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Breast Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Gaural Patel, Lucy Kate Satherley, Animesh JK Patel, Georgina SA Phillips
If the patient had no suitable donor sites for lipomodelling, what other volume replacement techniques could you consider?Latissimus dorsi myocutaneous or miniflap (myosubcutaneous flap based on thoracodorsal pedicle) or ICAP (intercostal artery perforator) flap Donor-site morbidity, long scar, suitable vessels available (may be damaged with axillary surgery)Pedicled TRAM flap (transverse rectus abdominis myocutaneous) Increased risk of fat necrosis, abdominal wall herniaImplant reconstruction Risk of capsular contracture; may limit subsequent mammographic surveillance
Biological reactions to reconstructive materials
Published in Steven J. Kronowitz, John R. Benson, Maurizio B. Nava, Oncoplastic and Reconstructive Management of the Breast, 2020
Steven J. Kronowitz, John R. Benson, Maurizio B. Nava
ASCs are thought to have specific beneficial effects on radiotherapy-induced skin and soft tissue changes in breast cancer patients. Significant improvements in subcutaneous fibrosis, skin atrophy, and even radiation-induced ulceration following injections with purified lipoaspirate have been reported. Interestingly, autologous fat grafting has also been shown to minimize the risk of severe capsular contracture that is often seen with implant-based breast reconstruction following radiotherapy. Similarly, reduction in the severity of capsular contracture in patients who have previously undergone implant-based reconstruction has also been demonstrated. Although the underlying mechanisms for these clinical observations remain poorly understood, ASCs have been implicated.
Breast
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
How you define the condition, as well as the time span studied, affects the incidence; also consider the fact that implant designs have changed over time. New implants seem to be less prone to capsular contracture.
In search for the ‘perfect’ breast implant: are textured implants still indicated in today’s breast augmentation practice?
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Paolo Montemurro, Mubashir Cheema, Per Hedén
In total, 113 patients (11.0%) developed a complication postoperatively (Table 1). These represented 15.1% (n = 29) of patients with round implants and 10.0% (n = 84) of those with anatomical implants (not statistically significant, p-value = .07). Among all patients, in 27 cases (2.6%) the implants ‘bottomed out’ at a mean 10.7 months after augmentation (range, 5 to 39 months). Six patients (0.6%) developed a ‘double bubble’ deformity at a mean 14.0 months of follow up (range, 6 to 58 months). 33 patients (3.2%) developed capsular contracture (CC) at an average 35.6 months (range, 3 to 112 months). Ten patients (1.0%) developed postoperative hematomas that were managed surgically. There were 12 (1.2%) small volume uncomplicated seromas that were aspirated with ultrasound guidance and managed according to existing protocol. In 29 patients (3.4% of) the anatomical implants mal-rotated at a mean 13.4 months after surgery (range 3 to 48 months). Tables 1 and 2 give the breakdown of complications for implant with respect to their shapes and surfaces.
Histopathological evaluation of the effect of hyperbaric oxygen therapy on capsule occurrence around silicone breast prosthesis: an experimental study
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Serhat Yarar, Abdullah Arslan, Bilsev Ince, Mehmet Emin Cem Yildirim, Pembe Oltulu, Ilker Uyar, Mehmet Dadaci
According to this principle, it is known that the capsule becomes thick around the silicone implant and is contracted around silicon, causing distortion of the implant [3]. Although several factors such as bacterial colonization, occurrence of hematoma, implant surface properties, mobilization, and radiation have been proposed as the causes of capsular contracture, its etiology and pathogenesis are still not fully understood [4]. However, it has been argued in the literature that capsule contracture develops by reorganization of collagen around the implant. Many different methods have been tested to prevent development of capsule contracture including irrigation of the pouch with various agents, antibiotherapy, the use of fibrin glue, prevention of possible hematoma, lining the external silicone surfaces with materials of different properties, insertion of the prosthesis in different anatomic localization and even fat grafts, and application of acellular dermal matrix [5,6]. There are studies in the literature that suggest drugs such as triamcinolone, rifampicin, verapamil, and zafirlukast decrease capsule contracture [7–9].
Novel Histopathologic and Immunohistochemical Observations in Explanted Orbital Peri-implant Capsules
Published in Current Eye Research, 2021
Tarjani Vivek Dave, Dilip Kumar Mishra, Vivek Singh, Sonali Kumar, Noopur Mitragotri, B Sridhar Rao
Our anecdotal observation during socket surgeries involving orbital spherical implant exchange either for cosmetic indications or for implant exposure revealed the existence of such hitherto unreported capsules. Capsular contracture around breast implants has been known to be a distressing and an unpredictable complication.4 On histopathologic examination, these capsules demonstrate an increase in inflammatory cells and foreign body granulomas.9 The postulated mechanism for non-porous orbital implant exposure and extrusion are (i) socket infection leading to a breakdown in the barrier to implant exposure, i.e. the conjunctiva, tenons, and sclera, (ii) tension on the wound closure and (iii) repeated disruption of orbital anatomy such as following secondary implant placement.10 However, the exact mechanism for delayed implant exposure and extrusion has not been elucidated. We hypothesize a possible role of peri-implant capsules in delayed orbital implant exposure and extrusion and hence undertook this study to look for the histopathologic and immunohistochemical properties of these capsules.