Total Capsulectomy Research Articles

Mucormycotic late seroma after Poland syndrome correction with implant-enhanced latissimus dorsi flap – A case report

Introduction. Breast malformation correction with implants is a com-mon procedure, and a potential complication is the development of a late seroma, defined as occurring more than one year post-implan-tation. Etiologies include infectious, auto-inflammatory, and neoplastic factors. This case report presents an unusual case of seroma due to mycosis emerging 15 years after amastia correction using a latissimus dorsi flap (LD) and implants. Materials and methods. In 2006, a 44-year-old patient underwent amastia correction with an LD flap and implants in Ecuador. She pre-sented with sudden breast volume increase, tension, and pain in the left breast. Urgent intervention involved implant removal, collection evacuation, and total capsulectomy. Cytological/histological analysis ruled out neoplasia, while microbiological examination identified Muco-rales as the cause. After an uneventful postoperative period, a definitive breast prosthesis was implanted two years later, following ultrasound evaluation and inflammation indices. Discussion. Mucorales are opportunistic pathogens, particularly in im-munocompromised or uncontrolled diabetes patients, causing infections in sinuses, brain, and lungs. Mucormycosis linked to breast implants in immunocompetent individuals is rare and poorly defined in literature. Conclusions. Late seroma onset post-breast implants is rare, and a prompt differential diagnosis is crucial due to potential malignancies like BIA-ALCL. Mucormycosis, a potentially lethal condition, requires medical and sometimes surgical intervention. The incidental discovery of Mucorales infection facilitated complete eradication of the patholo-gy, resulting in full recovery.

Breast implant illness: A United Kingdom patient-centred approach

Silicone breast implants are widely prevalent. An increasing group of patients detail self-reported somatic and psychological symptoms that have been ascribed as breast implant illness (BII) and seek capsulectomy and implant removal. To guide consultations and shared decision making, more outcome data relating to this intervention are required. To present a multicentre study of patient-centred (n = 100) outcome data, following total capsulectomy with implant removal for BII. A questionnaire survey was cross-referenced with medical records. Collected data included demographics, operation details, pre- and postoperative symptom scores, overall self-perceived percentage improvement in BII symptoms and breast shape satisfaction ratings after explantation. The 10 most frequently self-reported symptoms were fatigue (81%), pains/aches (72%), brain/memory fog (56%), mood disturbances (36%), neuropathic pain (28%), hair loss (28%), headaches (25%), gastric symptoms/intolerances (24%), eczema/rash (18%) and vision disturbance (17%). A high proportion of patients (98%) experienced a 62 ± 4% average symptom improvement; most self-reported symptoms (21/28) improved significantly after explantation with total capsulectomy (p < 0.05). Furthermore, patients had high overall self-perceived BII percentage improvement (76 ± 3%) and satisfaction with breast shape numerical rating score (8 ± 0.30) postoperatively. Despite BII not being a defined disease entity, symptom association with silicone breast implants continues for a growing number of patients. It is important to recognise that in this patient group, capsulectomy and implant removal may not be curative, however we have demonstrated that symptom improvement can occur. It is very difficult to prove a causal link between breast implants and BII; to do so will require extensive prospective data collection.

Total Capsulectomy Without Drains is a Safe Technique Facilitated by Pectoralis Major Muscle Repair.

The number of breast implant removal and capsulectomy procedures continues to increase rapidly. The aim of explant surgery should be to optimise patient outcomes from both an aesthetic and functional perspective. To confirm the safety of drainless total capsulectomy and to determine the role of muscle repair in explant outcomes following the removal of sub-pectoral or dual-plane cosmetic breast implants. We conducted a retrospective evaluation of our technique between January 2021 and November 2023. We report a single surgeon series of 140 consecutive cases of cosmetic breast implant removal from dual-plane or sub-pectoral pockets, all performed with total capsulectomy. In each case, meticulous repair of the Pectoralis major muscle was performed following capsulectomy. Drains were not used in any case. All patients were followed up for a minimum of 3months. Patient satisfaction was assessed a minimum of 6months post-operatively. By performing the described drainless technique, there were no cases of seroma, haematoma, pneumothorax or cosmetic breast distortion in this series. 83% of patients were treated as day cases and patient satisfaction with outcomes was high. Total capsulectomy without the use of drains is a novel and safe approach, aided by careful repair of the Pectoralis major muscle. There is no increased risk of seroma. The muscle repair may help to prevent post-explant cosmetic deformity of the breast. 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 .

