropriate for rare patients with large volumes of native breast tissue. Mastectomy with immediate reconstruction might be a more suitable choice for these patients.

  2. [Combining mastopexy and triple-plane breast augmentation in correction of breast atrophy and ptosis].

    Science.gov (United States)

    Long, Xiao; Wang, Yang; Bai, Ming; Zhao, Ru

    2015-01-01

    To investigate the application of combining mastopexy and triple-plane breast augmentation in correction of breast ptosis and atrophy. Peri-areolar incision was performed to finish the fascia and dermal suspension to correct the breast ptosis. The implant was inserted under the pectoralis major muscle through lateral lower border of the gland and a "X" shape full thickness incision was made on the pectoralis major muscle according to the new position of nipple-areolar complex. 14 patients received combined mastopexy and triple-plane breast augmentation to correct breast atrophy and mastopexy simultaneously. All the patients were regularly followed for 6-12 months. No patients suffered severe complication and the results were satisfied. "Triple-plane" breast augmentation could be safely performed with peri-areolar mastopexy with minor injury. The technique could help to ensure the balance between the gland, nipple-areolar complex and the implant.

  3. Initial clinical experience with the Strut-Adjusted Volume Implant (SAVI) breast brachytherapy device for accelerated partial-breast irradiation (APBI): first 100 patients with more than 1 year of follow-up.

    Science.gov (United States)

    Yashar, Catheryn M; Scanderbeg, Daniel; Kuske, Robert; Wallace, Anne; Zannis, Victor; Blair, Sarah; Grade, Emily; Swenson, Virginia H; Quiet, Coral

    2011-07-01

    The Strut-Adjusted Volume Implant (SAVI; Cianna Medical, Aliso Viejo, CA) is a multichannel single-entry brachytherapy device designed to allow dose modulation to minimize normal tissue dose while simultaneously maximizing target coverage. This is the first report on the initial 102 patients with nearly 2 years of median follow-up. One hundred two patients were treated at two institutions. Data were collected on eligibility and dosimetry and followed for toxicity and recurrence. The median follow-up is 21 months. Overall dosimetry is outstanding (median percent of target volume receiving 90% of the prescription dose was 95.9%, volume of target receiving 150% of the prescription dose was 27.8 mL, and volume of target receiving 200% of the prescription dose was 14.0 cm(3)). No devices were pulled prior to treatment completion. For patients with a skin bridge of less than 7 mm, the maximum median skin dose was 280 cGy (median percent of target volume receiving 90% of the prescription dose was 95.2%, volume of target receiving 150% of the prescription dose was 25.8 cm(3) and volume of target receiving 200% of the prescription dose was 12.7 mL). For patients with both chest wall and skin of less than 7 mm, the maximum median lung dose was 205 cGy with simultaneous skin dose of 272 cGy. The rate of telangiectasia was 1.9%. Grade 1 hyperpigmentation developed in 10 patients (9.8%) and Grade 2 fibrosis in 2 patients (1.9%). There were 2 symptomatic seromas and 2 cases of asymptomatic fat necrosis (1.9%). Of the patients, 27% were not eligible for MammoSite balloon brachytherapy (Hologic, Inc., Marlborough, MA) and 5% were not eligible for any balloon brachytherapy. The recurrence rate was 1%. The SAVI appears to safely allow an increase in eligibility for APBI over balloon brachytherapy or three-dimensional conformal radiation, highlighting the outstanding device flexibility to maximize the target dose and minimize the normal tissue dose. The device was well tolerated by

  4. Quality of the capsule in reconstructions with textured or smooth silicone implants after mastectomy.

    Science.gov (United States)

    Hammerstad, M; Dahl, B H; Rindal, R; Kveim, M R; Roald, H E

    1996-03-01

    Many women desire some kind of reconstruction after mastectomy for breast cancer to improve the cosmetic result. Since the introduction of silicone breast implants, capsular contracture has been the most common complication of breast augmentation or reconstruction. The aim of the present study was to evaluate the capsule quality in patients with breast cancer who had undergone reconstructions with either textured (rough) or smooth silicone implants after simple or modified radical mastectomy. Forty-three consecutive patients had reconstructions with textured silicone implants (49 implants) and were evaluated 32 months post-operatively in a prospective clinical trial. The last 43 consecutive patients who had reconstructions with bilumen smooth silicone implants (49 implants) acted as controls. The results were graded by Baker's classification. Among the patients with textured implants only 9% (4/47) was graded as having moderate or severe capsular contracture in contrast to 24% (11/46) in patients with bilumen smooth-surface implants (p < 0.05). These results confirm previous reports that favour textured silicone implants in breast augmentation and reconstruction.

  5. Linguine sign in musculoskeletal imaging: calf silicone implant rupture

    Energy Technology Data Exchange (ETDEWEB)

    Duryea, Dennis; Petscavage-Thomas, Jonelle [Milton S. Hershey Medical Center, Department of Radiology, H066, 500 University Drive, P.O. Box 850, Hershey, PA (United States); Frauenhoffer, Elizabeth E. [Milton S. Hershey Medical Center, Department of Pathology, 500 University Drive, P.O. Box 850, Hershey, PA (United States); Walker, Eric A. [Milton S. Hershey Medical Center, Department of Radiology, H066, 500 University Drive, P.O. Box 850, Hershey, PA (United States); Uniformed Services University of the Health Sciences, Department of Radiology and Nuclear Medicine, Bethesda, MD, 20814 (United States)

    2015-08-15

    Imaging findings of breast silicone implant rupture are well described in the literature. On MRI, the linguine sign indicates intracapsular rupture, while the presence of silicone particles outside the fibrous capsule indicates extracapsular rupture. The linguine sign is described as the thin, wavy hypodense wall of the implant within the hyperintense silicone on T2-weighted images indicative of rupture of the implant within the naturally formed fibrous capsule. Hyperintense T2 signal outside of the fibrous capsule is indicative of an extracapsular rupture with silicone granuloma formation. We present a rare case of a patient with a silicone calf implant rupture and discuss the MRI findings associated with this condition. (orig.)

  6. Tuberous breast: a new approach.

    Science.gov (United States)

    Ribeiro, L; Canzi, W; Buss, A; Accorsi, A

    1998-01-01

    The authors make a historical summary of the pathologic condition of tuberous breast and describe a new procedure for its correction. The method involves a periareolar approach, dividing the breast in two portions to disrupt the constricting ring, and making an inferiorly based flap or pedicle, as described and used by the senior author since 1969, with publication in 1973. The main goal is to correct the deformity at a one-stage operation, resulting in a periareolar scar only, without the use of alloplastic elements such as prostheses, mesh, or tissue expanders. The authors emphasize that Brazilian patients prefer having small breasts rather than large ones, even though the procedure allows the implantation of pre- or retromuscular implants through the periareolar incision.

  7. Breast Diseases

    Science.gov (United States)

    Most women experience breast changes at some time. Your age, hormone levels, and medicines you take may cause lumps, bumps, and discharges (fluids that are not breast milk). If you have a breast lump, pain, ...

  8. Cochlear Implant

    Directory of Open Access Journals (Sweden)

    Mehrnaz Karimi

    1993-03-01

    Full Text Available People with profound hearing loss are not able to use some kinds of conventional amplifiers due to the nature of their loss. In these people, hearing sense is stimulated only when the auditory nerve is activated via electrical stimulation. This stimulation is possible through cochlear implant. In fact, for the deaf people who have good mental health and can not use surgical and medical treatment and also can not benefit from air and bone conduction hearing aids, this device is used if they have normal central auditory system. The basic parts of the device included: Microphone, speech processor, transmitter, stimulator and receiver, and electrode array.

  9. Cochlear Implant

    Directory of Open Access Journals (Sweden)

    Mehrnaz Karimi

    1992-04-01

    Full Text Available People with profound hearing loss are not able to use some kinds of conventional amplifiers due to the nature of their loss . In these people, hearing sense is stimulated only when the auditory nerve is activated via electrical stimulation. This stimulation is possible through cochlear implant. In fact, for the deaf people who have good mental health and can not use surgical and medical treatment and also can not benefit from air and bone conduction hearing aids, this device is used if they have normal central auditory system. The basic parts of the device included: Microphone, speech processor, transmitter, stimulator and receiver, and electrode array.

  10. Degradation of implant materials

    CERN Document Server

    Eliaz, Noam

    2012-01-01

    This book surveys the degradation of implant materials, reviewing in detail such failure mechanisms as corrosion, fatigue and wear, along with monitoring techniques. Surveys common implant biomaterials, as well as procedures for implant retrieval and analysis.

  11. Hernia Surgical Mesh Implants

    Science.gov (United States)

    ... Procedures Implants and Prosthetics Hernia Surgical Mesh Implants Hernia Surgical Mesh Implants Share Tweet Linkedin Pin it ... between patients and their surgeons. What is a Hernia? A hernia occurs when an organ, intestine or ...

  12. Nanotechnology and Dental Implants

    OpenAIRE

    Sandrine Lavenus; Guy Louarn; Pierre Layrolle

    2010-01-01

    The long-term clinical success of dental implants is related to their early osseointegration. This paper reviews the different steps of the interactions between biological fluids, cells, tissues, and surfaces of implants. Immediately following implantation, implants are in contact with proteins and platelets from blood. The differentiation of mesenchymal stem cells will then condition the peri-implant tissue healing. Direct bone-to-implant contact is desired for a biomechanical anchoring of i...

  13. Breast pain

    Science.gov (United States)

    ... the level of of hormones during menstruation or pregnancy often cause breast pain. Some swelling and tenderness just before your period is normal. Some women who have pain in one or both breasts may fear breast cancer . However, breast pain is not a common symptom ...

  14. Complications after cardiac implantable electronic device implantations

    DEFF Research Database (Denmark)

    Kirkfeldt, Rikke Esberg; Johansen, Jens Brock; Nohr, Ellen Aagaard

    2013-01-01

    Complications after cardiac implantable electronic device (CIED) treatment, including permanent pacemakers (PMs), cardiac resynchronization therapy devices with defibrillators (CRT-Ds) or without (CRT-Ps), and implantable cardioverter defibrillators (ICDs), are associated with increased patient...

  15. Lipomodelling: an important advance in breast surgery.

    Science.gov (United States)

    Delay, E; Streit, L; Toussoun, G; La Marca, S; Ho Quoc, C

    2013-01-01

    Based on long-term experiences, the authors consider lipomodelling to be a major advance in plastic, reconstructive and aesthetic surgery of the breast. The technique is now well established and the complication rate is very low. The risk of focal fat necrosis is around 3%. Oncological follow-up (now 14 years for the first patients) shows no increased risk of local recurrence or development of a new cancer. 30-40% of the injected fat is absorbed. Volume of the breast becomes stable in 3 to 4 months and remains definitive if the patient maintains constant weight. Because of very good results obtained and excellent acceptance of the procedure by the patients, this technique has completely modified our indications. In breast reconstruction, lipomodelling with autologous latissimus dorsi flap enables obtaining an entirely autologous breast in the majority of the patients. Analogically, lipomodelling can improve results of implant reconstructions, especially if the expander or the implant is planned to be exchanged. Lipomodelling is an effective tool for correction deformities especially in the décolleté after breast reconstruction with abdominal flap (DIEP, SIEA and TRAM). Lipomodelling is also progressively used in the correction of breast and chest wall deformities. In Poland syndrome, this technique appears to be a major advance that will probably revolutionize the treatment of severe cases. This is mainly due to its ability to achieve previously unachievable quality of reconstruction with minimal scaring. The application of lipomodelling in the treatment of pectus excavatum deformities is promising. Lipomodelling represents an advanced therapeutic alternative for tuberous breasts without the need to use an implant, as well as for breast asymmetry due to unilateral hypoplasia. Lipomodelling is an ideal option for cosmetic breast augmentation in patients who wish to achieve moderate, natural enlargement of breasts and who have considerable fat deposits.

  16. [THE EFFECT OF PREGNANCY ON BREAST CANCER].

    Science.gov (United States)

    Matalon, Shelly Tartakover; Shochet, Gali Epstein; Drucker, Liat; Lishner, Michael

    2015-08-01

    Cancer and pregnancy coincide in about one in 1,000 pregnancies. One of the most common malignancies associated with pregnancy is breast cancer. Women with pregnancy-associated breast cancer (PABC) have a higher likelihood of being diagnosed with metastatic disease and estrogen receptor (ER) negative tumors than do non-pregnant women. Controversies exist regarding the effect of pregnancy on breast cancer prognosis. Some researchers suggest that pregnancy does not affect breast cancer prognosis, whereas others claim the opposite. Although PABC is usually discovered in an advanced stage, breast cancer metastasis on the placenta is a rare event. During cancer progression, the surrounding microenvironment co-evolves into an activated state through continuous communication with the malignant cells, thereby promoting tumor growth. The effect of pregnancy and placental environment on breast cancer biology is the issue of this review. Placental and cancer cells implantation processes share similar molecular pathways. This suggests that placental factors may affect breast cancer cells biology. Previously, we analyzed the effect of first trimester human placenta on breast cancer cells. Breast cancer cells were co-cultured with placental explants during their implantation on matrigel substrate. We found that the placenta reduced ER expression on the cancer cells and induced their migration and invasion abilities. As a result of it, breast cancer cells migrated away from the placental implantation sites. Hormonal pathways were involved in these phenomena. These results may explain the high incidence of metastases during pregnancy in on the one hand and the rarity of metastases on the placenta on the other hand.

  17. Magnetic resonance imaging of breast prostheses | Corr | SA ...

    African Journals Online (AJOL)

    Breast MR imaging is the most accurate imaging investigation to detect breast prosthesis rupture. Rupture is common in older prostheses (> 10 years post implantation) and is often asymptomatic. The radiological signs of rupture are due to collapse of the elastomer shell which is eneveloped by silicone gel and when the ...

  18. Design for Natural Breast Augmentation: The ICE Principle.

    Science.gov (United States)

    Mallucci, Patrick; Branford, Olivier Alexandre

    2016-06-01

    The authors' published studies have helped define breast beauty in outlining key parameters that contribute to breast attractiveness. The "ICE" principle puts design into practice. It is a simplified formula for inframammary fold incision planning as part of the process for determining implant selection and placement to reproduce the 45:55 ratio previously described as fundamental to natural breast appearance. The formula is as follows: implant dimensions (I) - capacity of the breast (C) = excess tissue required (E). The aim of this study was to test the accuracy of the ICE principle for producing consistent natural beautiful results in breast augmentation. A prospective analysis of 50 consecutive women undergoing primary breast augmentation by means of an inframammary fold incision with anatomical or round implants was performed. The ICE principle was applied to all cases to determine implant selection, placement, and incision position. Changes in parameters between preoperative and postoperative digital clinical photographs were analyzed. The mean upper pole-to-lower pole ratio changed from 52:48 preoperatively to 45:55 postoperatively (p principle for surgical planning in breast augmentation that attractive natural breasts may be achieved consistently and with precision. Therapeutic, IV.

  19. Is routine biopsy of sonographically benign breast lesions in black ...

    African Journals Online (AJOL)

    The Breast Imaging Reporting and Data System. (BIRADS) classification has been developed for both ultrasound and mammography.[1] 'BIRADS 2 lesions are described as benign findings inclu ding intramammary nodes and breast implants. BIRADS 3 lesions are probably benign lesions including non calcified ...

  20. Chronic breast abscess due to Mycobacterium fortuitum: a case report

    Directory of Open Access Journals (Sweden)

    MacNeill Fiona A

    2011-05-01

    Full Text Available Abstract Introduction Mycobacterium fortuitum is a rapidly growing group of nontuberculous mycobacteria more common in patients with genetic or acquired causes of immune deficiency. There have been few published reports of Mycobacterium fortuitum associated with breast infections mainly associated with breast implant and reconstructive surgery. Case presentation We report a case of a 51-year-old Caucasian woman who presented to our one-stop breast clinic with a two-week history of left breast swelling and tenderness. Following triple assessment and subsequent incision and drainage of a breast abscess, the patient was diagnosed with Mycobacterium fortuitum and treated with antibiotic therapy and surgical debridement. Conclusion This is a rare case of a spontaneous breast abscess secondary to Mycobacterium fortuitum infection. Recommended treatment is long-term antibacterial therapy and surgical debridement for extensive infection or when implants are involved.

  1. Which Breast Is the Best? Successful Autologous or Alloplastic Breast Reconstruction : Patient-Reported Quality-of-Life Outcomes

    NARCIS (Netherlands)

    Eltahir, Yassir; Werners, Lisanne L. C. H.; Dreise, Marieke M.; Zeiffmans van Emmichoven, Ingeborg A.; Werker, Paul M. N.; de Bock, Geertruida H.

    Background: Breast reconstruction is an appropriate option offered to women who are diagnosed with breast cancer or gene mutations. It may be accomplished with implants or autologous procedures. This cross-sectional study evaluated the satisfaction and quality of life in addition to complications

  2. Retrograde peri-implantitis

    Directory of Open Access Journals (Sweden)

    Mohamed Jumshad

    2010-01-01

    Full Text Available Retrograde peri-implantitis constitutes an important cause for implant failure. Retrograde peri-implantitis may sometimes prove difficult to identify and hence institution of early treatment may not be possible. This paper presents a report of four cases of (the implant placed developing to retrograde peri-implantitis. Three of these implants were successfully restored to their fully functional state while one was lost due to extensive damage. The paper highlights the importance of recognizing the etiopathogenic mechanisms, preoperative assessment, and a strong postoperative maintenance protocol to avoid retrograde peri-implant inflammation.

  3. Breast prostheses and connective tissue disease (CTD): myth or reality?

    Science.gov (United States)

    Bassetto, F; Vindigni, V; Scarpa, Carlotta; Doria, A

    2010-06-01

    Since their first appearance, breast prostheses have been criticized as being both responsible for and giving rise to systemic disease. The literature contains many reports on the subject, and theories were controversial from the 1980s to the 2000s. The aim of this review was to gather together the most important studies on breast prostheses and systemic disease, with particular attention to connective tissue disease (CTD), in order to verify any relationship between silicone breast implants and the occurrence of pathologies.

  4. A review of psychological outcomes and suicide in aesthetic breast augmentation.

    Science.gov (United States)

    Rohrich, Rod J; Adams, William P; Potter, Jason K

    2007-01-01

    Aesthetic surgery is an essential component of plastic surgery and has become increasingly popular in American society. In 2002, 1.8 million surgical cosmetic procedures were performed in the United States, representing a 294 percent increase from 1992. The 1992 U.S. Food and Drug Administration moratorium on silicone breast implants arose in response to numerous reports of connective tissue disease associated with silicone gel breast augmentation and has led to a decade-long battle over the safety of silicone breast implants that continues today. Numerous scientific and epidemiologic studies of the past decade have established that there is no association between silicone breast prostheses and systemic disease. Recently, a new front has opened in the conflict regarding the safety of breast augmentation: the psychological impact of breast augmentation. Quality studies assessing the psychological characteristics of breast augmentation patients and the psychological impact of breast augmentation surgery are few and most studies are flawed in their methods. Recent reports have provided corroborating evidence to support the psychological benefits of cosmetic surgery and breast augmentation. New reports citing an increased risk for suicide among women with breast implants have brought renewed concerns but are unable to demonstrate a cause-and-effect relationship between breast implants and suicide. The present challenge is to determine whether the increased risk reported in epidemiologic studies is falsely associated with breast implants or whether it represents underlying risk factors or psychopathology in women undergoing breast augmentation that puts them at increased risk for suicide. The purpose of this article is to review the literature regarding the psychological impact of breast augmentation and assesses current scientific findings, with emphasis on the validity of suicide risk in breast augmentation patients.

  5. Local complications after cosmetic breast augmentation: results from the Danish Registry for Plastic Surgery of the breast

    DEFF Research Database (Denmark)

    Hvilsom, Gitte B; Hölmich, Lisbet R; Henriksen, Trine F

    2009-01-01

    , and postoperative data for women undergoing breast augmentation in Denmark since 1999. From the Registry, the authors identified 5373 women with a primary cosmetic breast augmentation between 1999 and 2007. The authors calculated incidence proportions of adverse clinical outcomes within three time intervals (0....... CONCLUSIONS: Population-based complication frequencies among women with cosmetic breast augmentation in a Danish nationwide implant registry were generally lower than those reported in other studies, although frequencies of complications increased with length of follow-up....

  6. The Diagon/Gel Implant: A Preliminary Report of 894 Cases

    Directory of Open Access Journals (Sweden)

    Constantin Stan, MD

    2017-07-01

    Full Text Available Background:. The breast has always been perceived as the emblem of femininity. Desire of having an ideal breast form has been of interest for a long time. Methods:. This preliminary article is a retrospective analysis of 894 cases of breast augmentation with Diagon/Gel breast implants covered with a micropolyurethane foam (Microthane. The surgical technique employed is a modified dual plane, which enables us to use a new anatomical implant to move the glandular parenchyma into a higher position. Results:. The study extended from January 2010 to September 2015, during which no breast implant developed Baker grade III or IV capsular contracture (CC and only a few adverse events occurred. Patients reported to be highly satisfied with the final outcome, which was very natural both in the form and movement. Conclusions:. The new concept of Diagon/Gel represents the next step in the evolutionary progress of breast implants and allows the surgeon to perform not only a breast augmentation but also parenchymal elevation, which otherwise would have required a mastopexy, and we have called it breast enhancement.

  7. Breast Gangrene

    Directory of Open Access Journals (Sweden)

    Husasin Irfan

    2011-08-01

    Full Text Available Abstract Background Breast gangrene is rare in surgical practice. Gangrene of breast can be idiopathic or secondary to some causative factor. Antibiotics and debridement are used for management. Acute inflammatory infiltrate, severe necrosis of breast tissue, necrotizing arteritis, and venous thrombosis is observed on histopathology. The aim of was to study patients who had breast gangrene. Methods A prospective study of 10 patients who had breast gangrene over a period of 6 years were analyzed Results All the patients in the study group were female. Total of 10 patients were encountered who had breast gangrene. Six patients presented with breast gangrene on the right breast whereas four had on left breast. Out of 10 patients, three had breast abscess after teeth bite followed by gangrene, one had iatrogenic trauma by needle aspiration of erythematous area of breast under septic conditions. Four had history of application of belladonna on cutaneous breast abscess and had then gangrene. All were lactating female. Amongst the rest two were elderly, one of which was a diabetic who had gangrene of breast and had no application of belladonna. All except one had debridement under cover of broad spectrum antibiotics. Three patients had grafting to cover the raw area. Conclusion Breast gangrene occurs rarely. Etiology is variable and mutifactorial. Teeth bite while lactation and the iatrogenic trauma by needle aspiration of breast abscess under unsterlised conditions could be causative. Uncontrolled diabetes can be one more causative factor for the breast gangrene. Belladonna application as a topical agent could be inciting factor. Sometimes gangrene of breast can be idiopathic. Treatment is antibiotics and debridement.

  8. Breast Tomosynthesis

    Science.gov (United States)

    ... cancers when they are most curable and breast-conservation therapies are available. See the Mammography page for ... special platform and gradually compressed with a clear plastic paddle. Breast compression is necessary during tomosynthesis imaging ...

  9. Breast Exam

    Science.gov (United States)

    ... 210:314. Mac Bride MB, et al. The evolution of the breast self-examination to breast awareness. ... of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo ...

  10. Breast cancer

    Science.gov (United States)

    ... help you not feel alone. Outlook (Prognosis) New, improved treatments are helping people with breast cancer live ... carcinoma in situ Patient Instructions Breast radiation - discharge Chemotherapy - what to ask your doctor Lymphedema - self-care ...

  11. One-Stage Immediate Breast Reconstruction: A Concise Review

    Directory of Open Access Journals (Sweden)

    Nicolò Bertozzi

    2017-01-01

    Full Text Available Background. One-stage direct-to-implant immediate breast reconstruction (IBR is performed simultaneously with breast cancer resection. We explored indications, techniques, and outcomes of IBR to determine its feasibility, safety, and effectiveness. Material and Methods. We reviewed the available literature on one-stage direct-to-implant IBR, with or without acellular dermal matrix (ADM, synthetic mesh, or autologous fat grafting. We analyzed the indications, preoperative work-up, surgical technique, postoperative care, outcomes, and complications. Results. IBR is indicated for small-to-medium nonptotic breasts and contraindicated in patients who require or have undergone radiotherapy, due to unacceptably high complications rates. Only patients with thick, well-vascularized mastectomy flaps are IBR candidates. Expandable implants should be used for ptotic breasts, while anatomical shaped implants should be used to reconstruct small-to-medium nonptotic breasts. ADMs can be used to cover the implant during IBR and avoid muscle elevation, thereby minimizing postoperative pain. Flap necrosis, reoperation, and implant loss are more common with IBR than conventional two-staged reconstruction, but IBR has advantages such as lack of secondary surgery, faster recovery, and better quality of life. Conclusions. IBR has good outcomes and patient-satisfaction rates. With ADM use, a shift from conventional reconstruction to IBR has occurred. Drawbacks of IBR can be overcome by careful patient selection.

