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BACKGROUND: Capsular contracture (CC) remains a very common complication and the main cause of reoperation following a mammary implant surgery. Leukotrienes play an important role in the inflammatory cascade linked to the development of the periprosthetic capsule. The aim of this paper is to evaluate the incidence of recurrence of capsular contracture in female patients who underwent a secondary mammary augmentation due to this etiology, with and without treatment with leukotriene inhibitors during postoperative care. MATERIAL AND METHODS: Sixty-four women submitted to a secondary mammary augmentation due to CC were evaluated retrospectively. Out of these patients, 20 (31%) were treated with Montelukast for 3 months. The remaining 44 (69%) did not receive antileukotriene. The presence of capsular contracture was measured using the Baker classification and magnetic resonance imaging a year after postoperative care. The median follow-up period was 15 months. RESULTS: The patients receiving Montelukast (n = 20) presented a 15% CC rate (n = 1). The women that did not receive antileukotriene therapy (n = 44) presented a 16% CC rate (n = 7). CONCLUSION: The results of our study show that treatment with Montelukast for 3 months after the operation is associated with lower rates of capsular contracture when compared to patients that did not receive the treatment. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Introdução: A mamoplastia de aumento é uma das cirurgias plásticas mais realizadas no mundo. Tendo em vista sua alta aplicabilidade, é fundamental conhecer os fatores de risco relacionados à incidência de complicações pós-operatórias a fim de reduzilas nesse tipo de procedimento. Método: Este estudo é retrospectivo feito por meio da análise dos prontuários de 76 pacientes que realizaram mamoplastia de aumento primária com implantes de silicone durante os meses de janeiro de 2018 a dezembro de 2020. Resultados: Observou-se que a presença de comorbidades aumentou a incidência de complicações pós-operatórias precoces (p<0,001), mas não de complicações pósoperatórias tardias (p=0,8). O maior tempo cirúrgico também aumentou a incidência de complicações pós-operatórias (p=0,005). Conclusão: A presença de comorbidades influencia diretamente na incidência de complicações pós-operatórias da mastoplastia de aumento e por esta razão deve-se realizar uma adequada compensação pré-operatória antes de submeter as pacientes a este procedimento cirúrgico.
Introduction: Breast augmentation is one of the most performed plastic surgeries in the world. Given its high applicability, it is essential to know the risk factors related to the incidence of postoperative complications to reduce them in this type of procedure. Method: This retrospective study analyzed the medical records of 76 patients who underwent primary breast augmentation with silicone implants from January 2018 to December 2020. Results: It was observed that the presence of comorbidities increased the incidence of early postoperative complications (p<0.001) but not of late postoperative complications (p=0.8). Longer surgical time also increased the incidence of postoperative complications (p=0.005). Conclusion: The presence of comorbidities directly influences the incidence of postoperative complications after breast augmentation, and for this reason, adequate preoperative compensation must be carried out before submitting patients to this surgical procedure.
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OBJECTIVE: To determinate the prevalence of the main risk factors associated with development of capsular contracture after placement of breast implants in a referral center. METHOD: Retrospect study on 210 patients where sociodemographic variables, Baker's clinical scale and histopathological results were recorded. RESULTS: Statistical analysis of 210 patients was performed; 98.1% were women. The average age was 47 years (± 11), body mass index 25 (± 10) and onset of symptoms 13 years (± 8.5). Sociodemographic factors: domestic work 63.3%. Alcoholism 70% and smoking 65.7%. The main reason for consultation was pain plus deformity in 81.6%. The risk factors with statistical significance were the history of trauma, with 83.3% (p = 0.004), and the subglandular plane, with 73.8% (p = 0.0115). Histopathology: fibrous capsule 81.4%. CONCLUSIONS: The prevalence of the risk factors described are similar to those reported in the literature. Only for the history of trauma and the subglandular plane there was statistical significance.
OBJETIVO: Determinar la prevalencia de los principales factores de riesgo asociados a contractura capsular posterior a mamoplastia de aumento en un centro de referencia. MÉTODO: Estudio retrospectivo de 210 pacientes en el que se registraron variables sociodemográficas, escala clínica de Baker y resultados histopatológicos. RESULTADOS: Se realizó el análisis estadístico de 210 pacientes; el 98.1% fueron mujeres. La edad promedio fue de 47 años (± 11), el índice de masa corporal 25 kg/m2 (± 10) y el inicio de los síntomas 13 años (± 8.5). Factores sociodemográficos: labores domésticas 63.3%. Alcoholismo 70% y tabaquismo 65.7%. El principal motivo de consulta fue dolor más deformidad, en el 81.6%. Los factores de riesgo con significancia estadística fueron el antecedente de traumatismo, con un 83.3% (p = 0.004), y el plano subglandular, con un 73.8% (p = 0.0115). Histopatología: cápsula fibrosa 81.4%. CONCLUSIONES: La prevalencia de los factores de riesgo descritos es similar a lo reportado en la literatura. Solo para el antecedente de traumatismo y el plano subglandular hubo significancia estadística.
