The Double Capsule Phenomenon in a Case Series and its Relationship with the Macro-Textured Breast Implant.

BACKGROUND: Silicone breast augmentation remains one of the most common aesthetic surgery procedures, and 2022 marks the 60th anniversary of the first case. Recent studies suggest a link between double capsule (DC) formation and macro-textured devices. METHODS: Between 2010 and 2015, 268 aesthetic patients underwent bilateral mammary prosthesis exchange for indications including PIP exchange, adverse capsular contracture and ultrasonographic evidence of rupture. All surgery, in the form of implant exchange and capsulectomy, was undertaken by the senior author using standard techniques. A retrospective review was undertaken, and data analysed with descriptive statistics and Fisher's exact and Mann-Whitney U tests. RESULTS: Of 268 patients identified, 40 (14.9%) showed some degree of capsular duplication and bilateral involvement was marginally more common (52.5%). Two macroscopic patterns of duplication were observed: complete and subtotal. Complete DCs correlated with a clinical triad of extreme firmness, mobility and minimal-to-no pain. Whilst a wide range of manufacturers was represented, macro-textured devices were associated with the highest DC prevalence (58.3% vs. 5.6%) (Fisher's exact test p < 0.00001). Patients with DC had been implanted for less than half the time, median 52 versus. 120 months (p = 0.0003) of those without. DISCUSSION: An elevated prevalence of duplicate capsules in macro-textured prostheses is reconfirmed in addition to a novel symptom constellation that may assist with clinical diagnosis. Our study reinforces the aetiopathogenic influence of the elastomer in DC formation and reports DC for the first time in non-macrotextured implants. Single-surgeon cohort of 268 consecutive patients with 532 implants Statistically significant association of macro-textured devices with DC Statistically significant reduced duration of implantation of macro-textured devices First report of DC in non-macro-textured devices 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 .

Short-stay hospitalisation for benign thyroid surgery: a prospective study.

We report our prospective experience of short-stay hospitalisation for benign thyroid surgery. Post-operative outcome, complication rate and duration of hospitalisation were evaluated for 200 similar patients with bilateral multi-nodular goitres treated surgically by total thyroidectomy. All subjects gave written informed consent. A short-stay regimen, with discharge within 24 h of admission, was possible in 92.5 %. Fourteen (7 %) were discharged on the second post-operative day and one on the fourth post-operative day. Causes of the 15 delayed discharges beyond 24 h were 11 hypocalcaemia (5.5 %), 3 haematoma (1.5 %) and 1 dysphonia (0.5 %). All compressive haematoma were treated by urgent reoperation. No mortality occurred. None required tracheostomies. Transient complications were diagnosed in 36 cases: 25 with hypocalcaemia and 11 with recurrent laryngeal nerve injuries. Permanent complications were observed in three patients: two with hypoparathyroidism and one with nerve damage. All patients were carefully counselled about potential thyroid surgery complications and a 24-h emergency-contact number was provided. Short-stay hospitalisation represents safe and cost-saving surgical management for benign thyroid surgery.

Comparison of carbon dioxide laser and scalpel for breast lumpectomy: a randomized controlled trial.

OBJECTIVE: To investigate whether the CO2 laser is superior to conventional surgical techniques for minor breast surgery in a randomized clinical trial. BACKGROUND DATA: It has been suggested in the literature that application of CO2 laser in breast surgery might be superior to conventional surgery in some aspects. PATIENTS AND METHODS: Sixty women whose breast masses were suitable for excisional biopsy were randomly allocated to laser and control (conventional surgical technique with scalpel) groups. Perioperative and postoperative variables were recorded and analyzed. RESULTS: The patients' ages ranged from 16-63 y. There were no significant differences between the two groups in total operative time (17.4 min with laser and 17.5 min with scalpel). There was a significant decrease in the required dose of lidocaine in the laser group (9.3 mL) compared to the scalpel group (12.4 mL; p = 0.01). In addition, hemorrhage was significantly lower in the laser group (6.6 mL) compared to the control group (11.9 mL; p = 0.006). There was no difference in the grade of the scar or postoperative pain between the two groups. CONCLUSION: Use of the CO2 laser in breast mass biopsy has some advantages, including a lower requirement for local anesthetic and a lower rate of intraoperative bleeding. Furthermore, using the laser does not prolong the operative time.

Abdominal constriction band: A rare location for amniotic band syndrome.

Amniotic band syndrome refers to the uncommon occurrence of a variety of congenital deformities, most probably due to foetal entanglement in strands ruptured from the amniotic sac. We present a rare case of an abdominal constriction band together with a short literature review.