  12. Breast Cancer

    Science.gov (United States)

    Breast cancer affects one in eight women during their lives. No one knows why some women get breast cancer, but there are many risk factors. Risks that ... who have family members with breast or ovarian cancer may wish to be tested for the genes. ...

  13. The bioceramic implant: evaluation of implant exposures in 419 implants.

    Science.gov (United States)

    Jordan, David R; Klapper, Stephen R; Gilberg, Steven M; Dutton, Jonathan J; Wong, Amy; Mawn, Louise

    2010-01-01

    To compare the rate of exposure in the immediate 3-month postoperative follow-up period with the rate of exposure after the immediate postoperative period in 419 anophthalmic patients with a bioceramic (aluminum oxide) orbital implant. This is a retrospective, clinical case series of 419 patients who received a bioceramic orbital implant. All patients who presented to five oculofacial surgeons (D.J., S.G., J.D., S.K., L.M.) from January 1, 2000, to June 1, 2007, who received a bioceramic orbital implant and had a minimum of 3 months of follow-up were included in this study. The authors analyzed age, gender, type of surgery, implant size, peg system, follow-up duration, time of pegging, and problems encountered. The data from the patients with greater than 3 months of follow-up with exposure of the bioceramic implant are detailed in this report. There were 353 patients followed for 3 to 96 months with an average of 30 months of follow-up (median 23 months). Implant exposure occurred in 32/353 bioceramic implants (9.1%). Six of the 32 (19%) exposures occurred during the 90-day postoperative period (average 2.1 months). Twenty-six (81%) exposures occurred outside of the 90-day postoperative period (average 27.5 months, range 4-82 months). Implant exposures can occur anytime postimplant placement. This review discovered an implant exposure rate of 9.1%, with the majority of the exposures occurring after the postoperative follow-up period. Patients with porous orbital implants should be followed on a long-term basis to detect this complication.

  14. Pilot study of breast sensation after breast reconstruction: evaluating the effects of radiation therapy and perforator flap neurotization on sensory recovery.

    Science.gov (United States)

    Magarakis, Michael; Venkat, Raghunandan; Dellon, A Lee; Shridharani, Sachin M; Bellamy, Justin; Vaca, Elbert E; Jeter, Stacie C; Zoras, Odysseas; Manahan, Michele A; Rosson, Gedge D

    2013-09-01

    Some sensation to the breast returns after breast reconstruction, but recovery is variable and unpredictable. We primarily sought to assess the impact of different types of breast reconstruction [deep inferior epigastric artery perforator (DIEP) flaps versus implants] and radiation therapy on the return of sensation. Thirty-seven patients who had unilateral or bilateral breast reconstruction via a DIEP flap or implant-based reconstruction, with or without radiation therapy (minimum follow-up, 18 months; range, 18-61 months) were studied. Of the 74 breasts, 27 had DIEP flaps, 29 had implants, and 18 were nonreconstructed. Eleven breasts with implants and 10 with DIEP flaps had had prereconstruction radiation therapy. The primary outcome was mean patient-perceived static and moving cutaneous pressure threshold in nine areas. We used univariate and multivariate analyses to assess what independent factors affected the return of sensation (significance, P < 0.05). Implants provided better static (P = 0.071) and moving sensation (P = 0.041) than did DIEP flaps. However, among irradiated breasts, skin over DIEP flaps had significantly better sensation than did that over implants (static, P = 0.019; moving, P = 0.028). Implant reconstructions with irradiated skin had significantly worse static (P = 0.002) and moving sensation (P = 0.014) than did nonirradiated implant reconstructions. Without irradiation, skin overlying implants is associated with better sensation recovery than DIEP flap skin. However, with irradiation, DIEP flap skin had better sensation recovery than did skin over implants. Neurotization trended toward improvement in sensation in DIEP flaps. Copyright © 2013 Wiley Periodicals, Inc.

  15. Implant success!!!.....simplified

    Directory of Open Access Journals (Sweden)

    Luthra Kaushal

    2009-01-01

    Full Text Available The endeavor towards life-like restoration has helped nurture new vistas in the art and science of implant dentistry. The protocol of "restoration-driven implant placement" ensures that the implant is an apical extension of the ideal future restoration and not the opposite. Meticulous pre-implant evaluation of soft and hard tissues, diagnostic cast and use of aesthetic wax-up and radiographic template combined with surgical template can simplify the intricate roadmap for appropriate implant treatment. By applying the harmony of artistic skill, scientific knowledge and clinical expertise, we can simply master the outstanding implant success in requisites of aesthetics, phonetics and function.

  16. Implant success!!!.....simplified.

    Science.gov (United States)

    Luthra, Kaushal K

    2009-01-01

    The endeavor towards life-like restoration has helped nurture new vistas in the art and science of implant dentistry. The protocol of "restoration-driven implant placement" ensures that the implant is an apical extension of the ideal future restoration and not the opposite. Meticulous pre-implant evaluation of soft and hard tissues, diagnostic cast and use of aesthetic wax-up and radiographic template combined with surgical template can simplify the intricate roadmap for appropriate implant treatment.By applying the harmony of artistic skill, scientific knowledge and clinical expertise, we can simply master the outstanding implant success in requisites of aesthetics, phonetics and function.

  17. Padrão de aleitamento materno no primeiro mês de vida em mulheres submetidas a cirurgia de redução de mamas e implantes Breastfeeding pattern in the first month of life in women submitted to breast reduction and augmentation

    Directory of Open Access Journals (Sweden)

    Regina Aparecida de Andrade

    2010-06-01

    Full Text Available OBJETIVO: Descrever o padrão de aleitamento materno no primeiro mês de vida da criança em mulheres que se submeteram a dois tipos de cirurgias mamárias - redução e implante - e comparar com o padrão praticado por mulheres que não se submeteram às cirurgias. MÉTODOS: Coorte prospectiva controlada com 25 mulheres submetidas a cirurgia redutora, 24 a cirurgia de implante e 25 sem cirurgia de mama, que tiveram seus filhos no Hospital Israelita Albert Einstein, São Paulo (SP. Os dados foram coletados por meio de avaliações realizadas entre 48 e 72 horas, entre os quinto e sétimo dias e 30 dias após o parto. Para análise dos dados, usaram-se os testes qui-quadrado, exato de Fisher, curva de Kaplan-Meier e regressão de Cox. RESULTADOS: A probabilidade de uma criança estar em aleitamento exclusivo no final do primeiro mês de vida foi de 29% em mulheres com cirurgia redutora e 54% nas com cirurgia de implante, e 80% nas mulheres sem cirurgia. A probabilidade do aleitamento misto estar presente neste mesmo período foi de 68% entre mães com cirurgia de redução, 32% com cirurgia de implante e apenas 16% entre as mulheres sem cirurgia mamária. O risco de uma criança estar em aleitamento não exclusivo foi cinco vezes maior entre mães do grupo submetido a redução, quando comparado àquelas do grupo sem cirurgia (p = 0,002. Para o grupo de mulheres com implante, o risco de uma criança estar em aleitamento não exclusivo foi 2,6 vezes aquele observado entre crianças cujas mães fazem parte do grupo sem cirurgia (p = 0,075. CONCLUSÃO: A cirurgia redutora de mama e de implante refletiu em menor taxa de aleitamento materno exclusivo no primeiro mês de vida da criança.OBJECTIVE: To describe the breastfeeding pattern in the first month of life in women submitted to two types of surgery - breast reduction and augmentation - and to compare it with the pattern exhibited by women who had no surgery. METHODS: Controlled prospective cohort

  18. [Biomaterials in cochlear implants].

    Science.gov (United States)

    Stöver, T; Lenarz, T

    2009-05-01

    Cochlear implants (CI) represent the "gold standard" for the treatment of congenitally deaf children and postlingually deafened adults. Thus, cochlear implantation is a success story of new bionic prosthesis development. Owing to routine application of cochlear implants in adults but also in very young children (below the age of one), high demands are placed on the implants. This is especially true for biocompatibility aspects of surface materials of implant parts which are in contact with the human body. In addition, there are various mechanical requirements which certain components of the implants must fulfil, such as flexibility of the electrode array and mechanical resistance of the implant housing. Due to the close contact of the implant to the middle ear mucosa and because the electrode array is positioned in the perilymphatic space via cochleostomy, there is a potential risk of bacterial transferral along the electrode array into the cochlea. Various requirements that have to be fulfilled by cochlear implants, such as biocompatibility, electrode micromechanics, and although a very high level of technical standards has been carried out there is still demand for the improvement of implants as well as of the materials used for manufacturing, ultimately leading to increased implant performance. General considerations of material aspects related to cochlear implants as well as potential future perspectives of implant development will be discussed.

  19. Mammography and breast sonography in transsexual women

    Energy Technology Data Exchange (ETDEWEB)

    Weyers, S., E-mail: steven.weyers@ugent.b [Department of Gynecology, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent (Belgium); Villeirs, G.; Vanherreweghe, E. [Department of Radiology, Ghent University Hospital, Ghent (Belgium); Verstraelen, H. [Department of Gynecology, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent (Belgium); Monstrey, S. [Department of Plastic Surgery, Ghent University Hospital, Ghent (Belgium); Van den Broecke, R.; Gerris, J. [Department of Gynecology, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent (Belgium)

    2010-06-15

    Data on the necessity of performing screening mammographies in transsexual women are lacking. The main objective of this study was to assess the possibility to perform mammography and breast sonography in transsexual women. Fifty Dutch-speaking transsexual women were interviewed about the following: attitude towards mammography and breast sonography, importance attributed to and satisfaction with breast appearance, opinion about the necessity of breast check-up, expectations regarding discomfort during the exams and knowledge about the breast surgery. A fasting blood sample, clinical breast exam, mammography and breast sonography were performed. At mammography the following parameters were noted: density, technical quality, location of the prostheses, presence of any abnormalities and painfulness. At sonography the following parameters were recorded: density, presence of cysts, visualisation of retro-areolar ducts or any abnormalities. Twenty-three percent of patients are not aware of the type of breast implants and 79% do not know their position to the pectoral muscles. Patient satisfaction with the appearance of their breasts was rather high (7.94 on a scale of 0-10). Mean expected and experienced pain from mammography was low (4.37 and 2.00 respectively). There was no statistically significant difference in expected pain between those who already had mammography and those who did not. There was a significant positive correlation between the expected and the experienced pain. Mammography and breast sonography were technically feasible and no gross anomalies were detected. Since both exams were judged as nearly painless, 98% of transsexual women intended to come back if they would be invited. Since breast cancer risk in transsexual women is largely unknown and breast exams are very well accepted, breast screening habits in this population should not differ from those of biological women.

  20. Mammography and breast sonography in transsexual women.

    Science.gov (United States)

    Weyers, S; Villeirs, G; Vanherreweghe, E; Verstraelen, H; Monstrey, S; Van den Broecke, R; Gerris, J

    2010-06-01

    Data on the necessity of performing screening mammographies in transsexual women are lacking. The main objective of this study was to assess the possibility to perform mammography and breast sonography in transsexual women. Fifty Dutch-speaking transsexual women were interviewed about the following: attitude towards mammography and breast sonography, importance attributed to and satisfaction with breast appearance, opinion about the necessity of breast check-up, expectations regarding discomfort during the exams and knowledge about the breast surgery. A fasting blood sample, clinical breast exam, mammography and breast sonography were performed. At mammography the following parameters were noted: density, technical quality, location of the prostheses, presence of any abnormalities and painfulness. At sonography the following parameters were recorded: density, presence of cysts, visualisation of retro-areolar ducts or any abnormalities. Twenty-three percent of patients are not aware of the type of breast implants and 79% do not know their position to the pectoral muscles. Patient satisfaction with the appearance of their breasts was rather high (7.94 on a scale of 0-10). Mean expected and experienced pain from mammography was low (4.37 and 2.00 respectively). There was no statistically significant difference in expected pain between those who already had mammography and those who did not. There was a significant positive correlation between the expected and the experienced pain. Mammography and breast sonography were technically feasible and no gross anomalies were detected. Since both exams were judged as nearly painless, 98% of transsexual women intended to come back if they would be invited. Since breast cancer risk in transsexual women is largely unknown and breast exams are very well accepted, breast screening habits in this population should not differ from those of biological women. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.

  1. Non-microsurgical breast reconstruction

    Directory of Open Access Journals (Sweden)

    Sharma Sheel

    2007-12-01

    Full Text Available Breast reconstruction after mastectomy should aim at resulting in an aesthetic outcome that matches the patient′s expectations and without interfering in the oncologic treatment. Whether the reconstruction is performed immediately or in a delayed fashion depends on various factors, which needs detailed attention. Autologous tissue, implants or both are used in the reconstruction. This article reviews the current concepts in these, with emphasis on non-microsurgical methods of using the autologous tissue for reconstruction. Breast conservation has become an accepted practice of treatment. Reconstruction in these situations as well as in an occasion when the surgery is done for failed breast conservation is discussed in detail. The article also reviews the various methods for nipple reconstruction available.

  2. Management of Tuberous Breast Deformities: Review of Long-term Outcomes and Patient Satisfaction with BREAST-Q.

    Science.gov (United States)

    Tenna, Stefania; Cagli, Barbara; Brunetti, Beniamino; Barone, Mauro; Persichetti, Paolo

    2017-12-01

    The treatment of a tuberous breast deformity has changed over the years, with a large variety of procedures described. However, maintaining a long-lasting breast contour is an ongoing challenge. The aim of this study was to evaluate the long-term results of tuberous breast corrections, focusing on the incidence of secondary procedures and patient satisfaction. Forty-six patients who underwent correction of a tuberous breast deformity from 2000 through 2013 were considered. Age, degree of deformity, asymmetry, BMI, pregnancy, first surgical technique used, complications and further surgical procedures were evaluated. Statistical analysis was conducted to identify predicting factors for multiple procedures. Patient satisfaction was evaluated with BREAST-Q. Eighty-eight breasts were treated: 57 breasts underwent implant-based corrections, whereas 31 breasts underwent autologous procedures. A multi-step procedure was initially planned in 7 breasts only, and 41 breasts underwent secondary procedures: 33 out of 53 breasts (62.3%) were re-operated in the implant-based group, whereas 8 out of 28 breasts (28.6%) were re-operated in the autologous group. Statistical analysis showed a correlation between the number of procedures and young age (P = 0.0253) and between the number of procedures and the primary surgical technique (P = 0.0132). The BREAST-Q evaluation suggested that patient satisfaction was comparable. The question of time is one of the main issues in breast surgery. The management of tuberous breast deformities requires a customized strategy considering all parameters to improve the longevity of the result in the long term. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  3. Implantable Medical Devices

    Science.gov (United States)

    ... Artery Disease Venous Thromboembolism Aortic Aneurysm More Implantable Medical Devices Updated:Sep 16,2016 For Rhythm Control ... a Heart Attack Introduction Medications Surgical Procedures Implantable Medical Devices • Life After a Heart Attack • Heart Attack ...

  4. Predictors for contralateral prophylactic mastectomy in breast cancer patients.

    Science.gov (United States)

    Fu, Yun; Zhuang, Zhigang; Dewing, Michelle; Apple, Sophia; Chang, Helena

    2015-01-01

    In recent years, radical breast cancer surgery has been largely replaced by breast conservation treatment, due to early diagnosis and more effective adjuvant treatment. While breast conservation is mostly preferred, the trend of bilateral mastectomy has risen in the United States. The aim of this study is to determine factors influencing patients' choice for having contralateral prophylactic mastectomy (CPM). This is a retrospective study of 373 patients diagnosed with primary invasive breast cancer who were treated by bilateral or unilateral mastectomy (BM or UM) at the Revlon/UCLA Breast Center between Jan. 2002 and Dec. 2010. In the BM group, only those with unilateral breast cancer who chose CPM were included in the analysis. When compared with the UM group, the following factors were found to be associated with BM: younger age, pre-menopausal, a family history of breast/ovarian cancer, BRCA mutation, more breast biopsies, history of breast augmentation, having MRI study within 6 months before the surgery, more likely to have reconstruction and sentinel lymph node biopsy (SLNB) and fewer had neoadjuvant/adjuvant chemotherapy/radiation. When patients with bilateral breast cancer were excluded, multivariate logistic regression analysis indicated younger patients with negative nodes, SLNB as the only nodal surgery and positive family history were significant factors predicting CPM and immediate reconstruction using tissue expanders or implants. Younger age, lower TN stage, requiring only SLNB and high risk family history predict contralateral prophylactic mastectomy. Tissue expander/implant-based reconstructions were more frequently chosen by patients with BM.

  5. [Percutaneous fasciotomies to improve fat grafting into the breast].

    Science.gov (United States)

    Ho Quoc, C; Michel, G; Dlimi, C; Gourari, A; Meruta, A; Delay, E

    2014-04-01

    Breast reconstruction or for breast deformities is a difficult challenge to get excellent results. Lipomodeling technique can improve thoracic malformations and breast deformities. Percutaneous fasciotomies can be an excellent tool for recipient site improvement. The aim of this study is to discuss interest of percutaneous needle fasciotomies with fat grafting into breast surgery. We have realized a retrospective study with fat transfer into the breast surgery. Recipient site prepared fasciotomies during fat grafting surgical procedure. Fat was harvested and centrifugated. Fat was injected into breast reconstructions or thoracic malformations. We did notice: population (age, BMI, uni/bilateral breasts), surgical procedure (mean sessions number, mean fat transfer). Aesthetic aspects of breasts were rated by both surgeon and patient: skin improvement, volume and shape of breast. Each complication was noticed: tissue wounds, scar evolution, hematoma, infection. We started a retrospective study between 2006 and 2011. One thousand patients were treated with fasciotomies and fat grafting during the same procedure. Main indications were breast reconstruction with latissimus dorsi flap, breast implant reconstruction, breast cancer conservative surgeries, tuberous breast and Poland syndrom. Sessions number expected was between 1 and 3. No complication has been noticed, except 1 tissular wound that needed a medical treatment to solve the problem. Fasciotomie is an indispensable complement tool for fat grafting. It is a safe and reliable technique. It improves aesthetic outcomes of breast surgery. Main indications of fasciotomies with fat grafting are breast reconstruction with radiation, breast cancer conservative surgery, and tuberous breast. Percutaneous fasciotomies provide excellent aesthetic result with no scar. They improve the shape of the breast with long-standing result. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  6. Implantable electronic medical devices

    CERN Document Server

    Fitzpatrick, Dennis

    2014-01-01

    Implantable Electronic Medical Devices provides a thorough review of the application of implantable devices, illustrating the techniques currently being used together with overviews of the latest commercially available medical devices. This book provides an overview of the design of medical devices and is a reference on existing medical devices. The book groups devices with similar functionality into distinct chapters, looking at the latest design ideas and techniques in each area, including retinal implants, glucose biosensors, cochlear implants, pacemakers, electrical stimulation t

  7. Breast reconstruction by pedicled transverse rectus abdominis myocutaneous flap

    Directory of Open Access Journals (Sweden)

    Kozarski Jefta

    2004-01-01

    Full Text Available Reconstruction of the amputated breast in female patients after surgical management of breast carcinoma is possible with the use of autologous tissue, synthetic implants, or by combining autologous tissue and synthetic materials. Autologous tissue provides soft and sufficiently elastic tissue which is usable for breast reconstruction and eventually obtains original characteristics of the surrounding tissue on the chest wall. The use of the TRAM flap for breast reconstruction was introduced in 1982 by Hartrampf Scheflan, and Black. The amount of the TRAM flap tissue allows breast reconstruction in the shape most adequate to the remaining breast. The possibilities of using the TRAM flap as pedicled myocutaneous flap or as free TRAM flap make this flap a superior choice for breast reconstruction in comparison with other flaps.

  8. Breast Reconstruction After Mastectomy

    Science.gov (United States)

    ... Cancers Breast Cancer Screening Research Breast Reconstruction After Mastectomy On This Page What is breast reconstruction? How ... are some new developments in breast reconstruction after mastectomy? What is breast reconstruction? Many women who have ...

  9. Breast Cancer Treatment

    Science.gov (United States)

    ... of Breast & Gynecologic Cancers Breast Cancer Screening Research Breast Cancer Treatment (PDQ®)–Patient Version General Information About Breast Cancer Go to Health Professional Version Key Points Breast ...

  10. Stages of Breast Cancer

    Science.gov (United States)

    ... of Breast & Gynecologic Cancers Breast Cancer Screening Research Breast Cancer Treatment (PDQ®)–Patient Version General Information About Breast Cancer Go to Health Professional Version Key Points Breast ...

  11. Breast Cancer Prevention

    Science.gov (United States)

    ... of Breast & Gynecologic Cancers Breast Cancer Screening Research Breast Cancer Prevention (PDQ®)–Patient Version What is prevention? Go ... from starting. Risk-reducing surgery . General Information About Breast Cancer Key Points Breast cancer is a disease in ...

  12. Breast cancer screening

    Science.gov (United States)

    Mammogram - breast cancer screening; Breast exam - breast cancer screening; MRI - breast cancer screening ... is performed to screen women to detect early breast cancer when it is more likely to be cured. ...

  13. Animation Deformity in Postmastectomy Implant-Based Reconstruction

    Directory of Open Access Journals (Sweden)

    Lauren C. Nigro, MD

    2017-07-01

    Full Text Available Background:. Despite increasing interest in prepectoral implant-based reconstruction to avoid animation deformity (AD, the prevalence of this deformity and patient attitudes toward it have not been extensively studied. The purpose of this study was to report on AD in the breast reconstruction population and identify those at highest risk. Methods:. A retrospective chart review was completed for patients at least 6 months postoperative from subpectoral, implant-based breast reconstruction using acellular dermal matrix in the lower pole. Patient age, BMI, and implant size were collected. A questionnaire was distributed to the patients. Returned questionnaires were compiled and data were analyzed. Results:. Eighty-four of 108 patients (77.8% returned the questionnaire with 62 (75.6% reporting AD; 75.6% of patients were aware of AD, 14.6% considered it moderate, and 11% considered it severe. No statistically significant differences in age, body mass index, implant size, or athleticism were found between those who noted AD versus those who did not. Forty-one of 79 patients (51.9% would have been interested in an initial surgical procedure without AD; interest dropped significantly if the alternative surgery involved increased risk, cost, or additional stages of reconstruction. Conclusion:. The prevalence of AD in subpectoral implant-based breast reconstruction is significantly higher than in subpectoral augmentation. The majority of patients expressed interest in an alternative procedure to avoid AD unless it involved increased risk, cost, or additional surgeries. We found insignificant differences in age, athleticism, BMI, and implant size between patients who note AD and those who do not. Further study is necessary to better define patients at risk for AD to guide patient-centered breast reconstruction.

  14. Women's Impression of the Expected Breast Appearance and its Association with Breast Cancer Operations.

    Science.gov (United States)

    Komenaka, Ian K; Winton, Lisa M; Bouton, Marcia E; Hsu, Chiu-Hsieh; Nodora, Jesse N; Olson, Loyd; Maffi, Terry R; Nesset, Elizabeth M; Martinez, Maria Elena

    2015-01-01

    Significant concern exists from clinicians in all fields that rates of bilateral mastectomy and prophylactic mastectomy are increasing. This study was performed to evaluate women's perception of breast appearance and its association with breast cancer operations. From April 2012 to May 2013, all women attending a breast clinic were shown two breast pictures, "natural" and "augmented," and asked which photograph represented the current expected appearance of breasts. Among breast cancer patients, the choice of breast cancer operation was correlated with picture selection. Of 1,177 consecutive women, mean age was 45 years. Overall, 70 % of patients felt that the augmented appearance is expected. This impression was seen in all racial/ethnic groups: non-Hispanic White 65 %, African American 67 %, Hispanic 71 %, and other groups 70 %. Younger age was strongly associated with the augmented appearance (p breast cancer patients, augmented appearance selection was more likely for patients who underwent reconstruction (92 %; p breasts is currently expected, and this impression was more common in young women. This impression may be another factor contributing to the current trend of more extensive breast cancer operations and implant-based reconstructions.

