Silicone Gel Breast Prostheses Research Articles

Depth dose enhancement in the presence of silicone gel breast prosthesis

Depth dose enhancement in the presence of silicone gel breast prosthesis

Impact of Silicone gel breast prosthesis on photon beam therapy of recurrence carcinoma post mastectomy

AbstractIntroduction Silicone gel breast implants are used for breast reconstruction post mastectomy. In the event of cancer recurrence, the radiation oncologists are forced to irradiate through the prosthesis device. Due to prosthesis higher atomic number dose perturbations occur during treatment. This study determined the influence of silicone gel thickness on the photon beam distribution. Materials and MethodsA Varian linear accelerator, water phantom (dimensions 30 × 30 × 30 cm3), silicone gel breast prosthesis and Omni-Pro Accept software were used in the study. With the gantry positioned at at a source-to-surface distance (SSD) of 100 cm, the collimators were adjusted to a field size of 10 × 10 cm2 and the 6 MeV photon beam was used. Omni-Pro Accept software was used to plot the percentage depth dose curves and the beam profiles. The results obtained with a Monte Carlo Nuclear Particle (MCNP) Code were validated with the measurement data. The beam profile and percentage depth dose curves were also measured for silicone gel thicknesses (4, 6, 8, 10, 12, 14 and 16 cm) and width 16.5 cm aligned 1 cm below the surface of the water.ResultsThe measured and calculated percentage depth dose (PDD) ratio was 0.03. The measured and calculated beam profiles were 0.5% and 0.9% respectively. For the silicone gel prosthesis, the depth dose values at 0.5 cm below the prosthesis were 2.8%.ConclusionDose perturbations below the breast prosthesis are insignificant, breast prosthesis are safe in the event of carcinoma recurrences.

Vacuum-Assisted Breast Implant Insertion in Primary Augmentation Mammaplasty

We read with great interest the article by Savaci and colleagues [1] published in your journal regarding the use of a drainage tube to facilitate breast implant replacement. In fact, they suggested a useful and repeatable trick to exploit during secondary augmentation mammoplasty. Breast augmentation is the cosmetic surgical procedure most commonly performed in the United States. In 2010, nearly 300,000 women underwent this operation [2], most of them for cosmetic reasons. Minimal incisions to introduce the prostheses usually are preferable. However it may be a difficult, time-consuming, and risky procedure to perform. Thus, a system facilitating breast implant insertion through an incision of minimal length can be useful. In 2004, Savaci et al. [1], taking into consideration that only in an empty space can be filled with something, elaborated a successful method for breast implant replacement (secondary augmentation) using a simple drainage tube. Starting with the same assumptions that inspired these authors, we decided to append the tube to a suction system to further reduce air behind the prosthesis and to maximize the benefits. Our trick consists of exploiting a Redon tube (a closed high-vacuum drainage system) appended to a suction system to remove air from the surgical pocket, decreasing its resistance to implant insertion. From 2004 to 2008, our study enrolled 115 patients with an average age of 37 years (range, 20–51 years) and a mean body mass index (BMI) of 23.7 kg/m (range, 21.9–26.2 kg/m). They all underwent primary breast augmentation with implants. Actually, in contrast to Savaci et al., we performed only primary augmentation mammaplasties, meaning that we created the surgical pocket ex novo in all cases. This procedure was performed bilaterally for 111 patients and unilaterally for the remaining patients. All procedures were accomplished exclusively for cosmetic reasons. Our incision was along the inferior EMIperiareolar line, which usually is sufficient for introducing most prostheses sizes. Although other approaches (transaxillary and submammary) could benefit from the trick we propose, we opted for the periareolar route because it is associated, according to our experience and the literature [3], with several specific advantages. After the incision, we performed a ‘‘triple-plane’’ dissection [4] to create the surgical pocket for implant placement. At this site, before prosthesis introduction, we inserted the multiple-hole part of a drainage tube through the same skin incision, with no need for lengthening. We used a typical, commercially available Ch 14 sterile polyvinylchloride (PVC) Redon drainage tube with a standard length of 50 cm and a diameter of 4.6 mm. The exit end of the tube was connected to a vacuum system with an applied suction of -10 ± 3 cmHg switched on during implant placement (Fig. 1). Povidone-iodine irrigation of the pocket and the skin incision margins was provided. Furthermore, the breast implants were immersed in a povidone-iodine solution before they were introduced. In all cases, textured anatomic silicone gel breast prostheses were used. The implant sizes ranged from 180 to 350 ml, with 75% of the implants smaller than 250 ml. The implant pocket was kept open by Mathieu retractors to avoid collapse during aspiration (Fig. 2). R. Bracaglia M. D’Ettorre (&) S. Gentileschi D. Tambasco Department of Plastic and Reconstructive Surgery, Catholic University of the Sacred Heart, Largo A. Gemelli, 8, 00168 Rome RM, Italy e-mail: marco.dettorre@hotmail.it