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Implantes de Mama , Contractura , Humanos , Femenino , Persona de Mediana Edad , Masculino , Implantes de Mama/efectos adversos , Prevalencia , Factores de Riesgo , Fumar/efectos adversos , Fumar/epidemiologíaRESUMEN
Resumen Existe un gran número de enfermedades del tejido mamario que tienen patrones radiológicos específicos y hallazgos imagenológicos concretos. No obstante, el linfoma anaplásico de células gigantes asociado a implantes mamarios (LACG-AIM) es una enfermedad con hallazgos poco específicos que ha presentado un aumento en su incidencia debido al crecimiento exponencial de la mamoplastia de aumento a lo largo de los años en todo el mundo, así como al uso de implantes tanto en cirugía estética como reconstructiva. En este artículo se realiza una revisión de la epidemiología, etiología, fisiopatología y diagnóstico del LACG-AIM. Se plantean hallazgos radiológicos sugestivos de esta enfermedad, lo que permite al radiólogo aportar información al equipo tratante para el diagnóstico y la planificación quirúrgica en caso de ser necesario.
Abstract There are many diseases related to breast tissue that have specific radiological patterns and imaging findings. However, anaplastic large cell lymphoma associated with breast implants is a condition with nonspecific findings that has an increased incidence due to the exponential growth worldwide of augmentation mammoplasty over the years and the use of implants in aesthetic and reconstructive surgery. In this article, a review of the epidemiology, etiology, pathophysiology, and diagnosis of this disease is carried out, highlighting radiological findings suggestive of this disease, which allows the radiologist to provide information to the treating team for diagnosis and surgical planning if necessary.
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Introduction: The search for an anatomical substitute for the breast, for the purpose of correcting aesthetic problems has a long history of failure until the arrival of silicone. Since the beginning of its use, in the 1960s, many complications have appeared, such as infection, rejection, rupture, in addition to silicone leakage. We did not find in the literature, however, any report on the passage of materials from the human organism to the interior of implants. The objective is to identification by infrared spectrophotometry (FTIR) and clinical analysis, reporting the passage of organic substances into breast implants without any violation of their capsule. Methods: 1500 pairs of breast implants were analyzed, surgically removed from 1998 to 2018. Of which six were included in the study. Results: Three materials were analyzed showing macroscopic changes in their interior, without violating the capsule. A second sample was performed on a similar implant, but without use. The third material was a sample of fatty breast tissue removed from the patient during the surgery. Materials compatible with fat, animal protein and hemoglobin were found inside the implant. Conclusions: The change evidenced in the material inside the two implants indicates the occurrence of the passage of organic materials through an intact capsule.
Introdução: A busca de um substituto anatômico para a mama, para fins de correção de problemas estéticos, tem longa história de insucessos até a chegada do silicone. Desde o início de seu uso, na década de 1960, muitas complicações surgiram, como infecção, rejeição, rotura, além do extravasamento de silicone. Não encontramos na literatura, porém, relato algum sobre a passagem de materiais do organismo humano para o interior de implantes. O objetivo é a identificação por espectrofotometria de infravermelho (FTIR) e análise clínica, relatando a passagem de substâncias orgânicas para o interior de implantes mamários sem que os mesmos apresentem violação qualquer de sua cápsula. Método: Foram analisados 1500 pares de implantes mamários, removidos cirurgicamente no período de 1998 a 2018. Destes, seis foram encaminhados incluídos no estudo. Resultados: Foram analisados três materiais apresentando alterações macroscópicas em seu interior, sem que houvesse violação da cápsula. Uma segunda amostra foi realizada em implante semelhante, porém sem uso. O terceiro material foi uma amostra de tecido gorduroso mamário removido da própria paciente durante o ato cirúrgico. Foram encontrados materiais compatíveis com gordura, proteína animal e hemoglobina no interior do implante. Conclusões: A alteração evidenciada no material do interior dos dois implantes nos indica a ocorrência de passagem de materiais orgânicos através de cápsula intacta.
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Introdução: A descrição do linfoma anaplásico de células T e o recente aumento das cirurgias de explante resultou na elevação do número de exames anatomopatológicos nas cirurgias de retirada de implantes mamários de silicone. O objetivo desta pesquisa é analisar a qualidade e quantidade de dados contidos na requisição do exame histopatológico. Métodos: Foram estudados 251 casos. Os seguintes dados foram analisados: sexo, idade, localização anatômica e espacial, lateralidade, história clínica, sinais e sintomas, quimioterapia e radioterapia prévia, hipótese diagnóstica, cirurgias prévias, tipo e marca do implante, exames de imagem prévios e número e características dos espécimes enviados. Resultados: A idade média foi de 43 anos. A lateralidade não foi mencionada em 16 (0,84%). A localização anatômica foi citada em 15 casos. O tipo de cirurgia foi mencionado por 40 (15,94%). O número de contêineres variou de 1 a 5, com mediana de 2. A cápsula foi enviada em 242 casos, em 161 de forma isolada, tecido mamário em conjunto com cápsula em 27, tecido mamário e cápsula em contêineres diferentes em 54 casos. A história clínica foi incluída em 19,12%, sinais e sintomas em 13,94%, em que a contratura foi o único termo inserido em 64. Em 27 requisições foi citado linfoma. Em 15 pacientes a presença de seroma foi referida e destes nove foram enviados. O tipo e marca do implante não foi citado. Conclusão: Os dados são escassos. Recomenda-se a criação de protocolos na retirada da cápsula e tecido adjacente, incluindo a orientação anatômica e espacial.
