Pleural Damage During Capsulectomy and Exchange of Long-standing Breast Implants in Poland Syndrome

Gascoigne, Adam C.; Malata, Charles M.

doi:10.1097/sap.0b013e318226b4c4

Cited by 19 publications

(15 citation statements)

References 10 publications

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“… 6 Indeed, hematomas, pneumothoraxes, and injury to adjacent structures have all been widely observed, although the specific incidence of each, and within each capsulectomy type and the plane of implant insertion, remains elusive. 19 , 20 Such challenges may be further exacerbated in the setting of post-mastectomy radiation therapy, even within the prepectoral plane, wherein simple capsulotomies may risk breaching thin fibrosed mastectomy skin flaps and culminate in adverse outcomes. In the present study, although a total of 2231 cases of surgeon-reported capsulectomies were identified from the NSQIP database, it remained unclear the specific types of capsulectomies performed.…”

Section: Discussionmentioning

confidence: 99%

Complications of Capsulectomies: An Analysis of the American College of Surgeons National Surgical Quality Improvement Program Database

Abi‐Rafeh

Safran

Winocour

et al. 2022

Aesthetic Surgery Journal Open Forum

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Background Although plastic surgeons commonly perform capsulectomies for a variety of peri-prosthetic capsular conditions, the safety of capsulectomy remains unknown, and the literature lacks evidence describing its morbidity and complication rates for patients inquiring about its associated risks. Objectives The present study aims to identify and define the complication rates associated with capsulectomies. Methods An analysis of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was performed between the years 2015-2018. All information pertaining to demographics, patient-related information, surgical indications, procedure-related information, outcomes, and complications, were assessed. Results The study identified 2231 cases of surgeon-reported capsulectomies; indications most commonly reported included capsular contracture (n=638, 28.6%) and breast implant rupture (n=403, 18.1%). 141 patients (6.32%) were hospitalized for longer than one post-operative day (range 2-28 days), while the overall complication rate was 3.0% (n=67/2231 patients). Incidence of minor complications, representing superficial surgical site infections, was 0.8%, while the major complication rate was 2.24%. These included 7 cases of deep surgical site infections (0.3%), 19 organ space infections (0.9%) and 8 cases of wound dehiscence (0.4%). Eight patients developed sepsis (0.4%); 6 patients required transfusions (0.3%), one case of post-operative pneumonia and one myocardial infarction were also identified (n=1 each, 0.0%). The overall reoperation and readmission rates were 2.0%, representing a readmission rate of 66% among patients with complications. Conclusions The present study provides the first estimate of the incidence of complications associated with capsulectomies. Although the NSQIP database contains significant limitations, the data presented herein describes a complication profile that plastic surgeons can share with their patients during informed consent.

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Section: Discussionmentioning

confidence: 99%

Complications of Capsulectomies: An Analysis of the American College of Surgeons National Surgical Quality Improvement Program Database

Abi‐Rafeh

Safran

Winocour

et al. 2022

Aesthetic Surgery Journal Open Forum

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“…24 Complications cited as risks associated with capsulectomy include bleeding and hematomas, nerve injury, trauma to the muscle, and pneumothorax. [24][25][26][27][28][29][30][31] However, developing a pneumothorax after a capsulectomy appears to be a very rare event, confirmed by a recent report from CosmetAssure data on 3048 capsulectomy revealing 6 cases of hypoxia and pulmonary dysfunction but no cases of pneumothorax. 32 These data do not specify the type of capsulectomy performed and the absence may represent surgeon Fig.…”

Section: Decision On Management Of the Capsule Capsulectomies In Seco...mentioning

confidence: 97%

Elective Implant Removal and Replacement in Asymptomatic Aesthetic Patients with Textured Devices