One-Stage Deep Inferior Epigastric Perforator Flap Salvage of Infected Tissue Expanders

Background Tissue expander-based breast reconstruction is associated with high rates of infectious complications, often leading to tissue expander explants and delays in receipt of definitive breast reconstruction and adjuvant therapy. In this study, we describe a single-stage technique where deep inferior epigastric artery perforator (DIEP) flaps are used to salvage actively infected tissue expanders among patients originally planning for free flap reconstruction. Methods In this technique, patients with tissue expander infections without systemic illness are maintained on oral antibiotics until the day of their DIEP flap surgery, at which time tissue expander explant is performed in conjunction with aggressive attempt at total capsulectomy and immediate DIEP flap reconstruction. Patients are maintained on 1–2 weeks of oral antibiotics tailored to culture data. Patients undergoing this immediate salvage protocol were retrospectively reviewed, and complications and length of stay were assessed. Results In a retrospective series, a total of six consecutive patients with culture-proven tissue expander infections underwent tissue expander removal and DIEP flap reconstruction in a single stage and were maintained on 7–14 days of oral antibiotics postoperatively. Within this cohort, no surgical site infections, microvascular complications, partial flap losses, reoperations, or returns to the operating room were noted within a 90-day period. Conclusions Among a select cohort of patients, actively infected tissue expanders may be salvaged with free flap breast reconstruction in a single surgery with a low incidence of postoperative complications. Prospective studies are needed to evaluate the influence of this treatment strategy on costs, number of surgeries, and dissatisfaction after staged breast reconstruction complicated by tissue expander infections.

Breast Implant Illness as a Clinical Entity: A Systematic Review of the Literature.

Breast implant illness (BII) has become a contentious subject in recent years. While some studies have reported associations between breast implants and autoimmune diseases, others have failed to establish a definitive link. The objective of this study is to provide a comprehensive, up-to-date evaluation of the literature surrounding BII, with an emphasis on identifying patient-related factors that may be associated with BII. A systematic review was performed following PRISMA guidelines using Pubmed (MEDLINE), EMBASE, and Cochrane databases to search for relevant studies published in the last twenty years. Thirty-one studies were included with a total of 39,505 implant patients and mean age of 44.2 ± 9.30 years. Fifteen studies reported implant explantation status with 72.4% patients choosing to remove their implants. Among these, nine studies reported symptom improvement in 83.5% patients. Fifty-three percent of patients undergoing explantation had total capsulectomy. Twenty-eight studies documented total numbers of patients experiencing symptoms related to BII, with 31.3% patients reporting such symptoms. Among these, sixteen studies of 4,109 BII patients distinguished whether the reason for implantation was cosmetic augmentation or reconstruction. When specified, more patients experiencing BII-related symptoms received implants for "cosmetic" versus "reconstructive" reasons (Cosmetic: 3,864/4,109; 94.0% vs. Reconstruction: 245/4,109; 5.96%, p < 0.001). This review provides an overview of the current state of knowledge regarding BII. Our study highlights a potential relationship between BII and indication for implants (cosmetic vs. reconstructive) among other variables, offering valuable insight on factors associated with BII and directions for future research.

Breast Implant Illness May Be Rooted in Mast Cell Activation: A Case-Controlled Retrospective Analysis.

