RESUMO
To evaluate the current state of the evidence regarding the association of silicone breast implantation with the onset of connective tissue diseases, constitutional symptoms, and rheumatic serological profile in adult women. A comprehensive search was carried out using MEDLINE, Embase, Web of Science and Scopus, from inception to September 2, 2020. Cohort studies assessing the clinical and serological profile of women with cosmetic breast implants were included. Meta-analyses were conducted using risk ratios. A total of 10 cohorts with overall moderate quality of evidence were included in this systematic review. Exposure to silicone breast implants was slightly associated with the development of rheumatoid arthritis [RR: 1.35; (95% CI 1.08 to 1.68); P = .008; I2 = 0%]. However, no significant differences were exhibited between the breast implant-exposed population and controls regarding the rest of the outcomes. In adult women, exposure to silicone breast implantation is not associated with the onset of constitutional symptoms and most connective tissue diseases. A marginal association with rheumatoid arthritis was exhibited, but the certainty of this result is jeopardized by the significant amount of self-reported data for this outcome. Further research is required to adequately explore the clinical significance of these results.
Assuntos
Artrite Reumatoide , Implantes de Mama , Doenças do Tecido Conjuntivo , Adulto , Artrite Reumatoide/epidemiologia , Artrite Reumatoide/etiologia , Implantes de Mama/efeitos adversos , Doenças do Tecido Conjuntivo/diagnóstico , Doenças do Tecido Conjuntivo/epidemiologia , Doenças do Tecido Conjuntivo/etiologia , Consenso , Feminino , Humanos , Silicones/efeitos adversosRESUMO
The association of the diastasis of the rectus abdominis muscle and the medial pectus excavatum was reported. We have been using soft silicone block, sculpted intraoperatively, to correct pectus excavatum. The horizontal access used, 2 cm at a subxiphoid position, allows us to expose the sternum and the rectus abdominis muscles (RAMs). We report a case, male, 31 years presenting medial pectus excavatum and supraumbilical diastasis of the rectus abdominis muscle with a width of 35 mm at the costal arches, and 27 mm at 6 cm from the xiphoid process edge. The muscle borders presented a curved lateral deviation up to the insertion in the costal arches. The necessary space for the implant was dissected and the block was sculpted. The medial and superior aponeurosis borders of the RAM were incised at 6 cm from the xiphoid, and the posterior border of the RAM was released. The aponeurosis borders were brought together, promoting a medial and anterior positioning of the RAM. The inferior border of the implant was attached to the raw superior borders of the RAM. The result was considered satisfactory, and a magnetic resonance image 14 months after showed continuity of the implant and the muscles, promoting a uniform body contour. Registry: CAAE63181616.7.0000.0071.
Assuntos
Tórax em Funil , Tórax em Funil/complicações , Tórax em Funil/diagnóstico por imagem , Tórax em Funil/cirurgia , Humanos , Masculino , Próteses e Implantes , Reto do Abdome/diagnóstico por imagem , Reto do Abdome/cirurgia , Silicones , Esterno/cirurgiaRESUMO
BACKGROUND: SmoothSilk implants (SSI) are the first generation of implants to incorporate a radio-frequency identification device (RFID-M), a non-invasive traceability system. Although the RFID-M is considered compatible with magnetic resonance imaging (MRI), the size of the artifact and its influence on breast tissue vary. This prospective study assessed safety and MRI issues in a cohort of breast reconstruction patients. METHODS: Forty-four SSI were used for breast reconstruction in patients undergoing treatment for breast cancer. All patients were evaluated for magnetic field interactions, MRI-related heating and artifacts in a 1.5-T MRI unit using standard T1/T2-weighted sequences utilized in clinical assessment of breast tissue/implants. RESULTS: Mean patient age was 41.5 years (27-53ys) and body mass index was 28+-6.44 kg/m2. In 18/22 patients (81.8%), mastectomies were unilateral. No patients reported local heat/discomfort. All implants showed RFID-M-related artifacts with an estimated mean volume in T1 of 42.9cm3 (26.2-63.6cm3; SD±8.6 and 95% CI, 40.37-45.45) and in T2 of 60.5cm3 (35.4-97.2cm3; SD±14.7 and 95% CI, 56.29-65.01). Artifact volume was smaller in T1 than in T2, to a statistically significant degree (p <0.001). There were no statistically significant differences in artifact volume according to surgical indication, breast side or implant volume. There were 4/44 (9%) cases of minor rotation (<45°). In all cases, adequate analysis of the breast tissue was performed. CONCLUSIONS: The results demonstrate that SSI with RFID-M technology presented an artifact volume of 42.9cm3 and 60.5cm3 in T1 and T2 images, respectively. Our findings provide detailed information on the quality and location of MRI artifacts in a reconstructed cohort which can help guide clinical decision-making for patients. To our knowledge, this is the first time RFID-M breast implants have been prospectively evaluated for clinical and MRI issues in a cohort of reconstructive patients. LEVEL OF EVIDENCE IV: 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 .