  15. Methylene Blue Dye-Induced Skin Necrosis in Immediate Breast Reconstruction: Evaluation and Management

    Directory of Open Access Journals (Sweden)

    Ji Hwan Lee

    2014-05-01

    Full Text Available Background For early breast cancer patients, skin-sparing mastectomy or nipple-sparing mastectomy with sentinel lymph node biopsy has become the mainstream treatment for immediate breast reconstruction in possible cases. However, a few cases of skin necrosis caused by methylene blue dye (MBD used for sentinel lymph node localization have been reported. Methods Immediate breast reconstruction using a silicone implant was performed on 35 breasts of 34 patients after mastectomy. For sentinel lymph node localization, 1% MBD (3 mL was injected into the subareolar area. The operation site was inspected in the postoperative evaluation. Results Six cases of immediate breast reconstruction using implants were complicated by methylene blue dye. One case of local infection was improved by conservative treatment. In two cases, partial necrosis and wound dehiscence of the incision areas were observed; thus, debridement and closure were performed. Of the three cases of wide skin necrosis, two cases underwent removal of the dead tissue and implants, followed by primary closure. In the other case, the breast implant was salvaged using latissimus dorsi musculocutaneous flap reconstruction. Conclusions The complications were caused by MBD toxicity, which aggravated blood disturbance and skin tension after implant insertion. When planning immediate breast reconstruction using silicone implants, complications of MBD should be discussed in detail prior to surgery, and appropriate management in the event of complications is required.

  16. Examining the efficacy, safety, and patient acceptability of the etonogestrel implantable contraceptive

    Directory of Open Access Journals (Sweden)

    Heather Hohmann

    2009-07-01

    Full Text Available Heather HohmannDepartment of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USAAbstract: Contraceptive implants provide long-acting, highly effective reversible contraception. The etonogestrel implant (ENG implant is a single rod implant that offers three years of efficacy. The ENG implant was designed to provide contraceptive efficacy by inhibiting ovulation and Pearl Index scores reported for this method are similar to other long-acting reversible contraception as well as similar to sterilization. The implant has been shown to be safe during breast feeding and may improve symptoms of dysmenorrhea and endometriosis. Irregular bleeding patterns can be expected with the device’s use and should be addressed in order to decrease rates of discontinuation.Keywords: contraception, Implanon®, progestin-only, ENG-implant

  17. Complications After Mastectomy and Immediate Breast Reconstruction for Breast Cancer: A Claims-Based Analysis

    Science.gov (United States)

    Jagsi, Reshma; Jiang, Jing; Momoh, Adeyiza O.; Alderman, Amy; Giordano, Sharon H.; Buchholz, Thomas A.; Pierce, Lori J.; Kronowitz, Steven J.; Smith, Benjamin D.

    2016-01-01

    Objective To evaluate complications after post-mastectomy breast reconstruction, particularly in the setting of adjuvant radiotherapy. Summary-Background Data Most studies of complications after breast reconstruction have been conducted at centers of excellence; relatively little is known about complication rates in radiated patients treated in the broader community. This information is relevant for breast cancer patients' decision-making. Methods Using the claims-based MarketScan database, we described complications in 14,894 women undergoing mastectomy for breast cancer from 1998-2007 who received immediate autologous reconstruction (n=2637), immediate implant-based reconstruction (n=3007), or no reconstruction within the first two postoperative years (n=9250). We used a generalized estimating equation to evaluate associations between complications and radiotherapy over time. Results Wound complications were diagnosed within the first two postoperative years in 2.3% of patients without reconstruction, 4.4% with implants, and 9.5% with autologous reconstruction (p<0.001). Infection was diagnosed within the first two postoperative years in 12.7% of patients without reconstruction, 20.5% with implants, and 20.7% with autologous reconstruction (p<0.001). 5219 (35%) women received radiation. Radiation was not associated with infection in any surgical group within the first six months but was associated with an increased risk of infection in months 7-24 in all three groups (each p<0.001). In months 7-24, radiation was associated with higher odds of implant removal in patients with implant reconstruction (OR 1.48, p<0.001) and fat necrosis in those with autologous reconstruction (OR=1.55; P=0.01). Conclusions Complication risks after immediate breast reconstruction differ by approach. Radiation therapy appears to modestly increase certain risks, including infection and implant removal. PMID:25876011

  18. Diagnostic Imaging for Implants

    Directory of Open Access Journals (Sweden)

    Sanjay M Mallya

    2004-01-01

    Full Text Available Dental implants are a popular modality for permanent tooth replacement. The key to successful implant placement, its subsequent osseointegration and the final prosthetic rehabilitation is proper preoperative assessment. Diagnostic imaging plays an important role in the pre- and post-surgical evaluation process. Imaging is used to evaluate suitability of implant sites, aid in selection of appropriate implants, and finally evaluate implant placement and osseointegration. This article reviews the role of diagnostic imaging in the various phases and the advantages and limitations of the numerous imaging modalities.

  19. The Economics of Prepectoral Breast Reconstruction.

    Science.gov (United States)

    Glasberg, Scot Bradley

    2017-12-01

    The world of breast reconstruction over the last several years has seen a dramatic shift in focus to discussion and the application of placing tissue expanders and implants back into the prepectoral space. Although this technique failed during the early advent of breast reconstruction, newer technologies such as advances in fat grafting, improved acellular dermal matrices, better methods of assessing breast flap viability, and enhanced implants appear to have set the stage for the resurgence and positive early results seen with this technique. The main benefits of a switch to prepectoral breast reconstruction clinically appears to be less associated pain, lower incidence of animation deformities, and its associated symptoms as well as presumably better aesthetics. Early data suggest that the results are extremely promising and early adopters have attempted to define the ideal patients for prepectoral breast reconstruction. As with any new operative procedure, an assessment of finances and costs are crucial to its successful implementation. Although current data are minimal, this article attempts to build the fundamentals of an economic model that exhibits and displays potential savings through the use of prepectoral breast reconstruction.

  20. Surgical reconstruction of tuberous breasts.

    Science.gov (United States)

    Foustanos, Andreas; Zavrides, Harris

    2006-01-01

    Tuberous breast deformity is a rare entity affecting young women bilaterally or unilaterally. It requires surgical correction, depending on the severity of the clinical expression, because of its aesthetic appearance. Since the presentation of the malformation by Rees and Aston in 1976, many surgical procedures have been developed, but the deformity still is one of the most challenging congenital breast anomalies. Between September 1999 and September 2005, eight patients with tuberous breast deformity underwent surgery in our department. A two-stage approach was used to manage 14 tuberous breasts. We used a combination of anatomic textured tissue expanders with magnetic injection sites and silicone gel implants. Other reconstructive procedures such as mastopexy, breast reduction, and areolar reduction can be considered. Our long-term results, with a maximum follow-up of 6 years, were satisfying. They have been uniformly good and compare favorably with those presented in the literature when the use of other methods. This two-stage approach is a relatively simple, safe, and technically easy procedure that is easy to learn. The results achieved with this approach seem to be reliable and gratifying.

  1. Sterile Acellular Dermal Collagen as a Treatment for Rippling Deformity of Breast

    Directory of Open Access Journals (Sweden)

    Brittany Busse

    2014-01-01

    Full Text Available Prosthetic implants are frequently used for breast augmentation and breast reconstruction following mastectomy. Unfortunately, long-term aesthetic results of prosthetic breast restoration may be hindered by complications such as rippling, capsular contracture, and implant malposition. The advent of use of acellular dermal matrices has greatly improved the outcomes of prosthetic breast reconstruction. We describe a case of rippling deformity of breast that was treated using an acellular dermal matrix product, AlloMax. The patient presented with visible rippling of bilateral prosthetic breast implants as well as significant asymmetry of the breasts after multiple excisional biopsies for right breast ductal carcinoma in situ. A 6×10 cm piece of AlloMax was placed on the medial aspect of each breast between the implant and the skin flap. Follow-up was performed at 1 week, 3 months, and 1 year following the procedure. The patient recovered well from the surgery and there were no complications. At her first postoperative follow-up the patient was extremely satisfied with the result. At her 3-month and 1-year follow-up she had no recurrence of her previous deformity and no new deformity.

  2. Aesthetic reconstruction of the tuberous breast deformity.

    Science.gov (United States)

    Mandrekas, Apostolos D; Zambacos, George J; Anastasopoulos, Anastasios; Hapsas, Dimitrios; Lambrinaki, Nektaria; Ioannidou-Mouzaka, Lydia

    2003-09-15

    The tuberous breast deformity is a rare entity affecting young women bilaterally or unilaterally. The deformity is characterized by a constricting ring at the base of the breast, which leads to deficient horizontal and vertical development of the breast with or without herniation of the breast parenchyma toward the nipple-areola complex and areola enlargement. Several methods have been put forward to correct the deformity, but most of these fail to address the issue of the constricting ring and subsequently yield results that are not aesthetically satisfactory. A new approach to the treatment of the deformity is presented, which consists of a periareolar approach and rearrangement of the inferior part of the breast parenchyma by division of the constricting ring, thus creating two breast pillars. These pillars are allowed to redrape, and in cases of volume deficiency, a silicone breast implant is placed in a subglandular pocket. The procedure is completed by a donut-type excision to address the size of the nipple-areola complex. The technique has used on 11 patients (21 breasts) with excellent aesthetic results.

  3. Characteristics of women with cosmetic breast augmentation surgery compared with breast reduction surgery patients and women in the general population of Sweden

    NARCIS (Netherlands)

    Fryzek, JP; Weiderpass, E; Signorello, LB; Hakelius, L; Lipworth, L; Blot, WJ; McLaughlin, JK; Nyren, O

    2000-01-01

    To determine whether women with cosmetic breast implants have distinct demographic, lifestyle, and reproductive characteristics that put them at increased risk for subsequent morbidity, the authors compared 1,369 such women to 2,211 women who had undergone breast reduction surgery, and to a random

  4. Breast Feeding.

    Science.gov (United States)

    International Children's Centre, Paris (France).

    This set of documents consists of English, French, and Spanish translations of four pamphlets on breast-feeding. The pamphlets provide information designed for lay persons, academics and professionals, health personnel and educators, and policy-makers. The contents cover health-related differences between breast and bottle milk; patterns of…

  5. Breast lymphoma

    African Journals Online (AJOL)

    outside the breast. Histological diagnoses of the so-called primary breast lymphomas included 1 case of Hodgkin's disease and 6 of non-Hodgkin's lymphoma (inclUding 2 with T-cell phenotypes). ... adequate specimens; (iI) mammary tissue and lymphomatous infiltrate ... All the patients were female. Their ages ranged from ...

  6. Breast asymmetry and predisposition to breast cancer

    OpenAIRE

    Scutt, D; Lancaster, GA; Manning, JT

    2006-01-01

    INTRODUCTION: It has been shown in our previous work that breast asymmetry is related to several of the known risk factors for breast cancer, and that patients with diagnosed breast cancer have more breast volume asymmetry, as measured from mammograms, than age-matched healthy women. METHODS: In the present study, we compared the breast asymmetry of women who were free of breast disease at time of mammography, but who had subsequently developed breast cancer, with that of age-matched healthy ...

  7. Congenital breast deformity reconstruction using perforator flaps.

    Science.gov (United States)

    Gautam, Abhinav K; Allen, Robert J; LoTempio, Maria M; Mountcastle, Timothy S; Levine, Joshua L; Allen, Robert J; Chiu, Ernest S

    2007-04-01

    Congenital breast deformities such as Poland syndrome, unilateral congenital hypoplasia, tuberous breast anomaly, and amastia pose a challenging plastic surgical dilemma. The majority of patients are young, healthy individuals who seek esthetic restoration of their breast deformities. Currently, both implant and autologous reconstructive techniques are used. This study focuses on our experience with congenital breast deformity patients who underwent reconstruction using a perforator flap. From 1994 to 2005, a retrospective chart review was performed on women who underwent breast reconstruction using perforator flaps to correct congenital breast deformities and asymmetry. Patient age, breast deformity type, perforator flap type, flap volume, recipient vessels, postoperative complications, revisions, and esthetic results were determined. Over an 11-year period, 12 perforator flaps were performed. All cases were for unilateral breast deformities. The patients ranged from 16 to 43 years of age. Six patients had undergone previous correctional surgeries. Eight (n = 8) flaps were used for correction of Poland syndrome and its associated chest wall deformities. Four (n = 4) flaps were used for correction of unilateral breast hypoplasia. In all cases, the internal mammary vessels were the recipient vessels of choice. No flaps were lost. No vein grafts were used. All patients were discharged on the fourth postoperative day. Complications encountered included seroma, hematoma, and nipple malposition. Revisional surgery was performed in 30% of the cases. Esthetic results varied from poor to excellent. Perforator flaps are an acceptable choice for patients with congenital breast deformities seeking autologous breast reconstruction. Deep inferior epigastric artery (DIEP) or superficial inferior epigastric artery (SIEA) flaps are performed when adequate abdominal tissue is available; however, many young patients have inadequate abdominal tissue, thus a GAP flap can be used

  8. Update on imaging of the postsurgical breast.

    Science.gov (United States)

    Margolis, Nathaniel E; Morley, Christopher; Lotfi, Philip; Shaylor, Sara D; Palestrant, Sarah; Moy, Linda; Melsaether, Amy N

    2014-01-01

    Oncologic, reconstructive, and cosmetic breast surgery has evolved in the last 20 years. Familiarity with cutting-edge surgical techniques and their imaging characteristics is essential for radiologic interpretation and may help avert false-positive imaging findings. Novel surgical techniques include skin- and nipple-sparing mastectomies, autologous free flaps, autologous fat grafting, and nipple-areola-complex breast reconstruction. These techniques are illustrated and compared with conventional surgical techniques, including modified radical mastectomy and autologous pedicled flaps. The role of magnetic resonance (MR) imaging in surgical planning, evaluation for complications, and postsurgical cancer detection is described. Breast reconstruction and augmentation using silicone gel-filled implants is discussed in light of the Food and Drug Administration's recommendation for MR imaging screening for "silent" implant rupture 3 years after implantation and every 2 years thereafter. Recent developments in skin incision techniques for reduction mammoplasty are presented. The effects of postsurgical changes on the detection of breast cancer are discussed by type of surgery. RSNA, 2014

  9. Initial results from an online breast augmentation survey.

    Science.gov (United States)

    Young, V Leroy; Watson, Marla E; Boswell, C B; Centeno, Robert F

    2004-01-01

    Data have been lacking to answer many questions raised in the clinical literature and by the US Food and Drug Administration with regard to patient satisfaction with breast implants, informed consent, the impact of augmentation on quality of life, repeat operations, and other issues related to breast augmentation. The authors conducted an online survey of women with and without breast implants to collect data on key issues related to breast augmentation. A survey including 177 questions was posted on the Web site www.implantinfo.com for 6 months, from August 2001 to February 2002. The survey was aimed at women who had undergone augmentation and those who were considering augmentation but had not yet undergone surgery. The raw data were analyzed by Data Harbor (Chicago, IL), an independent data management and technology development company with experience in managing large, complex medical databases. The survey was completed by 4011 women, including 2273 who had received breast implants and 1738 who were considering augmentation. Among the key findings: More than half of the women who had undergone breast augmentation and those who were considering the procedure thought about the decision for at least 3 years before proceeding. Most women who underwent breast augmentation (88%) were satisfied with the results, and 93% said they would recommend the procedure to friends or family members. Nearly all women who received implants thought the surgery improved their overall appearance (92%) and self-confidence (82%) but said it did not result in significant changes in their marriage/dating activities, careers, or social lives. At least 92% said their surgeons had answered their questions and listened to their concerns, and more than 75% said they remembered being informed of the risks of surgery. The percentage of women with breast pain was greater among women with implants than among those without. However, other physical symptoms, such as those associated with

  10. Failures in implants

    Directory of Open Access Journals (Sweden)

    E Prashanti

    2011-01-01

    Full Text Available The burning problem that all the implantologists are confronted today is the complications and failures occurring with the treatment of osseointegrated implants. To further optimize the treatment outcome, etiologies and factors associated with implant failures should be elucidated. Conceivably such knowledge is needed for developing adequate treatment and prevention strategies. Hence, this paper is intended to provide an insight regarding various aspects of failures that affect dental implants.

  11. A review: Cochlear implants

    OpenAIRE

    Batman, Ç.; Üneri, C.; Şehitoijlu, M.A.

    1991-01-01

    Electrical stimulation of the auditory system in deaf individuals has been first explained in 1935 by Andreev et al. and in 1940 by Jones et al, resulting in sensation of hearing (1,2). These attempts are facilitated by Djourno et al who first implanted electrical devices in two subjects in 1957 (3). But this type of stimulation has been a controversy until 1974, when cochlear implant was successfully implanted by W.F. House. Since that time over 5000 individuals have been implanted with a va...

  12. Ion implantation technology

    CERN Document Server

    Downey, DF; Jones, KS; Ryding, G

    1993-01-01

    Ion implantation technology has made a major contribution to the dramatic advances in integrated circuit technology since the early 1970's. The ever-present need for accurate models in ion implanted species will become absolutely vital in the future due to shrinking feature sizes. Successful wide application of ion implantation, as well as exploitation of newly identified opportunities, will require the development of comprehensive implant models. The 141 papers (including 24 invited papers) in this volume address the most recent developments in this field. New structures and possible approach

  13. Breast MRI scan

    Science.gov (United States)

    MRI - breast; Magnetic resonance imaging - breast; Breast cancer - MRI; Breast cancer screening - MRI ... radiologist) see some areas more clearly. During the MRI, the person who operates the machine will watch ...

  14. MRI of the Breast

    Science.gov (United States)

    ... News Physician Resources Professions Site Index A-Z Magnetic Resonance Imaging (MRI) - Breast Magnetic resonance imaging (MRI) of the breast ... limitations of MRI of the Breast? What is MRI of the Breast? Magnetic resonance imaging (MRI) is ...

  15. Premenstrual breast changes

    Science.gov (United States)

    Premenstrual tenderness and swelling of the breasts; Breast tenderness - premenstrual; Breast swelling - premenstrual ... Symptoms of premenstrual breast tenderness may range from mild to ... most severe just before each menstrual period Improve during ...

  16. Breast Cancer: Treatment Options

    Science.gov (United States)

    ... Breast Cancer > Breast Cancer: Treatment Options Request Permissions Breast Cancer: Treatment Options Approved by the Cancer.Net Editorial ... as possible. Learn more about palliative care . Recurrent breast cancer If the cancer does return after treatment for ...

  17. Breast pain (image)

    Science.gov (United States)

    ... breast pain is from hormonal fluctuations from menstruation, pregnancy, puberty, menopause, and breastfeeding. Breast pain can also be associated with fibrocystic breast disease, but it is a very unusual symptom of breast cancer.

  18. Long-term Follow-up with AlloDerm in Breast Reconstruction

    Directory of Open Access Journals (Sweden)

    Richard A. Baxter, MD, FACS

    2013-05-01

    Full Text Available Summary: Little is known about the long-term fate of acellular dermal matrices in breast implant surgery. A 12-year follow-up case with tissue analysis of AlloDerm in revision breast reconstruction reveals retention of graft volume and integration with an organized collagen structure, minimal capsule formation, and little or no indication of inflammation.

  19. Super obesity is not necessarily a contraindication to deep inferior epigastric perforator flap breast reconstruction.

    Science.gov (United States)

    Papadakis, Marios; Schuster, Frauke; Djedovic, Gabriel; Rahmanian-Schwarz, Afshin

    2018-01-24

    The deep inferior epigastric perforator (DIEP) flap is widely recognised as a safe and reliable flap for use as a first-choice option in autologous tissue breast reconstruction. Patients with obesity represent a challenging group for autologous breast reconstruction, as they are at increased risk of developing major and minor complications in comparison with patients with normal weight. We report a 59-year-old woman with super obesity, who presented to our department with right breast skin necrosis after implant reconstruction following mastectomy for right breast cancer. After implant removal and local treatment with both surgical debridement and negative pressure wound therapy, the patient successfully underwent a DIEP flap breast reconstruction. We conclude that super obesity should not be a contraindication to DIEP flap breast reconstruction. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  20. Epidemiology of Breast Cancer

    OpenAIRE

    南, 優子; ミナミ, ユウコ; MINAMI, Yuko

    2007-01-01

    During recent decades, breast cancer incidence has been increasing in Japan. Epidemiological studies have clarified the trend in breast cancer incidence and identified risk factors for breast cancer. Established risk factors for breast cancer include early age at menarche, late age at first birth, low parity, postmenopausal obesity, family history of breast cancer, and history of benign breast disease. Breast-feeding and physical activity may also be associated with breast cancer risk. Detail...

  1. HA-Coated Implant

    DEFF Research Database (Denmark)

    Daugaard, Henrik; Søballe, Kjeld; Bechtold, Joan E

    2014-01-01

    The goal of osseointegration of orthopedic and dental implants is the rapid achievement of a mechanically stable and long lasting fixation between living bone and the implant surface. In total joint replacements of cementless designs, coatings of calcium phosphates were introduced as a means...

  2. Implantable CMOS Biomedical Devices

    Directory of Open Access Journals (Sweden)

    Toshihiko Noda

    2009-11-01

    Full Text Available The results of recent research on our implantable CMOS biomedical devices are reviewed. Topics include retinal prosthesis devices and deep-brain implantation devices for small animals. Fundamental device structures and characteristics as well as in vivo experiments are presented.

  3. Ectopic breasts: familial functional axillary breasts and breast cancer arising in an axillary breast.

    Science.gov (United States)

    Osswald, Sandra S; Osswald, Michael B; Elston, Dirk M

    2011-06-01

    Supernumerary breasts and nipples are not uncommon and have familial and syndrome associations. Although usually of only cosmetic concern, hormonal changes and inflammatory or neoplastic conditions that affect primary breast tissue also may occur in areas of ectopic breast tissue. We describe cases of familial functional axillary breasts and primary carcinoma of the breast arising in ectopic axillary breast tissue.

  4. Breast Rash

    Science.gov (United States)

    ... rashes/rash-in-adults. Accessed Dec. 29, 2016. Papadakis MA, et al., eds. Breast disorders. In: Current ... http://www.accessmedicine.com. Accessed Dec. 28, 2016. Papadakis MA, et al., eds. Dermatologic disorders. In: Current ...

  5. Breast Cancer

    Science.gov (United States)

    ... a reduced risk of breast cancer. The Mediterranean diet focuses mostly on plant-based foods, such as fruits and vegetables, whole grains, legumes, and nuts. People who follow the Mediterranean diet choose healthy fats, such as olive oil, over ...

  6. Breast reduction

    Science.gov (United States)

    ... difficulty finding clothes that fit, and low self-confidence. Chronic rashes under your breasts. Unwelcome attention that is making you feel awkward. Inability to participate in sports. Some women may benefit from non-surgical treatments, such as: ...

  7. Dense Breasts

    Science.gov (United States)

    ... also appear white on mammography, they can be hidden by or within dense breast tissue. Other imaging ... understanding of the possible charges you will incur. Web page review process: This Web page is reviewed ...

  8. Breast Cancer

    Science.gov (United States)

    ... disease. It’s estimated that about 10% of breast cancer cases are hereditary (run in the family). In many of these cases, you inherited a gene from your parents that has mutated (changed from ...

  9. Central Mound Mastopexy for the Correction of Tuberous/Tubular Breast Deformity

    OpenAIRE

    Olivia A. Abbate, BA; Kenneth L. Fan, MD; Maurice Y. Nahabedian, MD

    2017-01-01

    Summary:. Tuberous and tubular breast deformity are well-recognized abnormalities in the plastic surgery community that incur severe physical and psychological consequences in affected patients. Current reconstructive options for the tuberous and tubular breasts favor the use of prosthetic implants and soft-tissue manipulation. We present a case of tuberous and tubular breast deformity treated with a central mound reduction technique and mastopexy with imbricating sutures without the use of p...

  10. Central Mound Mastopexy for the Correction of Tuberous/Tubular Breast Deformity

    OpenAIRE

    Abbate, Olivia A.; Fan, Kenneth L.; Nahabedian, Maurice Y.

    2017-01-01

    Summary: Tuberous and tubular breast deformity are well-recognized abnormalities in the plastic surgery community that incur severe physical and psychological consequences in affected patients. Current reconstructive options for the tuberous and tubular breasts favor the use of prosthetic implants and soft-tissue manipulation. We present a case of tuberous and tubular breast deformity treated with a central mound reduction technique and mastopexy with imbricating sutures without the use of pr...

