Incidence Of Capsular Contracture Research Articles

Breast Implant Illness: Surgical, Autoimmune, and Breast Reconstruction Associations

Breast implant illness refers to a combination of different symptoms related to breast implant surgery, including fatigue, brain fog, and arthralgias. This malaise occurs after cosmetic and reconstructive breast surgeries, although it has not been proven to be a disease. Even recent studies have reported concluding statements of the etiology, diagnosis, and treatment as unclear and widely unknown. Therefore, this review aimed to determine the associations between the manifestations of breast implant illness in surgery and breast reconstruction, as well as the autoimmune responses involved. Complications associated with breast implants include breast pain, capsular contracture, infections, as well as other manifestations specific to breast reconstruction. Moreover, patients with implants may present with new-onset systemic sclerosis, Sjögren’s syndrome, and connective tissue diseases. However, the incidence of capsular contracture has steadily decreased with each generation of implants, particularly since the development of textured implants, as well as with the use of antibiotics and antiseptic pocket irrigation. However, the incidence of anaplastic large cell lymphoma has increased with the use of textured implants. Remarkably, the autoimmune response to these implants remains unclear. Therefore, close follow-up, careful observation of any symptom presentation, and evidence-based treatment decisions are necessary for patients with breast implants.

The incidence of capsular contracture after breast augmentation with the different prostheses.

The incidence of capsular contracture after breast augmentation with the different prostheses.

Smooth versus Textured Implants and Their Association with the Frequency of Capsular Contracture in Primary Breast Augmentation.

Capsular contracture is the most frequent complication of breast implant augmentation. Although studies indicate that textured implants have a low incidence of contracture, they have been associated with anaplastic cell lymphoma, which influences the choice of surface. This study estimated and compared the annual capsular contracture rate of both smooth and textured implants in primary breast implants. Two hundred fifty-three patients (506 implants) were evaluated from January of 2017 to July of 2019; 42.2 percent of the implants were smooth and 57.8 percent were textured. The inframammary approach was used in the subfascial (55.3 percent) and submuscular (44.7 percent) pockets. The primary outcome was the appearance of capsular contracture (Baker grade II, III, and IV) within the first postoperative year. Smooth implants had a higher capsular contracture rate at 1 year postoperatively compared with textured implants, although with borderline statistical significance (p = 0.06). Smooth surface breast implants in the subfascial plane had a 4-fold higher risk of contracture than those with a textured surface in the same plane (OR, 4.4; 95 percent confidence interval, 1.6 to 12.4). However, when placed in the submuscular plane, both textures had a similar contracture risk. The rate of contracture was similar after 2 years postoperatively (p = 0.21). Using the inframammary approach and a standardized technique, there were no significant differences in the incidence of capsular contracture between the smooth and textured implants. In the subfascial plane, the contracture rate with smooth implants was higher than with textured implants. However, in the submuscular plane, there was no difference between the surfaces. Therapeutic, III.

A systematic review and meta-analysis of capsular contracture rate after breast augmentation with textured and smooth breast prostheses.

With the development of breast augmentation and the increased people's pursuit of beauty, more and more women choose breast prosthesis breast augmentation. This study aimed to evaluate the incidence of capsular contracture after breast augmentation with textured and smooth breast prostheses by meta-analysis. Studies relating to capsular contracture after breast augmentation with textured breast prosthesis and smooth breast prosthesis were retrieved from the Chinese Journal Full-text Database (CNKI), VIP, the Wanfang Science and Technology Journal Full-text Database, the Chinese Biomedical Literature Search Database (CBM), PubMed, Embase, and the Cochrane Library. The search period was from database establishment to October 2021. EndNote X9 software (Clarivate, Philadelphia, PA, USA) was used to screen and exclude duplicate studies, screen the studies according to the inclusion and exclusion criteria, and extract data for quality evaluation. The data were recorded using the Stata 15.1 software (StataCorp LLC, College Station, TX, USA), and a meta-analysis was performed on the incidence of capsular contracture after breast augmentation with textured and smooth breast prostheses. Finally, the reliability of the results was assessed by sensitivity analysis. A funnel plot was used to evaluate the publication bias of the literature. A total of 13 articles were included, and the total sample size of the study was 5,440. The results of the meta-analysis showed that the incidence of capsular contracture after breast augmentation with textured breast prostheses was significantly lower than that with smooth breast prostheses (OR =0.26; 95% CI: 0.08, 0.81; P<0.05). The incidence of capsular contracture after breast augmentation with textured breast prosthesis is significantly lower than that with smooth breast prosthesis.

