Effect of a topical silicone gel and a polyurethane dressing on the evolution of scars.

OBJECTIVE: To assess the effectiveness and safety of a topical silicone gel (BE + Gel reductor y reparador de cicatrices) and a polyurethane dressing (BE + Apósito reductor y reparador de cicatrices) on the evolution of scars of patients who were previously recruited in the emergency care unit while seeking wound care. METHOD: A single center, stratified observational, open label study was performed in the emergency care unit of Donostia Universitary Hospital (recruitment) and in the Biodonostia Health Research Institute (intervention). Scars located in unexposed body areas with the dressing, and scars located in exposed areas with either the gel or the dressing. Investigators assessed interventions at day 1 and on weeks 4, 8 and 12. Vancouver Scar Scale (VSS) and a photographical assessment were used to determine the scars evolution, and the subjective perception of the scar was evaluated by means of a questionnaire administered to the patients. RESULTS: Patients whose scars were treated with the silicone gel had an average initial VSS score of 5.4 ± 2.08. This value was reduced to 0.86 ± 1.17 after 90 days of treatment. Patients treated with the polyurethane dressing had an average initial VSS score of 5.8 ± 2.29. After 90 days of treatment, this average score was reduced to 0.33 ± 0.66. Positive evolution of scars was also supported by photographs and by a patient questionnaire. CONCLUSIONS: Both treatments appear to be safe and effective, objectively, and subjectively, in the context of scar evolution.

Photon-counting CT of degenerative changes and rupture of silicone breast implants: a pilot study.

BACKGROUND: Accurate assessment of breast implants is important for appropriate clinical management. We evaluated silicone properties and diagnostic accuracy for characterizing silicone implants and detecting degenerative changes including rupture in photon-counting computed tomography (PCCT). METHODS: Over 16 months, we prospectively included patients with silicone implants and available breast magnetic resonance imaging (MRI) who received thoracic PCCT performed in prone position. Consensus reading of all available imaging studies including MRI served as reference standard. Two readers evaluated all implants in PCCT reconstructions for degenerative changes. In a subgroup of implants, mean density of silicone, adjacent muscle, and fat were measured on PCCT reconstructions. Contrast-to-noise ratios (CNRs) were calculated for implant-to-muscle and implant-to-fat. RESULTS: Among 21 subjects, aged 60 ± 13.1 years (mean ± standard deviation) with 29 implants PCCT showed the following: high accuracy for linguine sign, intraimplant fluid (all > 0.99), peri-implant silicone (0.95), keyhole sign (0.90), and folds of the membrane (0.81); high specificity for linguine sign, intraimplant fluid, keyhole sign, folds of the membrane (all > 0.99), and peri-implant silicone (0.98); and high sensitivity for linguine sign and intraimplant fluid (all > 0.99). In a subgroup of 12 implants, the highest CNR for implant-to-muscle was observed on virtual unenhanced reconstructions (20.9) and iodine maps (22.9), for implant-to-fat on iodine maps (27.7) and monoenergetic reconstructions (31.8). CONCLUSIONS: Our findings demonstrate that silicone breast implants exhibit distinct contrast properties at PCCT, which may provide incremental information for detection of degenerative changes and rupture of implants. RELEVANCE STATEMENT: Thoracic photon-counting computed tomography is a promising modality for the diagnostic assessment of silicone breast implants. KEY POINTS: • Thoracic photon-counting computed tomography demonstrates unique contrast properties of silicone breast implants. • Iodine map reconstructions reveal strong contrast-to-noise ratios for implant-to-muscle and implant-to-fat. • Thoracic photon-counting computed tomography shows high diagnostic accuracy in detecting implant degeneration and rupture. TRIAL REGISTRATION: German Clinical Trials Register number DRKS00028997, date of registration 2022-08-08, retrospectively registered.

Takayasu arteritis associated with autoimmune/inflammatory syndrome induced by adjuvants: a case-based review.