To investigate the possible association between breast implant illness (BII) and mast cell activation syndrome (MCAS), which often manifests increased mast cells (MCs) in assorted tissues and may explain BII symptoms. Mechanisms by which implants cause BII symptoms remain unclear, but BII and MCAS symptom profiles heavily overlap, warranting investigation of potential linkage. We retrospectively analyzed 20 implant patients who underwent explantation and total capsulectomy; 15 self-reported preoperatively they had BII (subject group); 5 felt they did not [control group 1 (CG1)]. Five prophylactic mastectomy patients constituted control group 2 (CG2). Subjects and CG1 patients completed BII symptom questionnaires preoperatively and multiple points postoperatively. With CD117 staining, average and maximum mast cell counts (MCCs) in resected tissues were determined. Mean BII symptom score 2 weeks postexplantation was reduced by 77% (P < 0.0001), and 85% by 9 months. Analysis suggested BII in CG1 patients, too, who improved similarly. Among CG2 patients, healthy breast tissue showed mean and maximum MCCs of 5.0/hpf and 6.9/hpf. Mean and maximum MCCs in capsules in BII patients were 11.7/hpf and 16.3/hpf, and 7.6/hpf and 13.3/hpf in CG1 patients. All intergroup comparisons were significantly different (P < 0.0001). MCCs in peri-implant capsules in BII patients are increased; some implanted patients appear to have unrecognized BII. Given that neoantigenic/xenobiotic exposures commonly trigger dysfunctional MCs in MCAS to heighten aberrant mediator expression driving inflammatory and other issues, further investigation of whether BII represents an implant-driven escalation of preexisting MCAS and whether an MCAS diagnosis flags risk for BII seems warranted.

Feasibility of ultrasonic surgical system in breast total capsulectomy

Background Capsulectomy is a crucial procedure in cosmetic breast surgery, and there is demand for an efficient and convenient tool to perform it. This study analyzed the postoperative outcomes of total capsulectomy by comparing an ultrasonic system to conventional electrosurgery.Methods This retrospective cohort study included patients who underwent total capsulectomy and implant removal from 2012 to 2020. The ultrasonic surgery group underwent this procedure using the Harmonic scalpel, while the electrosurgery group underwent the same surgery using conventional electrocautery. A statistical analysis of the two groups was performed using multivariate linear regression analysis to determine the unbiased effect of ultrasonic surgery on operative efficiency and outcomes.Results A total of 89 patients were included in the study. The operative time was significantly shorter in the ultrasonic surgery group (60 minutes vs. 70 minutes, P=0.002). After adjusting for other independent variables that might also be related to the outcomes, shorter operative time (P=0.014) and faster drain removal (P=0.003) were associated with the use of ultrasonic surgery.Conclusions The use of an ultrasonic system (Harmonic scalpel) for total capsulectomy and explantation in cosmetic breast revision surgery was associated with shorter operative times and faster drain removal than conventional electrosurgery.

Early Postoperative Change in Hip Rotation Angle and Factors Contributing to It for Patients Undergoing Total Hip Arthroplasty.

A possible impairment in hip proprioception after total hip arthroplasty (THA) has been an issue of concern. The aims of this study were to investigate the extent of early postoperative change in standing hip rotation angle (HRAng) in patients with osteoarthritis (OA) undergoing THA and to consider a possible mechanism behind this. A total of 82 hips (82 patients; 63 women and 19 men) undergoing unilateral primary THA with total capsulectomy were included. We characterized the standing HRAng and internal/external range of motion (ROM) in the prone position before THA and 2 weeks after THA. Acetabular/cup and femoral/stem anteversion, combined anteversion (CA), and leg length discrepancy were also characterized. Correlations were examined postoperatively between the HRAng and the other analyzed variables. The median standing HRAng showed a significant internal shift from external to more medial position (6.3° to 1.7°) 2 weeks after THA (P<.0001). The postoperative change in standing HRAng was significantly negatively correlated with the difference between the postoperative femoral anteversion and the stem anteversion (rs=-0.429, P<.0001) and with the pre- to postoperative change in CA (rs=-0.3012, P=.0063). This study demonstrated that the extent of the rotational shift of the distal femur toward medial direction was significantly associated with increasing stem anteversion and CA. This phenomenon can be interpreted as a compensatory mechanism for maintaining the relative positional relationship between the pelvis and the proximal femur using proprioception. Therefore, we conclude that the extracapsular/extra-articular components may be prominent determinants of joint position sense. [Orthopedics. 2024;47(3):e114-e118.].

