Saline-filled Prostheses Research Articles

Short-term revision rate of Rigicon Testi10TM testicular prosthesis in adolescents and adults: a retrospective chart review.

Testicular prosthesis implantation is a valuable solution for the physical, cosmetic, and psychological challenges associated with testicular loss which may affect males of any age. We evaluated the safety and reliability of the new Rigicon Testi10TM testicular prosthesis in adults and adolescents by performing an IRB-approved retrospective study of data drawn from Patient Information Forms (PIFs). A total of 427 patients (382 adults and 45 adolescents) had at least one testicular prosthesis implanted. Only one adult patient required revision surgery due to rupture of the Rigicon Testi10 TM saline-filled prosthesis. A 40-year-old patient was found to have a leaking prosthesis approximately one week postoperatively, which was suspected to be due to inadvertently punctured by the surgeon during the sterile saline filling process. There were no post-implantation revisions required for adolescent patients. According to our results, Kaplan-Meier calculation of survival from removal or revision was 99.8% for all patients at 54 months (99.7% for adults and 100% for adolescents). The complication rates among patients in this study are lower than those reported in previous published studies. Our study underscores the generally safe nature of testicular prosthesis implantation, as well as the very rare incidence of revision surgery for this new device.

Postpneumonectomy Syndrome

A 17-yr-old female presented with increasing dyspnea 10 months after a right pneumonectomy. Chest radiograph (fig. A) revealed rightward shift of the heart and mediastinum with left lung hyperexpansion and tracheal deviation, consistent with postpneumonectomy syndrome. She underwent thoracotomy and mediastinal repositioning by insertion of saline-filled prostheses into the right hemithorax (arrows, fig. B).Postpneumonectomy syndrome is a rare, life-threatening complication caused by extreme rotation and shift of the mediastinum after pneumonectomy. Compression of distal trachea and main bronchus results in central airway compression and dynamic airway obstruction. Patients present with progressive dyspnea, stridor, and recurrent respiratory infections. Symptoms occur weeks to years after pneumonectomy. Diagnosis is based on imaging and bronchoscopy. Treatment consists of insertion of saline-filled prostheses within the empty hemithorax to reposition the mediastinum and alleviate the bronchial compression.1Potential anesthetic challenges in postpneumonectomy syndrome include difficult airway management due to tracheal deviation, difficult passage of the endotracheal tube caused by airway compression, hypoxemia and hypercapnia secondary to one-lung ventilation and increased respiratory dead space in lateral position, and hemodynamic compromise due to decreased venous return.2,3 Excessive administration of intravenous fluids can cause increased shunting and pulmonary edema. Therefore, fluid administration should be judicious. Use of lung-protective strategy with smaller tidal volumes (i.e., 5–6 ml/kg ideal body weight), limiting plateau pressure to less than 25 cm H2O, and application of positive end-expiratory pressure is recommended in an attempt to prevent acute lung injury and atelectrauma.3The authors declare no competing interests.

Correction of postpneumonectomy syndrome in infants with saline-filled expandable prosthesis

We report two infants who underwent right pneumonectomy in infancy and developed postpneumonectomy syndrome with obstruction of the left main bronchus causing severe airway obstruction in one patient and gastrointestinal reflux due to a displaced and grossly dilated oesophagus in the other patient. Both patients were operated with implantation of an expandable breast prosthesis.

Breathlessness After Pneumonectomy: Consider Postpneumonectomy Syndrome

A 59-year-old woman presented with increasing breathlessness several weeks after right pneumonectomy. Imaging confirmed features of postpneumonectomy syndrome with marked mediastinal shift, and compression of the left main bronchus and pulmonary vein. The mediastinum was repositioned by insertion of saline-filled prostheses into the pneumonectomy space with symptomatic and radiologic improvement. Clinicians caring for patients after pneumonectomy should be aware of this rare but treatable complication.

Bronchial Obstruction after Pneumonectomy

A 42-year-old woman underwent right pneumonectomy because of extensive parenchymal destruction due to tuberculosis. Five years after resection, she reported increasing shortness of breath, wheezing, and dyspnea on exertion. A computed tomographic scan of the chest revealed counterclockwise rotation of the mediastinum, with mediastinal shift and compression of the left-lower-lobe bronchus (LLLB) between the pulmonary artery and aorta (Panel A, arrow), features consistent with the post-pneumonectomy syndrome. Mediastinal repositioning was accomplished with the use of an intrapleural-tissue expander and saline-filled prosthesis. Panel B shows a patent left-lower-lobe bronchus (asterisk) and the saline-filled prosthesis in the right side of the chest . . .