Calobrace

2021

Plastic &Amp; Reconstructive Surgery

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ince breast implant-associated large cell lymphoma (BIA-ALCL) was first described in a case report in 1997, the most significant in the evolving concepts is its association with almost exclusively textured devices. On July 24, 2019, the US Food and Drug Administration (FDA) requested a Class I device recall on all Biocell devices that ultimately led to a voluntary worldwide recall by the Allergan Corporation (Dublin, Ireland). This request was prompted by the growing evidence that their particular texture, Biocell, was associated with a preponderance of the reported cases. 1 In the most recent update by the FDA, of the 733 cases, 620 were Allergan Biocell, 50 Mentor Siltex (Mentor Corporation, Irving, Texas), 10 Sientra True texture (Sientra Corporation, Santa Barbara, Calif.), and 53 other or unknown. 2 When evidenced-based data are lacking, the appropriate counseling and management of patients can be challenging and lead to less than optimal outcomes in surgical results and meeting patients' expectations. The focus of this will review will be the management of the asymptomatic-textured breast implant patients and options for explantation versus removal and replacement in an effort to provide some best breast practice guidelines to assist the surgeon in the management of these very challenging issues. AN ALGORITHM FOR MANAGEMENT IN EXPLANTATION SURGERYWith the increasing concern and ever-growing evidence that textured implants are associated with the development of BIA-ALCL, explantation or implant exchange is increasingly sought by patients with textured implants that are otherwise doing well, the so-called asymptomatic textured implant patient. The sole desire for the

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“… 51 This is usually possible, but the procedure can become more complicated if the posterior capsule is adhering to the chest wall, which may increase risk of pleural damage and pneumothorax. 11 , 70 Those patients who request or are considering en bloc resection should be educated on the anatomy of capsulectomy and on the potential risks of en bloc resection compared with a total precise capsulectomy or partial capsulectomy. 51 Patients should be counseled that en bloc capsulectomy is not always possible.…”

Section: Explantation Considerationsmentioning

confidence: 99%

A Practical Guide to Managing Patients With Systemic Symptoms and Breast Implants

McGuire¹,

Clauw

Hammer

et al. 2021

Aesthetic Surgery Journal

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Numerous studies have explored the possibility of an association between breast implants and systemic symptoms potentially linked to exposure to silicone. Some studies show no direct association while others provide insufficient scientific evidence to prove or disprove an association. Nonetheless, some patients with breast implants remain concerned about the possible role of their implants in systemic symptoms they may be experiencing. This paper provides a practical approach for plastic surgeons in managing patients with breast implants who present with systemic symptoms, including recommendations for patient counseling, clinical and laboratory assessment of symptoms, and/or referral. Integral components of patient counseling include listening attentively, providing unbiased information, and discussing the risks and benefits of options for evaluation and treatment. A thorough history and assessment of symptoms, including appropriate laboratory tests, may identify underlying conditions to expeditiously address patients’ health issues through a specialist referral. Diagnosing and treating disorders that are causing a patient’s symptoms, if unrelated to their implant, would avoid a potentially unnecessary surgery. Ultimately, better information is needed to reliably guide patients in an evidence-based fashion. Long-term follow-up of patients who are explanted to see what symptoms may or may not improve could be useful in educating patients. Control groups in studies prospectively following women with implants for development of systemic symptoms would also be useful as the symptoms reported are common in women without implants. Cases are presented to illustrate the recommendations for a practical approach toward management of women reporting systemic symptoms with breast implants.

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Pleural Damage During Capsulectomy and Exchange of Long-standing Breast Implants in Poland Syndrome

Cited by 19 publications

References 10 publications

Complications of Capsulectomies: An Analysis of the American College of Surgeons National Surgical Quality Improvement Program Database

Complications of Capsulectomies: An Analysis of the American College of Surgeons National Surgical Quality Improvement Program Database

Elective Implant Removal and Replacement in Asymptomatic Aesthetic Patients with Textured Devices

A Practical Guide to Managing Patients With Systemic Symptoms and Breast Implants

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