Cerebral Abscess In A Child With Unknown Origin Of Infection

Introduction: The incidence of brain abscesses is higher in developing countries. The classic triad of fever, headache, and focal neurological signs was seen in 9–28% of the pediatric cases. Brain abscesses occur infrequently with potentially life-threatening conditions. Case Report: The patient was a child 1 year 8 months old with a main complaint of weakness in the left arm and leg progressively for one month. She had a local seizure on her left arm and leg one month before admission with a duration of 30 minutes. She was irritable for the last two weeks. The strength of the upper and lower extremities was 3 respectively. The physiology reflex was hyper-reflex on the upper and lower extremities. A Head non-contrast CT scan showed a hypodense lesion on the right parietal with a perifocal edema lesion. A head contrast CT scan showed a hypodense lesion on the right parietal with ring enhancement measuring approximately 6,2 cm x 4,5 cm. Craniotomy evacuation abscess with near total capsulectomy was done on initial and capsule resection was done. Discussion: Brain abscess is a focal pyogenic infection of the brain parenchyma, and the frontotemporal lobe is the most common site of brain abscess, followed by frontal-parietal, parietal, occipital lobes, and cerebellar. The most common risk factors that predispose a child to the formation of a brain abscess include congenital heart disease, sinus and otogenic infections, and poor dental hygiene. The triad of brain abscess, including headache, fever, and neurological symptoms is only present in (15%) of the cases reported. Medical treatment is recommended in patients without increased intracranial pressure, with symptoms of less than 1 week long and abscess of less than 2 cm seen in tomography. The suggested time of treatment is between 6 and 8 weeks with intravenously administered antibiotics. A full recovery rate from the infection of about 60–70% is reported in the case of early diagnosis and proper therapy Conclusion: Cerebral abscess in pediatrics with unknown origin of infection may happen in 12%. Early diagnosis and treatment of pediatric cerebral abscesses can reduce morbidity and mortality rates. A broadspectrum antibiotic is an optimal treatment in the postoperative evacuation of cerebral abscess cases with unknown origin infection.

Oncological Outcomes After Multidisciplinary Management of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL).

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon type of non-Hodgkin lymphoma, associated with breast implant capsules. Despite improvements in our understanding of BIA-ALCL, communicating the prognosis to patients remains challenging due to limited long-term follow-up data. This has important implications for decision-making, including recommendations for subsequent reconstructive procedures. The aim of this study was to assess the longer-term oncological outcomes of patients receiving multidisciplinary treatment for BIA-ALCL. This was a retrospective cohort study of BIA-ALCL patients treated at a tertiary referral unit. The data are presented using simple descriptive statistics. Between 2015 and 2022, 18 BIA-ALCL patients were treated at our institution. The median age at diagnosis was 48.5 (IQR 41-55) years. Ten patients developed BIA-ALCL after cosmetic breast augmentation, and 8 after breast reconstruction following mastectomy for cancer. All patients had a history of textured implant insertion. The median time from first implant surgery to diagnosis was 8.5 (IQR 7-12) years. All patients underwent en-bloc total capsulectomy with implant removal, and 2 received systemic therapy. Fifteen patients had Stage I (IA-IC) disease, 2 had Stage IIA and 1 Stage III BIA-ALCL, based on the TNM classification system. At a median follow-up of 45 (IQR 15-71) months, there were no episodes of local or systemic relapse or death. Surgical management for BIA-ALCL is sufficient in early-stage disease, and associated with excellent oncological outcomes. This information is reassuring for patients when discussing recurrence risk.

Practice Trends in the Management of Asymptomatic Breast Reconstruction Patients with Textured Implants: A Survey Analysis.

An electronic survey was distributed to members of the American Society of Plastic Surgeons, regarding management of asymptomatic breast reconstruction patients with textured devices. Anonymous responses were collected, and statistical analysis was performed. A total of 304 responses were received. Of respondents, 237 (92%) have managed asymptomatic patients with textured devices. Historically, the overwhelming majority (89%) used textured devices; however, only 25% report current use. Regarding management of asymptomatic breast reconstruction patients, 87% recommend conservative management, while 13% recommend surgical management. When surgery is performed, 16.3% of respondents elected for implant exchange, 33.8% recommended implant exchange with partial capsulectomy, and 49.8% elected for implant exchange with total capsulectomy. Evaluation of practice patterns based on demographics demonstrated statistically significant differences in current use of textured devices and management of acellular dermal matrix. Despite decreased current use, there is a significant population of asymptomatic breast reconstruction patients with a history of textured devices concerned for risk of breast implant associated anaplastic large cell lymphoma. This survey demonstrates ongoing variability in surgeon recommendations regarding conservative and surgical management of these patients and the need for continued development of evidence-based guidelines.