Assuntos
Implante Mamário , Implantes de Mama , Mamoplastia , Dispositivo de Identificação por Radiofrequência , Adulto , Implante Mamário/efeitos adversos , Implantes de Mama/efeitos adversos , Estudos de Coortes , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Mamoplastia/efeitos adversos , Estudos Prospectivos , Géis de Silicone , Resultado do TratamentoRESUMO
INTRODUCTION: Breast implants follow-up with any type of examination is often neglected; this may cause an error or delay in the diagnosis of complications prosthesis-related such as BIA-ALCL. This study aims to better understand adequate follow-up criteria. METHOD: All female patients undergoing aesthetic breast augmentation and breast MRI in its follow-up conducted from April 2006 to December 2019 were included in this study. The variables analyzed were age, breast implant surgery date, time with the implant, reason for the examination, and the final examination report. A logistic regression analysis was conducted to search for the predictors of positive findings in MRI. A Cox Regression analysis and cumulative risk curves, controlled by age, was performed to investigate the relationship between time with implants and the risk of positive findings in MRI. RESULTS: The patients submitted to MRI had complaints in 29.6% of cases, with pain being the most common, 13.9% of cases. In logistic regression analysis, time with the implant was associated with a higher risk of positive findings in univariate analysis (OR = 1.07, p = 0.036), but not in multivariate analysis. Both pain and breast form changes were independent predictors for positive findings in MRI, OR = 2.79, p = 0.04, and OR = 16.98, p < 0.001, respectively. The cumulative risk of positive findings in MRI increased considerably only after 10 years of implantation. CONCLUSIONS: Time with breast implants may be associated with a higher risk of changes in breast MRI examinations, although this relationship was not significant in multivariate logistic regression analysis. The cumulative risk for positive findings seems to increase considerably only after 10 years of implantation. This study draws attention to the paramount importance of follow-up with a clinical breast examination. Despite time with implants or patients' age, both pain and breast form changes were the most important predictors for MRI alterations. LEVEL OF EVIDENCE IV: 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 .
Assuntos
Implante Mamário , Implantes de Mama , Linfoma Anaplásico de Células Grandes , Mamoplastia , Implante Mamário/efeitos adversos , Implantes de Mama/efeitos adversos , Estudos Transversais , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Resultado do TratamentoRESUMO
BACKGROUND: Currently, the metatarsophalangeal joint replacement through a restorative arthroplasty, where implants are used, is a viable invasive surgical medical procedure in the treatment of severe cases of osteoarthritis in this joint, better known as hallux rigidus. However, few things are known about the postoperative complications that implants can cause on the joint, like Swanson and Tornier implants.Research in this field can provide a valuable information that would help the specialist surgeon in the decision-making during the selection of the more suitable joint implant in each patient, as well as the redesign of the devices, to make them more efficient, durable and biocompatible with the human body. METHODS: The aim of this work is to perform a structural biomechanical analysis of a restorative arthroplasty of the first metatarsophalangeal joint, and to analyze the interaction between bone and medical grade silicone implants. For that, a simulation of a foot with Swanson and Tornier joint implants were performed to evaluate the stress/strain distribution during a critical stage (toe-off). RESULTS AND CONCLUSIONS: Principal stresses obtained for the first metatarsal with both implants suggest that failure is induced in this bone because, values exceed (up to 136.84% for Swanson model) the tensile strength reported for phalange trabecular bone, which may be related to osteolysis. Stress and strain values obtained in this work suggest that arthroplasty surgery with Swanson implant is more likely to cause postoperative complications versus Tornier implant.