Introduction: The description of the Anaplastic Large Cell Lymphoma and the explantation surgery resulted in an increase of histopathological exams in breast implant removing surgery. Methods: 251 pathology requests were studied. The following data from the medical requests were analyzed: gender, age, type of surgery, number of specimens containers sent, laterality, anatomical and spatial location, clinical history, signs and symptoms, previous radiotherapy, previous chemotherapy, diagnostic hypothesis, previous surgeries, and reference to previous breast exams. Results: The mean age was 43 years old. Laterality was not mentioned in 16 requests. The surgery performed was mentioned in 15.94% requests. The number of containers varies from 1 to 5, with a median of 2. The containers include capsules in 242 cases, 161 as isolated capsule, 27 mammary tissue, and capsule in the same specimen, 54 mammary tissues sent in a separate container, anatomical and spatial location was mentioned in 6.33% cases. The detailed clinical data was included in 19.12%, signs and symptoms 13.94%, contracture as the only item mention in 64 of them. In 27 requests, lymphoma evaluation was requested. 15 included seroma and from nine of those, liquid was sent with a request for immunohistochemical and cytology analysis. None of the requests had any data on implant type or brand. Conclusion: The amount of information contained in the medical request forms is minimal. The authors recommend the need for a protocol to standardize the surgical removal of the capsule and the adjacent mammary tissue. Surgical specimens should be spatially oriented.
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Introdução: Em 1963 Cronin e Gerow introduziram o uso do implante de silicone e seu uso aumentou exponencialmente. Contudo, complicações relacionadas aos implantes surgiram ao longo do tempo. O conjunto de situações adversas ao uso dos implantes de silicone, alimentado pelo crescimento das mídias sociais, culminou em um aumento da retirada definitiva do implante. Muitos casos de explante têm o pedículo inferior comprometido pela lesão dos vasos perfurantes e a técnica dos retalhos cruzados é uma alternativa para a reconstrução das mamas explantadas. Métodos: Foram realizados explantes de silicone com reconstrução imediata da mama sem o uso de um novo implante, motivados por indicação médica ou por desejo próprio do paciente. A técnica dos retalhos cruzados foi utilizada em todos os casos. Ela se vale do cruzamento de retalhos parenquimatosos de pedículo superior, um medial e outro lateral, conforme descrito por Sperli. Resultados: Foram operados 10 casos de 2004 a 2021. O tempo de uso das próteses variou de 3 a 19 anos e a principal motivação para o explante foi contratura capsular. Nenhum caso de necrose foi observado. Conclusões: A técnica dos retalhos cruzados é uma alternativa útil e segura para as cirurgias de reconstrução da mama após explante definitivo.
Introduction: In 1963 Cronin and Gerow introduced the use of the silicone implant and its use increased exponentially. However, complications related to implants emerged over time. The set of adverse situations to the use of silicone implants fueled by the growth of social media culminated in an increase in the permanent removal of the implant. Many cases of explants have the inferior pedicle compromised by injury to the perforating vessels, and the crossed flap technique is an alternative for the reconstruction of explanted breasts. Methods: Silicone explants were performed with immediate breast reconstruction without the use of a new implant, motivated by medical indication or the patients own desire. The crossed flap technique was used in all cases. It uses the crossing of parenchymal patches of the superior pedicle, one medial and one lateral, as described by Sperli. Results: 10 cases were operated from 2004 to 2021. The time of use of the prostheses ranged from 3 to 19 years and the main motivation for the explant was capsular contracture. No cases of necrosis were observed. Conclusions: The crossed flap technique is a useful and safe alternative for breast reconstruction surgeries after definitive explantation.
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Introdução: O aumento mamário é um procedimento estético frequente na cirurgia plástica, o plano ideal ainda não foi encontrado. Cada loja tem sua indicação, suas vantagens e desvantagens. A técnica da loja intramuscular foi inicialmente descrita para uso em cirurgias de aumento dos glúteos com implantes de silicone, e mais tarde sua segurança foi reforçada com a utilização do método XYZ. O estudo tem a finalidade de apresentar a utilização da técnica intramuscular na mamoplastia de aumento com implante de silicone. Métodos: Este estudo descreve em detalhes a técnica da loja intramuscular na mamoplastia de aumento com implante de silicone, utilizada em 50 pacientes do sexo feminino. Resultados: A técnica intramuscular propicia uma boa definição de contorno estético nos quadrantes mediais das mamas. Tivemos um caso de seroma no pós-operatório, causado por erro técnico na separação dos fascículos. Conclusão: A técnica é segura e apresenta baixa incidência de complicações.
Introduction: Breast augmentation is a frequent aesthetic procedure in plastic surgery; the ideal plane has not yet been found. Each pocket has its indication, its advantages, and disadvantages. The intramuscular pocket technique was initially described for use in buttock augmentation surgeries with silicone implants, and later its safety was reinforced with the use of the XYZ method. This study aims to present the use of the intramuscular technique in breast augmentation with a silicone implant. Methods: This study describes the intramuscular pocket technique in breast augmentation with a silicone implant used in 50 female patients. Results: The intramuscular technique provides a good definition of aesthetic contour in the medial quadrants of the breasts. We had a case of seroma in the postoperative period caused by a technical error in separating the fascicles. Conclusion: The technique is safe and has a low incidence of complications.
