Removing Highly Cohesive Silicone Gel after Breast Implant Rupture: An In Vitro Study

Abstract

Sir: After breast implant rupture, the silicone gel must be removed thoroughly from surrounding tissues to prevent inflammatory reaction, granuloma formation, and possible local infection. The fourth generation of implants commonly used today contains highly cohesive silicone gel. We know little about its gel-dissolving qualities. This study sought to determine which of the commonly used operating room irrigation solutions is best for dissolving the highly cohesive silicone gel. Special attention was given to dimethyl sulfoxide solution because of its chemical1 and clinical antiinflammatory2,3 and anticollagenous4 properties. Gravimetry was used to test silicone gel solubility in dimethyl sulfoxide and other agents commonly used in the operating room, as follows: Normal saline (0.9% sodium chloride). Iodine solution 10%. Polydine scrub (7.5% povidone-iodine with sodium laureth sulfate, potassium iodide, and trisodium phosphate). Unisept (0.05% chlorhexidine gluconate in aqueous solution containing sodium hydroxide, nonoxynol 10, and carnosine red). Hydrogen peroxide 3%. Septal scrub (chlorhexidine gluconate 4%). Aliquots of the gel from a new silicone gel implant (Mentor Corp., Santa Barbara, Calif.) were spread onto glass microscope slides in incremental weights of 0.02, 0.04, 0.06, and 0.08 g. Each slide was soaked in 40 ml of solvent for 2 minutes, rinsed with 80 cc of deionized water for 30 seconds, and placed in a vacuum desiccator for 24 hours. The percentage reduction in silicone weight was calculated for each solvent. Experiments were repeated six times. Results were confirmed by gas chromatography. None of the solutions examined, including dimethyl sulfoxide, dissolved the silicone gel. By gravimetry, the postsolvent silicone gel weights were equal to or, in some cases, even higher than the presolvent weights. Chromatography failed to yield a peak that might have been explained by silicone gel solubility. This study sought to determine the ability of dimethyl sulfoxide and other irrigation solutions to serve as a solvent for breast implant silicone gel. We assumed that the unique chemical structure and high solvent qualities of dimethyl sulfoxide would make it a good candidate agent for cleaning the breast pocket after implant rupture. Moreover, dimethyl sulfoxide, because of its proven clinical properties, such as maintenance of lysosomal integrity, inhibition of fibroblast proliferation, and antibacterial action, could have added value by decreasing capsular contracture and infection rates. Using both gravimetry and gas chromatography, we found that dimethyl sulfoxide, like all the other solutions studied, was ineffective in dissolving the highly cohesive silicone gel. Our findings disagree with those of Bitar et al.5 for saline and iodine solutions. The discrepancy in the results might be attributed to changes made in the cohesiveness of the gel in the interim between the two studies. The new, highly cohesive, silicone gel is difficult to dissolve in cases of implant rupture, and cleansing of the breast pocket is achieved by debulking only. Further studies are required to determine whether dimethyl sulfoxide, because of its clinical properties, has an advantage over saline in this setting by reducing the capsular contracture rate. DISCLOSURE No financial support or benefits have been received by any of the authors from any commercial source that is related directly or indirectly to the scientific work reported on in this article. Sagit Meshulam-Derazon, M.D. Department of Plastic Surgery Rabin Medical Center Beilinson Campus Petah Tiqwa, Israel and Sackler Faculty of Medicine Tel Aviv University Tel Aviv, Israel Igal Bar-Ilan, Ph.D. MIGAL-Research Institute Kiryat Shmona, Israel Ron Azaria, M.D. Dean Ad-El, M.D. Department of Plastic Surgery Rabin Medical Center Beilinson Campus Petah Tiqwa, Israel and Sackler Faculty of Medicine Tel Aviv University Tel Aviv, Israel