Postpneumonectomy syndrome

Postpneumonectomy syndrome is a rare postoperative complication whereby mediastinal shifting toward the pneumonectomy space results in bronchial compression between the pulmonary artery, aorta, and vertebral column. This syndrome is more common after right pneumonectomy; other risk factors include young age and female sex. Imaging studies consistently reveal massive mediastinal shifting and document airway compromise. Bronchoscopy and flow-volume loops are helpful in confirming the diagnosis. Other causes of dyspnea, including cancer recurrence, should be excluded. Definitive treatment involves surgical repositioning of the mediastinum in the midline, as well as insertion of a saline-filled silicone prosthesis into the pneumonectomy space in order to prevent recurrence.

Postpneumonectomy syndrome: Surgical management and long-term results

Postpneumonectomy syndrome is a rare syndrome of dynamic airway obstruction caused by extreme rotation and shift of the mediastinum after pneumonectomy, resulting in symptomatic central airway compression. We have treated this syndrome by mediastinal repositioning and placement of saline-filled prostheses into the pneumonectomy space. There is a paucity of outcome data for patients treated surgically, with only a single series of 11 patients previously reported. We analyzed our recent experience with treatment of this syndrome and report on the short and long-term outcomes and quality of life assessment of the largest series ever reported of patients treated by mediastinal repositioning. Records were reviewed of all patients who underwent mediastinal repositioning for postpneumonectomy syndrome between January of 1992 and June of 2006. Long-term health-related quality of life was assessed by administration of the Saint George's Respiratory Questionnaire. There were 18 patients (15 women and 3 men) with a median age of 44 years (range 14-67 years). Thirteen patients had undergone right pneumonectomy, and 5 patients had undergone left pneumonectomy. None of the patients in whom postpneumonectomy syndrome developed after left pneumonectomy had a right-sided aortic arch. Five patients had undergone pneumonectomy in childhood (age < 13 years). The median interval between pneumonectomy and mediastinal repositioning was 7.5 years (range 1.1-54.8 years). The median follow-up was 32 months (range 4-143 months). The operative mortality was 5.6% (1/18). Complications occurred in 5 patients (27.8%): pneumonia in 3 patients and acute respiratory distress syndrome in 2 patients. The median hospitalization was 6 days (range 3-155 days). Some 77% (10/13) of patients reported significant improvement in their breathing and overall state of health after surgery; 15.4% of patients (2/13) were somewhat better, and 7.7% of patients (1/13) had no improvement. No patients' condition was worse after surgery. All patients who reported improvement in their symptoms after surgery remained symptomatically improved at the time of the quality of life assessment. Some 92.3% (12/13) were not at all or only slightly limited in their social activities because of breathing problems, and 84.6% (11/13) were not at all or only slightly limited in their ability to work as a result of their physical health. Repositioning of the mediastinum with placement of prostheses for postpneumonectomy syndrome can be performed with low mortality and morbidity. Surgical repositioning provides immediate and lasting symptomatic relief to patients in whom postpneumonectomy syndrome develops.

Minimal Inframammary Incision for Breast Augmentation

The inframammary approach in breast augmentation, still the most popular technique among plastic surgeons, has always been hampered by the undesirable appearance of its scar. The present paper describes a modified approach to inframammary augmentation with saline-filled prostheses. This approach uses a very short incision, thus resulting in a much less noticeable scar. The surgical technique is easy to learn, simple to execute, does not necessitate any special equipment and gives consistent results. Decreasing the scar length to an absolute minimum ensures higher patient and surgeon satisfaction.

Testicular Prostheses: Development and Modern Usage

Testicular prostheses produced from various materials have been in use since 1941. The absence of a testicle has been shown to be a psychologically traumatic experience for males of all ages. The indications for insertion of a prosthesis include absence or following orchidectomy from a number of causes such as malignancy, torsion and orchitis. The most common substance used around the world in the manufacture of these implants is silicone; however, in the US, this material is currently banned because of theoretical health risks. This has led to the development of saline-filled prostheses as an alternative. A Medline search was carried out on all articles on testicular prosthesis between 1966 and 2006. This review highlights the controversies regarding prosthetic materials, the complications of insertion and the potential benefits of this commonly performed procedure.

