Combined Breast Implant Explantation and Multilevel Mastopexy Technique

Borenstein, Amiram; Friedman, Or

doi:10.1097/gox.0000000000002429

Cited by 14 publications

(14 citation statements)

References 5 publications

(7 reference statements)

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“…Due to the rising number of patients with breast implants, the number of revision surgeries may be expected to remain at least constant. Data concerning the actual revision surgery performed are comparably sparse [7, 12-18, 28], while complications leading to revision surgery are intensely analyzed and widely published. As Boer et al [7] stated “very few studies deal with the type of reconstruction of explanted breasts… more research should be done regarding this issue.” Besides the type of reconstruction performed after implant removal, our study examined the rate at which explantations were performed in the first place, as well as looking into the additional surgical procedures performed in order to reconstruct the breast.…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…Besides the replacement of a complication-inducing breast implant with a new implant, patients may also opt for a definite removal of the breast implant. Such indications and further consequences of definite explantation of breast implants have been explored by several publications [7, 12-18]. Medical indications but also patient choices may vary concerning the treatment of implant complications.…”

Section: Introductionmentioning

confidence: 99%

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Implant Replacement or Removal: What Happens after Capsular Contracture? A German Study Examining Breast Implant Revision Surgery and Patient Choices in 946 Cases

et al. 2020

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Introduction: Capsular contracture most often leads to implant revision surgery for aesthetic or reconstructive purposes. However, little is known about which operation is chosen when revision surgery has to be performed. We performed analysis of revision indications and performed revision surgery considering implant removal or replacement and additional surgical procedures. To our knowledge, this study presents the largest German single-center analysis regarding implant revision surgery after the onset of complications. Methods: Retrospective 10-year data analysis of a single-center population undergoing breast implant revision surgery. Results: Capsular contracture was the most frequent finding before reoperation, both removal and replacement (p < 0.05). It was linked to longer duration of in situ implant placement (p < 0.05) and more frequently in reconstructive patients (p < 0.05). Implant replacement was performed more often before definite implant removal for reconstructive patients (p < 0.05). Mean duration of in situ implant placement before definite removal was lower for reconstructive patients (p = 0.005). Overall reconstructive patients were older than aesthetic patients (p < 0.05). After implant removal, 61.7% of aesthetic patients chose to undergo mastopexy, 54.7% of reconstructive patients opted for autologous breast reconstruction, and 25.4% did not choose an additional surgical procedure after implant removal. Conclusion: Significant differences are observed for reconstructive and aesthetic patients regarding indication leading to revision surgery, time of revision surgery, and the type of performed revision surgery itself. After implant removal, more than 60% of aesthetic patients undergo mastopexy, more than half of reconstructive patients choose autologous breast reconstruction, and over a quarter of patients choose no additional surgical procedures.

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Section: Discussion/conclusionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Implant Replacement or Removal: What Happens after Capsular Contracture? A German Study Examining Breast Implant Revision Surgery and Patient Choices in 946 Cases

et al. 2020

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“…The complications associated with FBR are not limited to implantable devices used for medical or therapeutics purposes, but also in cosmetic or reconstructive surgeries. Placement of reconstructive or esthetic breast implants is one of the most common procedures performed in plastic surgery [ 29 , 30 ], with >330,000 implant surgeries performed in the US alone in 2020 [ 31 ]. Several complications have been reported with such procedures, including hematoma, seroma, asymmetry, scarring, swelling, and rupture [ 32 ].…”

Section: Clinical Complications With Implantsmentioning

confidence: 99%

Implant Fibrosis and the Underappreciated Role of Myofibroblasts in the Foreign Body Reaction