Primary Breast Augmentation Today: A Survey of Current Breast Augmentation Practice Patterns

A study was undertaken to survey current practice patterns concerning primary breast augmentation. Members of the American Society for Aesthetic Plastic Surgery (ASAPS) were electronically surveyed concerning issues such as incision location, implant size and type, and complications, as well as information about the surgeons, their practices, and where procedures are performed. The survey response rate was 30%. Plastic surgeons from the South and Southwest made up 40% of respondents. Forty-six percent of respondents had more than 20 years of experience in practice. Forty-three percent of primary breast augmentations were performed in outpatient surgery centers. An anesthesiologist was in attendance in 60% of cases. The average operative time--indicated in 80% of responses--ranged from 45 to 90 minutes. Thirty-three percent of responding plastic surgeons used the base diameter to determine implant size and respondents most commonly used a smooth saline implant placed through an inframammary incision in a submuscular pocket. The most frequently reported complication was nipple sensation changes. Although the reintroduction of silicone gel implants was accompanied by expectations of a sharp increase in their use, this survey revealed that among ASAPS members, saline implants currently are used more often than silicone gel implants. However, both saline and silicone gel implants are used frequently, safely, and reliably. This survey represents a snapshot of current practice and future trends in primary breast augmentation will require additional assessment, although increased use of silicone gel breast prostheses over time is expected.

Transaxillary dual-plane augmentation mammaplasty: experience with 98 breasts

The dual plane technique is a popular procedure for breast augmentation. However, traditional dual-plane augmentation mammaplasty usually requires incisions through the areola or inframammary crease, which produces a scar on the breast. Therefore, women may not favour this technique, especially Chinese women who are genetically susceptible to hyperplastic scars. In our institution, endoscopic transaxillary dual-plane augmentation mammaplasty was performed in patients under general anaesthesia. Incisions (4 cm long) were designed to overlap the natural creases of the skin bilaterally behind the mid-transaxillary frontline. The space behind the pectoralis major muscle was separated conventionally. Assisted by a 10mm/30 degrees endoscope, part of the ectopectoralis was excised. Through the transaxillary incision, the rough-surfaced silicone gel breast prosthesis was implanted. The volume varied from 185 to 315 g, and a routine indwelling drainage tube was inserted. From March 2006 to May 2007, we performed 49 cases of augmentation mammaplasty applying endoscopic-assisted dual-plane technique. At 6- to 12-month follow up, the surgical outcomes were satisfactory. There were no complications, such as capsular contracture, bleeding, scar hyperplasia, or infection. We believe that the dual-plane augmentation mammaplasty can be performed via transaxillary incision using an endoscope. Since the surgical incision is far from the front of the breast with this method, no scarring of the breast develops. Furthermore, the adoption of the dual-plane technique provides superior form to the anatomical prosthesis in the breast, alleviates postoperative pain, and improves suppleness of the postoperative breast.

Sudden onset breast swelling: an unusual presentation of ruptured prosthesis 10 years post-implantation

Silicone-gel breast implants are widely used throughout the world for breast augmentation and reconstruction, and complications associated with long-term in vivo presence are well reported, particularly in relation to implant rupture. We report an unusual and atypical clinical presentation of large intracapsular seroma formation, not previously reported with silicone-gel breast prosthesis rupture.

Chronic haematoma as a late complication of cosmetic breast augmentation

To our knowledge, a chronic expanding haematoma has not been reported in a patient who received silicone gel breast prostheses for augmentation and never before at an interval as long as 12 years, as in our case. There have been occasional reports of chronic haematoma as complication of implantation of silicone breast prostheses after mastectomy for cancer, presenting 2.5–8 years later.

Scleroderma and silicone gel breast prostheses--the Sydney study revisited.