  11. Immediate nipple reconstruction in combination with implant reconstruction using dermal sling.

    Science.gov (United States)

    Filobbos, George; Hamnett, Nathan; Hardwicke, Joseph; Skillman, Joanna

    2017-11-01

    The inferior de-epithelialized dermal flap with implant is increasingly used for immediate breast reconstruction. We have adapted the technique to provide concurrent immediate nipple reconstruction by recruiting the triangle of skin above the excised nipple as a modified C-V flap. The safety and efficacy of this technique has been assessed in 15 patients, of which eight were bilateral and seven were unilateral cases. We suggest that this is a safe, reliable, and original technique for immediate nipple reconstruction in patients undergoing immediate breast reconstruction with an inferior dermal sling and implant. © 2017 Wiley Periodicals, Inc.

  12. How to perform breast augmentation safely for a pectus excavatum patient.

    Science.gov (United States)

    Moscona, Rony A; Fodor, Lucian

    2011-04-01

    Pectus excavatum is the most common chest wall deformity. Women with pectus excavatum may have associated hypoplastic breasts and often desire breast augmentation. This report describes how to perform breast augmentation safely for a pectus excavatum patient. In the past 5 years, the authors have treated 11 women with hypoplastic breasts and pectus excavatum. Their ages have varied from 21 to 39 years. The women generally were healthy without cardiovascular function impairment. Four of the women had breast asymmetry, with a smaller right breast. It was decided to use wide silicone implants to augment the breast and to camouflage the chest wall deformity. The implants were placed under the pectoralis major muscle in all cases. The follow-up period varied from 10 months to 4.5 years. No acute or late complications related to the breast augmentation were encountered. All the patients were satisfied with the result, and none desired further surgical treatment for pectus excavatum. For two patients, a small depression in the upper part of the breast was persistent after surgery due to insufficient implant coverage. Most women with pectus excavatum desire to have the deformity corrected with minimal or no scarring. The chest is known to be an area prone to hypertrophic or keloid scars. The reported approach is simple and safe, easily camouflaging the deformity. It is a short procedure that results in high satisfaction.

  13. Oncoplastic Surgery for Upper/Upper Inner Quadrant Breast Cancer.

    Directory of Open Access Journals (Sweden)

    Joseph Lin

    Full Text Available Tumors located in the upper/upper inner quadrant of the breast warrant more attention. A small lesion relative to the size of breast in this location may be resolved by performing a level I oncoplastic technique. However, a wide excision may significantly reduce the overall quality of the breast shape by distorting the visible breast line. From June 2012 to April 2015, 36 patients with breast cancer located in the upper/upper inner quadrant underwent breast-conservation surgery with matrix rotation mammoplasty. According to the size and location of the tumor relative to the nipple-areola complex, 11 patients underwent matrix rotation with periareolar de-epithelialization (donut group and the other 25 underwent matrix rotation only (non-donut group. The cosmetic results were self-assessed by questionnaires. The average weights of the excised breast lumps in the donut and non-donut groups were 104.1 and 84.5 g, respectively. During the 3-year follow-up period, local recurrence was observed in one case and was managed with nipple-sparing mastectomy followed by breast reconstruction with prosthetic implants. In total, 31 patients (88.6% ranked their postoperative result as either acceptable or satisfactory. The treated breasts were also self-evaluated by 27 patients (77.1% to be nearly identical to or just slightly different from the untreated side. Matrix rotation is an easy breast-preserving technique for treating breast cancer located in the upper/upper inner quadrant of the breast that requires a relatively wide excision. With this technique, a larger breast tumor could be removed without compromising the breast appearance.

  14. Dental Implant Systems

    Science.gov (United States)

    Oshida, Yoshiki; Tuna, Elif B.; Aktören, Oya; Gençay, Koray

    2010-01-01

    Among various dental materials and their successful applications, a dental implant is a good example of the integrated system of science and technology involved in multiple disciplines including surface chemistry and physics, biomechanics, from macro-scale to nano-scale manufacturing technologies and surface engineering. As many other dental materials and devices, there are crucial requirements taken upon on dental implants systems, since surface of dental implants is directly in contact with vital hard/soft tissue and is subjected to chemical as well as mechanical bio-environments. Such requirements should, at least, include biological compatibility, mechanical compatibility, and morphological compatibility to surrounding vital tissues. In this review, based on carefully selected about 500 published articles, these requirements plus MRI compatibility are firstly reviewed, followed by surface texturing methods in details. Normally dental implants are placed to lost tooth/teeth location(s) in adult patients whose skeleton and bony growth have already completed. However, there are some controversial issues for placing dental implants in growing patients. This point has been, in most of dental articles, overlooked. This review, therefore, throws a deliberate sight on this point. Concluding this review, we are proposing a novel implant system that integrates materials science and up-dated surface technology to improve dental implant systems exhibiting bio- and mechano-functionalities. PMID:20480036

  15. Implants in the hand; Implantate der Hand

    Energy Technology Data Exchange (ETDEWEB)

    Wanivenhaus, A. [Medizinische Universitaet, Universitaetsklinik fuer Orthopaedie, Wien (Austria)

    2006-09-15

    Increasingly, implants in the region of hand joints and the wrist represent an alternative for the treatment of post-traumatic, inflamed, or degenerative joint damage. The diversity of hand functions also results in varied solutions, which are effective in their stability, mobility, and distraction. Different materials are necessary for this, and they require subtile radiological control. The native X-ray represents the substantial method to observe migration of the implants. Each interface between titanium, ceramic, zirconium, pyrocarbon, and silicon to the bone has to be assessed differently in order to obtain a relevant statement. The finger joints and to a limited extent the wrist represent the artificial joints with limited alternative therapy. Other implants in the hand should only be applied after strict indication and patient compliance, as arthrodesis and resection arthroplasty have shown very good long-term results. (orig.) [German] Implantate im Bereich der Gelenke der Hand und des Handgelenks stellen zunehmend Alternativen bei der Versorgung posttraumatischer, entzuendlicher oder degenerativer Gelenkschaeden dar. Die Vielfalt der Handfunktionen fuehrt auch zu unterschiedlichen Loesungen, die durch Stabilitaet, Mobilitaet und Distraktion wirksam werden. Dafuer sind unterschiedliche Materialien erforderlich, die eine subtile radiologische Kontrolle erfordern. Das Nativroentgen stellt das wesentlichste Verfahren zur Verlaufsbeobachtung von Implantaten dar. Das Interface zwischen Titan, Keramik, Zirkonium, Pyrokarbon und Silikon zum Knochen muss unterschiedlich bewertet werden, um relevante Aussagen treffen zu koennen. Die Fingergelenke und in begrenztem Ausmass auch das Handgelenk stellen Kunstgelenke mit geringen Alternativtherapiemoeglichkeiten dar. Die uebrigen Implantate der Hand sollten nur bei strenger Indikationsstellung und hoher Patientencompliance Anwendung finden, da Arthrodese oder Resektionsarthroplastik gute Langzeitresultate aufweisen. (orig.)

  16. Electromagnetic compatibility of electronic implants--review of the literature.

    Science.gov (United States)

    Kainz, W; Neubauer, G; Alesch, F; Schmid, G; Jahn, O

    2001-12-17

    The aim of the article was to provide an overview of published studies regarding the electromagnetic compatibility (EMC) of electronic implants. The available literature was sorted according to combinations of implant types and sources of interference. Several experiments concerning the susceptibility of pacemakers to mobile phones have been performed. The results of these experiments suggest measures that may be used to prevent the disturbance of pacemakers. For instance, instead of carrying the activated mobile phone in the breast pocket it is recommended that a distance of 30 cm be maintained between the pacemaker and the mobile phone, and that the mobile phone be used on the contralateral side of the pacemaker's location. Similar measures may be recommended for patients with implantable cardioverter defibrillators when using mobile phones. Patients with electronic implants should walk rapidly through anti theft-devices because some of these devices are liable to disturb implants. Patients with cardiac pacemakers should not be subjected to magnetic resonance imaging as far as possible. For a variety of combinations of implants and interference sources, e.g. cardiac pacemakers and base station antennas, no studies were found in the literature. It is strongly recommended that trials be carried out to evaluate the potential risk for patients in these settings.

  17. Propionibacterium acnes: An Underestimated Pathogen in Implant-Associated Infections

    Directory of Open Access Journals (Sweden)

    María Eugenia Portillo

    2013-01-01

    Full Text Available The role of Propionibacterium acnes in acne and in a wide range of inflammatory diseases is well established. However, P. acnes is also responsible for infections involving implants. Prolonged aerobic and anaerobic agar cultures for 14 days and broth cultures increase the detection rate. In this paper, we review the pathogenic role of P. acnes in implant-associated infections such as prosthetic joints, cardiac devices, breast implants, intraocular lenses, neurosurgical devices, and spine implants. The management of severe infections caused by P. acnes involves a combination of antimicrobial and surgical treatment (often removal of the device. Intravenous penicillin G and ceftriaxone are the first choice for serious infections, with vancomycin and daptomycin as alternatives, and amoxicillin, rifampicin, clindamycin, tetracycline, and levofloxacin for oral treatment. Sonication of explanted prosthetic material improves the diagnosis of implant-associated infections. Molecular methods may further increase the sensitivity of P. acnes detection. Coating of implants with antimicrobial substances could avoid or limit colonization of the surface and thereby reduce the risk of biofilm formation during severe infections. Our understanding of the role of P. acnes in human diseases will likely continue to increase as new associations and pathogenic mechanisms are discovered.

  18. Smoking and dental implants

    OpenAIRE

    Kasat, V.; Ladda, R

    2012-01-01

    Smoking is a prevalent behaviour in the population. The aim of this review is to bring to light the effects of smoking on dental implants. These facts will assist dental professionals when implants are planned in tobacco users. A search of “PubMed” was made with the key words “dental implant,” “nicotine,” “smoking,” “tobacco,” and “osseointegration.” Also, publications on tobacco control by the Government of India were considered. For review, only those articles published from 1988 onward in ...

  19. Optimization of dental implantation

    Science.gov (United States)

    Dol, Aleksandr V.; Ivanov, Dmitriy V.

    2017-02-01

    Modern dentistry can not exist without dental implantation. This work is devoted to study of the "bone-implant" system and to optimization of dental prostheses installation. Modern non-invasive methods such as MRI an 3D-scanning as well as numerical calculations and 3D-prototyping allow to optimize all of stages of dental prosthetics. An integrated approach to the planning of implant surgery can significantly reduce the risk of complications in the first few days after treatment, and throughout the period of operation of the prosthesis.

  20. Complications of Fat Transfer for Breast Augmentation.

    Science.gov (United States)

    Kontoes, Paraskevas; Gounnaris, George

    2017-10-01

    Autologous fat grafting is quite common for breast augmentations as well as for reconstructive breast surgery. Coleman has described the surgical technique of fat grafting. Fat is harvested, and after centrifugation and refinement, blunt infiltration cannulas are used to place the fat through small incisions. The grafted tissue is placed in small aliquots with each withdrawal of the cannula. In order to achieve an aesthetically pleasing contour of the breast, the fat should be layered into different levels from the chest wall to the skin. However, autogenous lipotransfer if not performed lege artis might lead to complications such as fat necrosis, calcification, formation of encapsulated fatty masses (cystic lesions), lymphadenopathy, disfigurement of breast contouring, hypersensitive breasts, itchy nipples. A 36-year old female patient, presented with multiple palpable cystic lesions, disrupted breast contouring, asymmetry, hypersensation and pain during examination, 6 months after autologous fat grafting for breast augmentation elsewhere. The patient had ultrasound and MRI screening, which revealed the multiple bilateral cysts formation in the breast tissue. Surgical removal of the large lesions was performed, and specimens were sent for pathology and cytology consideration and screening. A few months after surgical removal of these lesions and after symptoms subsided, breast augmentation was performed with silicone implants. An aesthetically pleasing result together with relief of the patient's initial symptomatology was achieved. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  1. Surgical intervention and capsular contracture after breast augmentation

    DEFF Research Database (Denmark)

    Henriksen, Trine F; Fryzek, Jon P; Hölmich, Lisbet R

    2005-01-01

    -requiring complications and capsular contracture grades III to IV among 2277 women who underwent cosmetic breast implantation from June 1999 through April 2003. During an average follow-up period of 1.6 years after implantation, 4.3% of these women (3% of implants) required secondary surgery as a result of short......-term complications. The most frequent clinical indications for surgery were displacement of the implant (38%), capsular contracture grades III to IV (16%), ptosis (13%), and hematoma (11%). Overall, the authors found that inframammary incision and subglandular placement were associated with decreased risks...... of developing complications requiring surgical intervention, whereas implants larger than 350 mL increased the risk of such complications (relative risk [RR], 2.3; 95% confidence interval [CI], 1.3-4.0). Thirty-nine Baker III to IV capsular contractures were identified, of which 22 were treated surgically...

  2. DEALING WITH DENTAL IMPLANT FAILURES

    Science.gov (United States)

    Levin, Liran

    2008-01-01

    An implant-supported restoration offers a predictable treatment for tooth replacement. Reported success rates for dental implants are high. Nevertheless, failures that mandate immediate implant removal do occur. The consequences of implant removal jeopardize the clinician's efforts to accomplish satisfactory function and esthetics. For the patient, this usually involves further cost and additional procedures. The aim of this paper is to describe different methods and treatment modalities to deal with dental implant failure. The main topics for discussion include identifying the failing implant, implants replacing failed implants at the exact site, and the use of other restorative options. When an implant fails, a tailor made treatment plan should be provided to each patient according to all relevant variables. Patients should be informed regarding all possible treatment modalities following implant failure and give their consent to the most appropriate treatment option for them. PMID:19089213

  3. Dealing with dental implant failures

    Directory of Open Access Journals (Sweden)

    Liran Levin

    2008-06-01

    Full Text Available An implant-supported restoration offers a predictable treatment for tooth replacement. Reported success rates for dental implants are high. Nevertheless, failures that mandate immediate implant removal do occur. The consequences of implant removal jeopardize the clinician's efforts to accomplish satisfactory function and esthetics. For the patient, this usually involves further cost and additional procedures. The aim of this paper is to describe different methods and treatment modalities to deal with dental implant failure. The main topics for discussion include identifying the failing implant, implants replacing failed implants at the exact site, and the use of other restorative options.When an implant fails, a tailor made treatment plan should be provided to each patient according to all relevant variables. Patients should be informed regarding all possible treatment modalities following implant failure and give their consent to the most appropriate treatment option for them.

  4. Perioperative Management of Multiple Noncardiac Implantable Electronic Devices.

    Science.gov (United States)

    Ramos, Juan A; Brull, Sorin J

    2015-12-01

    The number of patients with noncardiac implantable electronic devices is increasing, and the absence of perioperative management standards, guidelines, practice parameters, or expert consensus statements presents clinical challenges. A 69-year-old woman presented for latissimus dorsi breast reconstruction. The patient had previously undergone implantation of a spinal cord stimulator, a gastric pacemaker, a sacral nerve stimulator, and an intrathecal morphine pump. After consultation with device manufacturers, the devices with patient programmability were switched off. Bipolar cautery was used intraoperatively. Postoperatively, all devices were interrogated to ensure appropriate functioning before home discharge. Perioperative goals include complete preoperative radiologic documentation of device component location, minimizing electromagnetic interference, and avoiding mechanical damage to implanted device components.

  5. Pectus excavatum in adult women: repair and the impact of prior or concurrent breast augmentation.

    Science.gov (United States)

    Ma, Irene T; Rebecca, Alanna M; Notrica, David M; McMahon, Lisa E; Jaroszewski, Dawn E

    2015-02-01

    Women present with pectus excavatum five times less frequently than men. Adult women may have additional, associated cosmetic factors, including hypoplastic or asymmetric breasts, or prior augmentation. The authors evaluated the impact of prior or concurrent cosmetic breast surgery in an adult female cohort undergoing repair of pectus excavatum deformity. A retrospective review was performed of women (≥18 years old) who underwent pectus excavatum repair at a single institution from January of 2010 to September of 2013. Pectus excavatum repair was performed on 47 women with a median age of 35 years (range, 18 to 63 years). Mean pectus severity index was 6.2 (range, 3.1 to 16). All patients had physiologic symptoms as the primary purpose for seeking repair. Twenty patients (43 percent) presented with existing implants or the desire for implants at the time of repair. Fifteen patients (32 percent) had a history of implant placement including prior breast augmentation (n = 14) and/or pectus implant (n = 4). Concurrent augmentation (n = 5), breast implant exchange (n = 8), and/or removal of chest wall implants (n = 4) was performed during repair. Morbidity included one implant-related hematoma. Complications and hospital stay were not significantly different for patients undergoing primary repair alone versus those with prior or concurrent augmentation. Breast cosmesis was a concern in nearly half of adult women presenting for pectus excavatum repair. The authors' experience suggests neither prior nor concurrent breast augmentation increases the risk of complications in repair. The authors recommend that cosmetic breast surgery be performed concurrently with pectus excavatum repair. Therapeutic, III.

  6. Superelastic Orthopedic Implant Coatings

    Science.gov (United States)

    Fournier, Eric; Devaney, Robert; Palmer, Matthew; Kramer, Joshua; El Khaja, Ragheb; Fonte, Matthew

    2014-07-01

    The demand for hip and knee replacement surgery is substantial and growing. Unfortunately, most joint replacement surgeries will fail within 10-25 years, thereby requiring an arduous, painful, and expensive revision surgery. To address this issue, a novel orthopedic implant coating material ("eXalt") has been developed. eXalt is comprised of super elastic nitinol wire that is knit into a three-dimensional spacer fabric structure. eXalt expands in vivo to conform to the implantation site and is porous to allow for bone ingrowth. The safety and efficacy of eXalt were evaluated through structural analysis, mechanical testing, and a rabbit implantation model. The results demonstrate that eXalt meets or exceeds the performance of current coating technologies with reduced micromotion, improved osseointegration, and stronger implant fixation in vivo.

  7. Implantable Cardioverter Defibrillator

    Science.gov (United States)

    ... for example, iPods) Household appliances, such as microwave ovens High-tension wires Metal detectors Industrial welders Electrical ... of Having an Implantable Cardioverter Defibrillator? An ICD works well at detecting and stopping certain life-threatening ...

  8. Ion Implantation of Polymers

    DEFF Research Database (Denmark)

    Popok, Vladimir

    2012-01-01

    The current paper presents a state-of-the-art review in the field of ion implantation of polymers. Numerous published studies of polymers modified by ion beams are analysed. General aspects of ion stopping, latent track formation and changes of structure and composition of organic materials...... are discussed. Related to that, the effects of radiothermolysis, degassing and carbonisation are considered. Specificity of depth distributions of implanted into polymers impurities is analysed and the case of high-fluence implantation is emphasised. Within rather broad topic of ion bombardment, the focus...... is put on the low-energy implantation of metal ions causing the nucleation and growth of nanoparticles in the shallow polymer layers. Electrical, optical and magnetic properties of metal/polymer composites are under the discussion and the approaches towards practical applications are overviewed....

  9. [Osteoradionecrosis and dental implants].

    Science.gov (United States)

    Ben Slama, L; Hasni, W; De Labrouhe, C; Bado, F; Bertrand, J-C

    2008-12-01

    Osteoradionecrosis (ORN) is a severe complication of radiation therapy (RT). A triggering factor is frequently present. It is often a dental, periodental, or surgical traumatism. We report the case of a bilateral ORN: the first lesion appeared 3months after the end of RT around the osteosynthesis plate and was treated by mandibular resection. The second lesion appeared 40months after RT on the opposite side, due to peri-implantitis. Dental implants had been inserted 10years before cancer therapy. No case of ORN in post-implantation RT had been previously reported. A 75-year-old woman was admitted for a squamous cell carcinoma of the right cheek extending to the intermaxillary commissure, the maxillary tuberosity, the soft palate, the lingual junction, and the vestibule up to the second premolar area. There was no suspicious lymph node. She had undergone dental implant procedure 15 and 10 years before, respectively, one in the second premolar position of the right maxilla and four in the premolar and molar left mandible area. All of them were osseo-integrated and charged. A trans-mandibular buccopharyngectomy with modified radical neck dissection was performed, completed by RT. The total dose of irradiation was 65Gy in the oral cavity and 45Gy on cervical and supraclavicular areas. Delayed mucosal healing was observed on the right mandible and ORN appeared in this area 3months after the end of irradiation. Mandibular resection was necessary. Later, the right maxillary implant was lost, and multiple dental extractions were required. Forty months after RT, peri-implantitis was observed on the left side of the mandible, complicated by ORN and pathological fracture. No surgical reconstruction could be performed because of the patient's age and state. The patient was carrying a complete removable maxillary prosthesis on latest follow-up. This was the first case of ORN on dental implants placed before RT. RT is a risk factor of implant failure, a relatively rare and

  10. Lumbar herniation following extended autologous latissimus dorsi breast reconstruction.

    Science.gov (United States)

    Fraser, Sheila Margaret; Fatayer, Hiba; Achuthan, Rajgopal

    2013-05-30

    Reconstructive breast surgery is now recognized to be an important part of the treatment for breast cancer. Surgical reconstruction options consist of implants, autologous tissue transfer or a combination of the two. The latissimus dorsi flap is a pedicled musculocutaneous flap and is an established method of autologous breast reconstruction.Lumbar hernias are an unusual type of hernia, the majority occurring after surgery or trauma in this area. The reported incidence of a lumbar hernia subsequent to a latissimus dorsi reconstruction is very low. We present the unusual case of lumbar herniation after an extended autologous latissimus dorsi flap for breast reconstruction following a mastectomy. The lumbar hernia was confirmed on CT scanning and the patient underwent an open mesh repair of the hernia through the previous latissimus dorsi scar. Lumbar hernias are a rare complication that can occur following latissimus dorsi breast reconstruction. It should be considered in all patients presenting with persistent pain or swelling in the lumbar region.

  11. Analgesia in implant dentistry.

    Science.gov (United States)

    Garg, Arun

    2011-06-01

    This month's feature article offers a review of analgesics commonly used in implant dentistry. While the placement of an implant is certainly of the utmost importance to the practitioner, ensuring adequate pain control during and after the procedure is one of the more important aspects to the patient. Selecting the most effective and appropriate agent to control swelling, pain, and anxiety requires a broad knowledge of these classes of medication.

  12. Biomaterials in cochlear implants

    OpenAIRE

    Lenarz, Thomas; Stöver, Timo

    2011-01-01

    The cochlear implant (CI) represents, for almost 25 years now, the gold standard in the treatment of children born deaf and for postlingually deafened adults. These devices thus constitute the greatest success story in the field of ‘neurobionic’ prostheses. Their (now routine) fitting in adults, and especially in young children and even babies, places exacting demands on these implants, particularly with regard to the biocompatibility of a CI’s surface components. Furthermore, certain parts o...

  13. [Biological implant in single-stage reconstruction of mammary gland for cancer].

    Science.gov (United States)

    Zikiriakhodzhaev, A D; Ermoshchenkova, M V

    2015-01-01

    Brief literature review about features of biological implants application for mammary gland reconstruction is presented in the article. Possible complications after such materials use, first experience of acellular dermal matrix administration for single-stage mammary gland reconstruction in 6 patients with breast cancer are also described. We offered surgical techniques, complications and methods of its treatment. We presented advantages of biological implant use which are consisted in decrease of surgical damage and duration of surgery, opportunity for enlargement of pocket for implant, decrease of pain syndrome.

  14. Ion implantation. L'implantation ionique

    Energy Technology Data Exchange (ETDEWEB)

    Tousset, J. (Lyon-1 Univ., 69 - Villeurbanne (FR). Inst. de Physique Nucleaire)

    1989-10-01

    The ion implantation technique which has been used in the semiconductor industry for more than 20 years, is now gradually becoming adopted as a surface treatment process for various materials, particularly metals and ceramics. The aim is to improve wear, fatigue and or corrosion resistance. Its characteristic features are the absence of an interface between the modified surface layer and the substrate, and the conservation of the initial component dimensions and volume, since the process does not involve heating. Another characteristic concerns the nature of the chemical species created in the treated zone, whose formation does not necessarily correspond to thermodynamic equilibrum, and which can be amorphous or metastable. In its simple form, the technique is limited due to the low thickness affected. This paper definies the basic principles of the technique, the methods used for characterising the implanted zone, and the present and potential fields of application. 13 refs.