Noskovičová

Hinz

Pakshir

2021

Cells

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Body implants and implantable medical devices have dramatically improved and prolonged the life of countless patients. However, our body repair mechanisms have evolved to isolate, reject, or destroy any object that is recognized as foreign to the organism and inevitably mounts a foreign body reaction (FBR). Depending on its severity and chronicity, the FBR can impair implant performance or create severe clinical complications that will require surgical removal and/or replacement of the faulty device. The number of review articles discussing the FBR seems to be proportional to the number of different implant materials and clinical applications and one wonders, what else is there to tell? We will here take the position of a fibrosis researcher (which, coincidentally, we are) to elaborate similarities and differences between the FBR, normal wound healing, and chronic healing conditions that result in the development of peri-implant fibrosis. After giving credit to macrophages in the inflammatory phase of the FBR, we will mainly focus on the activation of fibroblastic cells into matrix-producing and highly contractile myofibroblasts. While fibrosis has been discussed to be a consequence of the disturbed and chronic inflammatory milieu in the FBR, direct activation of myofibroblasts at the implant surface is less commonly considered. Thus, we will provide a perspective how physical properties of the implant surface control myofibroblast actions and accumulation of stiff scar tissue. Because formation of scar tissue at the surface and around implant materials is a major reason for device failure and extraction surgeries, providing implant surfaces with myofibroblast-suppressing features is a first step to enhance implant acceptance and functional lifetime. Alternative therapeutic targets are elements of the myofibroblast mechanotransduction and contractile machinery and we will end with a brief overview on such targets that are considered for the treatment of other organ fibroses.

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“…45 Insufficient breast tissue, poor quality skin, and radiation history are also thought to negatively impact success of soft-tissue redistribution techniques. 26 Many patients with a history of implants will have the poorest quality tissue in the inferior pole, through mechanical pressure and aging, particularly if implants have been present for many years, making them poor candidates for many described autoaugmentations. 35,46 Some authors suggest algorithms incorporating hosts of incisions and soft-tissue rearrangements based on preoperative anatomical presentations.…”

Section: Smentioning

confidence: 99%

“…19,48 Of course, this carries additional scar burdens. 26 This is most frequently used for postmastectomy patients, but it has been reported in augmentation patients also. 19,48 Authors also explore reintroduction of volume using other materials.…”

Section: Smentioning

confidence: 99%

Adjunctive Procedures and Informed Consent with Breast Implant Explantation

Manahan

2021

Plastic &Amp; Reconstructive Surgery

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Background: The use of injectable or implantable materials or devices in the breast for augmentation or reconstruction has a history of innovation and controversy. Staying current in the field of breast implant management today means understanding not just the published literature but also its absence. Cutting edge breast implant treatment also means awareness of patient and media-driven interests and requests. Methods: Adjuvant treatments to optimize physical and psychological wellbeing with breast implant explantation, without replacement, will be addressed through literature review and analysis. Results: The body of literature demonstrates evidence of variable, and sometimes contradictory, methods to address adjunctive management of systemic concerns, the capsule, soft tissue of the native breast/chest, and treatment timing related to explantation. Few approaches are supported by very strong evidence. Many treatment methodologies are defensible. Any current attempts at optimizing management in patients undergoing explantation will be somewhat impaired by the ongoing nebulousness of related issues, such as breast implant illness. It seems clear, therefore, that plastic surgeons must fulfill their duty as caregivers to provide explantation surgery, either to attempt to improve physical health, mental well-being, or simply to respect patients' wishes. A wellinformed surgeon will likely employ a variety of approaches, adapted to the unique patient presentations at hand. Conclusion: It is expected that consultations, incisions, tissue rearrangements, surgical timing, and treatment indications will continue to vary as scientific investigation strives to understand and to optimize treatment of patients experiencing difficulty with breast implants.

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Combined Breast Implant Explantation and Multilevel Mastopexy Technique

Abstract: Supplemental Digital Content is available in the text.

Cited by 14 publications

References 5 publications

Implant Replacement or Removal: What Happens after Capsular Contracture? A German Study Examining Breast Implant Revision Surgery and Patient Choices in 946 Cases

Implant Replacement or Removal: What Happens after Capsular Contracture? A German Study Examining Breast Implant Revision Surgery and Patient Choices in 946 Cases

Implant Fibrosis and the Underappreciated Role of Myofibroblasts in the Foreign Body Reaction

Adjunctive Procedures and Informed Consent with Breast Implant Explantation

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