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BACKGROUND: We aimed to compare inflammatory and intercellular transcription responses induced by surface textured (ST) implants versus foam covered (FC) silicone implants placed on the dorsal aspect of rats. METHODS: We utilized 80 female rats of the Wistar lineage. The rats were divided into four subgroups of 20 with one type of implant placed in the dorsum per rat. Analysis was carried out on peri-implant capsules at 90 d and at 180 d post-surgery with microscopic evaluation of inflammatory and immuno-histochemical response of NF-κB-p65 and α-SMA in fibroblasts. This study was carried out at the Evangelical Faculty of Parana and at the Ivo Pitanguy Institute, Brazil in 2015. RESULTS: The FC exhibited higher levels of acute and chronic inflammation on evaluation in both time frames. The capsule surrounding the ST implants was significantly thicker with well-organized collagen fibres. NFκB-p65 expression in the capsule surrounding the FC implant was more pronounced. There was higher and more significant α-SMA expression in the capsules of the surface textured (ST) silicone implants compared to the foam-covered (FC) silicone implants. CONCLUSION: Activation of NFκB-p65 plays a key role in the evolution of capsule formation and maintenance of inflammation by regulating the healing process. Similarly, higher and more prolonged levels of inflammation (increased NF-κB-p65 results in increased inflammation) and lower α-SMA (higher α-SMA is protective against capsular contracture) did not directly translate to a thicker capsule and ultimately, capsular contracture in foam covered silicone implants.
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Abstract Objective: Breast surgery is considered a clean surgery; however, the rates of infection range between 3 and 15%. The objective of the present study was to intraoperatively investigate the presence of autochthonous microbiota in the breast. Methods: Pieces of breast tissue collected from 49 patients who underwent elective breast surgery (reconstructive, diagnostic, or oncologic) were cultured. The pieces of breast tissue were approximately 1 cm in diameter and were removed from the retroareolar area, medial quadrant, and lateral quadrant. Each piece of tissue was incubated in brain heart infusion (BHI) broth for 7 days at 37°C, and in cases in which the medium became turbid due to microorganism growth, the samples were placed in Petri dishes for culturing and isolating strains and for identifying species using an automated counter. Results: Microorganism growth was observed in the samples of 10 of the 49 patients (20.4%) and in 11 of the 218 pieces of tissue (5%). The detected species were Staphylococcus lugdunensis, Staphylococcus hominis, Staphylococcus epidermidis, Sphingomonas paucimobilis, and Aeromonas salmonicida. No patient with positive samples had clinical infection postoperatively. Conclusion: The presence of these bacteria in breast tissue in approximately 20% of the patients in this series suggests that breast surgery should be considered a potential source of contamination that may have implications for adverse reactions to breast implants and should be studied in the near future for their oncological implications in breast implant-associated large-cell lymphoma etiology.
Resumo Objetivo: A cirurgia de mama é considerada uma cirurgia limpa; entretanto, as taxas de infecção variam entre 3 e 15%. O objetivo deste estudo foi investigar no intraoperatório a presença de microbiota autóctone na mama. Métodos: Pedaços de tecido mamário coletados de 49 pacientes submetidas à cirurgia eletiva da mama (reconstrutiva, diagnóstica ou oncológica) foram cultivados. Os pedaços de tecido mamário tinham aproximadamente 1 cm de diâmetro e foram removidos da área retroareolar e dos quadrantes medial e lateral. Cada pedaço de tecido foi incubado em caldo BHI (brain heart infusion) por 7 dias a 37 ° C, e nos casos em que o meio ficou turvo devido ao crescimento de microrganismos, as amostras foram colocadas em placas de Petri para cultivo e isolamento de cepas e para identificação de espécies usando um contador automatizado. Resultados: O crescimento do microrganismo foi observado nas amostras de 10 das 49 pacientes (20,4%) e em 11 dos 218 pedaços de tecido (5%). As espécies detectadas foram Staphylococcus lugdunensis, Staphylococcus hominis, Staphylococcus epidermidis, Sphingomonas paucimobilis e Aeromonas salmonicida. Nenhum paciente com amostras positivas apresentou infecção clínica no pós-operatório. Conclusão: A presença dessas bactérias no tecido mamário em aproximadamente 20% das pacientes desta série sugere que a cirurgia mamária deve ser considerada uma fonte potencial de contaminação que pode ter implicações nas reações adversas aos implantes mamários e deve ser estudada em um futuro próximo por suas implicações oncológicas na etiologia do linfoma de células grandes associado ao implante de mama.