Takayasu's arteritis (TA) is a chronic granulomatous vasculitis that predominantly affects the aorta and its major branches. Despite advancements in the understanding of the pathogenic pathways of vascular inflammation, the etiology and predisposing factors of TA remain to be fully understood. In susceptible individuals, exposure to adjuvants may trigger, unlock or unmask an autoimmune disorder, presenting as non-specific constitutional symptoms or a fully developed autoimmune syndrome such as vasculitis. Here, we hypothesize that TA could be triggered by siliconosis, a subtype of the autoimmune/inflammatory syndrome induced by adjuvants (ASIA). ASIA, also known as Shoenfeld syndrome, encompasses a wide range of autoimmune and immune-mediated diseases resulting from dysregulation of the immune response after exposure to agents with adjuvant activity. This case report describes the development of large artery vasculitis, TA, in an individual one year following the placement of silicone breast implants. The patient initially presented with non-specific symptoms, and multiple imaging methods were employed, including ultrasound diagnostics, CT angiography, and 18-fluorodeoxyglucose positron emission tomography/CT. These techniques revealed vasculitic alterations in the carotid arteries and thoracic aorta. Initial treatment with glucocorticosteroids proved ineffective, prompting the addition of steroid-sparing immunosuppressive agents. Due to the distinct clinical symptoms, disease progression, implant-associated fibrosis, and resistance to therapy, the potential involvement of implants in the development of large-vessel vasculitis was considered, and a potential association with ASIA was postulated. Although there is limited evidence to support a direct link between adjuvants and the pathogenesis of TA, similarities in cellular immunity between the two conditions exist. The diagnosis of this complex and potentially debilitating condition requires a comprehensive clinical examination, laboratory evaluation, and instrumental assessment. This will aid in identifying potential contributing factors and ensuring successful treatment.

Compromiso del parénquima pulmonar secundaria a la inyección subcutánea de geles de silicona: reporte de caso

El compromiso del parénquima pulmonar secundario a la inyección subcutánea de geles de silicona es un cuadro de presentación excepcional, que se presenta con mayor frecuencia en mujeres entre los 22 a 55 años. Aunque se han planteado distintas teorías sobre su etiología, esta se desconoce y puede presentar complicaciones locales, sistémicas e incluso tener un desenlace fatal. Son pocos los casos reportados en América del Sur, y en el Perú no existe reporte alguno de esta singular entidad. Se presenta el caso de un paciente varón de 28 años, transexual, previamente sano, quien tras la inyección subcutánea de geles de silicona en la región glútea, en forma ilegal y por una persona que no es profesional de la salud, manifestó, dentro de las primeras 24 horas, un cuadro clínico caracterizado por dificultad respiratoria progresiva y dolor torácico punzante de aproximadamente 7 de 10 en la escala del dolor. Al ingresar a emergencias se evidenció de manera objetiva insuficiencia respiratoria, ya que el paciente presentó una saturación de oxígeno del 72 % a Fio₂: 21 %, asimismo, el compromiso del parénquima pulmonar tanto en la tomografía y radiografía de tórax con signos muy sugerentes de esta patología. Mediante la prueba ARN para SARS-CoV-2 en la muestra respiratoria por RT-PCR en tiempo real se descartó la neumonía secundaria al virus SARS-CoV-2, igualmente se excluyó la patología por inmunosupresión y tromboembolismo pulmonar. Debido a que no existe un tratamiento estandarizado se le brindó las medidas de soporte pertinentes, tales como administración de oxígeno suplementario a bajo flujo por cánula binasal, corticoides sistémicos vía endovenosa, además de antibioticoterapia, y se logró una evolución favorable con resolución del cuadro clínico inicial. Después de 10 días de tratamiento intrahospitalario el paciente fue dado de alta.

Pulmonary parenchymal involvement secondary to the subcutaneous injection of silicone gels is an unusual condition which occurs more frequently in women aged between 22 and 55 years. Although different theories have been put forward about its etiology, it is unknown and the condition may cause local and systemic complications and even have a fatal outcome. Few cases have been reported in South America and there is no report of this unique entity in Peru. We present the case of a previously healthy 28-year-old male transgender patient who, after an illegal subcutaneous injection of silicone gels in the gluteal region given by a non-healthcare professional, showed progressive respiratory distress and stabbing chest pain of approximately 7 out of 10 on the pain scale within the first 24 hours. Upon admission to the emergency room, respiratory failure was objectively evidenced since the patient had an oxygen saturation of 72 % at a FiO₂ of 21 %, as well as pulmonary parenchymal involvement both in the CT scan and chest X-ray with signs highly suggestive of this pathology. Using a SARS-CoV-2 RNA real-time RT-PCR test performed on a respiratory specimen, COVID pneumonia, immunodeficiency disorders and pulmonary embolism were ruled out. Since there is no standard treatment, the patient was given relevant support measures such as the administration of supplemental oxygen at a low flow rate by binasal cannula, intravenous systemic corticosteroids and antibiotic therapy, thus achieving good progress with resolution of the initial clinical presentation. Then, after 10 days of intrahospital treatment, the patient was discharged.