Robot-Assisted Capsulectomy with Immediate Reimplantation in Breast Reconstruction.

Recent reports have introduced robotic breast surgery for immediate breast reconstruction with an implant. However, relevant reports of robot-assisted breast reconstruction including capsulectomy are limited. Although capsulectomy lowers risk of capsular contracture and thus contributes to better aesthetic outcomes, total capsulectomy may have complications, such as injury to axillary structures or chest wall and overlying skin devascularization. To minimize the risk of injury, the authors used a robotic system with Da Vinci SP, which has freely movable arms and clear, magnified three-dimensional vision, for total capsulectomy. Compared with conventional procedures, robotic surgery has the critical advantage of minimal incision and concealed scars, contributing to positive aesthetic outcomes. This study suggests that robot-assisted capsulectomy is technically feasible and safe for patients undergoing breast reconstruction with immediate reimplantation.

Breast Implant Illness: A Cohort Study.

Background Breast implant illness (BII) is a clinical disease defined by a constellation of symptoms that patients experience as a result of their breast implants. This retrospective, cohort study evaluated the benefit of breast implant explantation with total capsulectomy on patients' symptoms. Methodology This is a single-center, single-arm,cohort study utilizing retrospectively collected data. All participants included in this study voluntarily presented to the department of plastic and reconstructive surgery and requested breast implant removal. A total of 229 patients were enrolled in the study over a three-year period from 2018 to 2021.The primary endpoints of the study were to objectively grade the improvement of symptomatology following surgical intervention. The secondary endpoints were to identify co-factors such as age, comorbidities, implant characteristics, the timing of symptoms, and other data that were potentially influenced by or influencers of the breast implant illness. Results The study achieved a total of 549-point decrease in symptom frequencies following surgery. Furthermore, with an average preoperative symptom score of 3.5 (scored 1-5) and a postoperative average of 1.9, the study demonstrated a score reduction of 1.6 across all symptoms. Furthermore, the study was able to eliminate on average 2.8 symptoms of breast implant illness from every patient following explantation. Conclusion Breast implant illness is a true clinical entity that affects an extensive population of patients who have undergone breast augmentation. This study has not only highlighted the extensive morbidity of breast implant illnessbut has also demonstrated that there is an opportunity to standardize treatment for this disease. These outcomes have proven that a significant reduction in disease severity can be achieved with breast implant explantation and total capsulectomy.

Outcomes of chlorhexidine lavagewithout capsulectomy versuscomplete capsulectomy after lead extraction for the treatment of cardiac implantable electronicdevice infection.

Capsulectomy is recommended in patients with cardiac implantable electronic device (CIED) infection after transvenous lead extraction (TLE) but is time-consuming and requires extensive tissue debridement. In this study, we describe the outcomes of chlorhexidine gluconate (CHG) lavage in lieu of capsulectomy for the treatment of CIED infections. This retrospective study included patients who underwent TLE for CIED-related infections in two institutions in Colombia. In the capsulectomy group, complete capsulectomy was performed after hardware removal. In the CHG group, exhaustive lavage of the generator pocket with 20 cc of CHG at2%followed by irrigation with approximately 500 cc of normalsaline(0.9%sodiumchloride) was performed. The primary outcomes included reinfection and hematoma formation in the generator pocket. Secondary outcomes included the occurrence of any adverse reaction to chlorhexidine, the need for reintervention, infection-related mortality, and total procedural time. A total of 102 patients (mean age 67.2 ± 13 years, 32.4% female) underwent CIED extraction with either total capsulectomy (n = 54) or CHG (n = 48) lavage. Hematoma formation was significantly higher in the capsulectomy group versus the CHG group (13% vs. 0%, p = .014), with no significant differences in the reinfection rate. Capsulectomy was associated with longer procedural time (133.7 ± 78.5 vs. 89.9 ± 51.8 min, p = .002). No adverse reactions to CHG were found. Four patients (4.3%) died from worsening sepsis: three in the capsulectomy group and one in the CHG group (p = .346). In patients with CIED infections, the use of CHG without capsulectomy resulted in a lower risk of hematoma formation and shorter procedural times without an increased risk of reinfection or adverse events associated with CHG use.

