Types Of Breast Implants Research Articles

Literature Review on the Different Types of Breast Implants: Advantages and Disadvantages

Breast implants are devices used in cosmetic and reconstructive surgery to increase the volume and improve the shape of the breasts. In this study, the different types of breast implants available in clinical practice were investigated. Four main types were identified: saline implants, silicone gel implants, highly cohesive silicone gel implants, and double lumen implants. Saline implants consist of a silicone shell filled with sterile saline. They have advantages such as the ability to adjust volume during surgery, easy rupture detection and lower cost. However, they may have a less natural feel and a higher risk of wrinkling and rippling. Silicone gel implants are widely used because of their more natural look and feel. Silicone gel is cohesive and offers a consistency similar to breast tissue. They have a lower incidence of wrinkling and rippling, greater durability and less sensitivity to cold. However, detection of ruptures can be more difficult and there is a potential risk of capsular contracture. Highly cohesive silicone gel implants, also known as anatomical implants, are designed to mimic the natural shape and projection of the breast. They have predictable aesthetic results, a lower incidence of capsular contracture and greater resistance to displacement. However, they may require longer incisions and have a higher cost. Double lumen implants have two separate shell layers, one internal with cohesive silicone gel and the other external with saline solution. They offer an additional layer of security in case of rupture of the inner shell and allow volume adjustment during surgery. However, they may have a less natural feel and greater technical complexity.

Literature Review on the Different Types of Breast Implants: Advantages and Disadvantages

Literature Review on the Different Types of Breast Implants: Advantages and Disadvantages

Breast Implant Capsule: A Murine Model Comparing Capsular Contracture Susceptibility Among Six Breast Implants Available in the Market.

Breast implant capsule development and behavior are mainly determined by implant surface combined with other external factors such as intraoperative contamination, radiation or concomitant pharmacologic treatment. Thus, there are several diseases: capsular contracture, breast implant illness or Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), that have been correlated with the specific type of implant placed. This is the first study to compare all major implant and texture models available in the market on the development and behave of the capsules. Through a histopathological analysis, we compared the behavior of different implant surfaces and how different cellular and histological properties give rise to different susceptibilities to develop capsular contracture among these devices. A total of 48 Wistar female rats were used to implant 6 different types of breast implants. Mentor®, McGhan®, Polytech polyurethane®, Xtralane®, Motiva® and Natrelle Smooth® implants were employed; 20 rats received Motiva®, Xtralane® and Polytech polyurethane®, and 28 rats received Mentor®, McGhan® and Natrelle Smooth® implants. The capsules were removed five weeks after the implants placement. Further histological analysis compared capsule composition, collagen density and cellularity. High texturization implants showed the highest levels of collagen and cellularity along the capsule. However, polyurethane implants capsules behaved differently regarding capsule composition, with the thickest capsules but fewer collagen and myofibroblasts than expected, despite being generally considered as a macrotexturized implant. Nanotextured implants and microtextured implants histological findings showed similar characteristics and less susceptibility to develop a capsular contracture compared with smooth implants. This study shows the relevance of the breast implant surface on the definitive capsules' development, since this is one of the most differentiated factors that determine the incidence of capsular contracture and probably other diseases like BIA-ALCL. A correlation of these findings with clinical cases will help to unify implant classification criteria based on their shell and their estimated incidence of capsule-associated pathologies. Up to this point, the establishment of additional groups is recommended as nanotexturized implants seem to behave differently to pure smooth surfaces and polyurethane implants present diverse features from macro- or microtextured implants. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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: A Case Report

This report aims to review a case of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) by comparing the patient's course with the current literature. BIA-ALCL is a specific type of T-cell lymphoma that can develop after breast implantation, but has only recently been recognized within the last decade. Although overall rare, certain types of breast implants have increased association with developing subsequent lymphoma. This case occurred after mastectomy with breast reconstruction for unilateral invasive ductal carcinoma with a textured, saline Allergan breast implant. BIA-ALCL manifested and was symptomatic nine years after implantation.

An Experimental Murine Model to Assess Biofilm Persistence on Commercial Breast Implant Surfaces.