Explante de silicone mamário: um estudo longitudinal multicêntrico / Breast silicone explant: a multicenter longitudinal study

Introdução: Após a colocação de implantes mamários de silicone, algumas pacientes apresentam sintomas descritos como doença do implante mamário e buscam a cirurgia de explante. O objetivo deste estudo é analisar o histórico de sintomas e verificar as impressões dos pacientes submetidos ao explante mamário em três momentos distintos: antes de colocar os implantes mamários, enquanto estavam com os implantes e após a cirurgia de explante. Métodos: Essa pesquisa foi delineada como um estudo observacional longitudinal multicêntrico utilizando um questionário on-line de participação voluntária enviado por e-mail. Resultados: Foram analisados 156 pacientes, 84% apresentavam três ou mais sintomas e 66,1% destes obtiveram melhora de sua sintomatologia após o explante (p<0,001). Antes da colocação de silicone, a mediana de autossatisfação corporal era de 7, enquanto estavam com os implantes a mediana tornou-se 9 e após a cirurgia de explante a mediana se manteve em 9 (p<0,001). Grupos de apoio em redes sociais auxiliaram na decisão de fazer o explante em 87,2% das pacientes. Conclusão: Pacientes que têm sintomas após colocarem silicone apresentam melhora com a retirada dos implantes mamários. A autossatisfação corporal aumenta com a colocação de implantes mamários e permanece elevada após a retirada destes. Pacientes que fazem a cirurgia do explante costumam estar arrependidas de terem colocado silicone, muito satisfeitas com a decisão de removêlos e igualmente satisfeitas com o resultado da cirurgia de explante mamário. Grupos de apoio em redes sociais foram importantes na tomada de decisão destas pacientes.

Introduction: Following silicone breast implant placement, some patients present symptoms described as breast implant illness and seek explant surgery. This study aims to analyze the historical symptoms and ascertain breast explant patients' impressions at three different times: before breast implant placement while having the implants, and after the explant surgery. Methods: This survey was designed as a multicenter longitudinal observational study using an online voluntary participation questionnaire sent by e-mail. Results: 156 patients were analyzed, 84% had three or more symptoms, and 66.1% improved their symptoms after the explant (p<0.001). Before the placement of silicone, the median self-body satisfaction was 7, while with the implants, the median became 9, and after the explant surgery, the median remained up to 9 (p<0.001). Support groups on social networks helped in the decision to explant in 87.2% of the patients. Conclusion: Patients presenting symptoms after silicone placement show improvement with breast implant removal. Body self-satisfaction increases with the placement of breast implants and remains increased after their removal. Patients who undergo the explant surgery usually regret having implanted silicone; they are very satisfied with the decision to remove them and equally satisfied with the result of the breast explant surgery. Support groups on social networks were important in the decision-making of these patients.

Clinical use of magnetic resonance imaging in buttock augmentation with silicone implants: a retrospective analysis.

Background: The objective of the current study was to retrospectively examine the morphological magnetic resonance imaging (MRI) characteristics of the gluteus maximus of buttock augmentation at levels of predetermined anatomic points. Methods: The present study was a retrospective cross-sectional study. Adult women who underwent high-quality MRI scanning at Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2018 to January 2021 were included in this work. The transverse MRI data measured at the inferior point of the sacroiliac joint, just above the femoral head, and at the ischial tuberosity were collected and statistically analyzed. Results: Fifty-two cases (104 sides of female gluteus maximus) were included in the final analysis. The A point (surgery starting point) were 54.4±6.34 mm, 54.91±5.57 mm, and 73.91±5.57 mm away from the posterior midline at the level of inferior point of the sacroiliac joint, just above the femoral head, and at the ischial tuberosity, respectively. Accordingly, the thickness of the muscle at these locations was 16.0±4.17 mm, 23.4±4.40 mm, and 24.6±7.58 mm, respectively. The diameter of the implant did not exceed 14.18±1.22 cm. In addition, the gluteus maximus at the lowest point of the sacroiliac joint and above the femoral head exhibited an arc structure, which needs to be tilted to the deep plane during separation. Conclusions: Dissimilar from previous experience of blind dissection, the gluteus maximus muscle can be more scientifically and reasonably dissected using the indexes for gluteus augmentation supplied in this study.

