Concerns regarding potential health effects of silicone breast implants have recently shifted from long-term illnesses to postoperative local complications. In this study, occurrence of local complications and treatment procedures were evaluated in a population of 685 Finnish women who received cosmetic silicone breast implants between 1968 and 2002. Patient records were abstracted, and additional information was gathered using a structured questionnaire that was mailed to 470 of the women in the cohort. Overall, 36% of the women had 1 or more diagnoses of postoperative complications in their medical records. The most common complication was capsular contracture, occurring in 17.7% of women and 15.4% of implantations. Other complications were more rare. The majority of women (74%) needed no postoperative treatment. However, 22% of women required 1 or more surgical procedures after the primary implantation. Most of the women were satisfied with the implantation, but only 40% considered the preoperative information on possible risks related to implantation as sufficient. With respect to the occurrence of local complications following cosmetic breast implantation, the findings of this study are consistent with previous studies. Frequencies of complications were remarkably similar in medical records and self-reports.

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The series of cutaneous melanoma compiled by the Finnish Cancer Registry, a total of 2501 cases covering all tumors diagnosed in Finland in 1953-1973, was analysed. The age adjusted incidence was equal in both sexes (about 3.5/105 in the 1970s). The risk more than doubled during the study period. The most common locations of melanoma in males were the trunk (48%) and lower limbs (17%), and in females the lower limbs (36%) and the trunk (28%).The age adjusted incidence rates were higher in urban areas than in rural districts and higher in southern parts of the country than in northern areas. However, after adjusting the rates for urban/rural residence of the population, the north south differences almost disappeared. In conclusion, the north south gradient was attributable to the degree of urbanization and not necessarily to the effect of latitude itself. Melanomas on the trunk in both sexes and those on the lower limbs in females had two features in common-the incidence of tumors on these locations increased markedly with time, and the age specific incidence rates increased sharply in middle age and levelled off thereafter. On the other hand, melanomas on the head and neck in both sexes and those on the lower limbs in males did not increase with time, and the risk was rather low in middle age and increased throughout life. The increase with time in the risk of melanoma could be accounted for by a cohort effect. These findings are not totally in accordance with the hypothesis of the association between sunlight and risk of melanoma, and it is concluded that recognition of sunlight as the only important risk factor of cutaneous melanoma may be an oversimplification of a complex problem.

Mortality patterns among women with cosmetic breast implants have not been well characterized. We examined cause-specific mortality among women who underwent cosmetic breast implantation at major public hospitals and private clinics in Finland from 1970 through 2000. Causes of death through 2001 were identified through the national mortality register. Expected numbers of deaths were calculated on the basis of mortality rates in the general female population, and standardized mortality ratios (SMR), i.e. ratios of observed to expected deaths, and 95% confidence intervals (CI) were calculated. Among the 2166 women with cosmetic breast implants, we observed 31 deaths versus 32.1 expected. Overall disease mortality was below expectation, mainly due to low mortality from diseases of the circulatory system (SMR, 0.28; 95% CI, 0.03-1.02). Mortality from cancer was close to expectation. There was a statistically significant excess of suicide, based on 10 deaths, which was most pronounced during the first 5 years of follow-up (SMR, 4.26; 95% CI, 1.56-9.26). In conclusion, although based on small numbers, women with cosmetic breast implants did not experience higher mortality overall than women in the general population. The high suicide risk supports other studies and warrants further detailed investigation.

Development of endoscopic techniques allows the separation and repositioning of the periosteum of the orbital rims and zygomaxilla for a brow lift without skin excision. Questions have been raised about the permanence of this repositioning without fixation. We have developed a technique using biodegradable polylactide pericranial pins that serve as fixation points to allow specific suspension of the periosteum with positive positioning until the third phase of wound healing is complete. Through two inconspicuous incisions near the midportion of the scalp, subperiosteal dissection is carried to the orbital rims and the zygomatic arch anteriorly and all the way to the base of the occiput posteriorly. This allows for contracture of the occipitalis muscle to contribute to the repositioning and lifting of the brow. Up to seven sutures are then placed through and through the pericranium of the periosteum and frontalis along the superior and lateral border of the orbital rim. These stitches of long-acting polylactide acid are secured to two pins placed in the outer table of the cranium to maintain positive fixation for more than 6 weeks. In this way precise, positive positioning is maintained until wound healing and reattachment of the structures are complete. We began these procedures in 1993; our results at 24 months are promising.