Breast implants are associated with a significant rate of local complications and reoperation. There are marked differences in outcomes as a function of implant surface type and surgical indication. Despite relatively frequent complications and reoperations, implant recipients are largely satisfied.

Polyurethane foam-covered implants result in long-term reduction in the risk of capsular contracture and appear to have a safety profile similar to other silicone gel-filled devices.

This study reports on complications, outcomes, re-operation rates and patient satisfaction among 1529 women who received 3495 implants for augmentation, reconstruction and secondary revision surgery.This populationbased study was comprised of all implant recipients treated at a multidisciplinary breast center between June 1979 and June 2004 (25 years).The database was constructed and maintained in Excel and statistical analysis was performed using SAS 8.2. Outcomes were compared among various surgical procedures, different implant surface textures and different filler materials. Outcomes monitored included rate of capsular contracture, incidence of infections, hematomas, undesirable waviness, saline implant deflation and gel implant rupture.Additionally, the rates and reasons for re-operation were determined. Our data reveal that implant recipients have a significant incidence of local complications and a relatively high rate of re-operation.The most common overall indication for reoperation is capsular contracture.The incidence of symptomatic capsular contracture does not diminish after one or two years.The longer implants are in place, the greater the cumulative risk for developing contracture.The occurrence of hematomas significantly increases the risk of contracture. Polyurethane foam-covered implants are associated with a dramatically reduced rate of contracture.This benefit of the polyurethane foam surface persists for at least ten years following implantation and is not associated with an increased risk of other complications. Mechanically textured implants do not afford significant protection against contracture and are associated with an increased risk of wrinkling and waviness as well as a higher rate of saline deflation. In spite of a significant incidence of side effects and local complications, as well as a high rate of re-operation, implant recipients in all categories expressed a high overall degree of satisfaction.The use of biomaterials for the repair of abdominal wall defect is becoming common and safe. It has been 20 years since the senior author developed a method to reconstruct the very large transfixing abdominal wall defect with a combination of two biomaterials (Gore Tex ® PTFE as a neo peritoneum and polypropylene superficial to this in order to give rigidity to the abdominal wall) and a superficial flap (Fig.1).An observation at the electron microscopy level of the two sides of the implants' surfaces was performed.At the time of a late abdominal wall surgical revision on 15 patients, the prosthesis fragments have been analyzed at the electron microscopy level.The aim of our study was to analyze the late evolution of the different sides of these prostheses.Our results showed, for the first time in vivo, that there is an impressive stability of the deep side of PTFE ultra structure after implantation, a significant difference of the two sides of PTFE at the ultrastructural level and the creation of an intermediate tissue between the two meshes (Fig 2). In contrast, the polypropylene invar...