Passado, presente e futuro utilizando implantes mamários de silicone no Brasil, um relato de 45 anos / Past, present and future using silicone breast implants in Brazil, a 45-year report

O autor conviveu com implantes mamários e relata a história da evolução em seus 45 anos de experiência. Aponta os pontos principais dessa evolução, as coincidências e as complicações no transcorrer do tempo, e propõe ao final acontecimentos possíveis no futuro.

The author lived with breast implants and tells the story of evolution in his 45 years of experience. It points out the main points of this evolution, the coincidences, and complications over time, and proposes possible future events in the end.

Tratamento cirúrgico de ptose mamária com inclusão de prótese de silicone: avaliação de resultados cirúrgicos e satisfação de pacientes / Surgical treatment for breast ptosis with silicone prosthesis: evaluation of surgical results and patient satisfaction

Introdução: A correção da ptose mamária associada à flacidez de pele é corrigida através da mastopexia com inclusão de implante. O objetivo deste trabalho foi avaliar os resultados cirúrgicos e a satisfação de pacientes submetidas à cirurgia de ptose mamária com inclusão de prótese de silicone. Métodos: Foram selecionadas 22 pacientes submetidas à mastopexia com inclusão de implante, no período de fevereiro a setembro de 2016, no Serviço de Cirurgia Plástica do Hospital Heliópolis. Foi realizada entrevista com as pacientes, por meio de aplicação de questionário, com a finalidade de verificar o grau de satisfação e as alterações no cotidiano diário após a cirurgia. A avaliação dos resultados cirúrgicos foi realizada mediante avaliação de três cirurgiões, do qual atribuíram notas a diferentes itens. Resultados: 100% das entrevistadas se sentem satisfeita com a cirurgia e todas relataram a melhora da autoestima delas. Na avaliação das cirurgias realizada com os cirurgiões, cerca de 91% dos resultados estão entre regular e bom. Conclusão: O grau de satisfação das pacientes submetidas à mastopexia com inserção foi excelente e houve impacto favorável na qualidade de vida e bem-estar das pacientes avaliadas, sendo que o resultado pós-cirúrgico se enquadra como regular ou bom.

Introduction: The correction of breast ptosis associated with skin flaccidity is done through mastopexy with the inclusion of an implant. This work's objective was to evaluate the surgical results and the satisfaction of patients who underwent breast ptosis surgery with silicone prosthesis placement. Methods: We selected 22 patients who underwent mastopexy with implant placement, from February to September 2016, at the Plastic Surgery Service of Hospital Heliópolis. Interviews were conducted applying to the patients a questionnaire to verify the degree of satisfaction and changes in the daily routine after surgery. The surgical results evaluation was carried out by three surgeons, who attributed scores to different items. Results: 100% of the interviewees feel satisfied with the surgery, and all reported an improvement in their self-esteem. In the evaluation of surgeries performed with surgeons, about 91% of the results are between regular and good. Conclusion: The degree of patient's satisfaction who underwent mastopexy with insertion was excellent. There was a favorable impact on the quality of life and well-being of the patients evaluated, with the post-surgical result being classified as regular or good.

Hyperbranched Silicone MDTQ Tack Promoters.

Low molecular weight, highly crosslinked silicone resins are widely used as reinforcing agents for highly transparent elastomers and adhesion/tack promoters in gels. The resins are complex mixtures and their structure / property relationships are ill defined. We report the synthesis of a library of 2, 3 and 4-fold hyperbranched polymeric oils that are comprised of linear, lightly branched or highly branched dendronic structures. Rheological examination of the fluids and tack measurements of gels filled with 10, 25 or 50% dendronic oils were made. Viscosity of the hyperbranched oils themselves was related to molecular weight, but more significantly to branch density. The properties are driven by chain entanglement. When cured into a silicone gel, less densely branched materials were more effective in improving tack than either linear oils or Me3SiO-rich, very highly branched oils of comparable molecular weight, because the latter oils underwent phase separation.

