BACKGROUND: Augmentation mammoplasty is rapidly becoming one of the most frequently performed cosmetic surgeries. Consequently, the number of breast cancer patients with a history of breast augmentation surgery will increase. The purpose of this study is to report our experience of breast reconstruction in augmented women and discuss their treatment characteristics. METHODS: From March 2010 to August 2015, 7 patients who had previously undergone breast augmentation were treated at our institution. Epidemiologic data as well as data regarding body mass index, types of mastectomy, and complication were recorded and analyzed. RESULTS: The mean age was 43.4 years, the average follow-up period was 21 months, and the mean body mass index (BMI) was 19.3 kg/m2, the average weight of the mastectomy specimen was 150 g. Implant-based immediate breast reconstruction after skin-sparing mastectomy was performed in seven patients and in four of these patients, acellular dermal matrix (ADM) was used. One patient had a capsular contracture of Baker grade II. One patient had seroma. CONCLUSIONS: Previously augmented patients tend to have a slender abdomen and back. Moreover, Asians have a smaller body frame and lower muscle and fat percentage than westerners, making it more suitable for implant-based reconstruction than autologous tissue. It can be recommended as a surgical method as our patients were highly satisfied with the cosmetic outcomes.
Abdomen ; Acellular Dermis ; Asian Continental Ancestry Group ; Body Mass Index ; Breast Neoplasms ; Breast* ; Contracture ; Female ; Follow-Up Studies ; Humans ; Mammaplasty* ; Mastectomy ; Seroma ; Silicon* ; Silicone Gels ; Silicones*

Capsular fibrosis and contracture occurs in most breast reconstruction patients who undergo radiotherapy, and there is no definitive solution for its prevention. Simvastatin was effective at reducing fibrosis in various models. Peri-implant capsular formation is the result of tissue fibrosis development in irradiated breasts. The purpose of this study was to examine the effect of simvastatin on peri-implant fibrosis in rats. Eighteen male Sprague-Dawley rats were allocated to an experimental group (9 rats, 18 implants) or a control group (9 rats, 18 implants). Two hemispherical silicone implants, 10 mm in diameter, were inserted in subpanniculus pockets in each rat. The next day, 10-Gy of radiation from a clinical accelerator was targeted at the implants. Simvastatin (15 mg/kg/day) was administered by oral gavage in the experimental group, while animals in the control group received water. At 12 weeks post-implantation, peri-implant capsules were harvested and examined histologically and by real-time polymerase chain reaction. The average capsular thickness was 371.2 μm in the simvastatin group and 491.2 μm in the control group. The fibrosis ratio was significantly different, with 32.33% in the simvastatin group and 58.44% in the control group (P < 0.001). Connective tissue growth factor (CTGF) and transforming growth factor (TGF)-β1 gene expression decreased significantly in the simvastatin group compared to the control group (P < 0.001). This study shows that simvastatin reduces radiation-induced capsular fibrosis around silicone implants in rats. This finding offers an alternative therapeutic strategy for reducing capsular fibrosis and contracture after implant-based breast reconstruction.
Administration, Oral ; Animals ; Breast/*drug effects/metabolism/pathology/radiation effects ; *Breast Implants ; Connective Tissue Growth Factor/genetics/metabolism ; Fibrosis ; Gamma Rays ; Male ; Rats ; Rats, Sprague-Dawley ; Real-Time Polymerase Chain Reaction ; Silicone Gels/*chemistry ; Simvastatin/*pharmacology ; Transforming Growth Factor beta1/metabolism