Impact of breast dimension in one-stage augmentation mastopexies on implant selection: review of 103 consecutive breast augmentations with nanotextured silicone implants

According to current studies, one-stage augmentation mastopexy (AM) is associated with only minor complications and a lower reoperation rate compared with a staged procedure. In AM, breast dimension can differ notably compared with those cases without simultaneous mastopexy. However, these differences have only been insufficiently investigated. This study aims to quantify the differences and then evaluate the effect of breast dimension on implant selection. In addition, it evaluates the influence of mastopexy on the outcome of augmentation mammoplasties with round nanotextured silicone gel implants. Over a two-year period, all patients with primary augmentation mammoplasties using nanotextured implants were included in the study. Patients' demographic data, breast measurements, specifications of the implants placed, and complications in the breast augmentation group without mastopexy were compared with those of the group with AM. The satisfaction of patients and surgeons was documented using Likert scales. A total of 206 breast augmentations were performed in n = 103 patients. The mean follow-up was 24.0 ± 4.3 months. Compared with augmentations without an indication for simultaneous mastopexy, the AM group had wider breast bases and larger preoperative cup sizes; p < 0.001. As a result, implants selected for AM had greater diameters and lower volumes (p < 0.05) and were associated with smaller projections; p < 0.001. The total revision rates after augmentations without (n = 51) and with combined mastopexy (n = 52) were 5.9 % and 19.2 % (p < 0.05), respectively. AM increased tissue-related revisions from 2.0 % to 13.4 % (p < 0.05) without having an impact on implant-related revisions (3.9 % vs. 5.8 %, p = 0.663). The overall incidence of capsular contracture was 1.9 %. Satisfaction levels were approximately equal in both groups. In comparison to augmentations without mastopexy, wider breast bases and larger breast volumes before surgery lead to the selection of significantly different implant dimensions in AM. Nanotextured silicone implants are associated with low complication rates, while an increased risk for tissue-related revisions of the combined procedure remains. Further studies are necessary in order to evaluate possible advantages and disadvantages over established implants.

Safety and Effectiveness of Silicone Gel-Filled Breast Implants in Primary Augmentation Patients.

BackgroundResults from the MemoryGel Breast Implants Core Clinical Study suggest these devices are safe and effective at 10 years after implantation. Although clinical trials are essential for measuring the safety and effectiveness of a device, real-world evidence can supplement clinical trials by providing information on outcomes observed in diverse clinical settings for a more heterogeneous population, without fixed treatment patterns, and without continuous patient monitoring, such that follow-up is more representative of normal clinical practice.ObjectivesThe aim of this study was to measure real-world outcomes, including safety and effectiveness, in patients who underwent primary breast augmentation with smooth MemoryGel implants.MethodsThis was a case series looking at patients, age 22 years and older, who underwent primary breast augmentation at a single site between December 2006 and December 2016 and who had a minimum of 2 years of follow-up. Descriptive statistics were used to summarize baseline characteristics and outcomes. Kaplan-Meier models were used to estimate safety outcomes for capsular contracture (Baker grade III/IV), infection, and rupture.ResultsA total of 50/777 (6.4%) patients reported a complication, with an average time to complication of 3.9 years (range, 19 days-11.8 years) postprocedure. Kaplan-Meier estimates of the 10-year cumulative incidence of capsular contracture (Baker grade III/IV), infection, and rupture were 4.7%, 0.1%, and 1.6%, respectively.ConclusionsAnalyses of a large population from a single site provide further support for the long-term safety and effectiveness of MemoryGel breast implants in a primary augmentation cohort.Level of Evidence: 4

Short-term Safety of a Silicone Gel-filled Breast Implant: A Manufacturer-sponsored, Retrospective Study.