  15. Contraceptive implants: current perspectives

    Directory of Open Access Journals (Sweden)

    Rowlands S

    2014-09-01

    Full Text Available Sam Rowlands,1,2 Stephen Searle3 1Centre of Postgraduate Medical Research and Education, School of Health and Social Care, Bournemouth University, Bournemouth, United Kingdom; 2Dorset HealthCare, Bournemouth, United Kingdom; 3Sexual Health Services, Chesterfield, United KingdomAbstract: Progestin-only contraceptive implants are a highly cost-effective form of long-acting reversible contraception. They are the most effective reversible contraceptives and are of a similar effectiveness to sterilization. Pregnancies are rare in women using this method of contraception, and those that do occur must be fully investigated, with an ultrasound scan of the arm and serum etonogestrel level if the implant cannot be located. There are very few contraindications to use of implants, and they have an excellent safety profile. Both acceptability and continuation with the method are high. Noncontraceptive benefits include improvements in dysmenorrhea, ovulatory pain, and endometriosis. Problematic bleeding is a relatively common adverse effect that must be covered in preinsertion information-giving and supported adequately if it occurs. Recognized training for both insertion and removal should be undertaken. Care needs to be taken at both insertion and removal to avoid neurovascular injury. Implants should always be palpable; if they are not, noninsertion should be assumed until disproven. Etonogestrel implants are now radiopaque, which aids localization. Anticipated difficult removals should be performed by specially trained experts. Keywords: contraceptive, subdermal implant, etonogestrel, levonorgestrel, progestin-only, long-acting reversible contraception

  16. Biomaterials in cochlear implants

    Science.gov (United States)

    Stöver, Timo; Lenarz, Thomas

    2011-01-01

    The cochlear implant (CI) represents, for almost 25 years now, the gold standard in the treatment of children born deaf and for postlingually deafened adults. These devices thus constitute the greatest success story in the field of ‘neurobionic’ prostheses. Their (now routine) fitting in adults, and especially in young children and even babies, places exacting demands on these implants, particularly with regard to the biocompatibility of a CI’s surface components. Furthermore, certain parts of the implant face considerable mechanical challenges, such as the need for the electrode array to be flexible and resistant to breakage, and for the implant casing to be able to withstand external forces. As these implants are in the immediate vicinity of the middle-ear mucosa and of the junction to the perilymph of the cochlea, the risk exists – at least in principle – that bacteria may spread along the electrode array into the cochlea. The wide-ranging requirements made of the CI in terms of biocompatibility and the electrode mechanism mean that there is still further scope – despite the fact that CIs are already technically highly sophisticated – for ongoing improvements to the properties of these implants and their constituent materials, thus enhancing the effectiveness of these devices. This paper will therefore discuss fundamental material aspects of CIs as well as the potential for their future development. PMID:22073103

  17. Short dental implants: an emerging concept in implant treatment.

    Science.gov (United States)

    Al-Hashedi, Ashwaq Ali; Taiyeb Ali, Tara Bai; Yunus, Norsiah

    2014-06-01

    Short implants have been advocated as a treatment option in many clinical situations where the use of conventional implants is limited. This review outlines the effectiveness and clinical outcomes of using short implants as a valid treatment option in the rehabilitation of edentulous atrophic alveolar ridges. Initially, an electronic search was performed on the following databases: Medline, PubMed, Embase, Cochrane Database of Systematic Reviews, and DARE using key words from January 1990 until May 2012. An additional hand search was included for the relevant articles in the following journals: International Journal of Oral and Maxillofacial Implants, Clinical Oral Implants Research, Journal of Clinical Periodontology, International Journal of Periodontics, Journal of Periodontology, and Clinical Implant Dentistry and Related Research. Any relevant papers from the journals' references were hand searched. Articles were included if they provided detailed data on implant length, reported survival rates, mentioned measures for implant failure, were in the English language, involved human subjects, and researched implants inserted in healed atrophic ridges with a follow-up period of at least 1 year after implant-prosthesis loading. Short implants demonstrated a high rate of success in the replacement of missing teeth in especially atrophic alveolar ridges. The advanced technology and improvement of the implant surfaces have encouraged the success of short implants to a comparable level to that of standard implants. However, further randomized controlled clinical trials and prospective studies with longer follow-up periods are needed.

  18. Tissue expansion for breast reconstruction: Methods and techniques

    Directory of Open Access Journals (Sweden)

    Nicolò Bertozzi

    2017-09-01

    Conclusions: TE/implant-based reconstruction has proved to be a safe, cost-effective, and reliable technique that can be performed in women with various comorbidities. Short operative time, fast recovery, and absence of donor site morbidity are other advantages over autologous breast reconstruction.

  19. A Limited Submuscular Direct-to-Implant Technique Utilizing AlloMax

    Directory of Open Access Journals (Sweden)

    Michal Brichacek, MD

    2017-07-01

    Full Text Available Background:. This study evaluates a novel limited submuscular direct-to-implant technique utilizing AlloMax where only the upper few centimeters of the implant is covered by the pectoralis, whereas the majority of the implant including the middle and lower poles are covered by acellular dermal matrix. Methods:. The pectoralis muscle is released off its inferior and inferior-medial origins and allowed to retract superiorly. Two sheets of AlloMax (6 × 16 cm are sutured together and secured to the inframammary fold, serratus fascia, and the superiorly retracted pectoralis. Thirty-seven breasts in 19 consecutive patients with follow-up at 6 months were reviewed. Results:. Nineteen consecutive patients with 37 reconstructed breasts were studied. Average age was 50 years, average BMI was 24.3. Ptosis ranged from grade 0–III, and average cup size was B (range, A–DDD. Early minor complications included 1 seroma, 3 minor postoperative hematomas managed conservatively, and 3 minor wound healing problems. Three breasts experienced mastectomy skin flap necrosis and were managed with local excision. There were no cases of postoperative infection, red breast, grade III/IV capsular contractures, or implant loss. A single patient complained of animation postoperatively. One patient desired fat grafting for rippling. Conclusions:. The limited submuscular direct-to-implant technique utilizing AlloMax appears to be safe with a low complication rate at 6 months. This technique minimizes the action of the pectoralis on the implant, reducing animation deformities but still providing muscle coverage of the upper limit of the implant. Visible rippling is reduced, and a vascularized bed remains for fat grafting of the upper pole if required.

  20. Breast Cancer Surgery

    Science.gov (United States)

    FACTS FOR LIFE Breast Cancer Surgery The goal of breast cancer surgery is to remove the whole tumor from the breast. Some lymph nodes ... might still be in the body. Types of breast cancer surgery There are two types of breast cancer ...

  1. [Quality of life and patient satisfaction after breast reconstruction].

    Science.gov (United States)

    Papadopulos, N A; Kovacs, L; Baumann, A; Ali, S; Herschbach, P; Henrich, G; Biemer, E

    2006-07-01

    Nowadays, the array of methods for reconstruction of the female breast following mastectomy is vast. In this study, we investigate and compare quality of life after breast reconstruction and satisfaction with the results of two commonly used techniques (autologous tissue vs. expander/implant). Ninety-one consecutive patients who underwent breast reconstruction at a German clinic between 1996 and 2001 were included in the study. Patient satisfaction and quality of life were assessed retrospectively using self-evaluation questionnaires. Patients were generally more satisfied with the outcome of the operation when autologous tissue was used. This was significant in the following areas: breast size, form, definition of the lower breast fold, softness of the breast, and symmetry of the breasts. In both groups the quality of life following breast reconstruction at least 2 years after the operation was equal to that of healthy women of the same age group. Although patients were more satisfied with the results of autologous breast reconstruction, procedure choice did not affect quality of life.

  2. Lipomodelling - advanced technique for the correction of Congenital hypoplastic breast malformations and deformities.

    Science.gov (United States)

    Streit, L; Dražan, L; Novák, P; Schneiderová, M; Dvořák, Z; Teplá, K; Veselý, J

    A variety of surgical techniques has been used to correct hypoplastic breast malformations and deformities, including tissue expanders, breast implants, custom chest wall implants, mammary gland remodelling, as well as locoregional or free flap. Case series of successful breast reconstruction using lipomodelling technique in one patient with severe Polands syndrome and two patients with tuberous breasts are reported together with literature review. No surgical complications were observed and ultrasound examination did not reveal any pathology in breast tissue other than oil pseudocysts postoperatively. In both malformations, submammary fold was moved downwards. Moreover, the lower part of the breast and areolar herniation was corrected in tuberous breast, and in Polands syndrome, the areolar complex was significantly shifted downwards and laterally. In comparison with other reconstructive techniques, lipomodelling allows for the breast correction to begin in early adolescence. Further growth of the unaffected breast may be effectively corrected by subsequent lipomodelling session. This technique appears to change the overall approach to the management of hypoplastic breast and chest wall malformations.

  3. Breast Reconstruction

    Science.gov (United States)

    ... clínico de los senos Preguntas Para el Médico Datos Para la Vida Komen Guía de herramientas de ... They vary in the amount of projection and base width. The best implant shape and size will ...

  4. Aesthetic correction of tuberous breast deformity: lessons learned with a single-stage procedure.

    Science.gov (United States)

    Bach, Alexander D; Kneser, Ulrich; Beier, Justus P; Breuel, Christiane; Horch, Raymund E; Leffler, Mareike

    2009-01-01

    Tuberous breast deformity is a pathologic condition of the breast affecting teenage women. The aberration of breast shape in tuberous breast deformity consisting of a constricting ring at the breast base, breast tissue deficiency, and herniation of breast tissue into the nipple-areola-complex with areola enlargement and additional asymmetry makes the surgical correction challenging. In the present study, 15 patients were operated using a surgical procedure, which addresses all aspects of the deformity at a one-stage operation. The described technique results in a periareolar scar only, and the use of tissue expanders or skin flaps is unnecessary. Minor periareolar scar revision surgery was necessary in eight of 15 patients (53%) because of hypertrophic or expanded scarring. In two patients, implant dislocation occurred and therefore surgical revision was necessary. In all cases, an excellent final aesthetic result with a high patient satisfaction was achieved.

  5. Stereotactic (Mammographically Guided) Breast Biopsy

    Science.gov (United States)

    ... Resources Professions Site Index A-Z Stereotactic Breast Biopsy Stereotactic breast biopsy uses mammography – a specific type ... Breast Biopsy? What is Stereotactic (Mammographically Guided) Breast Biopsy? Lumps or abnormalities in the breast are often ...

  6. Risks of Breast Cancer Screening

    Science.gov (United States)

    ... of Breast & Gynecologic Cancers Breast Cancer Screening Research Breast Cancer Screening (PDQ®)–Patient Version What is screening? ... cancer screening: Cancer Screening Overview General Information About Breast Cancer Key Points Breast cancer is a disease ...

  7. Treatment Option Overview (Breast Cancer)

    Science.gov (United States)

    ... of Breast & Gynecologic Cancers Breast Cancer Screening Research Breast Cancer Treatment (PDQ®)–Patient Version General Information About Breast Cancer Go to Health Professional Version Key Points Breast ...

  8. General Information about Breast Cancer

    Science.gov (United States)

    ... of Breast & Gynecologic Cancers Breast Cancer Screening Research Breast Cancer Treatment (PDQ®)–Patient Version General Information About Breast Cancer Go to Health Professional Version Key Points Breast ...

  9. Breast cancer

    CERN Multimedia

    2002-01-01

    "Cancer specialists will soon be able to compare mammograms with computerized images of breast cancer from across Europe, in a bid to improve diagnosis and treatment....The new project, known as MammoGrid, brings together computer and medical imaging experts, cancer specialists, radiologists and epidemiologists from Bristol, Oxford, Cambridge, France and Italy" (1 page).

  10. Breast Calcifications

    Science.gov (United States)

    ... and require no further testing or follow-up. Microcalcifications. These show up as fine, white specks, similar to grains of salt. They're usually noncancerous, but certain patterns can be an early sign of cancer. If breast calcifications appear suspicious on your initial mammogram, you ...

  11. Breast Cancer

    Science.gov (United States)

    ... the Mediterranean diet choose healthy fats, such as olive oil, over butter and fish instead of red meat. Breast cancer risk reduction for women with a high risk If your doctor has assessed your family history and determined that you have other factors, such ...

  12. Protective effect of topical antibiotics in breast augmentation

    DEFF Research Database (Denmark)

    Pfeiffer, Philip; Jørgensen, Signe; Kristiansen, Thomas B

    2009-01-01

    BACKGROUND: Previous studies indicate that antibacterial lavage and/or use of topical antibiotics may reduce infection in breast implant surgery and perhaps also reduce occurrence of capsular contracture. A retrospective analysis was performed to evaluate this effect. METHODS: The study participa......BACKGROUND: Previous studies indicate that antibacterial lavage and/or use of topical antibiotics may reduce infection in breast implant surgery and perhaps also reduce occurrence of capsular contracture. A retrospective analysis was performed to evaluate this effect. METHODS: The study...... versus 5.9 percent; p = 0.393). CONCLUSION: The authors' data support the use of topical antibiotics in cosmetic breast surgery, because significant increases of both infections and seroma were seen in patients not treated with topical antibiotics compared with a cohort of similar patients where topical...... antibiotics were used....

  13. Shaping the breast in aesthetic and reconstructive breast surgery: an easy three-step principle. Part II--Breast reconstruction after total mastectomy.

    Science.gov (United States)

    Blondeel, Phillip N; Hijjawi, John; Depypere, Herman; Roche, Nathalie; Van Landuyt, Koenraad

    2009-03-01

    This is Part II of four parts describing the three-step principle being applied in reconstructive and aesthetic breast surgery. Part I explains how to analyze a problematic breast by understanding the main anatomical features of a breast and how they interact: the footprint, the conus of the breast, and the skin envelope. This part describes how one can optimize results with breast reconstructions after complete mastectomy. For both primary and secondary reconstructions, the authors explain how to analyze the mastectomized breast and the deformed chest wall, before giving step-by-step guidelines for rebuilding the entire breast with either autologous tissue or implants. The differences in shaping unilateral or bilateral breast reconstructions with autologous tissue are clarified. Regardless of timing or method of reconstruction, it is shown that by breaking down the surgical strategy into three easy (anatomical) steps, the reconstructive surgeon will be able to provide more aesthetically pleasing and reproducible results. Throughout these four parts, the three-step principle will be the red line on which to fall back to define the problem and to propose a solution.

  14. Does the Use of Intraoperative Breast Sizers Increase Complication Rates in Primary Breast Augmentation? A Retrospective Analysis of 416 Consecutive Cases in a Single Institution

    Directory of Open Access Journals (Sweden)

    Lee Seng Khoo

    2016-01-01

    Full Text Available Background. Is the use of intraoperative breast sizers beneficial for plastic surgeons or do they result in higher complication rates? Methods. This is a retrospective study of 416 consecutive cases of primary breast augmentation with silicone implants at the Plastic Surgery Service of Professor Ivo Pitanguy at the 38th Infirmary Santa Casa Misericórdia Hospital, Rio De Janeiro, from January 2011 to March 2014. 212 cases (51% were carried out with use of intraoperative breast sizers with 204 cases (49% without the use of implant sizers. This study compares the outcome of cases that employed the use of intraoperative implant sizers versus those that did not in terms of infection, hematoma/seroma formation, and capsular contracture. Results. Of 416 primary breast augmentation cases, there were 5 cases of infection (1.2%, 4 cases of seroma (1%, 3 cases of hematoma (0.7%, and 7 cases of capsular contracture (Baker’s Grade III/IV(1.7%. Total complication rate limited to infection, seroma, hematoma, and capsular contracture was 1.15% (95% CI 0.96–1.93%. There was a significant difference in the scores for breast sizers (M = 4.3, SD = 1.4 and no breast sizers (M = 2.3, SD = 0.87 conditions, t(8 = 2.79, p=0.018. The use of implant sizers was correlated with a higher complication rate. Conclusion. Good results could be obtained without the use of breast sizers in primary breast augmentation with use of a biodimensional tissue based planning system while eliminating risks of infection and reducing intraoperative time. Notwithstanding, in a residency program breast sizers can be an excellent training tool to shorten the learning curve in the novice surgeon.

  15. Does the Use of Intraoperative Breast Sizers Increase Complication Rates in Primary Breast Augmentation? A Retrospective Analysis of 416 Consecutive Cases in a Single Institution.

    Science.gov (United States)

    Khoo, Lee Seng; Radwanski, Henrique N; Senna-Fernandes, Vasco; Antônio, Nsingi Nsosolo; Fellet, Leonardo Luiz Fernandes; Pitanguy, Ivo

    2016-01-01

    Background. Is the use of intraoperative breast sizers beneficial for plastic surgeons or do they result in higher complication rates? Methods. This is a retrospective study of 416 consecutive cases of primary breast augmentation with silicone implants at the Plastic Surgery Service of Professor Ivo Pitanguy at the 38th Infirmary Santa Casa Misericórdia Hospital, Rio De Janeiro, from January 2011 to March 2014. 212 cases (51%) were carried out with use of intraoperative breast sizers with 204 cases (49%) without the use of implant sizers. This study compares the outcome of cases that employed the use of intraoperative implant sizers versus those that did not in terms of infection, hematoma/seroma formation, and capsular contracture. Results. Of 416 primary breast augmentation cases, there were 5 cases of infection (1.2%), 4 cases of seroma (1%), 3 cases of hematoma (0.7%), and 7 cases of capsular contracture (Baker's Grade III/IV)(1.7%). Total complication rate limited to infection, seroma, hematoma, and capsular contracture was 1.15% (95% CI 0.96-1.93%). There was a significant difference in the scores for breast sizers (M = 4.3, SD = 1.4) and no breast sizers (M = 2.3, SD = 0.87) conditions, t(8) = 2.79, p = 0.018. The use of implant sizers was correlated with a higher complication rate. Conclusion. Good results could be obtained without the use of breast sizers in primary breast augmentation with use of a biodimensional tissue based planning system while eliminating risks of infection and reducing intraoperative time. Notwithstanding, in a residency program breast sizers can be an excellent training tool to shorten the learning curve in the novice surgeon.

  16. Evaluating the Public Information: Shaping News Coverage of the Silicone Implant Controversy.

    Science.gov (United States)

    Andsager, Julie; Smiley, Leiott

    1998-01-01

    Examines effectiveness of public information officers transmitting policy actors' frames through the media (six major newspapers) to the public during the 1991-92 silicone breast implant controversy that involved a major corporation, the medical community, and citizens' activist groups. Finds that the medical community's frame occurred most…

  17. Breast lift (mastopexy) - slideshow

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/presentations/100188.htm Breast lift (mastopexy) - series—Incisions To use the sharing features ... to slide 3 out of 3 Overview Breast lift (mastopexy) is usually performed for drooping breasts, which ...

  18. Male Breast Cancer

    Science.gov (United States)

    Although breast cancer is much more common in women, men can get it too. It happens most often to men between ... 60 and 70. Breast lumps usually aren't cancer. However, most men with breast cancer have lumps. ...

  19. Breast radiation - discharge

    Science.gov (United States)

    Radiation - breast - discharge ... You may notice changes in the way your breast looks or feels (if you are getting radiation ... after treatment is over. The skin on your breast may become more sensitive or numb. Skin and ...

  20. Breast Cancer Disparities

    Science.gov (United States)

    ... 2.65 MB] Read the MMWR Science Clips Breast Cancer Black Women Have Higher Death Rates from Breast ... of Page U.S. State Info Number of Additional Breast Cancer Deaths Among Black Women, By State SOURCE: National ...

  1. Types of Breast Pumps

    Science.gov (United States)

    ... Health and Consumer Devices Consumer Products Breast Pumps Types of Breast Pumps Share Tweet Linkedin Pin it ... a nipple and used for feeding a baby. Types of Breast Pumps There are three basic types ...

  2. Breast Cancer Trends

    Science.gov (United States)

    ... 2011 Funding: Increasing Awareness and Support Among Young Women with Breast Cancer Funding: Young Breast Cancer Survivors Funding: Breast Cancer Genomics Statistics Rates by Race and Ethnicity Rates by State ...

  3. Inflammatory Breast Cancer

    Science.gov (United States)

    ... breast cancer correctly. Their recommendations are summarized below. Minimum criteria for a diagnosis of inflammatory breast cancer ... Initial biopsy samples from the affected breast show invasive carcinoma. Further examination of tissue from the affected ...

  4. Corrosion on spinal implants.

    Science.gov (United States)

    Kirkpatrick, John S; Venugopalan, Ramakrishna; Beck, Preston; Lemons, Jack

    2005-06-01

    Modular spine implants are used as an aid to obtaining fusion, but fretting and corrosion occur between modular components in a biologic environment. Forty-eight spinal implant constructs manufactured by a variety of companies were retrieved from 47 patients and were subjected to surface analysis stereomicroscopy. Stainless-steel implants (n = 23) had either semirigid constructs with mild or no surface alteration (n = 7) or rigid constructs with moderate or severe alteration (n = 16). Surface damage was consistent with previously observed mechanically assisted crevice corrosion phenomena. Titanium alloy implants (n = 25) showed no significant corrosion but had three constructs with fatigue failure of anchoring screws. One cobalt alloy construct showed no evidence of corrosion. Long-term effects of fretting and corrosion are unclear, and minimization of these phenomena seems justified. Selection of modular components with similar materials and surface finish may help the surgeon minimize localized changes over time. Stainless-steel implants with rigid interconnections and those with different surface finishes between rods and connectors are most susceptible to corrosion.

  5. Interface Biology of Implants

    Science.gov (United States)

    Nebe, Barbara

    2009-01-01

    Implants are widely used in various clinical disciplines to replace or stabilize organs. The challenge for the future is to apply implant materials to specifically control the biology of the surrounding tissue for repair and regeneration. This field of research is highly interdisciplinary and combines scientists from technical and life sciences disciplines. To successfully apply materials for regenerative processes in the body, the understanding of the mechanisms at the interface between cells or tissues and the artificial material is of critical importance. The research focuses on stem cells, design of material surfaces, and mechanisms of cell adhesion. For the third time around 200 scientists met in Rostock, Germany for the international symposium “Interface Biology of Implants.” The aim of the symposium is to promote the interdisciplinary dialogue between the scientists from the different disciplines to develop smart implants for medical use. In addition, researchers from basic sciences, notably cell biology presented new findings concerning mechanisms of cell adhesion to stimulate research in the applied field of implant technology. PMID:19690468

  6. SERI Surgical Scaffold in 2-Stage Breast Reconstruction: 2-Year Data from a Prospective, Multicenter Trial.

    Science.gov (United States)

    Karp, Nolan; Choi, Mihye; Kulber, David A; Downey, Susan; Duda, Gloria; Kind, Gabriel M; Jewell, Mark L; Murphy, Diane K; Lehfeldt, Max R; Fine, Neil

    2017-05-01

    Soft-tissue support devices are used during breast reconstruction. This study investigated long-term clinical data following SERI Surgical Scaffold (SERI) implantation, a bioresorbable, silk-derived scaffold for soft-tissue support. This was a prospective, multicenter study in 103 subjects who received SERI during stage 1 of 2-stage breast reconstruction with subpectoral tissue expander placement (Natrelle Style 133V; Allergan plc, Dublin, Ireland) followed by subpectoral breast implant placement. Investigator satisfaction (11-point scale: 0, very dissatisfied and 10, very satisfied) at 6 months was the primary endpoint. Ease of use, satisfaction, scaffold palpability/visibility, breast anatomy measurements via 3D images, SERI integration, histology, and safety were also assessed through 2 years after stage 1 surgery. Analyses were performed on the per-protocol population (103 subjects; 161 breasts) with no protocol deviations that could affect outcomes. Ease of use and subject and investigator satisfaction with SERI were high throughout 2 years. Breast anatomy measurements with 3D images demonstrated long-term soft-tissue stability of the lower breast mound. Key complication rates per breast were tissue/skin necrosis and wrinkling/rippling (8.1% each) and seroma, wound dehiscence, and breast redness (5.0% each). Over 2 years, 4 breasts in 4 subjects underwent reoperation with explantation of any device; 2 breasts required SERI explantation. SERI was retained in 98.8% of breasts (159/161) at 2 years. SERI was associated with high and consistent levels of investigator and subject satisfaction and demonstrated soft-tissue stability in the lower breast through 2 years. SERI provides a safe, long-term benefit for soft-tissue support in 2-stage breast reconstruction.

  7. Psychological intervention following implantation of an implantable defibrillator

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; van den Broek, Krista C; Sears, Samuel F

    2007-01-01

    The medical benefits of the implantable cardioverter defibrillator (ICD) are unequivocal, but a subgroup of patients experiences emotional difficulties following implantation. For this subgroup, some form of psychological intervention may be warranted. This review provides an overview of current...