Capsular fibrosis and contracture occurs in most breast reconstruction patients who undergo radiotherapy, and there is no definitive solution for its prevention. Simvastatin was effective at reducing fibrosis in various models. Peri-implant capsular formation is the result of tissue fibrosis development in irradiated breasts. The purpose of this study was to examine the effect of simvastatin on peri-implant fibrosis in rats. Eighteen male Sprague-Dawley rats were allocated to an experimental group (9 rats, 18 implants) or a control group (9 rats, 18 implants). Two hemispherical silicone implants, 10 mm in diameter, were inserted in subpanniculus pockets in each rat. The next day, 10-Gy of radiation from a clinical accelerator was targeted at the implants. Simvastatin (15 mg/kg/day) was administered by oral gavage in the experimental group, while animals in the control group received water. At 12 weeks post-implantation, peri-implant capsules were harvested and examined histologically and by real-time polymerase chain reaction. The average capsular thickness was 371.2 μm in the simvastatin group and 491.2 μm in the control group. The fibrosis ratio was significantly different, with 32.33% in the simvastatin group and 58.44% in the control group (P < 0.001). Connective tissue growth factor (CTGF) and transforming growth factor (TGF)-β1 gene expression decreased significantly in the simvastatin group compared to the control group (P < 0.001). This study shows that simvastatin reduces radiation-induced capsular fibrosis around silicone implants in rats. This finding offers an alternative therapeutic strategy for reducing capsular fibrosis and contracture after implant-based breast reconstruction.
Administration, Oral ; Animals ; Breast/*drug effects/metabolism/pathology/radiation effects ; *Breast Implants ; Connective Tissue Growth Factor/genetics/metabolism ; Fibrosis ; Gamma Rays ; Male ; Rats ; Rats, Sprague-Dawley ; Real-Time Polymerase Chain Reaction ; Silicone Gels/*chemistry ; Simvastatin/*pharmacology ; Transforming Growth Factor beta1/metabolism

A foreign body granuloma is a non-allergic chronic inflammatory reaction that is mainly composed of multinucleated giant cells. Foreign body granulomas may occur after the administration of any dermal filler. Factors such as the volume of the injection, impurities present in the fillers, and the physical properties of fillers affect granuloma formation. The formation of granulomas involves five phases: protein adsorption, macrophage adhesion, macrophage fusion, and crosstalk. The clinical and pathologic features of granulomas vary depending on the type of filler that causes them. Foreign body granulomas can be treated effectively with intralesional corticosteroid injections. Surgical excisions of granulomas tend to be incomplete because granulomas have ill-defined borders and moreover, surgical excisions may leave scars and deformities.
Adsorption ; Cicatrix ; Collagen ; Congenital Abnormalities ; Giant Cells ; Granuloma ; Granuloma, Foreign-Body* ; Hyaluronic Acid ; Macrophages ; Silicone Gels

PURPOSE: Skin graft may fail for a number of reasons. Hematoma or seroma formation prevents graft adherence. Traditionally tie-over dressing has been used in skin graft fixation, but skin graft in convex and narrow place like fingers or toes, tie-over dressing is hard to be applied. And Vaseline gauze over graft often adheres to graft by exudate into gauze fibers and hardening, and may cause damage to graft in dressing change. We report successful results of using silicone net dressing in fixation of split thickness skin graft over these place. METHODS: After skin graft, the silicone net, Mepitel(R) (Molnlycke Health Care, Box 13080, SE-402 52 Goteborg, Sweden) was applied over the graft followed saline wet gauze dressing in 25 patients. 13 cases were on finger, 8 cases were on foot or toes, 4 cases were on anterior chest. RESULTS: In 22 cases, there were no hematoma or seroma formation, Mepitel(R) maintained 5 days after skin graft. And then, Mepitel(R) was removed from the graft. In 3 cases, there were hematoma formation, Mepitel(R) was removed at 3 days after skin graft. In all cases, grafts were taken well without maceration or skin eruption. CONCLUSION: The silicone net, Mepitel(R), is dressing material made of silicone gel bound to a pliable polyamide net, and it can provide uniform pressure to the graft, even in convex and narrow place. And net like structure allows the exudates of the wound to pass freely into the secondary absorbent dressing and easier to remove from the grafts than Vaseline gauze. We think that the use of a Mepitel(R) is a efficient tool for securing skin grafts.
Bandages* ; Delivery of Health Care ; Exudates and Transudates ; Fingers ; Foot ; Hematoma ; Humans ; Nylons ; Petrolatum ; Seroma ; Silicone Gels* ; Skin* ; Thorax ; Toes ; Transplants* ; Wounds and Injuries