Background:Currently, 8 different brands of a silicone gel–filled breast implant are commercially available in Korea. But the superiority of short-term safety has not been established.Methods:A total of 709 patients (1,418 breasts) received an implant-based augmentation mammaplasty. We compared a 1-year incidence of complications and complication-free survival among the breast implants. Moreover, we performed a subgroup analysis of the patient cohorts by excluding cases associated with a periareolar incision, revision or reoperation, and anatomic implants.Results:In our series, 1-year incidences of complications were 0.55% (1/182), 3.14% (5/159), 5.19% (7/135), and 6.58% (10/152) in patients receiving the BellaGel/BellaGel SmoothFine, the Mentor CPG, the Matrix, and the Motiva Ergonomix, respectively. Moreover, the incidence of capsular contracture was 0.55%, 0.63%, 1.32%, and 3.70% in patients receiving the BellaGel/BellaGel SmoothFine, the Mentor CPG, the Motiva Ergonomix, and the Matrix, respectively. Furthermore, a complication-free survival was 24.82 ± 0.18, 22.23 ± 1.09, 22.15 ± 0.77, and 22.12 ± 1.07 months in patients receiving the BellaGel/BellaGel SmoothFine, the Motiva Ergonomix, the Mentor CPG, and the Matrix, respectively, except for the 2 other remaining products used for a smaller number of patients. However, a subgroup analysis showed no significant differences in a 1-year incidence of complication and complication-free survival among the BellaGel SmoothFine, the Motiva Ergonomix, and the Naturgel.Conclusion:It is impossible to draw a definite conclusion about the superiority of the short-term safety among the silicone gel–filled breast implants that are commercially available in Korea.

Abstract P6-14-07: The evolving role of pre-pectoral acellular dermal matrix -assisted approach in implant-based immediate breast reconstruction following conservative mastectomy: A prospective observational study

Abstract Background: The recent development of acellular dermal matrix (ADM) devices has enhanced implant-based breast reconstruction (IBR) surgery following nipple-sparing mastectomy (NSM) for therapeutic and risk-reducing purposes leading to improved aesthetics. In the traditional sub-pectoral approach, coverage of the implant is provided by the pectoral muscles superiorly and the ADM inferiorly. The need to eliminate breast animation, reduce post-operative dysfunctional pain and the risk of capsular contracture, have stimulated surgeons to investigate the feasibility of placing the implant over the pectoralis major muscle with complete coverage with ADM thus introducing a novel pre-pectoral approach. The aim of this study was to evaluate the short clinical outcomes and patients’ satisfaction after NSM combined with ADM-assisted immediate IBR. Materials and Methods: Thirty consecutive patients underwent 40 pre-pectoral ADM-assisted IBR following NSM (61% therapeutic and 39% risk-reducing). A peri-areolar incision was used in all cases. A fixed volume microtextured (Mentor) or nanotextured (Sebbin) implant was used in 32 single stage procedures (80%) and a microtextured tissue expander was used in 2-stage reconstruction in 8(20%). A fenestrated ADM (SurgiMend) was used to provide full coverage of the implant. A drain and prophylactic antibiotics and anti-thromboembolism measures were used in all cases. All patients were followed up regularly in the outpatient department and were invited to complete a bespoke satisfaction questionnaire. Results: A total of 9 (22.5%) patients had prior radiotherapy (RT) or post-mastectomy RT (PMRT). Seventeen patients (56.7%) received adjuvant or neoadjuvant chemotherapy. The median hospital stay was 2 days (range: 2-4 days). The final surgical margins and subareolar biopsy were clear in all cases. After a median follow up of 12 months (6-24 months), we observed no cases of local recurrence, or loss of implant or nipple. There was one wound complication (2.5%). None of the patients developed grade 3/4 capsular contracture, however a significant degree of rippling of the upper pole requiring autologous fat grafting was seen in 2 cases (5%). Twenty-three patients completed the questionnaire and reported a median satisfaction score of 9 out of 10 with the unclothed appearance, 10 out of 10 with the clothed appearance and 10 out of 10 with the overall body image. Conclusions: Our study lends further support to the growing body of evidence that pre-pectoral ADM-assisted IBR following NSM is reliable and safe. It is associated with a low incidence of capsular contracture and high patient’s satisfaction. Neither prior RT nor PMRT represent contraindications to this approach. Citation Format: Salim Tayeh, Hiba El Hage Chehade, Aisling Manson, Kefah Mokbel. The evolving role of pre-pectoral acellular dermal matrix -assisted approach in implant-based immediate breast reconstruction following conservative mastectomy: A prospective observational study [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-14-07.

