Assessment of Risk Factors for Rupture in Breast Reconstruction Patients with Macrotextured Breast Implants

Paolini, Guido; Firmani, Guido; Briganti, Francesca; Macino, Mattia; Nigrelli, Simone; Sorotos, Michail; Pompeo, Fabio Santanelli di

doi:10.1007/s00266-022-03118-9

Cited by 11 publications

(5 citation statements)

References 40 publications

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“…We could not establish cause-and-effect relationships. There is also a debate in the literature regarding the timing of capsular contracture, and according to the authors, the reasons for this have not been clarified [36].…”

Section: Discussionmentioning

confidence: 99%

Stromal-cellular remodeling of breast tissue after silicone implant damage

Dadayan,

Adamovych,

Simonov

et al. 2024

Rep. of Morph.

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One of the current vectors of modern reconstructive and cosmetic surgery is augmentation mammoplasty - an operation to enlarge the mammary glands. The breast implant is well tolerated by the body, as the immunogenicity of its material is extremely low. At the same time, the silicone gel of the implant is a foreign object and the surrounding breast tissues give a stereotypical response in the form of growth of the connective tissue stroma with the formation of a capsule around the implant and the appearance of focal cellular infiltrates. Modern breast implants, unlike implants of previous decades, are more sophisticated in their structure, and the level of protection against damage is much higher. A complication associated with the long-term use (up to 20 years) of implants, where low-quality silicone or industrial silicone was used as a filler, is the penetration of low-molecular-weight particles of the implant through its shell to the surrounding tissues with the subsequent formation of silicone granules. In the vast majority, such changes develop after mechanical traumatization of the implant. The purpose of the study is to establish the morphological criteria of the reaction of breast tissue after silicone implant damage. The material for research was histological micropreparations of breast tissue from the archive of the "Grace Clinic" (Kyiv), with the mutual consent of patients who applied for repeated mammoplasty. The duration of the implants in the breast gland was from 6 to 20 years. The age range of the women was from 36 to 53 years. On preparations stained with hematoxylin and eosin, tissue biopsies of the glands of 9 patients with a diagnosis of deformation of silicone implants and violation of the integrity of their wall were presented. The micropreparations were visualized using a UlabXSP-137TLED light microscope at various magnifications and photographed with an XCAM 1080P camera. The study of histological preparations of soft tissues of the breast glands, from which silicone implants were removed, established changes in stromal-cellular elements, namely: decorated fibrous structures accumulated in the form of dense capsules with elements of local contractures; from the side of cellular elements, the most demonstrative were cellular infiltrates, which included macrophages, lymphocytes, and plasma cells, which indicated a high probability of a chronic inflammatory process. A large number of giant multinucleated cells of foreign bodies were present in practically all examined sections, which indicated the impossibility of macrophages to complete phagocytosis with lysis of the phagocytosed material, which by its chemical composition is the silicone of the implant. All the described phenomena can be interpreted as a natural reaction of the tissues to the implant, the contents of which got into the soft tissues of the breast. Thus, the presence of numerous giant multinucleated cells of foreign bodies, dense capsules with elements of local contractures, and a significant predominance of macrophages, lymphocytes, and plasma cells in cellular infiltrates over other cellular elements can be considered a morphological criterion for the reaction of breast tissue to silicone implant damage.

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Section: Discussionmentioning

confidence: 99%

Stromal-cellular remodeling of breast tissue after silicone implant damage

Dadayan,

Adamovych,

Simonov

et al. 2024

Rep. of Morph.

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“…Simultaneously, the risk stratification for BIA-ALCL and the assessment of potential risk factors for implant rupture holds paramount importance in terms of preoperative diagnosis and formulation of treatment plans, as mentioned within these papers. [ 24 , 25 ] Additionally, this patient’s treatment process highlights the need for further research in order to establish clear diagnostic criteria for complications related to prostheses.…”

Section: Discussionmentioning

confidence: 99%

Severe capsular contracture in a patient with a history of multiple malignancies – Hematoma or neoplasm recurrence?: A case report