BACKGROUND: Hypertrophic scars and keloids are associated with abnormal levels of growth factors. Silicone gel sheets are effective in treating and preventing hypertrophic scars and keloids. There has been no report on the change in growth factors in the scar tissue following the use of silicone gel sheeting for scar prevention. A prospective controlled trial was performed to evaluate whether growth factors are altered by the application of a silicone gel sheet on a fresh surgical scar. METHODS: Four of seven enrolled patients completed the study. Transforming growth factor (TGF)-beta1, platelet-derived growth factor (PDGF), and basic fibroblast growth factor (bFGF) were investigated immunohistochemically in biopsies taken from five scars at 4 months following surgery. RESULTS: In both the epidermis and the dermis, the expression of TGF-beta1 (P=0.042 and P=0.042) and PDGF (P=0.043 and P=0.042) was significantly lower in the case of silicone gel sheet-treated scars than in the case of untreated scars. The expression of bFGF in the dermis was significantly higher in the case of silicone gel sheet-treated scars than in the case of untreated scars (P=0.042), but in the epidermis, the expression of bFGF showed no significant difference between the groups (P=0.655). CONCLUSIONS: The levels of TGF-beta1, PDGF, and bFGF are altered by the silicone gel sheet treatment, which might be one of the mechanisms of action in scar prevention.
Biopsy ; Cicatrix* ; Cicatrix, Hypertrophic ; Cytokines ; Dermis ; Epidermis ; Fibroblast Growth Factor 2* ; Humans ; Intercellular Signaling Peptides and Proteins ; Keloid ; Platelet-Derived Growth Factor* ; Prospective Studies ; Silicone Gels ; Transforming Growth Factor beta1* ; Transforming Growth Factors

Mammary implants marketed by Poly Implant Prothese (PIP) were found to contain industrial grade silicone and this caused heightened anxiety and extensive publicity regarding their safety in humans. These implants were used in a large number of patients worldwide for augmentation or breast reconstruction. We reviewed articles identified by searches of Medline, PubMed, Embase, and Google Scholar databases up to May 2014 using the terms: "PIP", "Poly Implant Prothese", "breast implants" and "augmentation mammoplasty" "siloxanes" or "silicone". In addition the websites of regulating bodies in Europe, USA, and Australia were searched for reports related to PIP mammary implants. PIP mammary implants are more likely to rupture than other implants and can cause adverse effects in the short to the medium term related to the symptoms of rupture such as pain, lumps in the breast and axilla and anxiety. Based on peer-reviewed published studies we have calculated an overall rupture rate of 14.5% (383/2,635) for PIP implants. However, there is no evidence that PIP implant rupture causes long-term adverse health effects in humans so far. Silicone lymphadenopathy represents a foreign body reaction and should be treated conservatively. The long-term adverse effects usually arise from inappropriate extensive surgery, such as axillary lymph node dissection or extensive resection of breast tissue due to silicone leakage.
Anxiety ; Australia ; Axilla ; Breast ; Breast Implantation ; Breast Implants* ; Europe ; Female ; Foreign-Body Reaction ; Humans ; Lymph Node Excision ; Lymphatic Diseases ; Mammaplasty ; Prosthesis Failure ; Rupture ; Silicone Gels