Efficacy of Acellular Dermal Matrix in Capsular Contracture of Implant-Based Breast Reconstruction: A Single-Arm Meta-analysis.

A large number of clinical studies have suggested that acellular dermal matrix (ADM) can decrease the incidence of capsular contracture in implant-based breast reconstruction. Yet, there is currently no high-level epidemiological evidence to prove this. The goal of this meta-analysis was to clarify the efficacy of ADM in capsular contracture, and provide a reference value for plastic surgeons. We systematically performed a search on PubMed, EMBASE, and the Cochrane Library to identify eligible studies from inception up to October 1, 2019. A random-effects model was used to obtain a pooled incidence rate. We conducted subgroup analysis according to geographic region, type of ADM, body mass index (BMI), duration of follow-up, and proportion of participants who have received radiotherapy. A total of 18 studies involving 2941 cases were included. Overall, the pooled incidence rate of capsular contracture was 2.4% (95% CI 1.2-3.9%). The results from subgroup analyses indicated an even lower incidence in North America (1.6%, 95% CI 0.5-3.3%) and in human-derived ADM (HADM) (1.2%, 95% CI 0.2-3.0%). In addition, the results showed that the patients with BMI < 24, or who have received radiotherapy, were more prone to capsular contracture. The application of ADM can effectively reduce the incidence of capsular contracture in implant-based breast reconstruction. And we infer that it might also apply to breast augmentation. However, additional high-quality trials are warranted to corroborate the findings of this meta-analysis. 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.

Optimizing Breast Pocket Irrigation: The Breast Implant–Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) Era

Specific antimicrobial breast pocket irrigations have been proven over the past 20 years to reduce the incidence of capsular contracture by a factor of 10, and the emergence of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and its link to bacteria/technique has created renewed interest in different antimicrobial breast pocket preparation agents. Our previous studies have identified that both Betadine-containing and non-Betadine-containing antimicrobial irrigations provide excellent broad-spectrum bacterial coverage. The current science of BIA-ALCL has implicated the Gram-negative microbiome as a key in pathogenesis. The aim of this study was to revisit the antimicrobial effectiveness of clinically utilized Betadine and non-Betadine solutions, along with other antimicrobial agents that have not yet been tested, against multiple organisms, including additional common Gram-negative bacteria associated with chronic breast implant infections/inflammation. Current and new antimicrobial breast irrigations were tested via standard techniques for bactericidal activity against multiple Gram-positive and Gram-negative strains. Test results are detailed and clinical recommendations for current antimicrobial irrigations are provided. Betadine-containing irrigations were found to be superior according to the testing performed. There are quite few misconceptions with regard to antimicrobial breast pocket irrigation. These are discussed and final evidence-based recommendations for practice are given.

Outcomes Utilizing Inspira Implants in Revisionary Reconstructive Surgery.