Capsular contracture around saline-filled and textured subcutaneously-placed implants in irradiated and non-irradiated breast cancer patients: Five years of monitoring of a prospective trial

One hundred and seven breast cancer patients underwent subcutaneous mastectomy and immediate reconstruction with a subcutaneously-placed, round, saline-filled prosthesis with a textured surface. The primary aim of this prospective study was to determine the frequency of capsular contracture in both irradiated and non-irradiated breasts after this operation. Two different types of round implants with different pore sizes on their textured surfaces, Siltex and Microcell, were randomly chosen. Twenty-four patients received radiotherapy within the first year following the operation. Capsular contracture was measured by the Baker/Palmer classification and by applanation tonometry at regular intervals for 5 years or as long as the patients lived (median 60 months). Twenty-two patients (20.6%) developed capsular contracture, defined as Baker three or four. Sixteen of those were reoperated, 15 with open capsulotomy with or without implant exchange, one with closed compression capsulotomy, and monitored thereafter for 5 years or until death (median 60 months). All 107 patients could be monitored for 2 years, while 87 reported for the 5-year follow-up. The rate of capsular contracture was significantly higher (p=0.01) for irradiated breasts than for non-irradiated ones, 41.7 and 14.5%, respectively. It was slightly higher (p<0.05) for large-pore implants than for those with smaller (and more numerous) pores. There was a good correlation between the two different methods for measuring capsular contracture. None of the 16 reoperated patients had a recurrence of capsular contracture within 5 years. The results indicate a high rate of capsular contracture after this operation, especially when followed by radiation. However, a fairly simple procedure to treat capsular contracture seems to give good long-term results.

Z-plasty and Augmentation Mammaplasty for Correction of Severe Breast Deformity Caused by Abscess: Report of A Case

Breast deformity imposes great cosmetic and psychological problems on the inflicted patients. The treatment goal is to achieve an aesthetic and symmetric breast contour, especially when the other side is unaffected. Breast abscess is not uncommon, but rarely causes severe deformity. We present a 33-year-old woman treated with zplasty and augmentation mammaplasty. The patient had undergone received surgical drainage twice for her left breast abscess two years before, which led to breast volume deficiency, contour deformity and malposition of the nipple-areola complex. A 200 cc saline-filled prosthesis was implanted in a subpectoral pocket to build up a symmetric breast mound and z-plasty was performed to correct the trapdoor deformity and the malposition of the nipple-areola complex. The surgical result was satisfactory. To the best of our knowledge, this is the first report of severe breast deformity secondary to previous breast abscess that required reconstructive surgery.

Surgical correction of postpneumonectomy syndrome by intrapleural expandable prosthesis in a child

We report a case of postpneumonectomy syndrome in a 10-year-old boy operated on for right-sided destroyed lung 1 year previously. The treatment involved the insertion of saline-filled expandable prosthesis in the postpneumonectomy cavity. A favorable outcome was observed. We think that an intrapleural inflatable prosthesis has several advantages for postpneumonectomy syndrome seen in childhood.

Early results of an endoscope-assisted subcutaneous mastectomy and reconstruction for breast cancer

Subcutaneous mastectomy and reconstruction (SMR) is well established; however, most incisions are made directly on the breast, and the majority of patients care about visible scars even if they are satisfied with the reconstructed breast. From August 1998 to March 2001, a total of 46 patients (including 2 bilateral cases) with breast cancer underwent SMR using a saline-filled prosthesis by lateral axillary incision. There were 25 patients who received previous SMR without endoscopic assistance (group A) and 21 patients who underwent an endoscope-assisted SMR (E-SMR) (group B). These 2 groups were compared for curability, morbidity, and cosmesis. The median follow-up period was 19.2 + 9.8 months (range, 5.8 - 35.2 months). No significant difference was found in clinicopathologic data between the 2 groups. The operation time was 176 minutes in group A and 237 minutes in group B, and the estimated blood loss was 189 mL vs 356 mL, respectively. No critical complications were seen in either group. The average length of incision was 10 cm in group A and 5.7 cm in group B. As for the patients' satisfaction, the incidence of "excellent" plus "good" ratings was 76% in group A and 90.4% in group B. E-SMR is a new option that can provide an improved operative view and better cosmetic results for the treatment of breast cancer than with SMR. The operation time is longer than for SMR, but the incision is drastically shorter, resulting in better cosmesis and increased patient satisfaction.

Augmentation mammaplasty: Subpectoral augmentation using the periareolar or inframammary approach

The last decade has witnessed a resurgence in the popularity of augmentation mammaplasty, becoming one of the most sought-after cosmetic surgery procedures. There are a wide range of options in implant characteristics and surgical technique. To provide the best possible results in each case, it is advisable to subscribe to a well-thought out preoperative evaluation of the patient, a consistent operative plan, and a thorough postoperative regimen. We describe the subpectoral placement of the implant using either a periareolar or inframammary approach; our preference is for smooth, round, saline-filled prostheses. The details surrounding the choices made and the consideration that must be given to the various elements involved are discussed. In addition, the advantages and disadvantages of this technique as it compares with others, as well as complications and methods of avoiding and treating them, are also evaluated. Augmentation mammaplasty remains a very satisfying procedure given the right indications, appropriate surgery, and uneventful postoperative course.