Yuan,

Du,

Xiao

et al. 2024

Medicine

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Rationale: Complications associated with breast implants pose a significant obstacle to improving the quality of life for patients undergoing implant-based breast reconstruction. Due to the intricate nature of their presentation, diagnosis often becomes challenging and perplexing. Herein, we present a case report detailing the diagnostic and therapeutic processes employed in managing implant-related complications in a patient with multiple malignancies who underwent immediate breast reconstruction following mastectomy. Patent concerns: The patient, a 48-year-old woman, presented with severe pain and hardening in her left breast. She had previously undergone nipple-sparing mastectomy followed by immediate implant-based breast reconstruction 3 years ago. Diagnoses: Upon admission, we suspected a simple diagnosis of capsular contracture. However, upon investigation, she had a medical history of colon cancer, breast cancer, and acute B-lymphoblastic leukemia. Furthermore, she recently experienced nipple hemorrhage. Interventions: Considering her clinical manifestations, we postulated the possibility of tumor recurrence along with potential presence of breast implant-associated anaplastic large cell lymphoma. The situation took a new turn, as diagnostic imaging techniques including breast MRI, and ultrasound revealed indications of potential prosthesis rupture and periprosthetic infection. Outcomes: Ultimately, en bloc capsulectomy with implant removal was performed, revealing no evidence of implant rupture or infection but rather indicating delayed hematoma formation. Lessons: An accurate diagnosis of complications associated with breast prosthesis reconstruction is crucial for effective treatment. The examination and treatment processes employed in this case offer valuable insights toward achieving a more precise diagnosis of prosthesis-related complications, particularly in patients with complex medical histories.

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“…In our hands, autologous breast reconstruction is a suitable option given its durability and natural appearance, especially in the long term, due to the development of ptosis (Santosa et al , 2018). It has to be noted that the estimated rate for a change of implant rupture is 15% at 10 years and that the risk for capsular contracture for reconstruction patients is estimated between 19 and 25% (Hölmich et al ., 2003; Bachour, 2021; Paolini et al ., 2022). Both complications lead to reoperation for implant replacement, which in the case of younger women could mean more than one reoperation in their lifetime.…”

Section: Prophylactic Mastectomy In Healthy Womenmentioning

confidence: 99%

Comment on postmastectomy breast reconstruction for women with hereditary gastric and breast cancer syndrome

Berben

Hulst

2023

European Journal of Cancer Prevention

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With great interest, we have read the article 'Postmastectomy Breast Reconstruction for Women with Hereditary Gastric and Breast Cancer Syndrome' by De Lorenzi et al. (2023). The authors present a narrative review on their most used approaches for breast reconstruction in patients with hereditary gastric and breast cancer syndrome. The most extensively studied hereditary cancer syndromes (HCS) are BRCA1-and BRCA2-associated. Other genes, besides CDH1, that are associated with HCS, are TP53 in Li-Fraumeni syndrome, Phosphatase tensin homolog (PTEN) in Cowden syndrome, mismatch repair genes in Lynch syndrome, STK11 in Peutz-Jeghers syndrome, and NF1 in neurofibromatosis type 1 syndrome (Corso et al., 2020;Piombino et al., 2020). The authors structure their article, based on three different groups of women with hereditary breast cancer. First, they provide an overview of healthy women seeking prophylactic mastectomy, then for the group of women with breast cancer, requiring mastectomy of the affected breast and prophylactic mastectomy of the contralateral breast, and lastly, the women who underwent breast-conserving treatment, followed by adjuvant radiotherapy, who opt for risk-reducing mastectomies and reconstruction after radiotherapy. For us, it is unclear why the authors present the surgical approach for breast reconstruction specifically for women with a CDH1 genetic mutation, as the three scenarios presented are applicable to all women who opt for preventive mastectomy.De Lorenzi et al. (2023) achieve great results mainly using implant-based reconstruction. Due to extensive negative media attention on silicone breast implants in the Netherlands, the preference of a significant number of patients in our center has shifted towards autologous breast reconstruction. The Maastricht University Medical Center (MUMC+) is an expert center for autologous (tertiary) breast reconstruction and therefore our approach differs in certain parts from the approach of the authors. In this comment, we would like to elucidate the differences and illustrate our approach.

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Assessment of Risk Factors for Rupture in Breast Reconstruction Patients with Macrotextured Breast Implants

Cited by 11 publications

References 40 publications

Stromal-cellular remodeling of breast tissue after silicone implant damage

Stromal-cellular remodeling of breast tissue after silicone implant damage

Severe capsular contracture in a patient with a history of multiple malignancies – Hematoma or neoplasm recurrence?: A case report

Comment on postmastectomy breast reconstruction for women with hereditary gastric and breast cancer syndrome

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