Capsular contracture is the most frequently associated complication following breast implant placement. Biofilm formation on the surface of such implants could significantly influence the pathogenesis of this complication. The objective of this study was to design an experimental model of breast implant infection that allowed us to compare the in vivo S. epidermidis ability to form and perpetuate biofilms on commonly used types of breast implants (i.e., macrotexturized, microtexturized, and smooth). A biofilm forming S. epidermidis strain (ATCC 35984) was used for all experiments. Three different implant surface types were tested: McGhan BIOCELL® (i.e., macrotexturized); Mentor Siltex® (i.e., microtexturized); and Allergan Natrelle Smooth® (i.e., smooth). Two different infection scenarios were simulated. The ability to form biofilm on capsules and implants over time was evaluated by quantitative post-sonication culture of implants and capsules biopsies. This experimental model allows the generation of a subclinical staphylococcal infection associated with a breast implant placed in the subcutaneous tissue of Wistar rats. The probability of generating an infection was different according to the type of implant studied and to the time from implantation to implant removal. Infection was achieved in 88.9% of macrotextured implants (i.e., McGhan), 37.0% of microtexturized implants (i.e., Mentor), and 18.5% of smooth implants (i.e., Allergan Smooth) in the short-term (p < 0.001). Infection was achieved in 47.2% of macrotextured implants, 2.8% of microtexturized implants, and 2.8% of smooth implants (i.e., Allergan Smooth) in the long-term (p < 0.001). There was a clear positive correlation between biofilm formation on any type of implant and capsule colonization/infection. Uniformly, the capsules formed around the macro- or microtexturized implants were consistently macroscopically thicker than those formed around the smooth implants regardless of the time at which they were removed (i.e., 1–2 weeks or 3–5 weeks). We have shown that there is a difference in the ability of S epidermidis to develop in vivo biofilms on macrotextured, microtextured, and smooth implants. Smooth implants clearly thwart bacterial adherence and, consequently, biofilm formation and persistence are hindered.

MRI for Evaluation of Complications of Breast Augmentation.

Breast augmentation is one of the most common aesthetic procedures performed in the United States. Several techniques of breast augmentation have been developed, including the implantation of breast prostheses and the injection of autologous fat and other materials. The most common method of breast augmentation is to implant a prosthesis. There are different types of breast implants that vary in shape, composition, and the number of lumina. The rupture of breast implants is the leading cause of implant removal. The rupture rate increases substantially with the increasing age of the implant. Most implant ruptures are asymptomatic. Implant complications can be grouped into two categories: local complications in the breast and adjacent soft tissue, and systemic complications associated with rheumatologic or neurologic symptoms. The onset of local complications may be early (infection and periprosthetic collections including seromas, hematomas, or abscesses) or late (capsular contraction, implant rupture, gel bleed, or breast implant-associated anaplastic large cell lymphoma). Although mammography is the imaging modality for breast cancer screening, noncontrast breast MRI is the imaging modality of choice for evaluation of the integrity of breast implants and the complications of breast augmentation, for equivocal findings at conventional imaging, and as a supplement to mammography in patients with free injectable materials. The fifth edition of the Breast Imaging Reporting and Data System (BI-RADS) provides a systematic outline for MRI evaluation of patients with breast implants. Silicone- and water-selective sequences provide useful supplemental information to confirm intracapsular and extracapsular rupture. Breast MRI for evaluation of implant integrity does not require intravenous contrast material. The use of MRI contrast material in patients with breast augmentation is indicated when infection or malignancy is suspected. Radiologists should have a thorough understanding of the different techniques for breast augmentation, normal imaging features, and complications specific to breast augmentation. An invited commentary by Ojeda-Fournier is available online. ©RSNA, 2022.

Effect of Breast Silicone Implant Topography on Bacterial Attachment and Growth: An In Vitro Study.