Inspira round implants have a higher fill ratio than standard round implants and the 3 available implant types have increasing gel cohesivity. Collectively, these features may help provide a fuller upper pole and help reduce the risk of rippling, visible implant edges, and palpability and may be particularly beneficial in patients undergoing prepectoral reconstruction. Patient outcomes after prepectoral revision reconstruction with these implants are reviewed in this study. This retrospective study included consecutive patients who had previously undergone subpectoral (dual plane), implant-based, breast reconstruction and presented for revision reconstruction between June 2015 and January 2018. Reasons for revision included animation deformity, pain, asymmetry implant malposition, size change, capsular contracture, and rippling. Revision reconstruction involved implant removal, site change from subpectoral to prepectoral, and immediate implant replacement in all patients. Complications after revision reconstruction were obtained from patient records. A total of 64 patients (124 breasts) met the inclusion criteria. During a mean follow-up period of 18.9 months, complications occurred in 4 breasts (3.2%) and included implant loss (1.6%), seroma (1.6%), hematoma (0.8%), surgical site infection (0.8%), and skin necrosis (0.8%). There was no incidence of capsular contracture and presenting complaints were resolved in all cases. Prepectoral reconstruction, in conjunction with Inspira round implants, appears to be a safe and effective approach in suitable patients presenting for revision surgery, at least in the short term. Implant features facilitate prepectoral implant placement, resulting in pleasing aesthetic outcomes. Whether these outcomes will withstand the test of time remains to be seen.

Research Related to Capsular Contracture after Breast Augmentation for Cosmetic or Reconstructive Purposes

The upward trend of patients opting for elective breast augmentation, as well as the large number of patients benefiting from alloplastic breast reconstruction, require further studies on the safety profile of these techniques. Without any doubt, the incidence of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) has drawn attention to the possible unknown complications characteristic of these procedures, creating the context of further studies devoted to this issue. The present research examines the capsular contracture rate on a group of 253 patients between 2015 and 2019, also proposing a scoring system based on the integration of the main diagnostic criteria related to the capsular contracture. The results of the literature review indicate that a lower incidence of capsular contracture could be achieved by using the newest techniques in the field involving the application of chemical substances on the surface of the latest generation of silicone breast implants.

15. Can Strattice™ reduce the long-term incidence of capsular contracture compared to a submuscular implant based breast reconstruction? – a prospective multicentre study

15. Can Strattice™ reduce the long-term incidence of capsular contracture compared to a submuscular implant based breast reconstruction? – a prospective multicentre study

Periprosthetic Capsule Formation and Contracture in a Rodent Model of Implant-Based Breast Reconstruction With Delayed Radiotherapy.

Capsular contracture (CC) is the most common complication of breast implantation, with an incidence of nearly 50% in patients undergoing breast reconstruction with subsequent radiotherapy. Although the move toward submuscular (SM) device placement led to a decreased incidence of CC, subcutaneous (SQ) implantation has seen a resurgence. The purpose of this study was to use a rodent model of breast reconstruction with smooth silicone implants and delayed radiotherapy to assess the occurrence of CC in SQ versus SM implantation. Custom 2 mL smooth round silicone implants were placed bilaterally into 12 female Sprague Dawley rats that were randomized into 4 groups of 3, with each group differing by implantation plane (SQ vs SM) and irradiation status (irradiated vs nonirradiated). Rats from the SQ group received implants bilaterally underlying the skin on the flank. Rats in the SM groups received implants bilaterally under the latissimus dorsi muscle. Irradiated rats received 20 Gy localized to each implant on postoperative day 10. One rat from each group was imaged with a micro-computed tomography scanner at baseline and at explant 3 months later, whereupon capsules from all rats were examined histologically. Rats in the SQ group showed evidence of contracture on gross examination and greater evidence of morphologic disruption per micro-computed tomography scan. There was no evidence of contracture or morphologic disruption in either SM group. Mean ± SD capsule thickness was 39.0 ± 9.0 μm in the SQ versus 37.6 ± 9.8 μm in the SM nonirradiated groups and 43.9 ± 14.9 μm in the SQ versus 34.3 ± 8.3 μm in the SM irradiated groups (all P > 0.05). In a rodent model of smooth silicone breast implantation and delayed radiotherapy, although there did not appear to be differences in capsule thickness regardless of device placement plane, SQ implants demonstrated gross evidence of CC. These data indicate that capsule thickness is only part of a larger pathogenetic picture, which should take into consideration the contribution from all peri-implant tissue.