  8. Breast cancer in pregnancy.

    Science.gov (United States)

    Krishna, Iris; Lindsay, Michael

    2013-09-01

    Pregnancy-associated breast cancer is defined as breast cancer diagnosed during pregnancy or in the first postpartum year. Breast cancer is one of the more common malignancies to occur during pregnancy and, as more women delay childbearing, the incidence of breast cancer in pregnancy is expected to increase. This article provides an overview of diagnosis, staging, and treatment of pregnancy-associated breast cancer. Recommendations for management of breast cancer in pregnancy are discussed. Copyright © 2013 Elsevier Inc. All rights reserved.

  9. Tuberous breast correction by fat grafting.

    Science.gov (United States)

    Delay, Emmanuel; Sinna, Raphaël; Ho Quoc, Christophe

    2013-05-01

    Tuberous breast is a rare malformation that has negative physical and psychological impacts during puberty. A range of surgical techniques has been used to correct breast shape and volume in this context, including a combination of skin plasty and mammary gland remodeling, as well as prostheses and locoregional flaps. The authors have used fat grafting as a complementary technique to correct tuberous breasts since 1998. The authors discuss application of their lipomodeling technique for correction of tuberous breast deformity. The charts of tuberous breast patients treated consecutively over an 11-year period (n = 31) solely with fat grafting (ie, without using an implant) were retrospectively reviewed. Each breast deformation was graded according to the Grolleau classification. The number of sessions and the mean transfer of fat volume by lipomodeling session were recorded. Patient and surgeon satisfaction were evaluated. Of the 31 patients in this series, 18 had bilateral formations and 13 had unilateral malformations. The mean patient age was 23 years, and the mean body mass index was 21.9. A single session (mean transfer volume, 158 mL; range, 90-253 mL) was required in 14 (45%) cases. A second session (mean transfer volume, 226 mL; range, 100-316 mL) was necessary in the remaining 55% of cases. Mean follow-up period after the last fat transfer session was 6.5 years (range, 1.5-11 years). Patients were very satisfied in 94% of cases (n = 29) and satisfied in 6% (n = 2). The surgical team rated 94% of cases as being successful or very successful. No complications were observed. One patient developed hypertrophy of the treated breast following weight gain and thus required breast reduction. Imaging performed preoperatively and 1 year postoperatively did not reveal any anomalies other than oil cysts. Fat grafting is a reliable technique that produces excellent results and high levels of patient satisfaction for the treatment of tuberous breast. The aesthetic

  10. Lipoestructura y relleno del polo superior de la mama frente a implantes Structural fat graft and lipofilling of mammary upper pole versus mammary implants

    Directory of Open Access Journals (Sweden)

    J.M. Cervilla Lozano

    2012-09-01

    Full Text Available La lipoestructura mamaria ofrece nuevas alternativas de tratamiento en la cirugía estética de aumento mamario, cumpliendo en algunos casos las expectativas esperadas y en otros no. Analizamos este hecho en 4 tipos de aplicación de lipoestructura mamaria que hemos venido realizando en los últimos años, centrándonos en un aspecto importante de esta cirugía que es el relleno del polo superior de la mama. Los tipos de aplicación empleados son: aumento mamario simple mediante lipoestructura en comparación con implantes; pexia más lipoestructura frente a pexia más implantes mamarios; reconstrucción de mama tuberosa mediante lipoestructura o implantes y finalmente, relleno periprotésico mediante lipoestructura en mamas sometidas a cirugía de aumento mamario con implantes. En definitiva, podríamos resumir este trabajo en una frase diciendo que la lipoestructura mamaria, a nuestro juicio, no sirve si lo que prima es conseguir el relleno del polo superior de la mama, siendo en este caso de elección la colocación de implantes mamarios. No obstante, en alguno de los casos señalados no solo es una alternativa, sino que obtiene resultados superiores a los logrados sólamente con implantes.The mammary structural fat graft offers news treatment options in breast augmentation cosmetic surgery, but it sometimes meets expectations and sometimes doesn´t. We analyze 4 different types of lipostructure mammary applications that we have been using in the last years, focused in an important aspect of this surgery as it´s the filling of the upper mammary pole. These applications are: mammary augmentation by simple structural fat compared with the use of mammary implants; structural fat graft and mastopexy versus implants and mastopexy; tuberous breast reconstruction using structural fat graft or implants and finally, periprosthetic filling in breast augmentation with mammary implants using structural fat graft. In short, we could summarize this paper

  11. Management of peri-implantitis

    Science.gov (United States)

    Prathapachandran, Jayachandran; Suresh, Neethu

    2012-01-01

    Peri-implantitis is a site-specific infectious disease that causes an inflammatory process in soft tissues, and bone loss around an osseointegrated implant in function. The etiology of the implant infection is conditioned by the status of the tissue surrounding the implant, implant design, degree of roughness, external morphology, and excessive mechanical load. The microorganisms most commonly associated with implant failure are spirochetes and mobile forms of Gram-negative anaerobes, unless the origin is the result of simple mechanical overload. Diagnosis is based on changes of color in the gingiva, bleeding and probing depth of peri-implant pockets, suppuration, X-ray, and gradual loss of bone height around the tooth. Treatment will differ depending upon whether it is a case of peri-implant mucositis or peri-implantitis. The management of implant infection should be focused on the control of infection, the detoxification of the implant surface, and regeneration of the alveolar bone. This review article deals with the various treatment options in the management of peri-implantitis. The article also gives a brief description of the etiopathogenesis, clinical features, and diagnosis of peri-implantitis. PMID:23559913

  12. Management of peri-implantitis

    Directory of Open Access Journals (Sweden)

    Jayachandran Prathapachandran

    2012-01-01

    Full Text Available Peri-implantitis is a site-specific infectious disease that causes an inflammatory process in soft tissues, and bone loss around an osseointegrated implant in function. The etiology of the implant infection is conditioned by the status of the tissue surrounding the implant, implant design, degree of roughness, external morphology, and excessive mechanical load. The microorganisms most commonly associated with implant failure are spirochetes and mobile forms of Gram-negative anaerobes, unless the origin is the result of simple mechanical overload. Diagnosis is based on changes of color in the gingiva, bleeding and probing depth of peri-implant pockets, suppuration, X-ray, and gradual loss of bone height around the tooth. Treatment will differ depending upon whether it is a case of peri-implant mucositis or peri-implantitis. The management of implant infection should be focused on the control of infection, the detoxification of the implant surface, and regeneration of the alveolar bone. This review article deals with the various treatment options in the management of peri-implantitis. The article also gives a brief description of the etiopathogenesis, clinical features, and diagnosis of peri-implantitis.

  13. Implant therapy in irradiated patients.

    Science.gov (United States)

    Sammartino, Gilberto; Marenzi, Gaetano; Cioffi, Iacopo; Teté, Stefano; Mortellaro, Carmen

    2011-03-01

    In this multicenter study, submerged implants were prospectively followed to evaluate their long-term prognosis in irradiated patients. In a total of 77 patients treated for oral or neck cancer, 188 implants were consecutively placed. After a healing period, the successfully integrated implants were restored with 69 removable and 38 fixed restorations. The implants cumulative survival and success rates were evaluated over a period of at least 36 months. In addition, cumulative success rates were calculated for implant subgroups divided per implant site (mandible or maxilla), radiation dosage, and the time interval between the last irradiation and implant placement. During the healing period, 20 implants did not successfully integrate, whereas 168 implants were classified as success (including both survival and success rates). The analysis of implant subgroups showed slightly more favorable cumulative success rate for mandibular implants (98.4%) compared with maxillary implants (57.1%) and clearly better success rate for a radiation dosage minor of 50-Gy doses. A time greater than 12 months as interval between last irradiation and implant placement seems not to promote better clinical results.

  14. Breast reconstruction after breast cancer.

    Science.gov (United States)

    Serletti, Joseph M; Fosnot, Joshua; Nelson, Jonas A; Disa, Joseph J; Bucky, Louis P

    2011-06-01

    After reading this article, the participant should be able to: 1. Describe the mental, emotional, and physical benefits of reconstruction in breast cancer patients. 2. Compare the most common techniques of reconstruction in patients and detail benefits and risks associated with each. 3. Outline different methods of reconstruction and identify the method considered best for the patient based on timing of the procedures, body type, adjuvant therapies, and other coexisting conditions. 4. Distinguish between some of the different flaps that can be considered for autologous reconstruction. Breast cancer is unfortunately a common disease affecting millions of women, often at a relatively young age. Reconstruction following mastectomy offers women an opportunity to mollify some of the emotional and aesthetic effects of this devastating disease. Although varying techniques of alloplastic and autologous techniques are available, all strive to achieve the same goal: the satisfactory reformation of a breast mound that appears as natural as possible without clothing and at the very least is normal in appearance under clothing. This article summarizes the various approaches to breast reconstruction and offers a balanced view of the risks and benefits of each, all of which in the end offer the opportunity for excellent and predictable results with a high degree of patient satisfaction.

  15. Dental implants: A review.

    Science.gov (United States)

    Guillaume, B

    2016-12-01

    A high number of patients have one or more missing tooth and it is estimated that one in four American subjects over the age of 74 have lost all their natural teeth. Many options exist to replace missing teeth but dental implants have become one of the most used biomaterial to replace one (or more) missing tooth over the last decades. Contemporary dental implants made with titanium have been proven safe and effective in large series of patients. This review considers the main historical facts concerned with dental implants and present the different critical factors that will ensure a good osseo-integration that will ensure a stable prosthesis anchorage. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  16. Optimization of dental implant treatment

    National Research Council Canada - National Science Library

    Dmitriy V. Ivanov; Aleksandr V. Dol; Dmitriy A. Smirnov

    2016-01-01

    Aim ― Modern dentistry cannot exist without dental implantation. The lifetime of the installed implants depends on condition of the bone and on the quality of the treatment planning and surgery technique...

  17. [Breast asymmetry of the teenager and the young adult. Stability of the result in time. About 144 patients].

    Science.gov (United States)

    Ellart, J; François, C; Calibre, C; Guerreschi, P; Duquennoy-Martinot, V

    2016-10-01

    Breast asymmetry is defined by a difference in breast shape and/or volume. The goal of this study was to assess the stability of the surgical results and to highlight predictive factors for deterioration in results. This retrospective and monocentric study included all patients presenting constitutional isolated asymmetry, Poland's syndrome, asymmetric tuberous breast or pectus excavatum treated between 1980 and 2015. The statistical analysis included 144 patients and contained two parts. The first analysis compared patients with or without breast implant. Results were significant only for symmetry of shape, with better outcomes without breast implant (P=0.0170). The second analysis compared the subgroups of patients with breast asymmetry, according to the etiology. Patients with tuberous breasts and constitutional isolated asymmetry have been compared. We found a significant difference only regarding the long-term results (P=0.0091). Patients with tuberous breasts had deteriorating in results over time. Patients with Poland's syndrome, compared to patients with constitutional isolated asymmetry, had significantly less good results for symmetry of volume, of shape, of areola, and for early results (Pbreast implant, weight variations, pregnancies and breast-feeding, the use of hormonal treatments, ageing and tuberous malformation. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  18. Imaging Guided Breast Interventions.

    Science.gov (United States)

    Masroor, Imrana; Afzal, Shaista; Sufian, Saira Naz

    2016-06-01

    Breast imaging is a developing field, with new and upcoming innovations, decreasing the morbidity and mortality related to breast pathologies with main emphasis on breast cancer. Breast imaging has an essential role in the detection and management of breast disease. It includes a multimodality approach, i.e. mammography, ultrasound, magnetic resonance imaging, nuclear medicine techniques and interventional procedures, done for the diagnosis and definitive management of breast abnormalities. The range of methods to perform biopsy of a suspicious breast lesion found on imaging has also increased markedly from the 1990s with hi-technological progress in surgical as well as percutaneous breast biopsy methods. The image guided percutaneous breast biopsy procedures cause minimal breast scarring, save time, and relieve the patient of the anxiety of going to the operation theatre. The aim of this review was to describe and discuss the different image guided breast biopsy techniques presently employed along with the indications, contraindication, merits and demerits of each method.

  19. Orthosis reduces breast pain and mechanical forces through natural and augmented breast tissue in women lying prone.

    Science.gov (United States)

    Ried, Karin; Armstrong, Simon; Sali, Avni; McLaughlin, Patrick

    2014-01-13

    Breast implant displacement or rupture can cause aesthetic problems and serious medical complications. Activities with prone positioning and loading of the anterior chest wall, such as massage, chiropractic or osteopathic therapies may increase the risk of implant failure and can also cause discomfort in women with natural breast tissue. Here we test the effectiveness of a newly developed orthosis on pain, mechanical pressure and displacement of breast tissue in women with cosmetic augmentation, post-mastectomy reconstruction, lactating or natural breast tissue. Thirty-two females volunteers, aged 25-56 years with augmented, reconstructed, natural or lactating breast tissue and cup sizes B-F, participated in this open-label clinical trial. We measured pain perception, peak pressure, maximum force, and breast tissue displacement using different sizes of the orthosis compared to no orthosis. Different densities of the orthosis were also tested in a subgroup of women (n = 7). Pain perception was rated using a validated 11-point visual-analogue scale. Peak pressure and maximum force were assessed using a bilateral set of capacitance-pliance® sensor strips whilst participants were load bearing in a prone position, and breast displacement was measured by magnetic-resonance-imaging. The orthosis significantly reduced pain, breast displacement and mechanical pressures in women with natural and augmented breast tissue in prone position. Greater relief of pain and greater reduction in mechanical forces were found with increased size and density of the orthosis. Use of the orthosis improved overall comfort by 64-100%, lowered peak pressure by up to 85% and maximum force by up to 96%. Medio-lateral displacement of breast tissue was reduced by 16%, resulting in a 51% desirable increase of breast tissue height. Our study demonstrated that the newly developed orthosis significantly reduced pain, mechanical pressure and breast tissue displacement in women with augmented and

  20. Computer-guided Implant dentistry.

    Science.gov (United States)

    Schnitman, Paul A

    2007-01-01

    Computer-guided minimally invasive implant treatment promises to revolutionize the way we practice implant dentistry. This new technology allows implants and associated restorations to be precisely placed at the same procedure directly through the gingiva in an hour or less. Since there is no incision, there is minimal postoperative discomfort or swelling and no sutures.

  1. Recent advances in dental implants.

    Science.gov (United States)

    Hong, Do Gia Khang; Oh, Ji-Hyeon

    2017-12-01

    Dental implants are a common treatment for the loss of teeth. This paper summarizes current knowledge on implant surfaces, immediate loading versus conventional loading, short implants, sinus lifting, and custom implants using three-dimensional printing. Most of the implant surface modifications showed good osseointegration results. Regarding biomolecular coatings, which have been recently developed and studied, good results were observed in animal experiments. Immediate loading had similar clinical outcomes compared to conventional loading and can be used as a successful treatment because it has the advantage of reducing treatment times and providing early function and aesthetics. Short implants showed similar clinical outcomes compared to standard implants. A variety of sinus augmentation techniques, grafting materials, and alternative techniques, such as tilted implants, zygomatic implants, and short implants, can be used. With the development of new technologies in three-dimension and computer-aided design/computer-aided manufacturing (CAD/CAM) customized implants can be used as an alternative to conventional implant designs. However, there are limitations due to the lack of long-term studies or clinical studies. A long-term clinical trial and a more predictive study are needed.

  2. Biomimetic approach to dental implants.

    Science.gov (United States)

    Kim, Tae-Il; Jang, Jun-Hyeog; Kim, Hae-Won; Knowles, Jonathan C; Ku, Young

    2008-01-01

    Titanium, as an implant material, is regarded to be durable and biocompatible, which allows functional replacement of missing teeth. Successful dental implantation depends on an osseointegration phenomenon, a direct structural and functional binding reaction between bone and implant. It is well known that physicochemical characteristics of the dental implant surface, such as roughness, topography, chemistry, and electrical charge affect the biological reactions occurring at the interface of tissue and implant. Therefore, considerable efforts have been made to modify the surface of titanium implants which are based on mechanical, physical and chemical treatments. Recently, biological molecules were introduced onto the surface of implants to stimulate osteogenic cells in the early stage of implantation and consequently accelerate bone formation around implant and subsequent rapid implant stabilization. A range of extracellular matrix components, designed peptides, and growth factors have been proposed as the biological moiety. In this review, we address several issues related to the biology of dental implants and discuss biomimetic modification of the implant surface as a novel approach to obtain successful osseointegration.

  3. Treatment of peri-implantitis and the failing implant.

    Science.gov (United States)

    Robertson, Kevin; Shahbazian, Timothy; MacLeod, Stephen

    2015-04-01

    Appropriate treatment of implants is becoming increasingly important for the general dentist as the number of implants placed per year continues to increase. Early diagnosis of peri-implantitis is imperative; initiating the correct treatment protocol depends on a proper diagnosis. Several risk factors exist for the development of peri-implantitis, which can guide patient selection and treatment planning. Treatment of peri-implantitis should be tailored to the severity of the lesion (as outlined by the cumulative interceptive supportive treatment protocol), ranging from mechanical debridement to explantation. Several surgical and nonsurgical treatment alternatives exist. There is little consensus on superior treatment methods. Published by Elsevier Inc.

  4. [Fibrocystic breast disease--breast cancer sequence].

    Science.gov (United States)

    Habor, V; Habor, A; Copotoiu, C; Panţîru, A

    2010-01-01

    Fibrocystic breast disease has developed a major issue: the breast cancer sequence. Its involvement regarding the increse of breast cancer risk has 2 aspects: it may be either the marker of a prone tissue or a premalignant hystological deffect. Difficult differential diagnosis of benign proliferative breast lession and carcinoma led to the idea of sequency between the two: cancer does not initiate on normal mammary epithelia; it takes several proliferative stages for it to occur. In our series we analized a number of 677 breast surgical procedures where the pathologic examination reveals 115 cases (17%) of coexistence between cancer and fibrocystic breast disease. This aspect has proved to be related to earlier debut of breast cancer, suggesting that epithelial hyperplasia is a risk factor for breast cancer.

  5. Capsular synovial metaplasia mimicking silicone leak of a breast prosthesis: a case report

    Directory of Open Access Journals (Sweden)

    Krishnanandan Sarah

    2008-08-01

    Full Text Available Abstract Introduction Synovial metaplasia around a prosthesis and in particular around silicone breast implants has been noted by various investigators, but has unknown clinical significance. We report on a patient where a large amount of synovial fluid mimicked rupture of an implant. We believe this to be an unusual clinical presentation of this phenomenon. Review of the English language literature failed to identify a comparable case. Case presentation A 25-year-old woman had undergone bilateral breast augmentation for cosmetic reasons. One implant was subsequently subjected to two attempts at expansion to correct asymmetry. The patient was later found to have a large quantity of viscous fluid around the port of that same prosthesis. Histological assessment of the implant had consequently confirmed capsular synovial metaplasia. This had initially caused the suspicion of a silicone 'bleed' from the implant and had resulted in an unnecessary explantation. Conclusion Capsular synovial metaplasia should be ruled out before the removal of breast implants where a leak is suspected. Manipulation and expansion of an implant may be risk factors for the development of synovial metaplasia.

  6. [Fat grafting to improve severe tuberous breast].

    Science.gov (United States)

    Ho Quoc, C; Piat, J M; Michel, G; Dlimi, C; La Marca, S; Delay, E

    2015-06-01

    Tuberous breast is a rare malformation that has major, negative physical and psychological impacts during puberty. A range of surgical techniques has been used to correct breast shape and volume in this context. Most techniques are based on a combination of skin plasty and mammary gland remodelling, in order to redistribute volumes. Prostheses and local-regional flaps can also be used to correct the missing volume. Fat grafting to the breast has been used in our department since 1998 as a complementary technique in breast reconstruction; it constitutes a natural way of providing volume and modifying the shape of the breast. Since 2000, we have extended this lipomodelling technique to the correction of thorax malformations in general and tuberous breasts in particular. Here, we describe our experience of the correction of severe tuberous breasts by fat grafting. Over an 11-year period, we performed a retrospective study on tuberous breast patients treated solely with fat grafting (i.e. without using an implant). Each breast deformation was graded according to the Grolleau classification. After aspiration, the fat was centrifuged and then transferred with a specific cannula. Using an 18-G trocar, we sometimes also performed fasioctomies to free up fibrous bridges and mammary gland remodelling. We evaluated the lipofilling for each case (number of sessions and mean fat transfer volume). Technical efficacy was evaluated in terms of patient's satisfaction and the surgeon's opinion. Safety was evaluated by screening for recipient site complications. We performed a retrospective study of 31 cases of tuberous breasts treated between January 2000 and December 2010. The severe tuberous breasts were type 3 in 10 cases. The mean patient age was 21 and the mean body mass index was 21.5. Two session (mean transfer volume: 380 cc) were required in every case. The mean follow-up period after the last fat transfer session was 6 years (range: 1-11). The patients were very satisfied

  7. The Preventive Effect of Topical Zafirlukast Instillation for Peri-Implant Capsule Formation in Rabbits

    Directory of Open Access Journals (Sweden)

    Shin Hyuk Kang

    2015-03-01

    Full Text Available BackgroundCapsular contracture is the most troublesome complication in breast implant surgery. Although capsule formation can be seen as a normal reaction to a foreign body, it can induce pain, hardness, deformity, and other pathologic problems. Surgical intervention is required in severe cases, but even surgery cannot guarantee a successful outcome without recurrence. This experimental study confirms that single topical administration of leukotriene antagonist zafirlukast (Accolate, Astrazeneca reduces peri-implant capsule formation and prevents capsular contracture.MethodsTwelve smooth-surfaced cohesive gel implants were implanted in New Zealand White rabbits. These miniature implants were designed to be identical to currently used products for breast augmentation. The rabbits were divided into 2 groups. In the experimental group (n=6, the implant and normal saline with zafirlukast were inserted in the submuscular pocket. In the control group (n=6, the implant and normal saline alone were used. Two months later, the implants with peri-implant capsule were excised. We evaluated capsule thickness and collagen pattern and performed immunohistochemical staining of myofibroblasts, transforming growth factor (TGF-β1, 2.ResultsThe thickness of the capsules in the experimental group was reduced in both dorsal and ventral directions. The collagen pattern showed parallel alignment with low density, and the number of myofibroblasts as well as the amounts of TGF-β1 and TGF-β2 were reduced in the experimental group.ConclusionsWe suggest that single topical administration of leukotriene antagonist zafirlukast can be helpful in reducing capsule formation and preventing capsular contracture via myofibroblast suppression, modulation of fibroblastic cytokines, and anti-inflammatory effect.

  8. Remote actuated valve implant

    Science.gov (United States)

    McKnight, Timothy E; Johnson, Anthony; Moise, Jr., Kenneth J; Ericson, Milton Nance; Baba, Justin S; Wilgen, John B; Evans, III, Boyd McCutchen

    2014-02-25

    Valve implant systems positionable within a flow passage, the systems having an inlet, an outlet, and a remotely activatable valve between the inlet and outlet, with the valves being operable to provide intermittent occlusion of the flow path. A remote field is applied to provide thermal or magnetic activation of the valves.

  9. Implantable enzyme amperometric biosensors.

    Science.gov (United States)

    Kotanen, Christian N; Moussy, Francis Gabriel; Carrara, Sandro; Guiseppi-Elie, Anthony

    2012-05-15

    The implantable enzyme amperometric biosensor continues as the dominant in vivo format for the detection, monitoring and reporting of biochemical analytes related to a wide range of pathologies. Widely used in animal studies, there is increasing emphasis on their use in diabetes care and management, the management of trauma-associated hemorrhage and in critical care monitoring by intensivists in the ICU. These frontier opportunities demand continuous indwelling performance for up to several years, well in excess of the currently approved seven days. This review outlines the many challenges to successful deployment of chronically implantable amperometric enzyme biosensors and emphasizes the emerging technological approaches in their continued development. The foreign body response plays a prominent role in implantable biotransducer failure. Topics considering the approaches to mitigate the inflammatory response, use of biomimetic chemistries, nanostructured topographies, drug eluting constructs, and tissue-to-device interface modulus matching are reviewed. Similarly, factors that influence biotransducer performance such as enzyme stability, substrate interference, mediator selection and calibration are reviewed. For the biosensor system, the opportunities and challenges of integration, guided by footprint requirements, the limitations of mixed signal electronics, and power requirements, has produced three systems approaches. The potential is great. However, integration along the multiple length scales needed to address fundamental issues and integration across the diverse disciplines needed to achieve success of these highly integrated systems, continues to be a challenge in the development and deployment of implantable amperometric enzyme biosensor systems. Copyright © 2012 Elsevier B.V. All rights reserved.