Silicone augmentation mammoplasty has been postulated as a cause of environmentally-induced scleroderma. While representing a small proportion of all alleged causes of scleroderma, the issue has huge social, ethical and medicolegal ramifications. The hypothesis, however, has been recently questioned in results of comparative studies. We have previously reported no association between augmentation mammoplasty and scleroderma. However, all information was self-reported including augmentation mammoplasty status, and the prosthesis type was not identified. In addition, data were not available from untraceable cases. The current study addresses these issues. To validate self-reported augmentation mammoplasty status, re-analyse rates of exposure to silicone gel breast prostheses in 556 scleroderma patients and 289 general practice controls and evaluate whether silicone gel breast prostheses are causally linked to scleroderma. Study design-population-based case-control study; Cases-scleroderma patients resident in Sydney for at least six consecutive months between 1974-1988; Controls-patients from 29 randomly selected Sydney general practices, age- and gender-group-matched with cases. Validation of augmentation mammoplasty exposure was ascertained from the general medical practitioner of each interviewed case and control, or from the medical records of each deceased or untraceable case. Validation of the date of surgery and prosthesis type was from the relevant plastic surgeon. For each augmentation mammoplasty-positive case, validation of both the date and nature of the scleroderma onset was from the patient's medical records. Controls were given a "control date' for disease onset to adjust for duration of potential exposure. Validation of augmentation mammoplasty status was possible in 252 (87.2%) living controls, and 532 (95.7%) cases, of whom 287 were living. Self-reported augmentation mammoplasty status was highly reliable in living non-senile cases (kappa = 1), and living validated controls (kappa = 0.86). No association was identified between silicone gel augmentation mammoplasty and scleroderma with unadjusted odds ratios of 1.33 (95% CI: 0.26-6.71), and 1.00 (95% CI: 0.16-6.16) following adjustment for potential confounders of age, socioeconomic status and ethnicity. This validates the self-reported augmentation mammoplasty status previously reported and does not support the hypothesis that silicone gel augmentation mammoplasty is an environmental inducer of scleroderma in females.

Colchicine and capsular contracture around breast prostheses

Capsular contracture around the prosthetically reconstructed, breast is a very common problem which often leads to an unacceptable result. Colchicine, a drug known to inhibit contracture activity, was studied in an animal model of capsular contracture. Twenty-four 130 cc silicone gel breast prostheses were implanted subcutaneously into twelve rabbits. Colchicine was given daily in oral doses to half of the animals; the other half were used as controls. The prostheses were maintained insitu for two months. The degree of capsular contracture, as measured by applanation tonometry, was significantly less in the colchicine treated groups. The difference was often visually apparent. This study appears to be the first to demonstrate a significant inhibition of capsular contracture in an animal model by colchicine, an oral medication commonly used in the treatment of gout.

Augmentation mammaplasty and an improved method of silicone gel breast prosthesis implantation through an areolar incision. (Chinese)

Augmentation mammaplasty and an improved method of silicone gel breast prosthesis implantation through an areolar incision. (Chinese)

Electron beam irradiation after reconstruction with silicone gel implant in breast cancer.

Irradiation for breast cancer in the presence of a silicone gel breast prosthesis is sometimes necessary. There is a concern among radiation and other oncologists as to whether the presence of the prosthetic implant would interfere with delivery of the needed irradiation doses. Electron beams, with their finite penetration and rapid fall-off, offer a mode of adequately treating the recurrence and minimizing the radiation to the underlying normal structures, such as the lung and the heart. The dose distribution using 9-20 MeV electrons in the presence of a breast prosthesis is compared to the dose distribution without the implant in a tissue equivalent water phantom. The results reveal no significant difference in the dose delivered due to the presence of the prosthesis. Clinical verification of the dosimetry in the presence of the prosthesis confirmed that the presence of the silicone gel implant does not compromise treatment by irradiation in the management of breast cancer.

Effect of silicone gel breast prosthesis on electron and photon dose distributions.

The effect of a silicone gel breast prosthesis on the absorbed dose distribution of 9-20 MeV electron beams and 1.25-15 MV photon beams was studied. Compared to water measurements, at depths smaller than the practical range of the electron beams, the central axis depth dose values below the prosthesis were lower for all energies by as much as 3.5%. However, at depths near the practical range, the central axis depth dose values for the prosthesis were greater than that of water by as much as 33%. Since this occurs near the end of the electron range, the resultant difference may not be clinically significant. Results of the effect of breast prosthesis on photon depth dose distributions reveal that no clinically significant perturbation is produced by the breast prosthesis using Co-60, 6- and 15-MV radiations.