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Humanos , Implantes de Mama , Microbiota , Bacterias , Mama/cirugíaRESUMEN
RESUMO Introdução: 40% dos pacientes submetidos à radioterapia após reconstrução de mama por implante de prótese de silicone podem desenvolver encapsulamento da prótese. Diversas estratégias já foram testadas para prevenir a contratura da cápsula com resultados insatisfatórios. Este estudo analisou o efeito do antileucotrieno (AL) tópico na formação de contratura capsular em ratos com implantes de silicone associados à irradiação. Métodos: Foram implantados blocos de silicone na região dorsal em 20 ratas fêmeas, espécie Wistar com peso variando de 200-250g. Os animais foram divididos em dois grupos: controle (injeção de solução fisiológica 0,9% no tecido ao redor do implante) e grupo intervenção (injeção de 10mg de AL no tecido ao redor do implante). Imediatamente após a cirurgia os animais foram irradiados com dose única de 10Gy. Após dois meses, coletamos amostras de cápsulas para análise histológica e análise da expressão gênica dos seguintes biomarcadores: iNOS, VEGF-a e MMP-9. Resultados: A densidade vascular foi menor no grupo AL quando comparado ao grupo controle (55,4±30,0 vs. 81,8±26,7, p=0,05, respectivamente). Da mesma forma, o VEGF-a teve o mesmo comportamento (grupo controle - 0,34±0,1 vs. grupo Al - 0,02±0,001, p=0,04). Conclusão: Este estudo sugeriu que o tratamento com AL diminui a angiogênese em animais submetidos a implantes de silicone e submetidos à radioterapia
ABSTRACT Introduction: 40% of patients undergoing radiotherapy after breast reconstruction by silicone prosthesis implant may develop prosthesis encapsulation. Several strategies have already been tested to prevent capsule contracture with unsatisfactory results. This study analyzed the effect of topical antileukotriene (AL) on capsular contracture formation in rats with silicone implants associated with irradiation. Methods: Silicone blocks were implanted in the dorsal region in 20 female rats Wistar with weights ranging from 200-250g. The animals were divided into two groups: control (injection of 0.9% saline solution into the tissue around the implant) and intervention group (injection of 10mg of AL into the tissue around the implant). Immediately after surgery, the animals were irradiated with a single dose of 10Gy. After two months, we collected capsule samples for histological analysis and gene expression analysis of the following biomarkers: iNOS, VEGF-a and MMP-9. Results: Vascular density was lower in the AL group when compared to the control group (55.4±30.0 vs. 81.8±26.7, p=0.05, respectively). Similarly, VEGF-a had the same behavior (control group - 0.34±0.1 vs. group Al - 0.02±0.001, p=0.04). Conclusion: This study suggested that treatment with AL decreases angiogenesis in animals submitted to silicone implants and underwent radiotherapy.
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RESUMO A mamoplastia com próteses é uma das cirurgias plásticas mais realizadas no mundo. O processo cicatricial ao redor do implante e a presença de um biofilme pode acarretar o desenvolvimento de patologias como contratura capsular e seroma. Essas patologias parecem estar relacionadas fisiopatologicamente com o desenvolvimento do linfoma associado aos implantes mamários (BIA-ALCL), sendo este também um diagnóstico diferencial. A proposta deste trabalho é relatar o caso de uma paciente com desconforto mamário, que após 2 cirurgias prévias para drenagem de seroma e troca de próteses, apresentava desconforto mamário e alteração em exames de imagens da mama esquerda. Sendo submetida a uma capsulectomia em bloco da mama esquerda e completa à direita, tendo suas próteses substituídas. Os exames para investigação de BIA-ALCL foram negativos e os achados patológicos foram sugestivos de contratura capsular à esquerda e formação de dupla cápsula à direita. O trabalho enfatiza a importância do diagnóstico diferencial em patologias mamárias, o acompanhamento a longo prazo e medidas de profilaxia na formação do biofilme.
Abstract Mammoplasty with prostheses is one of the most performed plastic surgeries in the world. However, the healing process around the implant and the presence of a biofilm can lead to the development of pathologies such as capsular contracture and seroma. These pathologies seem to be physiologically related to the development of lymphoma associated with breast implants (BIA-ALCL), which is also a differential diagnosis. The purpose of this study is to report the case of a patient with breast discomfort who, after two previous surgeries for seroma drainage and prosthesis replacement, presented breast discomfort and alteration in imaging of the left breast. She was, submitted to a capsulectomy in a block of the left breast and complete on the right, having her prostheses replaced. Bia-ALCL investigation tests were negative and pathological findings were suggestive of left capsular contracture and double capsule formation on the right. The study emphasizes the importance of differential diagnosis in mammary pathologies, long-term follow-up, and prophylaxis measures in biofilm formation.
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Introdução: As cirurgias de aumento de mamas com implantes de silicone estão entre os procedimentos de cirurgia plástica mais realizados. O objetivo desse estudo é avaliar os casos de pacientes com prótese de silicone, submetidas à mamoplastia secundária, apresentando uma alternativa de abordagem com ressecção em monobloco do tecido mamário, cápsula fibrosa e prótese de silicone; e o neoposicionamento do implante em loja retromuscular peitoral parcial. Métodos: Foram analisados 24 casos de mamoplastia secundária com neoposicionamento da prótese, apresentando os motivos da indicação da cirurgia e o detalhamento da abordagem cirúrgica para maior facilidade na execução do procedimento e a obtenção de resultados mais satisfatórios. Resultados: Todos os casos operados apresentavam alterações no exame físico das mamas, como: ptose mamária contratura capsular, posicionamento inadequado dos implantes e assimetrias mamárias. Nos casos estudados, as próteses com revestimento de poliuretano e sua completa adesão à cápsula fibrosa permitiram a ressecção mais prática, mesmo com variáveis graus de contratura capsular. As cápsulas fibrosas que envolviam implantes texturizados tinham características mais finas e a instabilidade das próteses, pela presença de seroma residual ou pelo excessivo tamanho da loja da prótese, desencadearam maior dificuldade na ressecção. Conclusão: A realização de mamoplastia secundária com troca de prótese, empregando a ressecção em monobloco e neoposicionamento do implante no espaço retromuscular peitoral parcial com suturas do músculo ao tecido mamário, oferece uma alternativa para otimizar o procedimento, maior estabilidade do músculo até completa cicatrização e a formação de nova cápsula fibrosa.
