An Outcome Analysis of 100 Women After Explantation of Silicone Gel Breast Implants

Peters, Walter; Smith, Dennis C.; Fornasier, Victor; Lugowski, Stanley; Ibañez, Dominique

doi:10.1097/00000637-199707000-00002

Cited by 134 publications

(102 citation statements)

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“…In the literature, authors have suggested that the length of implantation time is an important factor in the symptomatology leading to implant failure; the longer the implant duration, the higher the risk of adverse symptoms and failure. 24 In the current study, we have not been able to demonstrate the selective activation of any lymphocyte phenotype in relation to duration (Table III).…”

Section: Clinical/pathological Correlationcontrasting

confidence: 67%

The peri-implant breast capsule: An immunophenotypic study of capsules taken at explantation surgery

Kamel

Protzner

Fornasier

et al. 2001

J. Biomed. Mater. Res.

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Silicone-based breast implants continue to be the focus of many studies attempting to correlate implant failure to clinical and pathological factors. Routine pathology of peri-implant capsule is extensively described in the literature. The actual significance of the cellular events remains unconfirmed, particularly with reference to clinical outcome. This study reviews our experience with explanted capsules. The study makes specific reference to the immunohistochemistry of the cells participating in the capsule and the significance of the immunophenotypic characterization of these cells to clinical outcome. The use of a wide selection of immunomarkers for T and B lymphocytes and histiocytes provided no supporting evidence for local cell participation in the capsule, which may indicate the presence of an immunological reaction present in the capsule at the time of explantation. One was only able to confirm the presence of a low grade inflammatory process and progression to fibrosis and calcification over time. Statistical correlation was obtained only between Baker grade of capsular contracture and CD3/CD68 immunomarker positivity. CD45RO did show correlation with pain. No correlation was demonstrated with calcification. The results obtained in this study highlighted the need for further investigations into the mechanism of histiocyte and fibrocyte recruitment and activation in the capsule, a possible source of pain and contracture, which is a serious long-term clinical finding leading to the necessity for explantation.

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Section: Clinical/pathological Correlationcontrasting

confidence: 67%

The peri-implant breast capsule: An immunophenotypic study of capsules taken at explantation surgery

Kamel

Protzner

Fornasier

et al. 2001

J. Biomed. Mater. Res.

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“…Peters et al 8 reported that 75 of 100 women requesting implant removal noted marked decreased sensitivity of the nipple after implantation. The association of prior breast surgery with Raynaud's phenomenon of the nipple during breastfeeding has not been reported previously.…”

Section: Discussionmentioning

confidence: 99%

Raynaud’s Phenomenon of the Nipple: A Treatable Cause of Painful Breastfeeding

Anderson

Held²,

Wright

2004

Pediatrics

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ABSTRACT. Maurice Raynaud first described the vasospasm of arterioles in 1862, and Raynaud's phenomenon is now felt to be common, affecting up to 20% of women of childbearing age. Raynaud's phenomenon has been reported to affect the nipples of breastfeeding mothers and is recognized by many lactation experts as a treatable cause of painful breastfeeding. In 1997, LawlorSmith and Lawlor-Smith reported 5 women with Raynaud's phenomenon associated with breastfeeding, but there are few other case reports, and none report the possible relationship between Raynaud's phenomenon of the nipple and previous breast surgery.We report 12 women who breastfed 14 infants, all of whom were seen in 1 pediatric practice and 1 lactation consultation center in San Francisco, California, within the past 3 years. Of the 12 women, 11 were seen between June 2002 and May 2003. All women suffered from extremely painful breastfeeding, with symptoms precipitated by cold temperatures and associated with blanching of the nipple followed by cyanosis and/or erythema. Poor positioning and poor attachment or latch may cause blanching of the nipple and pain during breastfeeding, but 10 of the 12 mothers were evaluated by experienced lactation consultations, who were sure that inappropriate breastfeeding techniques were not contributing factors.Because the breast pain associated with Raynaud's phenomenon is so severe and throbbing, it is often mistaken for Candida albicans infection. It is not unusual for mothers who have Raynaud's phenomenon of the nipple to be treated inappropriately and often repeatedly for C albicans infections with topical or systemic antifungal agents. Eight of our 12 mothers and their infants received multiple courses of antifungal therapy without relief before the diagnosis was made.To diagnose Raynaud's phenomenon accurately, additional symptoms such as precipitation by cold stimulus, occurrence of symptoms during pregnancy or when not breastfeeding, and biphasic or triphasic color changes must be present. All our mothers experienced precipitation of symptoms by cold stimuli and demonstrated biphasic or triphasic color changes, and 6 of the 12 experienced symptoms during pregnancy.Interestingly 3 of 12 mothers also reported a history of breast surgery, including 1 mother who had a fibroadenoma removed and 2 who had breast-reduction surgery. The association between breast surgery/implants and autoimmune disease, including Raynaud's phenomenon, has been discussed extensively, but the association of Raynaud's phenomenon of the nipple during breastfeeding has not been reported previously. Given the small numbers in the study, it is uncertain as to whether this may be a precipitating factor in developing Raynaud's phenomenon.Treatment options include methods to prevent or decrease cold exposure, avoidance of vasoconstrictive drugs/nicotine that could precipitate symptoms, and pharmacologic measures. There are reports in the lay press of the use of herbal medicines, aerobic exercise, and dietary supplements, but because most wom...

