Background The management of Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL) has been well established. However, there is minimal data and significant variability in the management of asymptomatic textured implant (ATI) patients. Objectives The purpose of this study is to survey members of The Aesthetic Society on management of ATI patients in order to understand trends in practice patterns. Methods Members of The Aesthetic Society were queried via an electronic survey regarding management of ATI patients. Anonymous responses were collected by QualtricsXM (SAP, Walldorf, Germany) survey software. Descriptive statistics were used to examine the data, reported as frequencies. All analyses were performed using IBM SPSS Statistics 26. Results The survey was sent to 2,149 active and candidate members of The Aesthetic Society with a total of 470 responses (21.87% response rate). For ATI patients presenting with concerns regarding BIA-ALCL risk, 88.8% of respondents educate the patient with clinical follow up and/or imaging. The other 11.2% of surgeons recommend implant removal with variability in capsulectomy technique. For ATI patients requesting surgery, 42.5% of respondents educate the patient with clinical follow up and/or imaging. The majority of surgeons (57.6%) recommend removal of the implant with 30% recommending total capsulectomies. Conclusions There is considerable variability in the management of ATI patients that request surgery by members of the Aesthetic Society. Future regulatory agency and professional society collaborative efforts should continue to aim for generation of high-level scientific data to aid in the counseling and management of ATI patients.
Objective: The purpose of this project was to study the incidence of ophthalmologic findings which are known to be risk factors for amblyopia in children who have coexisting metopic suture abnormalities and deformational plagiocephaly (DP) and brachycephaly (DB). Design: Institutional Review Board–approved retrospective study reviewing records of a consecutive cohort of children under 2 years of age with metopic suture abnormalities and cranial vault asymmetries seen in both the plastic surgery and ophthalmology clinics from 2007 to 2017. Setting: Institutional tertiary care center with all care in plastic surgery under the senior author and the standard of care accepted in pediatric ophthalmology under one of two ophthalmologists. Patients: After application of exclusion criteria, 76 children diagnosed with metopic suture abnormalities and DP/DB were included in the study. Patients with severe trigonocephaly, other suture involvement, syndromic diagnoses, and primary ocular disorders were excluded. Main Outcome Measures: Describe the incidences of refractive errors (astigmatism, hyperopia, and myopia), anisometropia, strabismus, and amblyopia within the study population. Results: In our patient population, the rates of amblyopia (17.1%) and strabismus (15.8%) are higher than the general pediatric population rates of 1.5% to 1.8% and 2.4% to 3.6%, respectively. Overall, 47.4% had significant refractive error: 28.9% with astigmatism, 15.8% with hyperopia, 5.3% with myopia, and 10.5% with anisometropia. Conclusions: In our patient population, children with coexisting metopic suture abnormalities and DP or DB had significant risk for amblyopia, strabismus, and refractive errors.
Background: Despite the increasing prevalence of breast implant associated anaplastic large cell lymphoma, there remains a paucity of literature guiding management of asymptomatic patients with textured breast implants. This risk can be anxiety provoking in breast reconstruction patients given their history of cancer or increased future risk. The purpose of this study is to evaluate current practice trends when managing the concerned asymptomatic patient following textured implant-based breast reconstruction. Methods: 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. Results: 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. Conclusions: 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.
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