Introduction: Breast augmentation with silicone implants is one of the most common plastic surgery procedures. The objective of this study was to evaluate patients with previous silicone implantations undergoing secondary mammaplasty, presenting an alternative approach with en block resection of breast tissue, fibrous capsule, and silicone implant, followed by implant repositioning in the partial retropectoral pocket. Methods: This study included 24 cases of secondary mammaplasty with implant repositioning. It presents the indications for surgery and details the surgical approach for easier procedures and more satisfactory results. Results: All the included cases presented breast changes on physical examination, such as breast ptosis, capsular contracture, improper implant position, and breast asymmetry. In the studied cases, the use of polyurethane-coated implants and their complete adherence to the fibrous capsule resulted in a more practical resection even with varying degrees of capsular contracture. Fibrous capsules of textured implants were thinner, and implant instability due to the presence of residual seroma or pockets bigger than necessary resulted in more difficult resection. Conclusion: Secondary mammaplasty with en bloc resection, along with implant replacement and repositioning in the partial retropectoral pocket with sutures involving muscle and breast tissue is an alternative to optimize the procedure, providing greater muscle stability until complete healing and new fibrous capsule formation.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Anciano , Historia del Siglo XXI , Músculos Pectorales , Prótesis e Implantes , Cirugía Plástica , Mama , Estudios Retrospectivos , Mamoplastia , Implantación de Mama , Contractura Capsular en Implantes , Músculos Pectorales/cirugía , Prótesis e Implantes/efectos adversos , Cirugía Plástica/efectos adversos , Cirugía Plástica/métodos , Mama/cirugía , Mamoplastia/efectos adversos , Mamoplastia/métodos , Implantación de Mama/métodos , Implantación de Mama/rehabilitación , Contractura Capsular en Implantes/cirugíaRESUMEN
Introdução: A última pesquisa da Sociedade Internacional de Cirurgia Estética (ISAPS) mostrou que 2.524.115 cirurgias plásticas foram realizadas no Brasil em 2017. O aumento de mama tem sido um dos procedimentos plásticos mais comumente realizados no Brasil, totalizando mais de 200.000 cirurgias no ano de 2016. O objetivo é avaliar as práticas e tendências atuais em aumento de mama no Brasil. Métodos: Um questionário de 31 itens foi construído e enviado para 6.200 membros ativos da Sociedade Brasileira de Cirurgia Plástica (SBCP). A pesquisa abordou algumas tendências atuais e práticas controversas considerando cinco áreas: controvérsias atuais, novas tecnologias, implantes mamários, considerações técnicas em procedimentos secundários e aspectos demográficos. O questionário foi desenhado para delinear o perfil das práticas, procedimentos e crenças entre os cirurgiões plásticos sobre o uso dos implantes mamários no Brasil. Resultados: Foram coletadas 505 respostas, representando uma taxa de resposta em torno de 10%, bem acima da taxa média de resposta de um questionário da SBCP. Os resultados foram distribuídos em 5 tabelas de acordo com as áreas de interesse. Conclusão: Nesta pesquisa, as práticas mais comuns incluíram o uso de implantes redondos de microtextura e silicone revestido com poliuretano no procedimento primário, poket subglandular, incisões inframamárias, dimensionamento pré-operatório com amostras de implante redondas, antibióticos intravenosos e orais, irrigação com duplo antibiótico, implante faixa de tamanho geralmente menos 325cc e sem drenagem. Não há consenso sobre a lipotransferência mamária e o manejo da contratura capsular e da deformidade da bolha dupla.
Introduction: The latest research by the International Society of Aesthetic Plastic Surgery (ISAPS) showed that 2,524,115 plastic surgeries were performed in Brazil in 2017. Breast augmentation has been one of the most commonly-performed plastic procedures in Brazil, totaling more than 200,000 surgeries in 2016. The objective is to evaluate the current practices and trends in breast augmentation in Brazil. Methods: A 31- item questionnaire was constructed and sent to 6,200 active members of the Brazilian Society of Plastic Surgery (SBCP). The research addressed some current trends and controversial practices in five areas: current controversies, new technologies, breast implants, technical considerations in secondary procedures, and demographic aspects. The questionnaire was designed to profile practices, procedures, and beliefs among plastic surgeons regarding the use of breast implants in Brazil. Results: A total of 505 responses were collected, representing a response rate around 10%, which is well above the average response rate for Brazilian Society of Plastic Surgery (SBCP) questionnaires. The results were distributed in five tables by area of interest. Conclusion: In this study, the most common practices included the use of microtexture round implants and polyurethane-coated silicone as the primary procedure, a subglandular pocket, inframammary incisions, preoperative sizing with round implant samples, intravenous and oral antibiotics, double irrigation antibiotics, an implant size that was generally less than 325 cc, and without drainage. There is no consensus on breast lip balancing and the management of capsular contracture and double bubble deformity.