Safely Shaping the Breast After Implant Removal and Total Intact Capsulectomy Using the Mammary Imbrication Lift and Fixation Technique.

Implant-based breast augmentation is one of the most popular plastic surgery procedures performed worldwide. As the number of patients who have breast implants continues to rise, so does the number of those who request breast implant removal without replacement. There is little in the current scientific literature describing total intact capsulectomy and simultaneous mastopexy procedures. Here, the authors present their current method using the mammary imbrication lift and fixation technique after explant and total capsulectomy. Between 2016 and 2021, a total of 64 patients (mean age: 42.95 years; range, 27-78 years) underwent the described mammary imbrication lift and fixation technique with bilateral breast implant removal and total capsulectomy. Mean follow-up was 6.5 months (range, 1-36 months). Postoperative complications included minor cellulitis in 1 patient (1.6%), late onset hematoma with infection in 1 patient (1.6%), fat necrosis and pulmonary embolism in 1 patient with prior history of thromboembolic events (1.6%), and breast scar irregularity in 4 patients (6.2%) who required subsequent minor scar revision or steroid injections. Two patients (1.6%) underwent revision surgery with bilateral breast fat grafting to improve shape and add volume. The mammary imbrication lift and fixation technique described here can safely and simultaneously be performed with a total intact capsulectomy and explant procedure. This technique avoids wide undermining, intentionally opening the capsule, performing subtotal capsulectomy, and preserving blood supply to the breast tissue and nipple with low complication rates.

Mortality Rate in Breast Implant Surgery: Is an Additional Procedure Worthwhile to Mitigate BIA-ALCL Risk?

BackgroundBecause of poor knowledge of risks and benefits, prophylactic explantation of high BIA-ALCL risk breast implant (BI) is not indicated. Several surgical risks have been associated with BI surgery, with mortality being the most frightening. Primary aim of this study is to assess mortality rate in patients undergoing breast implant surgery for aesthetic or reconstructive indication.Materials and MethodsIn this retrospective observational cohort study, Breast Implant Surgery Mortality rate (BISM) was calculated as the perioperative mortality rate among 99,690 patients who underwent BI surgery for oncologic and non-oncologic indications. Mean age at first implant placement (A1P), implant lifespan (IL), and women’s life expectancy (WLE) were obtained from a literature review and population database.ResultsBISM rate was 0, and mean A1P was 34 years for breast augmentation, and 50 years for breast reconstruction. Regardless of indication, overall mean A1P can be presumed to be 39 years, while mean BIL was estimated as 9 years and WLE as 85 years.ConclusionThis study first showed that the BISM risk is 0. This information, and the knowledge that BI patients will undergo one or more revisional procedures if not explantation during their lifetime, may help surgeons in the decision-making process of a pre-emptive substitution or explant in patients at high risk of BIA-ALCL. Our recommendation is that patients with existing macrotextured implants do have a relative indication for explantation and total capsulectomy. The final decision should be shared between patient and surgeon following an evaluation of benefits, surgical risks and comorbidities.Level of Evidence IV 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.

Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a distinct type of T-cell lymphoma, developing around implants, that can occur 2 to 25 years (median 8 years) post-implantation. Most patients present with a swelling of the breast, which is usually associated with pain and fluid collecting around the implant. Less commonly, a lump in the breast and/or in the axilla can be present. A periprosthetic fluid collection (> 1 year post-implantation) should be investigated with ultrasound and fine needle aspiration. Immunohistochemistry confirms the diagnosis BIA-ALCL with CD30+ and ALK- expression. In most patients with disease localized to the periprosthetic fluid, surgery alone usually is curative. A total capsulectomy and bilateral implant removal should be performed. Before surgical intervention, international recommendations state that a PET-CT scan should be done to exclude disseminated disease. The international profile registry (www.thepsf.org/profile) collects all confirmed cases.