Manejo de cicatrizes com uso de placas e gel de silicone / Management of scars with the use of silicone gel and sheets

A formação de cicatriz é a resposta de cura natural da pele para restabelecer a integridade dérmica após uma lesão. As cicatrizes, além de inestéticas, podem ainda apresentar-se hipertróficas ou queloidianas, tornando o tratamento difícil e, por vezes, insatisfatório. A etnia e a localização da ferida desempenham um papel importante na gênese dos tipos de cicatriz, mas nem sempre podemos prever o resultado final. O uso do silicone tópico tem sido uma opção para o manejo da cicatriz e alvo de diversas publicações ao longo dos anos. Acredita- se que o uso precoce possa prevenir o desenvolvimento de cicatrizes anormais e tratar cicatrizes existentes.

Scar formation is the natural healing response of the skin to reestablish dermal integrity after an injury. Besides being unsightly, the scars can also be hypertrophic or keloids, which makes treatment challenging and many times unsatisfactory. Ethnicity and site of the lesion have an important role in the formation of scar types, but it is not always possible to predict the final result. The use of topical silicone has been an option for scar management and the target of many publications over the years. It is believed that its early use can prevent the development of abnormal scars and treat existing scars.

Effectiveness of TGF-beta 1 neutralizing antibody against the capsule contracture of silicone prosthesis / 中华医学美学美容杂志

Objective To study the effects and mechanism of immediate application of transformation growth factor beta 1 (TGF-β1) neutralizing antibody postoperatively to prevent the fibrous capsule formation in animal model,and to observe the different effects between two concentrations of TGF-β1 neutralizing antibody.Methods Ten ml of smooth round silicone prostheses were implanted subcutaneously in the back of rats.Then 25 μg/0.1 ml or 50 μg/0.1 ml TGF-β1 neutralizing antibody were injected around the implanted prostheses in the experimental group,while the control group was injected with PBS 0.1 ml.On day 7,14 and 28,the thickness of capsule measured;The density of collagen;and the expression of TGF-β1,alpha smooth muscle actin (α-SMA),and fibronectin (FN) was detected.Results After 28 days,the average capsule thickness of the control group was significantly higher in the experimental group,and the difference between the control group and the 25 μg experimental group had statistical significance.TGF-β1 expression and the number of α-SMA positive fibroblasts in control group were significantly higher than that in the experimental group,the difference was statistically significant.In the control group,the expression of FN and collagen density was slightly higher than the two experimental groups,but the differences among the three groups showed no statistical significance at each time point.Conclusions Immediate application of the TGF beta 1 neutralizing antibody in the the implant prosthesis can reduce the thickness of the capsule to some extent.

Systematic review of the effectiveness of polyurethane-coated compared with textured silicone implants in breast surgery.

BACKGROUND: Silicone gel implants are used worldwide for breast augmentation and breast reconstruction. Textured silicone implants are the most commonly placed implant, but polyurethane-coated implants are increasingly being used in an attempt to ameliorate the long-term complications associated with implant insertion. METHODS: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Electronic searches of MEDLINE, EMBASE, the Cochrane Library and www.ClinicalTrials.gov were undertaken in March 2014 using keywords. RESULTS: Following data extraction, 18 studies were included in the review, including four core studies of textured silicone implants and five studies reporting outcomes for polyurethane-coated silicone implants. There are no clear data reporting revision rates in patients treated with polyurethane implants. In the primary reconstructive setting, capsular contracture rates with silicone implants are 10-15% at 6 years, whilst studies of polyurethane implants report rates of 1.8-3.4%. In the primary augmentation setting, core studies show a capsular contracture rate of 2-15% at 6 years compared with 0.4-1% in polyurethane-coated implants; however, the polyurethane studies are limited by their design and poor follow-up. CONCLUSIONS: The use of polyurethane implants should be considered a safe alternative to textured silicone implants. It is likely that an implant surface does influence short- and long-term outcomes; however, the extent of any benefit cannot be determined from the available evidence base. Future implant studies should target the short- and long-term benefits of implant surfacing by procedure with defined outcome measures; a head-to-head comparison would help clarify outcomes.