  10. Remote actuated valve implant

    Energy Technology Data Exchange (ETDEWEB)

    McKnight, Timothy E.; Johnson, Anthony; Moise, Kenneth J.; Ericson, Milton Nance; Baba, Justin S.; Wilgen, John B.; Evans, Boyd Mccutchen

    2016-05-10

    Valve implant systems positionable within a flow passage, the systems having an inlet, an outlet, and a remotely activatable valve between the inlet and outlet, with the valves being operable to provide intermittent occlusion of the flow path. A remote field is applied to provide thermal or magnetic activation of the valves.

  11. Middle ear implants

    Directory of Open Access Journals (Sweden)

    K S Gangadhara Somayaji

    2013-01-01

    Full Text Available Hearing loss is becoming more common in the society living in cities with lot of background noise around, and frequent use of gadgets like mobile phones, MP3s, and IPods are adding to the problem. The loss may involve the conductive or perceptive pathway. Majority of the patients with conductive hearing loss will revert back to normal hearing levels with medical and/or surgical treatment. However, in sensorineural hearing loss, many factors are involved in the management. Though traditionally hearing aids in various forms are the most commonly used modality in managing these patients, there are some drawbacks associated with them. Implantable middle ear amplifiers represent the most recent breakthrough in the management of hearing loss. Middle ear implants are surgically implanted electronic devices that aim to correct hearing loss by stimulating the ossicular chain or middle ear. Of late, they are also being used in the management of congenital conductive hearing loss and certain cases of chronic otitis media with residual hearing loss. The article aims to provide general information about the technology, indications and contraindications, selection of candidates, available systems, and advantages of middle ear implants. (MEI

  12. Dental Implant Surgery

    Science.gov (United States)

    ... upper jaw protrude into one of your sinus cavities How you prepare Because dental implants require one or more surgical procedures, you ... can take several months, helps provide a solid base for your new artificial tooth ... teeth. Placing the abutment When osseointegration is complete, you ...

  13. Corrosion of bio implants

    Indian Academy of Sciences (India)

    Chemical stability, mechanical behaviour and biocompatibility in body fluids and tissues are the basic requirements for successful application of implant materials in bone fractures and replacements. Corrosion is one of the major processes affecting the life and service of orthopaedic devices made of metals and alloys used ...

  14. Implantable Impedance Plethysmography

    Directory of Open Access Journals (Sweden)

    Michael Theodor

    2014-08-01

    Full Text Available We demonstrate by theory, as well as by ex vivo and in vivo measurements that impedance plethysmography, applied extravascularly directly on large arteries, is a viable method for monitoring various cardiovascular parameters, such as blood pressure, with high accuracy. The sensor is designed as an implant to monitor cardiac events and arteriosclerotic progression over the long term.

  15. [Retinal implants. Patients' expectations].

    Science.gov (United States)

    Gusseck, H

    2005-10-01

    The "Pro Retina" Society and the "Retina Implant" Foundation, two patients associations with the goal of "preventing blindness," view the "Retina Implant" project as a possibility for providing blind individuals a modicum of restored vision. Both patients associations cultivated a cooperative relationship with researchers and policy makers already during the research phase, introducing the wishes and concerns of patients into considerations and providing information and the groundwork for acceptance in society and among those who may potentially benefit from the method. An initial survey of patients, the visually impaired, and blind people revealed that recovery of sight not only represents a medical and technical problem but that it also involves numerous psychosocial implications. By adhering to ethical standards in implantations, in particular by taking patient autonomy into consideration, anxieties and fears can be reduced. It would appear from early positive results in a short-term clinical study that soon successful chronic retinal implantation can be expected. The dedication displayed by physicians, researchers, and the industry as well as the willingness of the Federal Ministry for Research to take the risk are appreciated and greatfully accepted by the patients and their relatives.

  16. Implantable Drug Dispenser

    Science.gov (United States)

    Collins, E. R. J.

    1983-01-01

    Drugs such as insulin are injected as needed directly into bloodstream by compact implantable dispensing unit. Two vapor cavities produce opposing forces on drug-chamber diaphragm. Heaters in cavities allow control of direction and rate of motion of bellows. Dispensing capsule fitted with coil so batteries can be recharged by induction.

  17. Paediatric cochlear implantation

    African Journals Online (AJOL)

    Chantel

    The internal portion consists of a multi- channel electrode array that is implanted in the cochlea and is attached to a receiv- er/stimulator, an antenna and a .... ties, cerebral palsy, sensory integra- tion problems, blindness and autism can be considered as CI candidates. The literature shows that CIs benefit children with hear-.

  18. Prospective review of integral implants.

    Science.gov (United States)

    Block, M S; Kent, J N

    1992-01-01

    There are several factors that strongly correlate to HA-coated implant success and the prevention of implant morbidity. Surgical placement must be performed without compromise in technique. Implants placed into thin ridges or those that had dehiscence of their surface did not uniformly gain bone attachment levels during the healing period. Countersinking implants in extraction sites was critical; labial bone implant defects should be grafted with particulate HA. HA grafts to labial bone defects at the time of implant placement surgery are still short-term. Primary closure of all implant surgical sites prevented epithelial invagination into the surgical site and is associated with improved bone height around implants. Premature exposure of the implant during the healing period is associated with crestal bone loss. Loading forces should be physiologic, with maintenance of a physiologic equilibrium by a balanced restoration. Bone bulk should be created or preserved. Bone around implants may adversely respond to excessive loading forces. In the posterior maxilla, crestal bone loss has been observed that seems to result from excessive cantilever-type forces placed on the implants or from when implants are placed in the posterior mandible developed progressive bone loss that was associated with several factors. These factors included articulation against a natural occlusion, a horizontal ridge contour level with the external oblique ridge, a nonhygienic restoration, and the lack of keratinized gingiva against the abutment. Whether titanium implants develop progressive bone loss in the face of these factors is unknown. The presence of keratinized gingiva strongly correlated to bone maintenance in the posterior mandible. Because of this statistically significant finding, implant exposure should preserve all keratinized gingiva by transposing it labially to the implants. Most patients who receive implants for dental restoration have lost teeth because of caries and

  19. Percutaneous fasciotomies and fat grafting: indications for breast surgery.

    Science.gov (United States)

    Ho Quoc, Christophe; Sinna, Raphaël; Gourari, Azouz; La Marca, Sophie; Toussoun, Gilles; Delay, Emmanuel

    2013-09-01

    The management of breast deformities can be very difficult in the presence of breast shape retraction. Percutaneous fasciotomies, which release fibrous strings, can be a very useful tool for shape improvement in the recipient site for a fat graft. The authors evaluate the efficacy of fasciotomies in association with fat grafting in breast surgery. A retrospective chart review was conducted for 1000 patients treated with concurrent fasciotomies and fat grafting between January 2006 and December 2011. The recipient site was prepared with fasciotomies, and fat was harvested from other parts of the body using a low-pressure 10-mL syringe lipoaspiration system. Fat was centrifuged and injected into the breast for reconstruction or chest deformities. The postoperative appearance of the breast scars was scored by both the surgeon and the patient. Each complication was recorded, including instances of hematoma, infection, tissue wounds, scar healing, and fat necrosis. In this series of patients, for whom the primary indications for the procedure were sequelae of breast-conserving surgery after cancer, latissimus dorsi flap breast reconstruction, breast implant reconstruction, tuberous breast, Poland syndrome, and funnel chest, we recorded the following complications: 0.8% local infections (8/1000), 0.1% delayed wound healing that required medical care (1/1000), and 3% fat necrosis (31/1000). Fasciotomy scarring was considered minor by the patient in 98.5% of cases and by the surgeon in 99% of cases at 1 year postoperatively. Fat grafting is a safe and reliable technique that improves the aesthetic outcomes of breast surgery. Percutaneous fasciotomies provide excellent aesthetic results and an improvement in breast shape with no scarring. In our experience, both fat grafting and fasciotomies offer a durable result over the long term.

  20. Breast cancer in men

    Science.gov (United States)

    ... in situ - male; Intraductal carcinoma - male; Inflammatory breast cancer - male; Paget disease of the nipple - male; Breast cancer - male ... The cause of breast cancer in men is not clear. But there are risk factors that make breast cancer more likely in men: Exposure to ...

  1. Breast Cancer Overview

    Science.gov (United States)

    ... are here Home > Types of Cancer > Breast Cancer Breast Cancer This is Cancer.Net’s Guide to Breast Cancer. Use the menu below to choose the Overview/ ... social workers, and patient advocates. Cancer.Net Guide Breast Cancer Introduction Statistics Medical Illustrations Risk Factors and Prevention ...

  2. Breast Cancer -- Male

    Science.gov (United States)

    ... Home > Types of Cancer > Breast Cancer in Men Breast Cancer in Men This is Cancer.Net’s Guide to Breast Cancer in Men. Use the menu below to choose ... social workers, and patient advocates. Cancer.Net Guide Breast Cancer in Men Introduction Statistics Risk Factors and Prevention ...

  3. Engineered porous metals for implants

    Science.gov (United States)

    Vamsi Krishna, B.; Xue, Weichang; Bose, Susmita; Bandyopadhyay, Amit

    2008-05-01

    Interest is significant in patient-specific implants with the possibility of guided tissue regeneration, particularly for load-bearing implants. For such implants to succeed, novel design approaches and fabrication technologies that can achieve balanced mechanical and functional performance in the implants are necessary. This article is focused on porous load-bearing implants with tailored micro-as well as macrostructures using laser-engineered net shaping (LENS™), a solid freeform fabrication or rapid prototyping technique that can be used to manufacture patient-specific implants. This review provides an insight into LENS, some properties of porous metals, and the potential applications of this process to fabricate unitized structures which can eliminate longstanding challenges in load-bearing implants to increase their in-vivo lifetime, such as in a total hip prosthesis.

  4. [Lipofilling and breast cancer: Literature review in 2015?].

    Science.gov (United States)

    Ho Quoc, C; Carrabin, N; Meruta, A; Piat, J-M; Delay, E; Faure, C

    2015-11-01

    The clinical surveillance of a patient treated for breast cancer involves many specialists: a surgeon, an oncologist, a radiotherapist, a gynecologist, and a general practitioner. The patients diagnosed with breast cancer will require regular clinical examination in order to identify possible recurrences. In our team, fat grafting has been used since 1998 for breast reconstruction because its results are natural breasts. Usually used as an adjuvant for flap or implant breast reconstruction, the lipofilling increases the aesthetic result and has a high satisfaction rate among patients. Despite of this advantage, some teams do not use lipofilling in patients with breast cancer history, because of doubts about oncology safety and screening difficulty. We performed an extensive review of the literature available regarding this subject. The purpose of this article is to evaluate the oncology safety of lipofilling in breast reconstruction after breast cancer. A literature review was undertaken using PubMed. The key words searched were: breast lipofilling, breast reconstruction, breast cancer, and recurrence. The results of the literature review showed a reduced number of articles reporting recurrence after lipofilling. The retrospective studies included few patients and searched for multiple variables: histological type, stage, surgery, marginal invasion, distance between cancer surgery and lipofilling. In our research, we found no correct control group, except the series of Petit. The follow-up is relatively short (between 1 and 3years), except for the series of Rigotti. The recurrence cases after lipofilling in patients with extensive in situ carcinoma, in the series of Petit, raised the problem to be cautious with lipofilling after extensive in situ carcinoma. Other factors involved are the age of the patient and the distance between the cancer surgery and the lipofilling. Breast cancer is a disease that is well managed regarding treatment and follow-up. After

  5. Imaging male breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Doyle, S., E-mail: sdoyle2@nhs.net [Primrose Breast Care Unit, Derriford Hospital, Plymouth (United Kingdom); Steel, J.; Porter, G. [Primrose Breast Care Unit, Derriford Hospital, Plymouth (United Kingdom)

    2011-11-15

    Male breast cancer is rare, with some pathological and radiological differences from female breast cancer. There is less familiarity with the imaging appearances of male breast cancer, due to its rarity and the more variable use of preoperative imaging. This review will illustrate the commonest imaging appearances of male breast cancer, with emphasis on differences from female breast cancer and potential pitfalls in diagnosis, based on a 10 year experience in our institution.

  6. Central Mound Mastopexy for the Correction of Tuberous/Tubular Breast Deformity.

    Science.gov (United States)

    Abbate, Olivia A; Fan, Kenneth L; Nahabedian, Maurice Y

    2017-11-01

    Tuberous and tubular breast deformity are well-recognized abnormalities in the plastic surgery community that incur severe physical and psychological consequences in affected patients. Current reconstructive options for the tuberous and tubular breasts favor the use of prosthetic implants and soft-tissue manipulation. We present a case of tuberous and tubular breast deformity treated with a central mound reduction technique and mastopexy with imbricating sutures without the use of prosthetic implants. The patient remained extremely pleased with her results at long-term follow-up. This represents a unique case of successful reconstruction in a patient with a tuberous and tubular breast deformity using a central mound reduction technique with mastopexy and without a prosthetic device.

  7. Central Mound Mastopexy for the Correction of Tuberous/Tubular Breast Deformity

    Directory of Open Access Journals (Sweden)

    Olivia A. Abbate, BA

    2017-11-01

    Full Text Available Summary:. Tuberous and tubular breast deformity are well-recognized abnormalities in the plastic surgery community that incur severe physical and psychological consequences in affected patients. Current reconstructive options for the tuberous and tubular breasts favor the use of prosthetic implants and soft-tissue manipulation. We present a case of tuberous and tubular breast deformity treated with a central mound reduction technique and mastopexy with imbricating sutures without the use of prosthetic implants. The patient remained extremely pleased with her results at long-term follow-up. This represents a unique case of successful reconstruction in a patient with a tuberous and tubular breast deformity using a central mound reduction technique with mastopexy and without a prosthetic device.

  8. Efter cochlear implant

    DEFF Research Database (Denmark)

    Højen, Anders

    2007-01-01

      Dit barn har netop fået et cochlear implant. Hvad nu? Skal barnet fokusere udelukkende på at lære talt sprog, eller skal det også lære/fortsætte med tegnsprog eller støttetegn? Det er et vanskeligt spørgsmål, og før valget foretages, er det vigtigt at vurdere hvilke konsekvenser valget har, dels...... for den sproglige udvikling isoleret set, og dels for barnets udvikling ud fra en helhedsbetragtning. Dette indlæg fokuserer på, hvilke forventninger man kan have til cochlear implant-brugeres sproglige udvikling med talt sprog alene, hhv. med to sprog (tale og tegn). Disse forventninger er baseret på...

  9. Efter cochlear implant

    DEFF Research Database (Denmark)

    Højen, Anders

    Dit barn har netop fået et cochlear implant. Hvad nu? Skal barnet fokusere udelukkende på at lære talt sprog, eller skal det også lære/fortsætte med tegnsprog eller støttetegn? Det er et vanskeligt spørgsmål, og før valget foretages, er det vigtigt at vurdere hvilke konsekvenser valget har, dels...... for den sproglige udvikling isoleret set, og dels for barnets udvikling ud fra en helhedsbetragtning. Dette indlæg fokuserer på, hvilke forventninger man kan have til cochlear implant-brugeres sproglige udvikling med talt sprog alene, hhv. med to sprog (tale og tegn). Disse forventninger er baseret på...

  10. COCHLEAR IMPLANTATION IN IRAN

    Directory of Open Access Journals (Sweden)

    M.H. Khalessi

    1996-07-01

    Full Text Available Deafness has been considered a non - resolving problem until the invention of cochlear implantation (CI. We are reporting the pre- and post-operative results of 14 patients underwent CI, for the first time in Iran, at the cochlear implantation Clinic of Tehran University of Medical Sciences. Four of our patients were able to hold a telephone conversation without difficulty 3 months post-operatively and the rest achieved considerable scores on audiologic tests and a remarkable improvement over 9 month interval between the two sets of tests. Also we have addressed the dramatic improvement in the quality of life of these patients in this paper as well as the results of promontory stimulation and audiometry.

  11. Capsular Contracture after Breast Augmentation: An Update for Clinical Practice

    Directory of Open Access Journals (Sweden)

    Hannah Headon

    2015-09-01

    Full Text Available Capsular contracture is the most common complication following implant based breast surgery and is one of the most common reasons for reoperation. Therefore, it is important to try and understand why this happens, and what can be done to reduce its incidence. A literature search using the MEDLINE database was conducted including search terms 'capsular contracture breast augmentation', 'capsular contracture pathogenesis', 'capsular contracture incidence', and 'capsular contracture management', which yielded 82 results which met inclusion criteria. Capsular contracture is caused by an excessive fibrotic reaction to a foreign body (the implant and has an overall incidence of 10.6%. Risk factors that were identified included the use of smooth (vs. textured implants, a subglandular (vs. submuscular placement, use of a silicone (vs. saline filled implant and previous radiotherapy to the breast. The standard management of capsular contracture is surgical via a capsulectomy or capsulotomy. Medical treatment using the off-label leukotriene receptor antagonist Zafirlukast has been reported to reduce severity and help prevent capsular contracture from forming, as has the use of acellular dermal matrices, botox and neopocket formation. However, nearly all therapeutic approaches are associated with a significant rate of recurrence. Capsular contracture is a multifactorial fibrotic process the precise cause of which is still unknown. The incidence of contracture developing is lower with the use of textured implants, submuscular placement and the use of polyurethane coated implants. Symptomatic capsular contracture is usually managed surgically, however recent research has focussed on preventing capsular contracture from occurring, or treating it with autologous fat transfer.

  12. Capsular Contracture after Breast Augmentation: An Update for Clinical Practice

    Science.gov (United States)

    Headon, Hannah; Kasem, Adbul

    2015-01-01

    Capsular contracture is the most common complication following implant based breast surgery and is one of the most common reasons for reoperation. Therefore, it is important to try and understand why this happens, and what can be done to reduce its incidence. A literature search using the MEDLINE database was conducted including search terms 'capsular contracture breast augmentation', 'capsular contracture pathogenesis', 'capsular contracture incidence', and 'capsular contracture management', which yielded 82 results which met inclusion criteria. Capsular contracture is caused by an excessive fibrotic reaction to a foreign body (the implant) and has an overall incidence of 10.6%. Risk factors that were identified included the use of smooth (vs. textured) implants, a subglandular (vs. submuscular) placement, use of a silicone (vs. saline) filled implant and previous radiotherapy to the breast. The standard management of capsular contracture is surgical via a capsulectomy or capsulotomy. Medical treatment using the off-label leukotriene receptor antagonist Zafirlukast has been reported to reduce severity and help prevent capsular contracture from forming, as has the use of acellular dermal matrices, botox and neopocket formation. However, nearly all therapeutic approaches are associated with a significant rate of recurrence. Capsular contracture is a multifactorial fibrotic process the precise cause of which is still unknown. The incidence of contracture developing is lower with the use of textured implants, submuscular placement and the use of polyurethane coated implants. Symptomatic capsular contracture is usually managed surgically, however recent research has focussed on preventing capsular contracture from occurring, or treating it with autologous fat transfer. PMID:26430623

  13. [Implantable middle ear hearing aids].

    Science.gov (United States)

    à Wengen, D F

    2004-01-01

    Conventional acoustic hearing aids are limited in their performance. Due to physical laws their amplification of sound is limited to within 5 kHz. However, the frequencies between 5 and 10 kHz are essential for understanding consonants. Words can only be understood correctly if their consonants can be understood. Furthermore noise amplification remains a problem with hearing aids. Other problems consist of recurrent infections of the external auditory canal, intolerance for occlusion of the ear canal, feedback noise, and resonances in speech or singing. Implantable middle ear hearing aids like the Soundbridge of Symphonix-Siemens and the MET of Otologics offer improved amplification and a more natural sound. Since the first implantation of a Soundbridge in Switzerland in 1996 almost one thousand patients have been implanted worldwide. The currents systems are semi-implantable. The external audio processor containing the microphone, computer chip, battery and radio system is worn in the hair bearing area behind the ear. Implantation is only considered after unsuccessful fitting of conventional hearing aids. In Switzerland the cost for these implantable hearing aids is covered by social insurances. Initially the cost for an implant is higher than for hearing aids. However, hearing aids need replacement every 5 or 6 years whereas implants will last 20 to 30 years. Due to the superior sound quality and the improved understanding of speech in noise, the number of patients with implantable hearing aids will certainly increase in the next years. Other middle ear implants are in clinical testing.

  14. Stages of Male Breast Cancer

    Science.gov (United States)

    ... Breast & Gynecologic Cancers Breast Cancer Screening Research Male Breast Cancer Treatment (PDQ®)–Patient Version General Information about Male Breast Cancer Go to Health Professional Version Key Points Male ...

  15. Tubo-uterine implantation.

    Science.gov (United States)

    Green-armytage, V G

    1957-02-01

    After characterizing 2 types of patients presenting with tubal infertility (1 that is "as a rule overweight (the uterus is fixed (and there is easily palpable tubo-uterine pathology," and 1 that is "slim, young, intelligent and often beautiful", 12 1-sentence suggestions are made to increase the success of tubo-uterine implantations in the second type of presenting patient (because the first group has, in the author's mind, disappointing prognosis). Figures are the bulk of the document, with 3 figures demonstrating the type of operation, 3 showing the scheme of the operation, 1 figure showing a posterior view of the implanted tube in utero with a polyethylene prosthesis in situ down to the cervix, and 1 figure showing the instruments used in the operation. A few points of experience the author shares are: 1) operate immediately after a menstrual period; 2) give antibiotics prophylactically and after the procedure; 3) use a Bonney Myomectomy Clamp to elevate the uterus; 4) never use a knife or bistoury at the cornua; 5) use polyethylene rods, when available; and 6) caesarean section is the indicated delivery route after tubo-uterine implantation. Out of 38 patients with the requisite history and findings who have been operated on by this author, 14 have gone to full-term, i.e., 36.1%; 2 have aborted, giving a pregnancy rate of 42.2%, and there was 1 ectopic pregnancy.

  16. Cochlear implants in children implanted in Jordan: A parental overview.

    Science.gov (United States)

    Alkhamra, Rana A

    2015-07-01

    Exploring the perspective of parents on the cochlear implant process in Jordan. Sixty parents of deaf children were surveyed on the information gathering process prior to cochlear implant surgery, and their implant outcome expectations post-surgery. Whether child or parent characteristics may impact parents' post-surgical expectations was explored. Although parents used a variety of information sources when considering a cochlear implant, the ear, nose and throat doctor comprised their major source of information (60%). Parents received a range of information prior to cochlear implant but agreed (93.3%) on the need for a multidisciplinary team approach. Post-surgically, parents' expected major developments in the areas of spoken language (97%), and auditory skills (100%). Receiving education in mainstream schools (92%) was expected too. Parents perceived the cochlear implant decision as the best decision they can make for their child (98.3%). A significant correlation was found between parents contentment with the cochlear implant decision and expecting developments in the area of reading and writing (r=0.7). Child's age at implantation and age at hearing loss diagnosis significantly affected parents' post-implant outcome expectations (pparents agree on the need for a comprehensive multidisciplinary team approach during the different stages of the cochlear implant process. Parents' education about cochlear implants prior to the surgery can affect their post-surgical outcome expectations. The parental perspective presented in this study can help professionals develop better understanding of parents' needs and expectations and henceforth improve their services and support during the different stages of the cochlear implant process. Copyright © 2015. Published by Elsevier Ireland Ltd.