The mechanisms underlying capsular contracture remain unclear. Emerging evidence supports the inflammation hypothesis, according to which bacteria from an adherent biofilm cause chronic inflammation and collagen deposition on the implant and trigger capsular contracture. Our goal was to evaluate the effect of different types of breast implants on the growth of Staphylococcus aureus, S. epidermidis, and Pseudomonas aeruginosa, which are commonly found in biofilms in infection. Bacteria were grown in tryptic soy broth at 37°C for 2, 6, and 24 h and subsequently incubated for 24 h on 12 shell sections of smooth, nano-, and macrotextured breast implants. After incubation, the solutions were ultrasonicated and bacterial numbers were determined by serial dilution. S. aureus were fixed, washed with phosphate-buffered saline, dehydrated in ethanol, and coated with a platinum film to visualize the presence of biofilms by scanning electron microscopy. The numbers of S. aureus and S. epidermidis attached to the smooth and nanotextured surface implants were significantly lower than those on the macrotextured surface for all incubation times, whereas the number of P. aeruginosa was non-significantly lowest on the nanotextured surface after 24h incubation. Biofilms on smooth and nanotextured implant surfaces showed patchy patterns on scanning electron microscopy in contrast to the continuous pattern detected on macrotextured implants. Nanotextured breast implants may limit bacterial growth and thus prevent capsular contracture.

Developing a Specific MRI Technology to Identify Complications Caused by Breast Implants

With advancements in aesthetic medicine, breast augmentation has become a popular plastic surgery worldwide, typically performed using either fine-needle injection or silicone implants. Both carry complication risks from rupture over time. In this study, we aimed to reduce misjudgments and increase diagnostic value by developing an MRI technique that can produce water- and silicone-specific images from MRI scans of phantoms (Natrelle® saline-filled breast implants) and human bodies. Pig oil, soybean oil, and normal saline were used to simulate human breast tissue, and two common types of breast implants, saline bags, and silicone bags, were selected as well, resulting in five materials scanned. Six pulse sequences were applied: T1W fast spin echo (FSE), T1W SPGR/60, T2W, T2W fat-saturation, STIR, and STIR water-saturation. Human body scans were additionally investigated using 3D SPGR fat-saturation dynamic contrast enhancement. Results show that the best way to enhance tissue contrast in images of silicone implants is to apply STIR combined with water suppression, and the best way to enhance saline bag implants is to apply T2W fat-saturation combined with fat suppression. Both offered very high sensitivity and specificity, rendering this method especially useful for distinguishing normal mammary glands from siliconoma.

An Ultrasound-Assisted Approach to an Early Detection of Complications of an Implant-Based Augmentation Mammaplasty using the BellaGel® SmoothFine: Preliminary 3-year Clinical Experience

Background: Selection of optimal types of breast implants is an essential factor that determines the degree of patients’ satisfaction with outcomes of augmentation mammaplasty, for which an evidence-based approach to it is mandatory. Several studies have supported the safety of the BellaGel® SmoothFine (HansBiomed Co. Ltd., Seoul, Korea), a silicone gel-filled breast implant from a Korean manufacturer. But such studies have been conducted in a manufacturer-sponsored setting. We therefore conducted this non-manufacturer-sponsored, retrospective study to assess its 3-year safety outcomes in Korean women.

PMD50 USING SOCIAL MEDIA TO CHARACTERIZE ADVERSE EVENTS: A CASE STUDY OF BREAST IMPLANT ILLNESS

Reports from recipients of breast implants about a diverse set of symptoms has led to the use of the term “breast implant illness” (BII), though no precise clinical definition of a symptom complex has been established. Breast implant options include both saline- and silicone-containing devices with textured or smooth surfaces. Using social media analysis, we qualitatively explored patients’ experience of complaints associated with different types of breast implants. We identified posts on 3 breast implant patient support websites between 2010-2019. Using natural language processing, we searched the post texts for symptoms from the FDA’s list of suspected BII symptoms, such as redness, swelling, skin rash, fatigue and any other mentioned complications. We tabulated complaints reported in posts by implant type. Posts included ≥1 complaint. There were 2,518 posts mentioning saline and 5,470 mentioning silicone gel breast implants. The most common complaints for saline implants were rupture (19.5%), wrinkling/rippling (19.2%), redness/bruising/skin rash (16.1%), inflammation/irritation (10.4%), malposition/displacement/ asymmetry (6.4%), infection (6.1%), deflation (4.9%), capsular contracture (4.0%), and tiredness/fatigue (2.9%). The complaints for silicone implants followed a similar pattern except that redness/bruising/skin rash was more frequent (24.2%), wrinkling/rippling (14.0%) and deflation were less common (0.7%). Brain fog and trouble concentrating were rarely mentioned (<1%). Comparing smooth and textured breast implants, wrinkling/rippling was more frequently mentioned for textured (25.3%) vs smooth (14.9%), while redness/bruising/skin rash was more frequent with smooth (33.0%) vs textured (21.6%). Malposition/displacement was more common for textured (5.4%) vs smooth implants (1.6%). Tiredness/fatigue (4.8% vs 1.7%) and brain fog/trouble concentrating/confusion/not thinking clearly (1.3% vs 0.5%) were mentioned more for smooth vs textured implants. Social media analysis using NLP may be useful to provide insights and qualitative characterization of experience of complications among breast implant recipients. However, multiple factors may influence differences, not just implant type.

