Breast Implant Mycobacterial Infections: An Epidemiologic Review and Outcome Analysis.

BACKGROUND: Epidemiologic evidence of periprosthetic mycobacterial infections is limited. The recent boom in cosmetic surgery tourism has been associated with a rise of surgical-site infections in returning patients. This review aims to explore available data, examine trends of documented periprosthetic mycobacterial infections, and analyze outcomes of management techniques. METHODS: A search in the Biosis, Embase, LILACS, MEDLINE, and Web of Science databases from inception until December of 2017 for "Breast Implants" and "Mycobacterial Infections" and equivalents was performed. Data were pooled after two screening rounds following full-text retrieval and cross-referencing. RESULTS: Forty-one reports describing 171 female patients who had breast prosthesis-related mycobacterial infections were identified. Bibliometric case-based analysis revealed a rise of periprosthetic mycobacterial infections in developing countries since the start of the millennium. The mean patient's age was 37.9 years and the majority of patients had undergone bilateral breast augmentation. Most patients presented with breast pain or tenderness, after an average incubation period of 9 months. Mycobacterium fortuitum was isolated from 90 cases (52.6 percent). Immediate explantation with or without delayed reimplantation was the most commonly used surgical strategy, complemented by combination antimicrobial therapy for an average of 4.6 months. The mean follow-up time was 39.7 months, during which recurrence was observed in 21 of 171 patients (12.3 percent). CONCLUSIONS: The emergence of periprosthetic mycobacterial infections in relation to cosmetic medical tourism alerts clinicians to the importance of educating the public about the associated risks. In addition, this study identifies risk factors associated with recurrence of periprosthetic mycobacterial infections.

A systematic review of complications associated with direct implants vs. tissue expanders following Wise pattern skin-sparing mastectomy.

INTRODUCTION: With proven oncological safety and improved aesthetic outcomes, the Type IV or "Wise pattern" skin-sparing mastectomy (SSM) is a procedure that is being performed with increasing frequency. Unfortunately, it is also associated with an increased risk of complications. The purpose of this investigation was to determine the complications associated with direct-to-implant and two-step tissue-expander breast reconstruction following Wise pattern SSM. METHODS: Systematic electronic searches were performed using PubMed, MEDLINE, and Embase databases. Search terms used were those for studies reporting complications following breast reconstruction using direct-to-implant and two-step tissue-expander approaches following Wise pattern SSM. Included studies were graded for their risk of bias. Pooled descriptive statistics on overall complication rates, skin flap necrosis, delayed wound healing, hematoma, and infections were performed for both procedures. Other complications specific to each procedure were also reported. RESULTS: A total of 16 articles met the inclusion criteria for this investigation, representing 561 direct-to-implant or two-step breast reconstruction procedures. For direct-to-implant reconstructions, the pooled complication rate was 30%, while for those using tissue expansion, it was 20.3%. Rates of skin flap necrosis (9.70%, 4.69%), delayed wound healing (2.77%, 0.78%), infection (2.54%, 3.91%), seroma (1.15%, 4.68%), and hematoma (0.92%, 0.78%) were calculated for direct-to-implant procedures and two-step tissue expansion, respectively. CONCLUSION: Following Wise pattern SSM, direct-to-implant reconstruction appears to be associated with an increased rate of overall complications and skin flap necrosis. Modification of the procedure through the placement of a de-epithelialized dermal flap may help limit delays in wound healing and infection. Future investigations that report complication rates for SSM should present data that are segregated according to the type of procedure and the method of reconstruction.

Evolving trends in the management of orbital floor fractures.

BACKGROUND: The management of orbital floor fractures is diverse and continues to evolve. The purpose of the current study was to provide an updated summary of the literature, with a focus on interspecialty differences, and contrast that with current treatment strategies of actively practicing plastic surgeons. METHODS: A survey was conducted of surgeons who currently manage orbital floor fractures. The results are summarized and compared with a 10-year literature review (2002-2012) of surgical approaches, indications and timing of surgery, and implant selection in various surgical disciplines. Inclusion criteria included studies in English language with 10 or more patients. RESULTS: The survey response rate was 56%, of which 86 surgeons were identified to currently manage orbit fractures. A third of participants reported they are less likely to operate on these fractures relative to earlier in their career. Six factors were found to have the greatest influence on surgeon's operative decision: enophthalmos, hypophthalmos, positive forced duction, defect size, motility restriction, and persistent diplopia. The most common preferred approach to the orbit is midlid/infraorbital (45%) followed by transconjunctival (31%) and subciliary (24%). Medpor and titanium are the most preferred implants (83%) compared with autologous bone (5%). CONCLUSIONS: Significant interdisciplinary and intradisciplinary differences in the management of orbital fractures exist. The most significant trends are the growing popularity of alloplastic versus autogenous materials for orbital floor reconstruction and the fact that one-third of surgeons are more likely to opt for a nonoperative (conservative) approach compared with earlier in their careers.