Asunto(s)
Humanos , Mama/cirugía , Mamoplastia/efectos adversos , Mamoplastia/métodos , Implantación de Mama/efectos adversos , Implantación de Mama/métodos , Encuestas y Cuestionarios , EstéticaRESUMEN
Introdução: A utilização de implantes mamários vem aumentando. O posicionamento do implante na literatura é relatado como subglandular, subfascial, submuscular total e parcial, cada qual com suas indicações, limitações e complicações. Métodos: Este trabalho mostra uma manobra para cobertura do implante e sua sustentação utilizando dois retalhos musculares. Entre novembro de 2009 e abril de 2012, foram analisados 80 casos de pacientes submetidas à inclusão de implantes em posição submuscular em duplo bolso, independentemente da via de acesso, do grau de flacidez e ptose. Resultados: A versatilidade desta manobra permite que seja utilizada em uma ampla variedade de mamas, desde aumento sem flacidez a mamopexia com implante, podendo ser realizada por via periareolar, inframamária ou aberta. Foi utilizada em cirurgias primárias e secundárias, com ou sem uso de retalho de tecido mamário e retirada de pele. Conclusões: A cobertura do implante com o músculo peitoral pela técnica de duplo bolso demonstrou ótimos resultados, com baixo índice de complicações e reintervenções. Esta técnica está sendo utilizada em uma maior casuística e um seguimento mais longo tem sido feito para confirmar os resultados obtidos até o momento.
Introduction: The use of implants is steadily increasing. Reports have been published of implants in the subglandular, subfascial, total, and partial submuscular positions each with its indications, limitations, and complications. Methods: This study presents a technique to cover the implant and support it using two muscle flaps. Between November 2009 and April 2012, 80 patients who submitted to inclusion of implants in the submuscular position in double pocket were analyzed, regardless of the access route, the degree of flaccidity, and ptosis. Results: The versatility of this maneuver allows it to be used in a wide variety of breasts, from breast augmentation without flaccidity to mastopexy with implant, and may be carried out via the periareolar, inframammary, or open access routes. It was used in primary and secondary surgeries, with or without the use of breast tissue flap and removal of skin. Conclusions: The coverage of the implant with the pectoral muscle by the double pocket technique displayed excellent results, with a low rate of complications and reinterventions. This technique is being studied in a larger sample with a longer follow-up to confirm the results obtained so far.
Asunto(s)
Humanos , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Implantación de Mama/efectos adversos , Implantación de Mama/métodos , Procedimientos de Cirugía Plástica/métodos , Contractura Capsular en Implantes/cirugía , Modalidades de Posición , Contracción MuscularRESUMEN
BACKGROUND: Altered glenohumeral joint range of motion can be caused by increased humeral retroversion (HR) and/or posterior capsule tightness (PCT). To make informed clinical decisions, it is vital to understand how HR and PCT alterations, individually and in combination, affect joint range of motion measurements. PURPOSE: To evaluate the effect of experimental tissue alterations on clinical range of motion measures. STUDY DESIGN: Controlled laboratory study. METHODS: Five clinical measurements were quantified in 8 fresh-frozen cadavers under 4 experimentally created conditions: baseline (no alterations), HR condition (20° increase in HR by transecting the bone), PCT condition (20% decrease in length via thermal energy), and PCT + HR combined. Clinical measurements included bicipital forearm angle, low flexion, glenohumeral internal and external rotation, and horizontal adduction. All measurements were taken by the same blinded tester. Separate 1-factor repeated measures analyses of variance were used to evaluate the effect of the alterations on each clinical measurement. RESULTS: There was a significant main effect of condition for bicipital forearm angle ( P = .02, F = 4.03), low flexion ( P = .02, F = 3.86), internal rotation ( P = .03, F = 3.65), and external rotation ( P < .001, F = 15.15) but not for horizontal adduction ( P = .29, F = 1.33). The HR condition resulted in a decreased bicipital forearm angle of 16.1° and 15.8° as compared with the PCT and PCT + HR conditions, respectively. When compared with baseline, the PCT + HR condition decreased the low flexion test by 13.5°, and the HR condition decreased internal rotation range of motion by 14.2°. All conditions increased external rotation when compared with baseline. CONCLUSION: Greater measurement changes were noted in both HR conditions, suggesting that bony alterations influence motion to a greater extent than posterior capsule alterations. CLINICAL RELEVANCE: Clinicians should be aware that humeral retroversion will influence the measurement of posterior shoulder tightness.