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“…In this study, there was a statistically significant correlation between positive capsule cultures and symptomatic capsular contrac-tures. During the same time period (1992 to 1995), Peters et al (25) analyzed capsular colonization in 100 consecutive patients who requested explantation. Forty-two per cent of the capsules demonstrated colonization by bacteria.…”

Section: Late Infectionmentioning

confidence: 99%

Late unilateral breast enlargement after insertion of silicone gel implants: A histopathological study

Peters¹,

Fornasier²

2007

CAN J PLAST SURG

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Late unilateral breast enlargement after the insertion of silicone gel breast implants is a very rare phenomenon. The present study reports five women who presented with this finding over the past 20 years. Three of these patients presented with late unilateral hematomas, which developed nine, 12 and 14 years, respectively, after initial breast augmentation, in the absence of any known trauma. These patients presented for treatment one, four and 12 months, respectively, after their breast enlargements initially appeared. Two of these patients had developed chronic expanding hematomas. Extensive histopathological analyses of the capsules of all three patients provided explanations for the etiologies and progressions of the findings in these patients. In each of the three patients, the etiology of the hematoma was consistent with erosion of a capsular artery. Numerous large vessels were seen within the wall of the capsules. In each case, there was a class IV capsular contracture, which could have increased the friction of the intact implant against the capsule, and there was both old (hemosiderin deposits) and new bleeding into the pocket from the capsules. This supports the concept that numerous episodes of bleeding had occurred in each case. Histopathology also demonstrated the progression of the hematomas. After four weeks, only liquefied hematoma was present, while after four months, there were both liquefied hematoma and blood clotting. The hematoma on the surface of the capsule was becoming organized peripherally, but not centrally. After 12 months, the hematoma was becoming very well organized compared with the hematoma at four months. In one of the two remaining cases, late infection was the cause of the breast enlargement. Histopathology of this capsule showed that the involved capsule was six times as thick as the other side. It also showed edema and infiltration by scattered mononuclear cells, polymorphonuclear cells, and irregular crenated and degenerating nuclei. In the final patient, chronic inflammation appeared to be the cause of the breast enlargement. The histopathology of this capsule was unique. Its inner surface showed re-epithelialization and metaplasia of the ductal epithelium to form stratified squamous epithelium with early surface keratinization. These findings are consistent with synovial metaplasia. Several areas of the fibrous portion of the capsule showed patchy loss of cellular staining with loss of nuclei, indicative of necrosis. This produced a 'washed out' staining appearance. This tissue was paucivascular and fibrotic, and showed areas of fibrinoid necrosis, suggestive of mechanical abrasion and increased pressure.Key Words: Enlargement; Silicone gel breast implants Hypertrophie mammaire unilatérale tardive après la pose d'une prothèse de silicone : examen histopathologique L'hypertrophie mammaire unilatérale tardive après la pose d'une prothèse de silicone est rarissime. Le présent rapport fait état de cinq femmes qui ont connu ce type de complication au cours des 20 dernières a...

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An Outcome Analysis of 100 Women After Explantation of Silicone Gel Breast Implants

Cited by 134 publications

References 0 publications

The peri-implant breast capsule: An immunophenotypic study of capsules taken at explantation surgery

The peri-implant breast capsule: An immunophenotypic study of capsules taken at explantation surgery

Raynaud’s Phenomenon of the Nipple: A Treatable Cause of Painful Breastfeeding

Late unilateral breast enlargement after insertion of silicone gel implants: A histopathological study

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