Pressure Resistance of Breast Implants as a Function of Implantation Time

Rappard, Julien H. A. van; Sonneveld, G. J.; Twisk, R. van; Borghouts, J. M. H. M.

doi:10.1097/00000637-198810000-00027

Cited by 5 publications

(11 citation statements)

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“…The clinical observation that older implants are more likely to rupture is consistent with results of mechanical studies, which suggest a weakening of the implant shell with increasing time after implantation [4,5]. There are two types of rupture: intracapsular rupture, in which a tear or disruption of the shell occurs such that a significant portion of the silicone gel lies outside the shell but within the capsule and the shell collapses into the gel to varying degrees; extracapsular rupture, when there is displacement of silicone gel from a ruptured implant through the fibrous scar or capsule into the adjacent tissues, often caused by a strong external force.…”

Section: Introductionsupporting

confidence: 82%

Breast prosthesis: Management of patients after plastic surgery

Bassetti

Pediconi

Luciani

et al. 2011

Journal of Ultrasound

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Breast augmentation and breast reconstruction are increasingly common operations. All radiologists need to be able to recognize the normal appearances of the more commonly used implants on various imaging modalities and breast radiologists in particular are facing new challenges when imaging the women involved. This work aims to review the normal and abnormal findings in women undergoing breast implant surgery using ultrasonography, mammography, and magnetic resonance imaging.

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Section: Introductionsupporting

confidence: 82%

Breast prosthesis: Management of patients after plastic surgery

Bassetti

Pediconi

Luciani

et al. 2011

Journal of Ultrasound

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“…Earlier studies suggested that gel implants could fail over time (22,23). However, before 1993, the incidence of disruption was thought to be very low.…”

Section: Prevalence Of Disruptionmentioning

confidence: 99%

Current status of breast implant survival properties and the management of the woman with silicone gel breast implants

Peters¹

2000

CAN J PLAST SURG

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The survival properties of silicone gel breast implants are dependent on their vintage (year of manufacture), duration in situ and manufacturer. A total of 527 gel implants have been explanted and analyzed in the author's laboratories. Of the 28 first-generation implants (1963 to 1972), 27 (96.4%) remained intact after 14 to 28 years in situ (mean 20.8 years). Of the 216 second-generation implants (1973 to mid-1980s) that were explanted from 1992 to 1998, 158 (73%) had disrupted. Kaplan-Meier survival curves demonstrated significantly different survival properties among second-generation manufacturers. Surgitek implants were by far the least durable. After 14 years, all second-generation Surgitek implants had disrupted. By contrast, after 20 years, about half of the Dow Corning and Heyer-Schulte implants remained intact. Among third-generation implants (mid-1980s to 1992), 43 of 46 (93.4%) remained intact after a mean of 6.3 years (range three to 12 years). The three disruptions were Surgitek implants. Implants from other manufacturers remained intact. However, the disruption frequencies of third-generation implants have yet to be measured over the relevant periods of time. Survival patterns appeared to be related to the thickness of the elastomeric shell of the three generations of implants. Mechanical strength analyses of the elastomeric shells of explants have exhibited little or no large scale material degradation, even after as long as 28 years in situ. The mechanism of implant disruption likely involves the 'fold flaw' theory, whereby an internal abrasion can develop over time at the site of a fold in the implant wall. Diagnosis of disruption is difficult. Mammography is helpful only if there has been extravasation of silicone gel into breast tissue. Extravasation was observed in only 4.2% of second-generation implants removed from 1992 to 1998. It was not seen with first-or third-generation implants. Ultrasound analyses are not generally helpful to predict disruption because they are very operator dependent and because capsular contracture causes folds in the implant wall, which result in false positives. Magnetic resonance imaging is the most accurate imaging modality to detect implant disruption. However, this technology is not indicated for monitoring implant status because it is too costly and time consuming, and because it has significant limitations, particularly with first-generation and textured implants. Careful explantation and direct visual examination are the standards for diagnosing gel implant disruption. Many implant disruptions are likely 'silent', with no specific symptoms or clinical findings. After disruption, none of the following are elevated above the levels seen in control women without implant exposure: serum autoantibodies, blood and serum silicon, and the incidence of breast cancer, autoimmune disease or any other medical disease. There is no evidence to support the existence of any 'novel' or 'atypical' syndrome associated with gel implants. Women over 30 years of age with breast...

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“…Since, it has been shown that the force to break the shell decreases over time; this could be the main cause of the limited lifetime [ 77 , 78 , 79 , 80 , 81 , 82 ]. Some have linked this change in properties to the gel diffusing into the shell, which it does before the gel is released (gel-bleed) [ 19 ].…”

Section: Silicone Breast Implantsmentioning

confidence: 99%

The Effect of Size of Materials Formed or Implanted In Vivo on the Macrophage Response and the Resultant Influence on Clinical Outcome

Feldman

2021

Materials

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Both the chemistry and size of a material formed in vivo, or an implanted biomaterial, can alter the in vivo host response. Within the size range covered within this review, over 1 μm, chemistry is only important if the solid material is unstable and leeching small molecules. The macrophage activity and the resultant inflammatory response, however, are related to the size of the solid material. The premise of this review is that differences in size of the solid material, in different cases, can be the reason why there is some individual-to-individual variation in response. Specifically, the inflammatory response is enhanced when the size is between 1–50 μm. This will be looked at for three configurations: spherical particulate (silicone oil or gel from breast implants), elongated particulate (monosodium urate [MSU] crystals in gout or in kidney stones), and fibers (e.g., polyester used in fabric implants). These specific examples were selected because many still believe that the clinical outcome for each is controlled by the surface chemistry, when in fact it is the size. In each case, specific studies will be highlighted to either show a mechanism for creating different sizes and therefore a differential biological response (first three) or how changing the size and shape (diameter and spacing of fibers, in this example) can affect the response and can help explain the different responses to fabric implants found in vivo within the 1–50 μm size range. It was found that polyester fibers under 70 μm had a significant increase in macrophage response. Further, it was found that compounds found in synovial fluid could limit MSU crystal size. In addition, it was shown that plasma with low triglyceride levels emulsifies silicone oils to a greater extent than plasma with higher triglyceride levels. Therefore, in three cases it appears that differences in the inflammatory response between individuals and between different implants could be explained just by the size of the material formed or implanted.

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Pressure Resistance of Breast Implants as a Function of Implantation Time

Cited by 5 publications

References 0 publications

Breast prosthesis: Management of patients after plastic surgery

Breast prosthesis: Management of patients after plastic surgery

Current status of breast implant survival properties and the management of the woman with silicone gel breast implants

The Effect of Size of Materials Formed or Implanted In Vivo on the Macrophage Response and the Resultant Influence on Clinical Outcome

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