In vitro investigation into the forces involved during lipofilling.

Breast augmentation using implants is the most common aesthetic and reconstructive breast surgical procedure. Complications such as implant rupture maybe related to surgical technique and damage to the implant. Autologous fat transfer (lipofilling) using metallic cannulae has become a standard adjunctive, yet there is little evidence on lipofilling safety in the presence of implants. The aims of this study are to verify the effects of different cannulae and to quantify the forces applied by surgeons during lipofilling. Silicone gel-filled textured implants (200 mL), mounted on a specially constructed mould were ruptured with two different cannulae: type A (hole at tip: sharp) and type B (hole away from tip: blunt), driven at three speeds (10, 100 and 1000 mm/min), and the force at rupture was recorded. In addition, the maximum 10 forces over a 30-s period applied by 11 plastic surgeons against a breast implant in an in vitro environment were recorded using a load cell attached to a type-A cannula. Statistical analysis of comparative results was performed using t-tests, with p < 0.05 considered significant. Results showed that the implant ruptured at forces up to 25% lower when cannula A was used compared to cannula B. This supports current technique in lipofilling in the use of a blunt tipped cannula. There was a significant difference between some displacement rates only, due to the viscoelastic nature of the material. The tactile force that surgeons use during lipofilling was modelled in vitro and showed a range of maximum forces between 0.23 and 16.8 N, with a mean maximum value of 6.9 N. Limitation of this study is that it may not reflect in vivo behaviour of breast implants. More studies are needed to confirm the safety of breast lipofilling in the presence of implants using these data as a starting point.

Effect of accelerated aging on the viscoelastic properties of a medical grade silicone.

The viscoelastic properties of cylinders (diameter 5 mm, height 2.2 ± 0.2 mm) of Nagor silicone elastomer of medium hardness, were investigated before and after the specimens had undergone accelerated aging in saline solution at 70°C for 38, 76 and 114 days (to simulate aging at 37°C, for 1, 2 and 3 years, respectively). All sets of specimens were immersed in physiological saline solution at 37°C during testing and the properties were measured using dynamic mechanical analysis (DMA). A sinusoidal cyclic compression of 40 N ± 5 N was applied over a frequency range, f, of 0.02-25 Hz. Values of the storage, E', and loss, E″, moduli were found to depend on f; the dependence of E' or E″ on the logarithm (base 10) of f was represented by a second-order polynomial. After accelerated aging, the E' and E″ values did not increase significantly (p<0.05). Furthermore, scanning electron microscopy (SEM) showed that accelerated aging did not affect the surface morphology of silicone. Attenuated total reflectance Fourier transform infra-red spectroscopy (ATR-FTIR) showed that accelerated aging had a negligible effect on the surface chemical structures of the material. Differential scanning calorimetry (DSC) showed no changes to the bulk properties of silicone, following accelerated aging.

Swelling of medical grade silicones in liquids and calculation of their cross-link densities.

Four medical grade silicones were swollen, until they reached equilibrium (i.e. constant mass) in eight liquids at 25 degrees C. The greatest swelling was obtained with n-heptane but the volume fraction, varphi, of the silicones in their swollen state was not significantly different (p<0.05) in this liquid than in cyclohexane. For each grade of silicone, varphi was plotted against delta(l), the liquid solubility parameter, for each liquid in which it was swollen. A second-order polynomial was plotted through the results; the minimum in this polynomial provided a value for the polymer solubility parameter, delta(p). The Flory polymer-liquid interaction parameter, chi, was calculated for the four best liquids, using Hildebrand's solubility parameter theory. An alternative method for calculating chi, directly from swelling measurements, was shown to produce physically unreasonable results. The cross-link density, upsilon, was calculated, from varphi and chi, for each grade of silicone, using the Flory-Rehner equation. Since the values of two parameters involved in Hildebrand's theory cannot be determined reliably and because the Flory-Rehner equation is an approximation, absolute values of upsilon cannot be obtained. However, the relative values of upsilon obtained were higher for the harder grades then for the softer grades and similarly, the grades with the higher Young's modulus had higher upsilon values.