The Influence of BIA-ALCL on the Use of Textured Breast Implant and its Placement: A Survey of Dutch Plastic Surgeons.

BACKGROUND: Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) and its association with macrotextured breast implants may have induced plastic surgeons to change their breast augmentation and breast reconstruction practice. OBJECTIVES: The aim of this study was to survey Dutch plastic surgeons about the effects of BIA-ALCL on their choice of breast implant texture and placement technique. METHODS: An online questionnaire was distributed to all members of the Dutch Association of Plastic Surgeons. Descriptive data were presented as frequencies and percentages. Technique alterations were analyzed by the marginal homogeneity test for paired nominal data. RESULTS: A total of 63 plastic surgeons completed the questionnaire. The majority of respondents altered their use of textured implants due to BIA-ALCL concerns for both breast augmentation and reconstruction (75.4% and 69.8%, respectively; both being statistically significant, P < .001). Microtextured and smooth/nanotextured breast implants are now most frequently used. BIA-ALCL did not influence the placement technique in breast augmentation and reconstruction (87.7% and 94.3%, respectively). Dual-plane breast implant placement is still the most favored technique for breast augmentation, and submuscular placement is still most favored for breast reconstruction. CONCLUSIONS: BIA-ALCL has had a significant impact on the use of macrotextured breast implants by Dutch plastic surgeons in both aesthetic and reconstructive breast surgery. Breast implant placement technique has not been affected.

[An atypical presentation of tuberculosis]. / Een atypische presentatie van tuberculose.

BACKGROUND: In 2020 there were 623 known TB infections in the Netherlands according to the Dutch ministry of health (RIVM). About 4% were located in bones and joints. The incidence of Multi Drug Resistant (MDR) TB in The Netherlands is about 1%. CASE: We describe the case of a 46-year-old female with a painful and swelling of the mid phalangeal bone of the fourth left digit. Quantiferon was positive and PCR of the biopsy for Mycobacterium tuberculosis complex (MTC) in Ziehl-Neelsen staining confirmed tuberculous osteomyelitis. The strain was resistant for rifampicin, isoniazid, ethambutol and pyrazinamid classifying it as MDR. Treatment in a specialized center with second line drugs was indicated due to rare resistance. CONCLUSION: Tuberculosis may manifest anywhere throughout the body, also as an (atypical) swelling of the hand. The golden diagnostic standard for bone and joint TB is biopsy with Ziehl-Neelsen staining.

Determining breast volume preference among patients, plastic surgeons, and laypeople: Is there a perfect breast size?

BACKGROUND: The female breast comes in many different shapes and sizes. The literature remains inconclusive on the ideal breast size. This study aims to investigate and compare breast size preferences among three cohorts (patients, plastic surgeons, and laypeople) to provide a better understanding of Western European ideals. METHODS: Patients, plastic surgeons, and laypeople were interviewed using a survey containing three-dimensional simulations of nine females, each depicted using five simulations with increasing breast size (1 = natural breast without breast implants, 2 = moderate, 3 = moderate plus, 4 = high, and 5 = ultra-high). Linear regression models were performed to define statistically significant associations between preferred breast size and predictor variables. RESULTS: In total, 28 patients, 45 plastic surgeons, and 100 laypeople (50 males and 50 females) participated in this study. On average, patients (3.5 ± 0.7) preferred larger breast sizes compared to surgeons (3.0 ± 0.7) and laypeople (3.1 ± 0.8). The difference between patients and surgeons was statistically significant. Overall, males preferred larger breast sizes than women. Patients of older age and with a higher BMI preferred larger breast sizes, while higher educational level was significantly associated with smaller breast size preference. Female plastic surgeons would undergo breast augmentation, while male plastic surgeons and female lay participants seem more skeptical. CONCLUSIONS: Significant preferential differences exist between patients and surgeons. It is important for professionals to be aware of societal ideals and preferential differences to adequately consult patients and achieve more satisfactory results.

Bilateral breast implant associated chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL): A case report.

INTRODUCTION: An estimated 30.000 breast implants are placed in the Netherlands annually. An increasing amount of reports have linked implants to the rare anaplastic large cell lymphoma (ALCL). Other implant-related lymphomas, such as those of B-cell lineage, are much rarer. PRESENTATION OF CASE: A 62-year-old female presented with pain and Baker grade III capsular contraction of the right breast. Subpectorally placed textured anatomical implants had been in situ for 26 years after cosmetic augmentation. Magnetic Resonance Imaging (MRI) showed bilateral implant leakage. Explantation of both implants confirmed bilateral leakage after which symptoms went into remission. Three months later our patient noticed an erythematous area, scar swelling and serous fluid leakage on the lateral side of the inframammary fold of the right breast. Siliconomas were excised bilaterally together with a partial capsulectomy on the left. Histopathology and immunohistochemical analysis showed monotonous small cell B-lymphocytic infiltration (CD20+, CD5+, CD23+, ALK-) in both capsules, highly suggestive for chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL). DISCUSSION: CLL/SLL are classified as nearly the same disease. The primary difference is the localization; CLL is found the bone marrow and blood whereas SLL is predominantly in the lymph nodes and spleen. There are no previous descriptions of bilateral CLL/SLL found in periprosthetic capsules. CONCLUSION: Breast implants are increasingly linked to various malignancies. In most cases, including our patient, implant explantation together with long-term follow-up suffices. MRI yields additional value in early stage diagnosis. More research is required to further optimize multidisciplinary care and improve patient outcomes.