Immediate Breast Reconstruction Using Silicone Implants in Previously Augmented Patients

BACKGROUND: Augmentation mammoplasty is rapidly becoming one of the most frequently performed cosmetic surgeries. Consequently, the number of breast cancer patients with a history of breast augmentation surgery will increase. The purpose of this study is to report our experience of breast reconstruction in augmented women and discuss their treatment characteristics. METHODS: From March 2010 to August 2015, 7 patients who had previously undergone breast augmentation were treated at our institution. Epidemiologic data as well as data regarding body mass index, types of mastectomy, and complication were recorded and analyzed. RESULTS: The mean age was 43.4 years, the average follow-up period was 21 months, and the mean body mass index (BMI) was 19.3 kg/m2, the average weight of the mastectomy specimen was 150 g. Implant-based immediate breast reconstruction after skin-sparing mastectomy was performed in seven patients and in four of these patients, acellular dermal matrix (ADM) was used. One patient had a capsular contracture of Baker grade II. One patient had seroma. CONCLUSIONS: Previously augmented patients tend to have a slender abdomen and back. Moreover, Asians have a smaller body frame and lower muscle and fat percentage than westerners, making it more suitable for implant-based reconstruction than autologous tissue. It can be recommended as a surgical method as our patients were highly satisfied with the cosmetic outcomes.

Foreign body granulomas after the use of dermal fillers: pathophysiology, clinical appearance, histologic features, and treatment.

A foreign body granuloma is a non-allergic chronic inflammatory reaction that is mainly composed of multinucleated giant cells. Foreign body granulomas may occur after the administration of any dermal filler. Factors such as the volume of the injection, impurities present in the fillers, and the physical properties of fillers affect granuloma formation. The formation of granulomas involves five phases: protein adsorption, macrophage adhesion, macrophage fusion, and crosstalk. The clinical and pathologic features of granulomas vary depending on the type of filler that causes them. Foreign body granulomas can be treated effectively with intralesional corticosteroid injections. Surgical excisions of granulomas tend to be incomplete because granulomas have ill-defined borders and moreover, surgical excisions may leave scars and deformities.

The clinical implications of poly implant prothèse breast implants: an overview.

Mammary implants marketed by Poly Implant Prothèse (PIP) were found to contain industrial grade silicone and this caused heightened anxiety and extensive publicity regarding their safety in humans. These implants were used in a large number of patients worldwide for augmentation or breast reconstruction. We reviewed articles identified by searches of Medline, PubMed, Embase, and Google Scholar databases up to May 2014 using the terms: "PIP", "Poly Implant Prothèse", "breast implants" and "augmentation mammoplasty" "siloxanes" or "silicone". In addition the websites of regulating bodies in Europe, USA, and Australia were searched for reports related to PIP mammary implants. PIP mammary implants are more likely to rupture than other implants and can cause adverse effects in the short to the medium term related to the symptoms of rupture such as pain, lumps in the breast and axilla and anxiety. Based on peer-reviewed published studies we have calculated an overall rupture rate of 14.5% (383/2,635) for PIP implants. However, there is no evidence that PIP implant rupture causes long-term adverse health effects in humans so far. Silicone lymphadenopathy represents a foreign body reaction and should be treated conservatively. The long-term adverse effects usually arise from inappropriate extensive surgery, such as axillary lymph node dissection or extensive resection of breast tissue due to silicone leakage.

Regulation of Transforming Growth Factor ß1, Platelet-Derived Growth Factor, and Basic Fibroblast Growth Factor by Silicone Gel Sheeting in Early-Stage Scarring.

BACKGROUND: Hypertrophic scars and keloids are associated with abnormal levels of growth factors. Silicone gel sheets are effective in treating and preventing hypertrophic scars and keloids. There has been no report on the change in growth factors in the scar tissue following the use of silicone gel sheeting for scar prevention. A prospective controlled trial was performed to evaluate whether growth factors are altered by the application of a silicone gel sheet on a fresh surgical scar. METHODS: Four of seven enrolled patients completed the study. Transforming growth factor (TGF)-ß1, platelet-derived growth factor (PDGF), and basic fibroblast growth factor (bFGF) were investigated immunohistochemically in biopsies taken from five scars at 4 months following surgery. RESULTS: In both the epidermis and the dermis, the expression of TGF-ß1 (P=0.042 and P=0.042) and PDGF (P=0.043 and P=0.042) was significantly lower in the case of silicone gel sheet-treated scars than in the case of untreated scars. The expression of bFGF in the dermis was significantly higher in the case of silicone gel sheet-treated scars than in the case of untreated scars (P=0.042), but in the epidermis, the expression of bFGF showed no significant difference between the groups (P=0.655). CONCLUSIONS: The levels of TGF-ß1, PDGF, and bFGF are altered by the silicone gel sheet treatment, which might be one of the mechanisms of action in scar prevention.

