Since the advent of breast implants, there has been unprecedented controversy and FDA bands regarding their safety. There has been a demonstrated link with certain types of lymphoma, autoimmune disorders, and systemic illness associated with breast implants. A significant population of women currently pursue bilateral breast implant removal in hopes to alleviate a constellation of symptoms anecdotally known as “breast implant illness”. This is not yet an accepted clinical entity due to the lack of sound literature on the subject. Common presenting symptoms include fatigue, anxiety, chronic pain, endocrine, autonomic, and peripheral nervous system dysfunction. Currently, there is no standard of care or guideline for treating women experiencing such symptoms. The current literature regarding breast implant illness has been widely observational and descriptive. With over four million women across the globe with augmented breasts, the potential impact of this research is great. This paper presents three patients believed to be suffering from breast implant illness, who after en-bloc resection, experienced resolution of their symptoms.
Fibrin-associated diffuse large B-cell lymphoma (FA-DLBCL) is in and of itself a rare entity and is a subset of the Epstein-Barr virus (EBV)-associated lymphoma. Due to its indolent course, FA-DLBCL is generally an incidental finding on histopathological examinations. We present the first reported case of FA-DLBCL found within a native aortic thrombus during an aorto-biiliac bypass. This is a 77-year-old male who was taken to the operative theater for open aorto-biiliac bypass secondary to aortooclusive disease resulting in intermittent claudication and gangrene of the right lower extremity digits. Intraoperatively, suspicious inflammatory changes were noted around the aorta. Pathological evaluation of the thrombus within the aorta noted cells of B-cell lineage with BCL2 and MYC positivity in addition to CD30 and EBV positivity. Postoperatively, the patient’s course was complicated by acute tubular necrosis, uremia, dialysis dependence, intubation, and cardiac arrhythmias including cardiac arrest. He was able to recover from these complications, however, he ultimately chose to self-enroll in hospice care. An extensive literature review of over 128 mentions of FA-DLBCL noted a complete paucity of reported cases of FA-DLBCL within a native aorta. The patient’s clinical presentation and histopathology without mass-forming lesions lead to the diagnosis of FA-DLBCL. FA-DLBCL is an extremely rare EBV+ lymphoproliferative disorder associated with chronic inflammation (DLBCL-CI). FA-DLBCL is a rare condition without defined uniform treatment. This article serves to highlight the first reported case of FA-DLBCL found within an abdominal aortic thrombus in a native aorta. Given the paucity of literature on this condition, postoperative treatment and long-term outcomes should be the focus of this condition.
BackgroundBreast 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. MethodologyThis 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. ResultsThe 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. ConclusionBreast 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 illness but 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.
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