Asunto(s)
Húmero/patología , Rango del Movimiento Articular/fisiología , Articulación del Hombro/fisiopatología , Anciano , Anciano de 80 o más Años , Cadáver , Femenino , Antebrazo , Humanos , Cápsula Articular , Masculino , Examen Físico , RotaciónRESUMEN
BACKGROUND: One of the undesirable complications that might occur after breast augmentation with silicone implants is capsular contracture. In its etiology, the relations between mast cells and myofibroblasts play an important role in collagen synthesis. Mast cells are able to activate fibroblasts into myofibroblasts, through paracrine secretions, inducing collagen production. The objectives of this study were to analyze the myofibroblast concentration through the α-SMA immunomarker and evaluate the intensity of mast cell expression against the C-Kit immunomarker. MATERIAL AND METHOD: Sixty-four Wistar rats were used, divided into two groups (polyurethane foam and textured surface) with 32 animals in each. The animals received silicone implants on the back, below the panniculus carnosus, and after the determined period, they were killed and the capsules formed around the implants were studied. The capsules were analyzed employing the immunohistochemical technique, with the α-SMA and C-Kit immunomarkers in subgroups of 30, 50, 70 and 90 days. RESULTS: The myofibroblast concentration was higher in the polyurethane group when compared to the textured group (30 days p = 0.105; 50 days p = 0.247; 70 days p = 0.014 and 90 days p = 0.536). The intensity of mast cell expression was more pronounced in the polyurethane group when compared to the textured group (30 days p = 0.798; 50 days p = 0.537; 70 days p = 0.094 and 90 days p = 0.536). CONCLUSIONS: Polyurethane-coated implants induced higher concentrations of myofibroblasts and higher expression of mast cells, when compared to the textured surface implants. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Asunto(s)
Actinas/inmunología , Implantación de Mama/efectos adversos , Contractura Capsular en Implantes/patología , Poliuretanos/efectos adversos , Proteínas Proto-Oncogénicas c-kit/inmunología , Geles de Silicona/efectos adversos , Animales , Biomarcadores/metabolismo , Implantación de Mama/métodos , Modelos Animales de Enfermedad , Femenino , Inmunohistoquímica , Contractura Capsular en Implantes/etiología , Músculo Liso/inmunología , Músculo Liso/patología , Fotomicrografía/métodos , Distribución Aleatoria , Ratas , Ratas Wistar , Sensibilidad y EspecificidadRESUMEN
This paper presents patients satisfaction using anatomical polyurethane breast implants. We performed surgery on 525 patients, 370 of which were primary and 155 were secondary to various causes such as capsular contracture, ruptured implants, volume changes, and incorrect positioning of the implant. The advantages of silicone polyurethane covers shown high level of patient satisfaction, low incidence of capsular contracture, and absence of implant rotation, and late seroma.
RESUMEN
PURPOSE:To assess the capsules formed by silicone implants coated with polyurethane foam and with a textured surface.METHODS:Sixty-four Wistar albinus rats were divided into two groups of 32 each using polyurethane foam and textured surface. The capsules around the implants were analyzed for 30, 50, 70 and 90 days. Were analyzed the following parameters: foreign body reaction, granulation tissue, presence of myofibroblasts, neoangiogenesis, presence of synovial metaplasia, capsular thickness, total area and collagen percentage of type I and III, in capsules formed around silicone implants in both groups.RESULTS:The foreign body reaction was only present in the four polyurethane subgroups. The formation of granulation tissue and the presence of myofibroblasts were higher in the four polyurethane subgroups. Regarding to neoangiogenesis and synovial metaplasia, there was no statistical difference between the groups. Polyurethane group presented (all subgroups) a greater capsule thickness, a smaller total area and collagen percentage of type I and a higher percentage area of type III, with statistical difference.CONCLUSION:The use of polyurethane-coated implants should be stimulated by the long-term results in a more stable capsule and a lower incidence of capsular contracture, despite developing a more intense and delayed inflammatory reaction in relation to implants with textured surface.(AU)
Asunto(s)
Animales , Femenino , Ratas , Siliconas/análisis , Siliconas/uso terapéutico , Poliuretanos , Contractura Capsular en Implantes/veterinaria , Mamoplastia/veterinaria , Implantación de Mama/veterinaria , Implantación de Mama/efectos adversos , Ratas WistarRESUMEN
ABSTRACT PURPOSE: To assess the capsules formed by silicone implants coated with polyurethane foam and with a textured surface. METHODS: Sixty-four Wistar albinus rats were divided into two groups of 32 each using polyurethane foam and textured surface. The capsules around the implants were analyzed for 30, 50, 70 and 90 days. Were analyzed the following parameters: foreign body reaction, granulation tissue, presence of myofibroblasts, neoangiogenesis, presence of synovial metaplasia, capsular thickness, total area and collagen percentage of type I and III, in capsules formed around silicone implants in both groups. RESULTS: The foreign body reaction was only present in the four polyurethane subgroups. The formation of granulation tissue and the presence of myofibroblasts were higher in the four polyurethane subgroups. Regarding to neoangiogenesis and synovial metaplasia, there was no statistical difference between the groups. Polyurethane group presented (all subgroups) a greater capsule thickness, a smaller total area and collagen percentage of type I and a higher percentage area of type III, with statistical difference. CONCLUSION: The use of polyurethane-coated implants should be stimulated by the long-term results in a more stable capsule and a lower incidence of capsular contracture, despite developing a more intense and delayed inflammatory reaction in relation to implants with textured surface.