Risk Factors for Capsular Contracture in Alloplastic Reconstructive and Augmentation Mammaplasty: Analysis of the National Surgical Quality Improvement Program (NSQIP) Database.

Capsular contracture is the most common complication of breast augmentation and reconstruction. It occurs in up to 45% of patients and is theorized to occur secondary to an immune reaction. It can lead to pain, dissatisfaction with aesthetic outcomes, and reoperation. The gold standard for management is capsulectomy. Prior similar studies are limited by narrow inclusion criteria, single-surgeon analysis, small sample size, or univariate analysis. The goal of the following study is to prospectively identify possible risk factors for capsular contracture using a national database. A retrospective review was conducted utilizing the National Surgical Quality Improvement Program (NSQIP) Database of prospectively collected data of patients undergoing periprosthetic and/or total capsulectomy for capsular contracture from 2013 to 2016. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for variables using a multivariable binary logistic regression model. A total of 6547 patients underwent reconstructive or augmentation mammaplasty with a prosthetic implant, out of which 2543 (39%) underwent capsulectomy. Capsular contracture was more likely in older (OR: 1.10, 95% CI: 1.09-1.10, p<.001), overweight (OR: 1.12, 95% CI: 1.10-1.13, p<.001), and cancer patients (OR: 7.71, 95% CI: 2.22-28.8, p=0.001). Wound infection was associated with capsulectomy (OR: 6.69, 95% CI: 1.74-25.8, p<.001). These identified risk factors should be comprehensively addressed with patients during the informed consent process before breast augmentation or reconstruction with implants. 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 .

Heavy Metals in Breast Implant Capsules and Breast Tissue: Findings from the Systemic Symptoms in Women–Biospecimen Analysis Study: Part 2

BackgroundBreast Implant Illness (BII), as described in recent medical literature and by social media, describes a range of symptoms in patients with breast implants for which there are no physical findings or laboratory results that explain their symptoms.ObjectivesPart 2 of this study aims to determine whether heavy metals are present in the capsules around saline and silicone implants and if there are statistical differences in the type or level of these metals between women with or without symptoms. Demographic data was collected to investigate potential alternate sources of metals: inhaled, absorbed, or ingested.MethodsA prospective, blinded study enrolled 150 consecutive subjects divided equally into in three cohorts: (A) women with systemic symptoms they attribute to their implants who requested implant removal, (B) women with breast implants requesting removal or exchange who do not have symptoms they attribute to their implants, and (C) women undergoing cosmetic mastopexy who have never had any implanted medical device. Capsule tissue was removed from Cohort A and B for analysis of 22 heavy metals. Additionally, breast tissue was obtained from a control group with no previous exposure to any implanted medical device.ResultsThe study was performed between 2019-2021. Heavy metal content was compared between the capsule tissue from Cohort A and B. The only statistically significant differences identified in Cohort A were higher levels of arsenic and zinc, and lower levels of cobalt, manganese, silver, and tin. There were no elevated levels or statistically significant differences in the other metals tested between Cohorts A and B.ConclusionsThis study analyzes the metal content in capsules surrounding both saline and silicone breast implants. Heavy metals were also detected in the non-implant control group breast tissue, with some metals at numerically higher levels than either breast implant cohort. Smoking, gluten free diets, dietary supplements, and the presence of tattoos were all identified as statistically significant sources of arsenic and zinc in Cohort A. The risk of heavy metal toxicity should not be used as an indication for total capsulectomy if patients elect to remove their breast implants.Level of Evidence: 3

Breast Implant Associated-Anaplastic Large-Cell Lymphoma (BIA-ALCL): Data Based on the Lymphoma Study Association (LYSA) Registry. Promising Results of Brentuximab Vedotin Combined with Cyclophosphamide, Doxorubicin and Prednisone (BV-CHP) As First Line Treatment for Patient Requiring Chemotherapy

Breast Implant Associated-Anaplastic Large-Cell Lymphoma (BIA-ALCL): Data Based on the Lymphoma Study Association (LYSA) Registry. Promising Results of Brentuximab Vedotin Combined with Cyclophosphamide, Doxorubicin and Prednisone (BV-CHP) As First Line Treatment for Patient Requiring Chemotherapy