Social Media: Is the Message Reaching the Plastic Surgery Audience?

BACKGROUND: The aim of this study was to assess readability of articles shared on Twitter and analyze differences between them to determine whether messages and written posts are at reading levels comprehended by the general public. METHODS: Top-rated #PlasticSurgery tweets (per Twitter algorithm) in January of 2017 were reviewed retrospectively. Text from tweeted links to full, open-access, and society/institutional patient information articles were extracted. Readability was analyzed using the following established tests: Coleman-Liau, Flesch-Kincaid, FORCAST Readability Formula, Fry Graph, Gunning Fog Index, New Dale-Chall Formula, New Fog Count, Raygor Readability Estimate, and Simple Measure of Gobbledygook Readability Formula. Ease-of-reading was analyzed using the Flesch Reading Ease Index. RESULTS: Of 234 unique articles, there were 101 full journal (43 percent), 65 open-access journal (28 percent), and 68 patient information (29 percent) articles. When compared using the Simple Measure of Gobbledygook Readability Formula, full and open-access journal articles attained similar mean reading levels of 17.7 and 17.5, respectively (p = 0.475). In contrast, patient information articles had a significantly lower mean readability level of 13.9 (p < 0.001). Plastic surgeons posted 128 articles (55 percent) and non-plastic surgeon individuals posted 106 articles (45 percent). Mean readability levels between the two were 16.2 and 16.9, respectively (p < 0.001). All tweeted articles were above the sixth-grade recommended reading level. CONCLUSIONS: Readability of #PlasticSurgery articles may not be appropriate for many American adults. Consideration should be given to improving readability of articles targeted toward the general public to optimize delivery of social media messages.

The National Surgical Quality Improvement Program 30-Day Challenge: Microsurgical Breast Reconstruction Outcomes Reporting Reliability.

BACKGROUND: The aim was to assess reliability of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) 30-day perioperative outcomes and complications for immediate, free-tissue transfer breast reconstruction by direct comparisons with our 30-day and overall institutional data, and assessing those that occur after 30 days. METHODS: Data were retrieved for consecutive immediate, free-tissue transfer breast reconstruction patients from a single-institution database (2010-2015) and the ACS-NSQIP (2011-2014). Multiple logistic regressions were performed to compare adjusted outcomes between the 2 datasets. RESULTS: For institutional versus ACS-NSQIP outcomes, there were no significant differences in surgical-site infection (SSI; 30-day, 3.6% versus 4.1%, P = 0.818; overall, 5.3% versus 4.1%, P = 0.198), wound disruption (WD; 30-day, 1.3% versus 1.5%, P = 0.526; overall, 2.3% versus 1.5%, P = 0.560), or unplanned readmission (URA; 30-day, 2.3% versus 3.3%, P = 0.714; overall, 4.6% versus 3.3%, P = 0.061). However, the ACS-NSQIP reported a significantly higher unplanned reoperation (URO) rate (30-day, 3.6% versus 9.5%, P < 0.001; overall, 5.3% versus 9.5%, P = 0.025). Institutional complications consisted of 5.3% SSI, 2.3% WD, 5.3% URO, and 4.6% URA, of which 25.0% SSI, 28.6% WD, 12.5% URO, and 7.1% URA occurred at 30-60 days, and 6.3% SSI, 14.3% WD, 18.8% URO, and 42.9% URA occurred after 60 days. CONCLUSION: For immediate, free-tissue breast reconstruction, the ACS-NSQIP may be reliable for monitoring and comparing SSI, WD, URO, and URA rates. However, clinicians may find it useful to understand limitations of the ACS-NSQIP for complications and risk factors, as it may underreport complications occurring beyond 30 days.

Evaluation of anatomical and round breast implant aesthetics and preferences in Dutch young lay and plastic surgeon cohort.

BACKGROUND: Literature remains inconclusive on the attractiveness and natural aspect of anatomical breast implants, and thus far, studies have failed to demonstrate the visible difference in implants that are in practice compared to those that are round. This study was undertaken to evaluate (1) whether lay and professional participants can distinguish between breasts augmented with either round or anatomical breast implants and (2) their opinion with regard to naturalness and attractiveness of these augmented breasts. METHODS: Twenty breast augmentations (10 anatomical and 10 round implants), each depicted by two postoperative pictures, were scored by 100 lay participants and 15 plastic surgeons. Implant volume ranged from 275 to 400 g. Ptotic or malformed breasts were excluded. Finally, they had to score the most natural, unnatural, attractive, and unattractive breast shapes on a schematic depiction of breast types with varying upper poles. RESULTS: The rate of correct implant identifications was 74.0% (1480/2000 observations, p < 0.001) in the lay and 67.3% (202/300 observations, p < 0.001) in the surgeon cohort. Breasts with anatomical implants were rated as significantly more natural (3.3 ± 1.0 vs. 2.6 ± 1.0, p < 0.001 and 3.3 ± 1.0 vs. 2.2 ± 0.9, p < 0.001, respectively) and more attractive (3.1 ± 1.0 vs. 2.6 ± 1.0, p < 0.001 and 3.6 ± 0.9 vs. 2.7 ± 0.9, p < 0.001, respectively) versus round implants by both lay participants and surgeons. Participants preferred breasts with a neutral or slightly negative upper pole contour. CONCLUSION: Participants were able to distinguish between the results achieved with either anatomical or round textured Allergan breast implants and found augmented breasts with the anatomical implants more natural and attractive.