Abstract P5-16-10: Post-mastectomy radiotherapy following immediate implant based reconstruction: A possible solution to a reconstructive challenge

Abstract Aims: The National Mastectomy and Breast Reconstruction Audit report (NMBRA, 2011)1 revealed that immediate implant-based breast reconstruction (IIBR) was the most common type of primary reconstruction performed in the UK (37%). The main reason given by clinicians for not offering immediate breast reconstruction was the need for adjuvant radiotherapy. Post-mastectomy radiotherapy (PMRT) decreases the rate of local recurrence as well as increase the long-term survival in patients who demonstrate intermediate to high-risk features2,3 but has been shown to increase the risk of implant complications in IIBR by up to 24% (Berry et al, 2010)4. Cordeiro et al (2004)5 showed the incidence of capsular contracture was 28% higher in the PMRT group compared with non-irradiated patients. Most patients in the UK receive hypofractionated PMRT of 40.05Gy in 15 fractions over 3 weeks based on the UK Standardisation of Breast Radiotherapy (START) trial6, which demonstrated that hypofractionated PMRT is as safe and effective as the conventional PMRT of 50Gy in 25 fractions over 5 weeks. The aim of this study was to determine whether the conventional PMRT of 50Gy in 25 fractions over 5 weeks (2Gy per fraction) was associated with a reduced risk of implant complications in patients undergoing mastectomy with IIBR compared with hypofractionated PMRT regiment of 40.05Gy in 15 fractions over 3 weeks (2.67Gy per fraction). Methods: A single centre retrospective review of data on patients who underwent IIBR followed by PMRT between September 2012 and May 2017 was conducted. Radiotherapy-related complications (surgical site infection, contracture, implant rupture or leakage, wound breakdown) were compared between the two groups of patients receiving conventional and hypofractionated PMRT. Results: Fifty-nine patients underwent IIBR followed by PMRT. Twenty-six patients received hypofractionated PMRT and thirty-three patients received conventional PMRT. Radiotherapy-related complications occurred in 62% of patients in the hypofractionated PMRT group compared with 45% in the conventional PMRT group (p = 0.30). The incidence of capsular contracture (31% in vs. 21%, p = 0.55) and wound breakdown (23% vs. 15%, p = 0.51) was higher in the hypofractionated PMRT group, but surgical site infection (SSI) was more common in the conventional group (4% vs. 6%, p = 1.00). Discussion: Possible confounding factors (BMI, smoking status, and adjuvant chemotherapy) were not analysed due to the small sample size and limitations of the retrospective nature of this study. However, our overall rate of SSI is low in comparison with national data from the NMBRA (2011), which states the SSI rate of 25% in patients who underwent breast reconstruction surgery. Conclusions: This study suggests that the rate of radiotherapy-related complications is lower in patients treated with conventional PMRT compared with hypofractionated PMRT, however the sample size is too small to demonstrate statistical significance. Further research is required to evaluate the effectiveness of conventional PMRT as an option to facilitate immediate implant-based reconstruction following mastectomy. Citation Format: Chaichanavichkij P, Arun KS, Conibear J, Ullah MZ. Post-mastectomy radiotherapy following immediate implant based reconstruction: A possible solution to a reconstructive challenge [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-16-10.

Abstract: A Definitive Solution to Animation Deformity: Sub-Pectoral to Pre-Pectoral Conversion