Breast implant-associated anaplastic large cell lymphoma, an under-recognised entity.

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare form of T-cell lymphoma, recently linked to the use of certain types of breast implants. Although rare, BIA-ALCL is being increasingly recognised and radiologists can play an important role in its early diagnosis. BIA-ALCL is thought to be related to chronic inflammation from indolent infection of the biofilm surrounding implants leading to malignant transformation of activated T cells in genetically susceptible individuals. Clinical features include breast enlargement or asymmetry, discomfort, heaviness and/or a palpable mass in the context of long-standing implant(s). Ultrasound is the primary imaging modality, and the presence of more than a trace of peri-implant fluid should prompt consideration of aspiration for cytology, flow cytometry and microbiological analysis. This article reviews the clinical, imaging and pathology features of BIA-ALCL. In addition, the current recommended management guidelines for suspected cases are discussed.

Complications in breast augmentation with textured versus smooth breast implants: a systematic review protocol

IntroductionBreast augmentation is one of the most popular aesthetic plastic surgeries worldwide. There are various types of breast implants, and these can be categorised into different broad groups based on...

Breast implants and possible association with ALCL: A retrospective study including a histological analysis of 296 explanted breast tissues and current literature.

To identify a possible connection between anaplastic large cell lymphoma and different types of breast implants. We conducted a retrospective evaluation of 296 breast tissues of 227 women with different breast implant types undergoing surgical revision or explantation between January 2000 and June 2015. Histological and selected immunohistochemical analyses of CD30-&ALK-1-markers of the breast capsules were performed. The womens' average age was 42.91±12.66 years (median: 43.83 years) during implantation and 51.40±11.40 years (median: 52.37 years) during revision or explantation of the implants. Average implant residing time was 8.49±8.90 years (median: 5.83 years). In 51% implantation was for reconstructive, in 48% for aesthetic reasons, in 1% for other reasons. At 59% the main reason for explantation or removal was capsular fibrosis (n = 173). In 296 breast capsules we could not find pathological lymphoma cells according to ALCL, retrospectively. In our study we detected high incidences of various cells in relationship to the implant's type and residing time, which will be published in further articles. We could not find ALCL-cells in breast capsules of explanted or revised breast implants during 2000-2015, retrospectively.There should be a heightened awareness of a possible relationship between the development of cancer and breast implants. To date there are case reports about a possible association between the development of ALCL and breast implants. The number of cases are few and our knowledge of the pathogenesis is little. Further investigation is needed to understand the possible link between breast implants and ALCL found in the breast.

SU‐F‐T‐314: Estimation of Dose Distributions with Different Types of Breast Implants in Various Radiation Treatment Techniques for Breast Cancer

Purpose:This study investigates the effects of different kinds and designs of commercialized breast implants on the dose distributions in breast cancer radiotherapy under a variety of conditions.Methods:The dose for the clinical conventional tangential irradiation, Intensity Modulated Radiation Therapy (IMRT), volumetric modulated arc therapy (VMAT) breast plans was measured using radiochromic films and stimulated luminescence dosimeter (OSLD). The radiochromic film was used as an integrating dosimeter, while the OSLDs were used for real‐time dosimetry to isolate the contribution of dose from individual segment. The films were placed at various slices in the Rando phantom and between the body and breast surface OSLDs were used to measure skin dose at 18 positions spaced on the two (right/left) breast. The implant breast was placed on the left side and the phantom breast was remained on the right side. Each treatment technique was performed on different size of the breasts and different shape of the breast implant. The PTV dose was prescribed 50.4 Gy and V47.88≥95%.Results:In different shapes of the breast implant, because of the shadow formed extensive around the breast implant, dose variation was relatively higher that of prescribed dose. As the PTV was delineated on the whole breast, maximum 5% dose error and average 3% difference was observed averagely. VMAT techniques largely decrease the contiguous hot spot in the skin by an average of 25% compared with IMRT. The both IMRT and VMAT techniques resulted in lower doses to normal critical structures than tangential plans for nearly all dose analyzation.Conclusion:Compared to the other technique, IMRT reduced radiation dose exposure to normal tissues and maintained reasonable target homogeneity and for the same target coverage, VMAT can reduce the skin dose in all the regions of the body.