A 50-year-old woman visited our hospital for two palpable masses on her sternal and left upper abdominal areas. She had augmentation mammoplasty 12 years prior. Based on the physical examination, the mass in the sternal area was firm, movable, and round. The size of the mass was approximately 3.0x3.0x1.0 cm3. The mass in the upper-left abdomen showed similar characteristics, with a size of approximately 10.0x15.0x1.5 cm3. Ultrasonography revealed a 3.9x1.0x3.4 cm3 hypoechoic lesion in the sternal area. On enhanced-mode computed tomography, a rupture of the left breast implant was noted. Both masses had similar densities as the implant. After rupture of the breast implant, surgery was performed under general anesthesia. Using an inframammary approach, both breast implants and masses were removed using the site of the previous mammoplasty incision. Intraoperative findings revealed that the left breast implant was ruptured and the masses consisted of implant gel components. After surgery, the patient's recovery was uneventful. The patient was discharged without any problem on hospital day 9.
Abdomen ; Anesthesia, General ; Breast Implants* ; Female ; Humans ; Mammaplasty ; Middle Aged ; Physical Examination ; Rupture ; Silicone Gels* ; Ultrasonography

BACKGROUND: In 2012, a new anatomic breast implant of form-stable silicone gel was introduced onto the Korean market. The intended use of this implant is in the area of aesthetic breast surgery, and many reports are promising. Thus far, however, there have been no reports on the use of this implant for breast reconstruction in Korea. We used this breast implant in breast reconstruction surgery and report our early experience. METHODS: From November 2012 to April 2013, the Natrelle Style 410 form-stable anatomically shaped cohesive silicone gel-filled breast implant was used in 31 breasts of 30 patients for implant breast reconstruction with an acellular dermal matrix. Patients were treated with skin-sparing mastectomies followed by immediate breast reconstruction. RESULTS: The mean breast resection volume was 240 mL (range, 83-540 mL). The mean size of the breast implants was 217 mL (range, 125-395 mL). Breast shape outcomes were considered acceptable. Infection and skin thinning occurred in one patient each, and hematoma and seroma did not occur. Three cases of wound dehiscence occurred, one requiring surgical intervention, while the others healed with conservative treatment in one month. Rippling did not occur. So far, complications such as capsular contracture and malrotation of breast implant have not yet arisen. CONCLUSIONS: By using anatomic breast implants in breast reconstruction, we achieved satisfactory results with aesthetics better than those obtained with round breast implants. Therefore, we concluded that the anatomical implant is suitable for breast reconstruction.
Acellular Dermis ; Breast ; Breast Implantation ; Breast Implants ; Breast Neoplasms ; Contracture ; Esthetics ; Female ; Hematoma ; Humans ; Korea ; Mammaplasty* ; Mastectomy ; Seroma ; Silicone Gels ; Skin ; Wounds and Injuries

BACKGROUND: Rupture is an important complication of breast implants. Before cohesive gel silicone implants, rupture rates of both saline and silicone breast implants were over 10%. Through an analysis of ruptured implants, we can determine the various factors related to ruptured implants. METHODS: We performed a retrospective review of 72 implants that were removed for implant rupture between 2005 and 2014 at a single institution. The following data were collected: type of implants (saline or silicone), duration of implantation, type of implant shell, degree of capsular contracture, associated symptoms, cause of rupture, diagnostic tools, and management. RESULTS: Forty-five Saline implants and 27 silicone implants were used. Rupture was diagnosed at a mean of 5.6 and 12 years after insertion of saline and silicone implants, respectively. There was no association between shell type and risk of rupture. Spontaneous was the most common reason for the rupture. Rupture management was implant change (39 case), microfat graft (2 case), removal only (14 case), and follow-up loss (17 case). CONCLUSIONS: Saline implants have a shorter average duration of rupture, but diagnosis is easier and safer, leading to fewer complications. Previous-generation silicone implants required frequent follow-up observation, and it is recommended that they be changed to a cohesive gel implant before hidden rupture occurs.
Breast Implantation ; Breast Implants* ; Contracture ; Diagnosis ; Follow-Up Studies ; Retrospective Studies* ; Rupture ; Silicone Gels ; Transplants