BACKGROUND: A significant disadvantage of sub-pectoral breast reconstruction procedures is animation deformity during pectoralis major contraction. The prevalence of this post-operative complication may be as high as 75.6%.1 Many authors have explored solutions to animation deformity associated with breast reconstruction and augmentation including muscle splitting2 and botulinum toxin injection into the pectoralis major.3 These options, however, increase muscle morbidity or are temporary interventions. With the advent of intraoperative angiography and Alloderm, implant placement in the anatomic pre-pectoral position has become a safe alternative to sub-pectoral breast reconstruction.4 In this study, we discuss one surgeon’s experience with elective sub-pectoral to pre-pectoral implant site conversion as a definitive solution to animation deformity. METHODS: Authors performed a retrospective review of patients with a history of a sub-pectoral breast reconstruction procedure who underwent implant site conversion to the pre-pectoral plane. Procedures were performed to alleviate chronic pain or animation deformity. All procedures were performed by a single surgeon. Implants placed in the pre-pectoral plane were supported with total anterior AlloDerm coverage. RESULTS: 90 patients underwent 142 revision procedures to change implant sites from years 2014 to 2018. Average followup period for the study group was 1.5 years (maximum followup time, 3.6 years). Mean patient age was 54.8 years and average BMI was 27.7. History of smoking was present in 60.0% of patients, with 8.9% of patients being current smokers. 14.8% of patients had a history of preoperative radiation. Postoperative complications included minor superomedial contour deformity or implant edge visibility (28.9%), minor rippling (4.9%), infection requiring oral antibiotics (3.5%), minor seroma requiring needle aspiration in the clinic (1.4%), seroma requiring drain replacement (0.7%), hematoma (0.7%), dehiscence (0.7%), partial thickness necrosis requiring local wound care (0.7%), and one infection requiring IV antibiotics with eventual explantation (0.7%). 18.3% of patients received a secondary fat grafting procedure for rippling or implant edge visibility. There was no incidence of capsular contracture. Animation deformity was completely resolved. CONCLUSION: Breast implant site conversion from the sub-pectoral to the pre-pectoral plane is a safe and definitive solution for animation deformity.

Microtexture and the Cell/Biomaterial Interface: A Systematic Review and Meta-Analysis of Capsular Contracture and Prosthetic Breast Implants.

The use of textured breast implants over smooth implants has been widely shown to have a lower incidence of capsular contracture. However, the impact of micropatterning techniques on the incidence of postoperative patient morbidity has not been comprehensively investigated. The authors sought to examine the incidence of capsular contracture, seroma, and implant rippling among the 3 major micropatterning techniques applied in the manufacturing of textured breast implants. Literature searches of PubMed/Medline and Embase between 1995 and 2017 were performed, and 19 studies were selected for analysis. Data from each study were extracted into a form including mean age, study design, population size, mean follow-up, number of capsular contracture cases, number of seroma cases, and number of rippling cases. Meta-analysis was performed separately for studies that included capsular contracture rates for foam textured implants, imprinted textured implants, and salt-loss textured implants. The pooled rate of capsular contracture rates in primary augmentation patients was 3.80% (95% CI, 2.19-5.40) for imprinted textured implants, 4.90% (95% CI, 3.16-6.64) for foam textured implants, 5.27% (95% CI, 3.22-7.31) for salt-loss textured implants, and 15.56% (95% CI, 13.31-18.16) for smooth implants. The results of each meta-analysis were summarized on a forest plot depicting the distribution of capsular contracture rates from each study. Micropatterning of prosthetic implants could drastically reduce postoperative patient morbidity given the advent of recent technologies that allow for more detailed texturing of implant surfaces.

Inhibition Mechanism of Acellular Dermal Matrix on Capsule Formation in Expander-Implant Breast Reconstruction After Postmastectomy Radiotherapy.