Poly Implant Prothèse (PIP®) et incidence des complications en reconstruction mammaire : une étude rétrospective contrôlée

On 29 March 2010, the Poly Implant Prothèse (PIP(®)) breast prosthesis was withdrawn from the market by the ANSM. In this study we review our experience with PIP(®) implants in breast reconstruction. We compare our complications with other types of breast implants used during the same period at our institution. This is a retrospective study conducted at the Hospital René Huguenin of the Institut Curie (Paris, France). It includes 327 prostheses, from 268 patients who underwent surgery for breast reconstruction between February 2008 and February 2012: 69 PIP(®) (Group 1), 82 Mentor(®) (Group 2) and 179 Allergan(®) (Group 3). The objective of the study was to compare the rates of early and late complications for each prosthesis. Our results are compared with the current literature. With regard to the rate of early complications (hematoma, infection, seroma, wound dehiscence), no difference was observed between the three groups (P not significant). However, the study found that 100% of the 13 PIP(®) implants with early complications required surgical revision. There were too few late complications (capsular contracture, prosthetic rupture) in our cohort to allow statistical comparison between the three groups (P not significant). We compare our results with the current literature. This study highlights the lack of significant difference in the occurrence of early adverse events between the three groups of implants. This may explain the time taken for surgeons to become aware there was a problem with the PIP(®) implants. The low rate of late complications in our series does not allow statistical analysis between the three groups of implants.

Prosthetic Mammoplasty Sensitivity Syndrome: A Case for Causation

Treatment of patients experiencing adverse health effects following prosthetic mammoplasty has suffered from a lack of an acknowledgment of a causal relationship to their breast prosthetic devices. Case reports and case series showing an association between adverse health effects and breast implants have been routinely dismissed as anecdotal, and epidemiological studies have been considered necessary to prove causality. We show that epidemiological research is not necessary for establishing a causal relationship, and one properly documented case can be, in fact, all that is needed to show causation. Presently in the peer-reviewed literature there exists a substantial scientifically sound body of data showing an association between breast implants and adverse health effects. Ample evidence has shown that exposure to the five common types of breast implants outlined, i.e., silicone gel filled, saline filled, double lumen, polyurethane coated, and cohesive silicone, has caused adverse health effects in humans. Prosthetic mammoplasty sensitivity syndrome (PMSS) is the proposed term to describe the disease processes documented in the literature that has a causal relationship to breast implants.

Breast enlargement and reduction: results from a breast cancer case-control study.

In a population-based case-control study of breast cancer that included 2174 cases and 2009 population controls under 55 years of age, prior breast implants were reported by 36 cases versus 44 controls. After adjustment for the matching factors as well as variables associated with both breast cancer risk and breast enlargement (race, family history of breast cancer, body size, screening history), the relative risk of breast cancer associated with a prior implant was 0.6 (95% CI 0.4-1.0). The reduced risk persisted with increasing interval since surgery, arguing against selection bias as an explanation. Further, although a deficit of in situ tumors was seen among women with implants (RR = 0.2), the risk associated with implants remained reduced for both localized and distant tumors (RR = 0.8 for both stages). In a smaller group of women who had prior breast reduction surgery (10 cases, 13 controls), a reduced risk of breast cancer also was observed (RR = 0.7, 95% CI 0.3-1.6). The results of this study must be interpreted cautiously because of the small number of women involved and reliance on patient reports of prior operations. In not showing any elevation in breast cancer risk following a breast implant, our results confirm several record linkage studies but contradict some clinical studies that suggest an adverse effect. Additional investigations are needed in relation to specific types of breast implants, including the polyurethane-coated implants, which have been linked to high cancer rates in laboratory animals.