Complications of latissimus dorsi myocutaneous flap breast reconstruction

To review the experience of a single unit in post-mastectomy reconstruction using the latissimus dorsi flap. A retrospective review of 111 cases treated between 1984 and 1993. The notes were evaluated for type of procedure, associated treatment and complications. A significant morbidity of this procedure was demonstrated with 41 (37%) patients requiring a second operation during the period of the study. The majority of these second operations were related to the prosthesis used to achieve symmetry. Second operations were more common in those who had saline-filled prostheses. Other complications seen included wound infection, small areas of flap necrosis, hypertrophic scars and problems with the donor scar. No differences in complication rates were demonstrated for delayed vs immediate procedures or for patients receiving or not receiving radiotherapy. No life-threatening complication were seen during the study. The latissimus dorsi reconstruction is reliable but the overall programme is beset with considerable morbidity. This factor needs to be taken into consideration when discussing reconstructive options with the post-mastectomy patient.

An easy method of creating the retro-mammary space in breast augmentation

Summary. Saline-filled breast prostheses can be inserted into a retro-mammary pouch through a small incision. The technique we describe achieves a good cosmetic result and minimal bleeding with a short operation time.

Silicone Breakdown and Capsular Synovial Metaplasia in Textured-Wall Saline Breast Prostheses

Saline-filled prostheses are currently the only type of prostheses available for cosmetic use in the United States because of concerns raised about the possibility of systemic toxicity of silicone-filled artificial mammary implants. Although the approved implants are saline-filled, their potential to release silicone particles from the shells has not been systematically evaluated. We performed microscopic examination of the pericapsular tissue of 54 patients with textured-surface implants and compared these with 51 patients with smooth-walled implants over a 2-year period. The capsules that had formed around virtually all textured-surface implants had silicone fragments present either in extracellular spaces, in vacuolated histiocytes, or in the form of foreign-body granulomas in surrounding fibroadipose tissue but not in capsules associated with smooth-walled implants. In 87 percent of samples of pericapsular tissue from textured saline implants, the contact surface displayed exuberant reactive synovial metaplasia, a histologic pattern not previously described with these devices. Our findings suggest that smooth-walled prostheses are associated with less silicone fragmentation than textured devices in the peri-implant tissue capsules that tend to form around artificial surfaces used for this purpose.

Polyarthralgia after augmentation mammaplasty with saline-filled implants

A case of polyarthralgia and serological abnormalities after augmentation mammaplasty with saline-filled prostheses is reported. Although such systemic disease has been reported in relation to gel-filled implants, this type of syndrome is very rare in association with saline-filled implants. Possible etiopathogenic factors are suggested in order to find out the mechanism of systemic immunological disease when no silicone gel is present. Shearing of silicone dioxide molecules from the implant shell could possibly be associated with the development of adjuvant disease in the case reported. It is stressed, however, that no definite connection between silicone implants and human adjuvant disease has ever been demonstrated.

The various etiological factors of “hard capsule” formation in breast augmentations

The use of Silastic implants in breast augmentation has been one of the greatest advances in aesthetic plastic surgery during the past 20 years. This article deals specifically with one of the most important complications, namely, the formation of the "hard capsule" surrounding the prosthesis. The specific use of a saline-filled Silastic prosthesis with the intra-luminal use of methylprednisolone acetate suspension is discussed, based on experience with 133 patients. Illustrative case histories and photos are shown. The etiology, prevention, and/or total definitive treatment is explained and the conclusion reached is that this management leads to permanent, satisfactory results.

Satisfactions and Dissatisfactions of Patients with Augmentation Mammaplasty

In the study group, the augmentation with silicone gel prostheses had a high rate (64%) of firmness (as felt by the patients), which seems not greatly affected by the surgeon or by patient exercises or manipulations. In the group, augmentations with saline-filled inflatable prostheses had a much lower incidence of firmness (40%, as felt by the patients). No deflations of the Heyer-Schulte R.T.V. "Jenny" prosthesis were found during the follow-up period. Augmentation mammaplasty by a certified plastic surgeon has a low rate of physical complications (in the range of one to two percent). However there were unfavorable cosmetic results causing patient dissatisfaction with part of the result in about 15%. The incidence of emotional dissatisfaction with the procedure as a whole, as judged by those who would not choose to repeat the operation, was less than 4%.