Capsular contracture is one of the most common complications of expander-implant breast reconstruction. Recently, clinical reports have shown that use of an acellular dermal matrix (ADM) to cover breast implants decreases incidence of capsular contracture, but the underlying mechanism is unclear. Here, we examine how ADM reduces capsular formation in expander-implant breast reconstruction and identify cellular and molecular mechanisms of ADM-mediated reduction of capsular contracture in nonirradiated and irradiated patients. Thirty patients who underwent immediate two-stage implant-based breast reconstruction were included; 15 received radiotherapy. While the tissue expander was changed to permanent silicone implant, biopsies of the subpectoral capsule and ADM capsule were performed. Capsule thickness, immunohistochemistry of α-smooth muscle actin (αSMA), vimentin, CD31, F4/80 expression, αSMA and CD31 coexpression, and relative gene expression levels of transforming growth factor (TGF)-β1 and platelet-derived growth factor (PDGF)-B were investigated. Irradiated submuscular capsules were thicker than nonirradiated submuscular capsules, but the thickness of ADM capsules did not significantly differ between nonirradiated and irradiated groups. Levels of myofibroblasts, fibroblasts, vascularity, EndoMT, and macrophages were significantly lower in ADM capsules than in submuscular capsules. With the exception of EndoMT, all others were increased in irradiated submuscular capsules compared with nonirradiated submuscular capsule, while none significantly differed between nonirradiated and irradiated ADM capsules. Use of ADM reduced myofibroblasts, vascularity, fibroblasts, and EndoMT in capsule tissues. Moreover, ADM use decreased macrophages, a key regulator of tissue fibrosis, as well as TGF-β1 and PDGF-B expression. We hope that these results provide basic concepts important for prevention of capsular contracture.

Postoperative outcomes of breast reconstruction after mastectomy: A retrospective study.

Breast reconstruction after mastectomy plays an active role in improving the quality-of-life (QoL) and alleviating the psychological trauma of breast cancer patients, and has become an indispensable part of the comprehensive treatment in breast cancer. However, compared with mastectomy alone, breast reconstruction also increase operative complications. The surgical, oncological outcomes, and cosmetic effect of breast reconstruction remains to be evaluated. Data for patients with breast cancer who underwent breast reconstruction after mastectomy from February 2009 to November 2015 in our hospital were retrospectively analyzed, with a median follow-up time of 44 months. The operating time, blood loss, drainage fluid, postoperative complications, postoperative cosmesis, oncological outcomes, and QoL were evaluated and compared between different reconstruction types. A total of 151 women were included. The flap-based group had higher complication rates of marginal necrosis of incision, while the incidence of capsular contracture was higher in immediate implant group. There was no difference in blood loss, drainage fluid, and other postoperative complications. Several independent factors were associated with increased postoperative complications included diabetic, obese, and reconstruction with flap. There was no significant difference in the disease-free survival rate and overall survival rate between different surgical groups. In terms of cosmetic effect, patients in the tissue expander group were more likely to get a satisfactory postoperative breast appearance. QoL outcomes shown that the tissue expander group has better body image and sexual enjoyment, while there was no significant difference for other QoL domains. In conclusion, different methods of breast reconstruction are safe and feasible for patients with breast cancer, tissue expander implantation following delayed implant breast reconstruction is a more effective treatment on cosmetic and QoL outcomes.

Microbial Evaluation in Capsular Contracture of Breast Implants.

Capsular contracture around breast implants is a severe and unpredictable complication experienced by up to 50 percent of patients after breast augmentation and reconstruction, and represents a major cause leading to reoperation. Several lines of evidence point to the involvement of subclinical infections and of bacterial biofilm formation. To reduce the incidence of capsular contracture following mammaplasty, the authors studied the correlation between contamination by exogenous and endogenous bacterial flora and the capacity to develop bacterial biofilm in mammary implants. The authors performed a microbiological study assessing microbial growth of swabs from breast skin, nipple-areola complex, and mammary gland biopsy specimens. Furthermore, the authors compared the results with the data resulting from cultural experiments from biopsy specimens of periprosthetic capsule, contracted or not, and from the surfaces of the relative prosthesis. Between July of 2012 and July of 2013, a series of 65 female patients from the area of Naples, Italy, and its province, who underwent breast plastic surgery with the use of implants for aesthetic or reconstructive reasons, were included in the study. The authors noticed that there is a greater tendency for capsular contracture to form in oncologic patients who received radiotherapy, patients with precedent capsular contracture, and patients with cutaneous contamination by biofilm-producing microbes. Although all of the new technical procedures tend to reduce the amount of bacterial charge that comes into contact with the prosthesis at the time of its introduction, a minimal amount must always be taken for granted. This is the rationale for a preventative personalized antibiotic therapy. Therapeutic, IV.