Adventures and Misadventures in Plastic Surgery and Soft-Tissue Implants

Abstract

Soft-tissue augmentation and implants are increasingly seen by the radiologist as more techniques emerge for a variety of indications and locations. Some surgical and implant procedures are performed for purely cosmetic reasons in otherwise healthy patients seeking to improve their body image, and some are performed for reconstruction after cancer or other chronic illnesses. Abdominoplasty, liposuction, and autologous fat grafting can be performed for abdominal and gluteal contouring. Injection of liquid injectable silicone has historically been fraught with legal issues, although it continues to be used for augmentation in a variety of anatomic locations. Newer solid silicone implants have revolutionized cosmetic and reconstructive muscular contouring. Subdermal implants placed by nonmedical professionals are relatively new and unrecognized within the medical establishment, although such implants have been described in the popular culture. Perhaps the most rapidly increasing segment of cosmetic procedures, however, is minimally invasive cosmesis in the form of soft-tissue fillers in the hands and face. Finally, the major principles of breast augmentation and penile implants are also reviewed. Regardless of the location and the type of implant, complications of plastic surgery and soft-tissue implants can generally be classified into the following categories: seroma, hematoma, infection, migration, vascular or nerve compression, fibrosis, foreign-body reaction, and rupture or breakdown. Key concepts include knowing the appropriate anatomic location and the normal postoperative appearance so that complications can be properly detected. A broad range of approved, off-label, and illicit plastic surgical and implant procedures are described and their complications illustrated with cases with classic imaging findings. RSNA, 2017.

Complications of Genital Enlargement Surgery

“…However, clearly, such interventions can be fraught with unexpected and undesirable consequences. 1,8 Silicone injection for girth enhancement can result in drifting, distant migration, swelling, penile distortion, and granulomatous reactions. This material can damage blood vessels and nerves, resulting in decreased sensation and erectile dysfunction.…”

Temporal Augmentation: A Systematic Review

“…34,35 The use of implants for temporal augmentation was investigated because previous traditional modalities, such as injectable fillers and fat grafts, had less predictable survival time, limited availability, and decreased pliability. 34,35 However, implants present their own challenges to clinicians, including difficulty in identifying good surgical candidates, improper implant size selection, and inappropriate implant location placement, as well as migra-tion and extrusion. 35,36 Traditional complications are also possible, including seroma, hematoma, and infection.…”

“…34,35 However, implants present their own challenges to clinicians, including difficulty in identifying good surgical candidates, improper implant size selection, and inappropriate implant location placement, as well as migra-tion and extrusion. 35,36 Traditional complications are also possible, including seroma, hematoma, and infection. 36 In our review, we identified studies using methyl methacrylate (MMA) and polytetrafluoroethylene (PTFE) implants for aesthetic temporal augmentation.…”

Mycobacterium agri Skin Infection in a Previously Healthy Patient: A Case Study

“…However, skin and soft tissue infections are common with rapid growers. 1 Here, we report the case of a previously healthy patient, who developed an infection with Mycobacterium agri (a rapidly growing nontuberculous bacillus) that was isolated from purulent samples. Treatment of NTM is challenging due to multiple antimycobacterial drug resistances.…”