  17. Sulforaphane, a Dietary Component of Broccoli/Broccoli Sprouts, Inhibits Breast Cancer Stem Cells

    Science.gov (United States)

    Li, Yanyan; Zhang, Tao; Korkaya, Hasan; Liu, Suling; Lee, Hsiu-Fang; Newman, Bryan; Yu, Yanke; Clouthier, Shawn G.; Schwartz, Steven J.; Wicha, Max S.; Sun, Duxin

    2010-01-01

    Purpose The existence of cancer stem cells (CSCs) in breast cancer has profound implications for cancer prevention. In this study, we evaluated sulforaphane, a natural compound derived from broccoli/broccoli sprouts, for its efficacy to inhibit breast CSCs and its potential mechanism. Experimental Design Aldefluor assay and mammosphere formation assay were used to evaluate the effect of sulforaphane on breast CSCs in vitro. A NOD/SCID xenograft model was employed to determine whether sulforaphane could target breast CSCs in vivo, as assessed by Aldefluor assay and tumor growth upon cell re-implantation in secondary mice. The potential mechanism was investigated utilizing Western blotting analysis and β-catenin reporter assay. Results Sulforaphane (1~5 μM) decreased aldehyde dehydrogenase (ALDH)-positive cell population by 65%~80% in human breast cancer cells (P sulforaphane for two weeks reduced ALDH-positive cells by more than 50% in NOD/SCID xenograft tumors (P = 0.003). Sulforaphane eliminated breast CSCs in vivo, thereby abrogating tumor growth after re-implantation of primary tumor cells into the secondary mice (P sulforaphane down-regulated Wnt/β-catenin self-renewal pathway. Conclusions Sulforaphane inhibits breast CSCs and down-regulates Wnt/β-catenin self-renewal pathway. These findings support the use of sulforaphane for chemoprevention of breast cancer stem cells and warrant further clinical evaluation. PMID:20388854

  18. New dental implant selection criterion based on implant design.

    Science.gov (United States)

    El-Anwar, Mohamed I; El-Zawahry, Mohamed M; Ibraheem, Eman M; Nassani, Mohammad Zakaria; ElGabry, Hisham

    2017-01-01

    A comparative study between threaded and plain dental implant designs was performed to find out a new criterion for dental implant selection. Several dental implant designs with a systematic increase in diameter and length were positioned in a cylindrical-shaped bone section and analyzed using finite element method. Four loading types were tested on different dental implant designs; tension of 50 N, compression of 100 N, bending of 20 N, and torque of 2 Nm, to derive design curves. Better stress distribution on both spongy and cortical bone was noted with an increase in dental implant diameter and length. With the increase in dental implant side area, a stress reduction in the surrounding bones was observed, where threaded dental implants showed better behavior over the plain ones. Increasing value of ratio between dental implant side area and its cross-sectional area reduces stresses transferred to cortical and spongy bones. The use of implants with higher ratio of side area to cross-section area, especially with weak jaw bone, is recommended.

  19. Sub-meninges Implantation Reduces Immune Response to Neural Implants

    Science.gov (United States)

    Markwardt, Neil T.; Stokol, Jodi; Rennaker, Robert L.

    2013-01-01

    Glial scar formation around neural interfaces inhibits their ability to acquire usable signals from the surrounding neurons. To improve neural recording performance, the inflammatory response and glial scarring must be minimized. Previous work has indicated that meningeally derived cells participate in the immune response, and it is possible that the meninges may grow down around the shank of a neural implant, contributing to the formation of the glial scar. This study examines whether the glial scar can be reduced by placing a neural probe completely below the meninges. Rats were implanted with sets of loose microwire implants placed either completely below the meninges or implanted conventionally with the upper end penetrating the meninges, but not attached to the skull. Histological analysis was performed 4 weeks following surgical implantation to evaluate the glial scar. Our results found that sub-meninges implants showed an average reduction in reactive astrocyte activity of 63% compared to trans-meninges implants. Microglial activity was also reduced for sub-meninges implants. These results suggest that techniques that isolate implants from the meninges offer the potential to reduce the encapsulation response which should improve chronic recording quality and stability. PMID:23370311

  20. High and low frequency subharmonic imaging of angiogenesis in a murine breast cancer model

    OpenAIRE

    Dahibawkar, Manasi; Forsberg, Mark A.; Gupta, Aditi; Jaffe, Samantha; Dulin, Kelly; Eisenbrey, John R.; Halldorsdottir, Valgerdur G.; Forsberg, Anya I.; Dave, Jaydev K.; Marshall, Andrew; Machado, Priscilla; Fox, Traci B.; Liu, Ji-Bin; Forsberg, Flemming

    2015-01-01

    This project compared quantifiable measures of tumor vascularity obtained from contrast-enhanced high frequency (HF) and low frequency (LF) subharmonic ultrasound imaging (SHI) to 3 immunohistochemical markers of angiogenesis in a murine breast cancer model (since angiogenesis is an important marker of malignancy and the target of many novel cancer treatments). Nineteen athymic, nude, female rats were implanted with 5×106 breast cancer cells (MDA-MB-231) in the mammary fat pad. The contrast a...

  1. Breast development and anatomy.

    Science.gov (United States)

    Pandya, Sonali; Moore, Richard G

    2011-03-01

    In this article, the development of the female breast, as well as the functional anatomy, blood supply, innervation and lymphatic drainage are described. A thorough understanding of the breast anatomy is an important adjunct to a meticulous clinical breast examination. Breast examination is a complex skill involving key maneuvers, including careful inspection and palpation. Clinical breast examination can provide an opportunity for the clinician to educate patients about their breast and about breast cancer, its symptoms, risk factors, early detection, and normal breast composition, and specifically variability. Clinical breast examination can help to detect some cancers not found by mammography, and clinicians should not override their examination findings if imaging is not supportive of the physical findings.

  2. MRI of the breast: state of the art

    Energy Technology Data Exchange (ETDEWEB)

    Friedrich, M. [Abteilung Radiologie/Nuklearmedizin, Krankenhaus am Urban, Dieffenbachstrasse 1, D-10 967 Berlin (Germany)

    1998-06-02

    Contrast-enhanced MRI of the breast is probably the most sensitive method to detect breast pathology. It is best used to improve the sensitivity of mammography and sonography in selected patient groups with high breast cancer prevalence, where conventional methods are known to be less sensitive. Despite the high sensitivity of MRI, 5-12 % of invasive carcinomas are not recognized during MRI, because of lack of the typical criteria of carcinoma. MRI is probably inferior to mammography in detecting ductal in-situ carcinoma or very small carcinomas (< 3 mm), because the neo-angiogenesis induced by these small carcinomas is too faint to be detected by contrast-enhanced MRI. These tumours cannot be excluded by a normal MRI examination. MRI is non-specific as the distinction of benign and malignant breast lesions is unreliable. Only in selected cases (fat- or blood-containing lesions) may it improve the specificity of mammography and sonography. Mostly image-guided core biopsy is by far the most specific and least expensive method to establish a definitive diagnosis. For lesions exclusively detected by contrast-enhanced MRI, simple and reliable localisation devices are urgently needed. Presently accepted indications for MRI of the breast are: patients with silicone implants after mastectomy or augmentation mammoplasty (detection of recurrence/prothesis rupture/silicon leakage); patients whose breasts are difficult to evaluate by combined mammography and sonography, who have had breast conservation therapy (local recurrence), or who have proven carcinoma in one breast (multifocality/-centricity or contralateral breast carcinoma) or proven axillary lymph node metastases from an unknown primary tumor, especially when these are hormone receptor positive; patients with extensive postoperative scarring. In the future, genetically defined high breast cancer risk may become an indication. (orig.) With 11 figs., 2 tabs., 151 refs.

  3. Breast development gives insights into breast disease.

    Science.gov (United States)

    Osin, P P; Anbazhagan, R; Bartkova, J; Nathan, B; Gusterson, B A

    1998-09-01

    Studies of developing human breasts are essential for understanding the organogenesis as well as molecular pathogenesis of benign and malignant breast diseases. In this study we have examined the distribution of TGF-alpha, TGF-beta 1, tenascin-C and collagen type IV with the aim of starting to build a picture of the profile of molecules that may be involved in the development of the human breast. Ten fetal breasts (16 to 23 weeks of gestation) and 45 infant breasts, ranging in age from newborn to 2 years, were used in this study. Paraffin sections from these samples were immunostained with antibodies for these proteins and for Ki67 to elucidate the level of proliferative activity in different stages of breast development. TGF-alpha immunoreactivity was observed both in the stromal and the epithelial cells within fetal and infant breasts up to 25 days. TGF-beta 1 immunoreactivity was localized in the extracellular matrix. Tenascin-C was found around the neck of the developing breast bud and in the extracellular matrix of the infant with peaks in the newborn at 6-12 weeks. The immunoreactivity for type IV collagen was more intense in the region of the breast bud neck in the fetal breasts and reduced around the tips of lobular and terminal-end buds within the infant breasts. The distribution of the growth factors and extracellular matrix proteins within the developing human breast indicates that they play a significant role in different cellular compartments during morphogenesis and provides insights into breast disease.

  4. Implantation of the Subcutaneous Implantable Cardioverter-Defibrillator: An Evaluation of 4 Implantation Techniques.

    Science.gov (United States)

    Brouwer, Tom F; Miller, Marc A; Quast, Anne-Floor B E; Palaniswamy, Chandrasekar; Dukkipati, Srinivas R; Reddy, Vivek; Wilde, Arthur A; Willner, Jonathan M; Knops, Reinoud E

    2017-01-01

    Alternative techniques to the traditional 3-incision subcutaneous implantation of the subcutaneous implantable cardioverter-defibrillator may offer procedural and cosmetic advantages. We evaluate 4 different implant techniques of the subcutaneous implantable cardioverter-defibrillator. Patients implanted with subcutaneous implantable cardioverter-defibrillators from 2 hospitals between 2009 and 2016 were included. Four implantation techniques were used depending on physician preference and patient characteristics. The 2- and 3-incision techniques both place the pulse generator subcutaneously, but the 2-incision technique omits the superior parasternal incision for lead positioning. Submuscular implantation places the pulse generator underneath the serratus anterior muscle and subfascial implantation underneath the fascial layer on the anterior side of the serratus anterior muscle. Reported outcomes include perioperative parameters, defibrillation testing, and clinical follow-up. A total of 246 patients were included with a median age of 47 years and 37% female. Fifty-four patients were implanted with the 3-incision technique, 118 with the 2-incision technique, 38 with submuscular, and 37 with subfascial. Defibrillation test efficacy and shock lead impedance during testing did not differ among the groups; respectively, P=0.46 and P=0.18. The 2-incision technique resulted in the shortest procedure duration and time-to-hospital discharge compared with the other techniques (P<0.001). A total of 18 complications occurred, but there were no significant differences between the groups (P=0.21). All infections occurred in subcutaneous implants (3-incision, n=3; 2-incision, n=4). In the 2-incision group, there were no lead displacements. The presented implantation techniques are feasible alternatives to the standard 3-incision subcutaneous implantation, and the 2-incision technique resulted in shortest procedure duration. © 2017 American Heart Association, Inc.

  5. [Silicone breast prosthesis and rheumatoid arthritis: a new systemic disease: siliconosis. A case report and a critical review of the literature].

    Science.gov (United States)

    Iannello, S; Belfiore, F

    1998-04-01

    Today the number of women receiving breast implants of silicone gel, for augmentation or reconstruction of the breast, is increasing. Silicon implants may cause local complications (such as capsular contracture, rupture, closed capsulotomy, gel "bleed", nodular foreign body granulomas in the capsular tissue and lymph nodes) or general symptoms. An adverse immune reaction with signs and symptoms of rheumatoid disorders is also possible, although an increased frequency of true autoimmune systemic connective tissue diseases is controversial. The US Food and Drug Administration advised that these silicone implants should be used only in reconstructive surgery and as part of clinical trials. Silicone is not an inert substance and silicone compounds were found in the blood and liver of women with silicone breast implants. The development of disease related to silicone implants would depend on genetic factors, so that only a very few women are potentially at risk. HLA-DR53 may be a marker of predisposed subjects. Breast-feeding by women with silicone implants should not be recommended for possible autoimmune disorders in the children. We report the case of an adult female patient with silicone breast implantation for bilateral mastectomy (performed 12 months before) and a unique syndrome characterized by low-grade fever, chronic fatigue, arthralgias of the hands, dysphagia, dry eye, increased level of rheumatoid factor and decreased value of complement C3 and C4. No increased erythrocyte sedimentation rate occurred, and no ANA, nDNA, ENA and AAT autoantibodies were evidence. A critical review of literature (source: MEDLINE 1980-1997) was performed and our case seems to be the first one reported in Italy. The internist should become familiar with the immunological disorders related to silicone breast implants, often so marked to require the explantation of the prostheses to improve symptomatology. However, perhaps due to the leak and spreading of silicone, the progression

  6. Ion Implantation In Optical Fibres

    Science.gov (United States)

    McStay, Daniel

    1989-10-01

    Some initial results on the implantation of single- and multi-mode optical fibres are described. Fibres are wound onto a bobin system for insertion into the implantation chamber. Long and short lengths of fibres as well as discrete elements along a fibre have been implanted. Refractive index changes of 5 x 10-3 have been produced in the fibres, leading to new guiding properties. A large dose dependent fluorescence and attenuation increase is also produced in the fibre.

  7. Dental implant infection and decontaimination

    OpenAIRE

    Mongra, Avtar Chander

    2012-01-01

    The ability of bacteria to adhere titanium implant surfaces has been confirmed in various studies. Elimination of bacteria from the implant surface is necessary in order to terminate the source of infection and disrupt the formation of bio-film. Biomaterial therapies using fibers, gels, and beads to deliver antibiotics have been used in the treatment of Peri-implantitis..There is possibility of development of recombinant protein using r -DNA technology and using the application of tissue engi...

  8. Current trends in dental implants

    OpenAIRE

    Gaviria, Laura; Salcido, John Paul; Guda, Teja; Ong, Joo L.

    2014-01-01

    Tooth loss is very a very common problem; therefore, the use of dental implants is also a common practice. Although research on dental implant designs, materials and techniques has increased in the past few years and is expected to expand in the future, there is still a lot of work involved in the use of better biomaterials, implant design, surface modification and functionalization of surfaces to improve the long-term outcomes of the treatment. This paper provides a brief history and evoluti...

  9. Presentation of Apocrine Breast Carcinoma in a Woman with Bilateral Silicone Prosthesis; Presentacion de un carcinoma apocrino de mama en una mujer con protesis bilateral de silicona

    Energy Technology Data Exchange (ETDEWEB)

    Alonso, J. A.; Salvador, R.; Salvador, M.; Barranco, C.

    2003-07-01

    We present a case of apocrine breast carcinoma in a 45 year-old woman with bilateral silicone breast prosthesis whose clinical manifestations and mammography were that of a palpable nodule-high glandular density, rounded and with imprecise borders devoid of any visible microcalcifications. A bibliographical revision confirmed the infrequent association of this type of tumor with the presence of silicone breast implants, precisely in which we consider its radiological interest to lie. (Author) 11 refs.

  10. Screening for Breast Cancer.

    Science.gov (United States)

    Niell, Bethany L; Freer, Phoebe E; Weinfurtner, Robert Jared; Arleo, Elizabeth Kagan; Drukteinis, Jennifer S

    2017-11-01

    The goal of screening is to detect breast cancers when still curable to decrease breast cancer-specific mortality. Breast cancer screening in the United States is routinely performed with mammography, supplemental digital breast tomosynthesis, ultrasound, and/or MR imaging. This article aims to review the most commonly used breast imaging modalities for screening, discuss how often and when to begin screening with specific imaging modalities, and examine the pros and cons of screening. By the article's end, the reader will be better equipped to have informed discussions with patients and medical professionals regarding the benefits and disadvantages of breast cancer screening. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Transfer characteristics of subretinal visual implants: corneally recorded implant responses.

    Science.gov (United States)

    Stingl, K; Bartz-Schmidt, K U; Braun, A; Gekeler, F; Greppmaier, U; Schatz, A; Stett, A; Strasser, T; Kitiratschky, V; Zrenner, E

    2016-10-01

    The subretinal Alpha IMS visual implant is a CE-approved medical device for restoration of visual functions in blind patients with end-stage outer retina degeneration. We present a method to test the function of the implant objectively in vivo using standard electroretinographic equipment and to assess the devices' parameter range for an optimal perception. Subretinal implant Alpha IMS (Retina Implant AG, Reutlingen, Germany) consists of 1500 photodiode-amplifier-electrode units and is implanted surgically into the subretinal space in blind retinitis pigmentosa patients. The voltages that regulate the amplifiers' sensitivity (V gl) and gain (V bias), related to the perception of contrast and brightness, respectively, are adjusted manually on a handheld power supply device. Corneally recorded implant responses (CRIR) to full-field illumination with long duration flashes in various implant settings for brightness gain (V bias) and amplifiers' sensitivity (V gl) are measured using electroretinographic setup with a Ganzfeld bowl in a protocol of increasing stimulus luminances up to 1000 cd/m2. CRIRs are a meaningful tool for assessing the transfer characteristic curves of the electronic implant in vivo monitoring the implants' voltage output as a function of log luminance in a sigmoidal shape. Changing the amplifiers' sensitivity (V gl) shifts the curve left or right along the log luminance axis. Adjustment of the gain (V bias) changes the maximal output. Contrast perception is only possible within the luminance range of the increasing slope of the function. The technical function of subretinal visual implants can be measured objectively using a standard electroretinographic setup. CRIRs help the patient to optimise the perception by adjusting the gain and luminance range of the device and are a useful tool for clinicians to objectively assess the function of subretinal visual implants in vivo.

  12. Silicone breast implants in the Netherlands : A market surveillance study

    NARCIS (Netherlands)

    Keizers P; van Drongelen A; de Jong W; van Oostrom C; Roszek B; Venhuis B; de Vries C; Geertsma R; Janssen R; PRS; V& Z

    2016-01-01

    Voor medische hulpmiddelen, zoals siliconen borstimplantaten, zijn fabrikanten verplicht om 'technische dossiers' aan te leggen op basis waarvan wordt bepaald of het product op de markt wordt toegelaten. Dossiers van 10 fabrikanten die in Nederland siliconen borstimplantaten op de markt

  13. Cochlear implant assessment: imaging issues

    Energy Technology Data Exchange (ETDEWEB)

    Marsot-Dupuch, K. E-mail: kathlyn.marsot-dupuch@bct.ap-hop-paris.fr; Meyer, B

    2001-11-01

    Cochlear implants are electronic auditory prostheses used to rehabilitate deafened persons who have lost their hair cells. They are partly worn externally and partly implanted in the ear. They provide a direct stimulation of the spiral ganglion cells of the cochlear nerve by bypassing the destroyed hair cells. The objectives of this article are to summarise what head and neck surgeons need to know before cochlear implantation and to describe the imaging study protocol used and anomalies to look for. A few explanations are resumed about placement of a brainstem implant.

  14. Antibacterial coatings on titanium implants.

    Science.gov (United States)

    Zhao, Lingzhou; Chu, Paul K; Zhang, Yumei; Wu, Zhifen

    2009-10-01

    Titanium and titanium alloys are key biomedical materials because of their good biocompatibility and mechanical properties. Nevertheless, infection on and around titanium implants still remains a problem which is usually difficult to treat and may lead to eventual implant removal. As a result, preventive measures are necessary to mitigate implant-frelated infection. One important strategy is to render the implant surface antibacterial by impeding the formation of a biofilm. A number of approaches have been proposed for this purpose and they are reviewed in this article. (c) 2009 Wiley Periodicals, Inc.

  15. Breast cancer screening in Korean woman with dense breast tissue

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Hee Jung [Dept. of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of); Ko, Eun Sook [Dept. of Radiology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul (Korea, Republic of); Yi, Ann [Dept. of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul (Korea, Republic of)

    2015-11-15

    Asian women, including Korean, have a relatively higher incidence of dense breast tissue, compared with western women. Dense breast tissue has a lower sensitivity for the detection of breast cancer and a higher relative risk for breast cancer, compared with fatty breast tissue. Thus, there were limitations in the mammographic screening for women with dense breast tissue, and many studies for the supplemental screening methods. This review included appropriate screening methods for Korean women with dense breasts. We also reviewed the application and limitation of supplemental screening methods, including breast ultrasound, digital breast tomosynthesis, and breast magnetic resonance imaging; and furthermore investigated the guidelines, as well as the study results.

  16. Breast volume estimation from systematic series of CT scans using the Cavalieri principle and 3D reconstruction.

    Science.gov (United States)

    Erić, Mirela; Anderla, Andraš; Stefanović, Darko; Drapšin, Miodrag

    2014-01-01

    Preoperative breast volume estimation is very important for the success of the breast surgery. In the present study, two different breast volume determination methods, Cavalieri principle and 3D reconstruction were compared. Consecutive sections were taken in slice thickness of 5 mm. Every 2nd breast section in a set of consecutive sections was selected. We marked breast tissue with blue line on each selected section, and so prepared CT scans used for breast volume estimation. The volumes of the 60 breasts were estimated using the Cavalieri principle and 3D reconstruction. The mean breast volume value was established to be 467.79 ± 188.90 cm(3) with Cavalieri method and 465.91 ± 191.41 cm(3) with 3D reconstruction. The mean CE for the estimates in this study was calculated as 0.25%. Skin-sparing volume was about 91.64% of the whole breast volume. Both methods are very accurate and have a strong linear association. Our results suggest that the calculation of breast volume or its part in vivo from systematic series of CT scans using the Cavalieri principle or 3D breast reconstruction is accurate enough to have a significant clinical benefit in planning reconstructive breast surgery. These methods can help the surgeon guide the choice of the most appropriate implant or/and flap preoperatively. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  17. Perioperative high-dose-rate interstitial brachytherapy boost for patients with early breast cancer.

    Science.gov (United States)

    Sharma, Daya Nand; Deo, S V S; Rath, Goura Kisor; Shukla, Nootan Kumar; Thulkar, Sanjay; Madan, Renu; Julka, Pramod Kumar

    2013-01-01

    To evaluate the clinical results of perioperative high-dose-rate interstitial brachytherapy boost treatment preceding whole breast external beam radiation therapy in patients with early breast cancer. From 2005-2010, 100 patients with early breast cancer who met the eligibility criteria were enrolled in the study. Brachytherapy implant was performed during the breast-conserving surgery procedure. The boost treatment was started on the 3rd postoperative day to deliver a dose of 15 Gy in 6 fractions over 3 days. Three weeks later, external beam radiation therapy to the whole breast was started for a prescription dose of 50 Gy. The study end points were local recurrence, acute toxicity and cosmetic outcome. Median age of the patients was 46 years, and median follow-up was 52 months. No patient developed a local recurrence but 5 patients developed distant metastases. The 5-year overall survival and disease-free survival were 86% and 77%, respectively. Eleven patients had acute toxicity; 4 wound complications and 7 grade III skin toxicity. Nine of the 11 patients had breast size of more than 1500 cc. Except for the breast volume (>1500 cc), there was no statistically significant correlation between any of the patient or dosimetry-related factors and acute toxicity. Good-excellent cosmesis was observed in 87% of patients. Perioperative high-dose-rate interstitial brachytherapy boost followed by whole breast external beam radiation therapy provides excellent local control, acceptable acute toxicity and good-excellent breast cosmesis in patients with early breast cancer.

  18. Dental implants in patients treated with oral bisphosphonates: a bibliographic review.

    Science.gov (United States)

    Montoya-Carralero, José-Maria; Parra-Mino, Pablo; Ramírez-Fernández, Piedad; Morata-Murcia, Isabel Maria; Mompeán-Gambín, Maria del Carmen; Calvo-Guirado, José-Luis

    2010-01-01

    Bisphosphonates inhibit bone resorption and are used to treat a range of pathologies, including Paget disease, osteoporosis, multiple myeloma and metastases associated with breast or prostate cancer. At present, there is no effective treatment for bisphosphonate induced osteonecrosis, so prevention is extremely important. Since quality of life deteriorates for those suffering osteonecrosis, maximum precautions should be taken with patients at risk, and especially whenever oral surgery, including dental implant placement, is contemplated. Dentists and oral or maxillofacial surgeons must keep up to date with the latest approaches to prevention, particularly when treating patients who are presently taking, or who will be taking bisphosphonates and are also candidates for dental implants.

  19. Age at implantation and auditory memory in cochlear implanted children.

    Science.gov (United States)

    Mikic, B; Miric, D; Nikolic-Mikic, M; Ostojic, S; Asanovic, M

    2014-05-01

    Early cochlear implantation, before the age of 3 years, provides the best outcome regarding listening, speech, cognition an memory due to maximal central nervous system plasticity. Intensive postoperative training improves not only auditory performance and language, but affects auditory memory as well. The aim of this study was to discover if the age at implantation affects auditory memory function in cochlear implanted children. A total of 50 cochlear implanted children aged 4 to 8 years were enrolled in this study: early implanted (1-3y) n = 27 and late implanted (4-6y) n = 23. Two types of memory tests were used: Immediate Verbal Memory Test and Forward and Backward Digit Span Test. Early implanted children performed better on both verbal and numeric tasks of auditory memory. The difference was statistically significant, especially on the complex tasks. Early cochlear implantation, before the age of 3 years, significantly improve auditory memory and contribute to better cognitive and education outcomes.

  20. Zirconia dental implants: a literature review

    National Research Council Canada - National Science Library

    Özkurt, Zeynep; Kazazoğlu, Ender

    2011-01-01

    Titanium and titanium alloys are widely used for fabrication of dental implants. Because of potential immunologic and possible esthetic compromises with titanium implants, novel implant technologies are being developed...