Assuntos
Artroplastia/métodos , Hallux Rigidus/cirurgia , Hallux Valgus/cirurgia , Prótese Articular , Articulação Metatarsofalângica/cirurgia , Adulto , Idoso , Feminino , Hallux Rigidus/diagnóstico , Hallux Valgus/diagnóstico , Humanos , Masculino , Articulação Metatarsofalângica/diagnóstico por imagem , Pessoa de Meia-Idade , Articulação do Dedo do Pé/cirurgiaRESUMO
BACKGROUND: Simultaneous augmentation-mastopexy is a particularly tricky operation with a considerable reoperation rate. The pectoralis muscle sling has proven to be a suitable alternative technique for long-term results in breast parenchyma suspension without silicone implants. This study aims to propose a promising approach to simultaneous augmentation-mastopexy revisional surgery using an inverted dual-plane technique acting as a muscular sling. METHODS: A 10-year historic cohort was conducted to obtain the following variables from our preexisting database: age, preoperative measurements, operative technicalities, implant details, time from procedure to revision, complications, and outcomes. RESULTS: Twenty-six patients assessed after the initial postoperative year were analyzed. Review of this series of patients revealed a revision rate of 3.8% and overall rate of morbidity of 11.5%. CONCLUSION: Simultaneous augmentation-mastopexy using an inverted dual-plane technique acting as a muscular sling is a reliable and safe procedure. Review of this series of patients revealed low rates of morbidity and reoperation need. LEVEL OF EVIDENCE IV: 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 .
Assuntos
Implantes de Mama/efeitos adversos , Mamoplastia/métodos , Músculos Peitorais/cirurgia , Falha de Prótese , Retalhos Cirúrgicos/transplante , Adulto , Estudos de Coortes , Bases de Dados Factuais , Estética , Feminino , Seguimentos , Humanos , Mamoplastia/efeitos adversos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Reoperação/métodos , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento , Cicatrização/fisiologiaRESUMO
Introdução: Insatisfação dos pacientes com resultado de mamoplastia redutora pode ser identificado em alguns casos, especialmente quando apresentam ptose acompanhada de flacidez excessive, estrias, e ainda, componente mamário mais gorduroso que glandular. Nesses tipos de pacientes, é muito difícil conseguir bons resultados por longo período. Implantes mamários de pequeno volume, podem ser colocados no mesmo tempo da mamoplastia redutora com o objetivo de se obter melhor forma, contorno e projeção das mamas, com maior satisfação a longo prazo. Método: No período de 1997 a 2012, duzentos e sessenta e quatro pacientes com idade entre 27e 55 anos (idade média de 38), foram submetidas à mamoplastia redutora com imediata colocação de implante mamário. Resultados: Foram obtidos resultados satisfatórios, com adequado preenchimento do pólo superior, mamas firmes e reduzida estatística de ptose pós-operatória. Foram identificados dois casos de carcinoma in sito, como achados no anátomo-patológico. Conclusão: Mastoplastia redutora associada a implantes de silicone é um procedimento seguro para casos selecionados.
INTRODUCTION: Patient dissatisfaction with reduction mammoplasty outcomes can occur, especially in cases of ptosis accompanied by excessive flaccidity, striations, and a higher fat than glandular content. In such cases, achieving long-lasting results is very difficult. Small-volume breast implants can be placed during the reduction mammoplasty with the purpose of obtaining better breast shape, contour, and projection as well as greater long-term satisfaction. METHOD: Between 1997 and 2012, 264 patients aged 27-55 years (mean, 38) underwent reduction mammoplasty with immediate placement of breast implants. RESULTS: Satisfactory results were obtained, with adequate filling of the upper pole, increased breast firmness, and statistical reduction in postoperative ptosis. Two cases of carcinoma in situ were identified in the pathological exam. CONCLUSION: Reduction mastoplasty associated with silicone implants is safe for selected cases.