Immediate breast construction with silicone prosthesis after nipple-areola complex sparing mastectomy / 中国组织工程研究

BACKGROUND:As Chinese women have the smaler breast capacity, the traditional breast conserving operation may lead to the poor breast shape, moreover, breast reconstruction with latissimus dorsi myocutaneous flap and transverse rectus abdominis myocutaneous flap is very difficult and has trauma and more complications. Therefore, the immediate breast construction with implants after nipple-areola complex sparing mastectomy is a good choice. OBJECTIVE: To investigate the feasibility of immediate breast construction using silicone prosthesis after nipple-areola complex sparing mastectomy. METHODS:The immediate breast reconstruction after nipple-areola complex sparing mastectomy was performed in 33 female patients with breast cancer (20 cases in the left side and 13 cases in the right side), aged 30-48 years. The effects of reconstructed breast were evaluated according to objective and subjective criteria during the folow-up. RESULTS AND CONCLUSION:Of the 33 cases, 2 cases had nipple-areola complex ischemic necrosis postoperatively and were cured quickly; 1 case had intra-operative blood loss > 800 mL and recovered wel after fluid and blood transfusion. The aesthetic outcome was wel in 31 cases and the satisfactory rate was 94% during 10-51 months of folow-up period. No recurrence and metastasis were found in al cases. The operation method of immediate breast reconstruction with implants after nipple-areola complex sparing mastectomy is maneuverable and has excelent aesthetic effects with no severe complications.

The Clinical Implications of Poly Implant Prothese Breast Implants: An Overview

Mammary implants marketed by Poly Implant Prothese (PIP) were found to contain industrial grade silicone and this caused heightened anxiety and extensive publicity regarding their safety in humans. These implants were used in a large number of patients worldwide for augmentation or breast reconstruction. We reviewed articles identified by searches of Medline, PubMed, Embase, and Google Scholar databases up to May 2014 using the terms: "PIP", "Poly Implant Prothese", "breast implants" and "augmentation mammoplasty" "siloxanes" or "silicone". In addition the websites of regulating bodies in Europe, USA, and Australia were searched for reports related to PIP mammary implants. PIP mammary implants are more likely to rupture than other implants and can cause adverse effects in the short to the medium term related to the symptoms of rupture such as pain, lumps in the breast and axilla and anxiety. Based on peer-reviewed published studies we have calculated an overall rupture rate of 14.5% (383/2,635) for PIP implants. However, there is no evidence that PIP implant rupture causes long-term adverse health effects in humans so far. Silicone lymphadenopathy represents a foreign body reaction and should be treated conservatively. The long-term adverse effects usually arise from inappropriate extensive surgery, such as axillary lymph node dissection or extensive resection of breast tissue due to silicone leakage.

Foreign Body Granulomas after the Use of Dermal Fillers: Pathophysiology, Clinical Appearance, Histologic Features, and Treatment

A foreign body granuloma is a non-allergic chronic inflammatory reaction that is mainly composed of multinucleated giant cells. Foreign body granulomas may occur after the administration of any dermal filler. Factors such as the volume of the injection, impurities present in the fillers, and the physical properties of fillers affect granuloma formation. The formation of granulomas involves five phases: protein adsorption, macrophage adhesion, macrophage fusion, and crosstalk. The clinical and pathologic features of granulomas vary depending on the type of filler that causes them. Foreign body granulomas can be treated effectively with intralesional corticosteroid injections. Surgical excisions of granulomas tend to be incomplete because granulomas have ill-defined borders and moreover, surgical excisions may leave scars and deformities.

Regulation of Transforming Growth Factor beta1, Platelet-Derived Growth Factor, and Basic Fibroblast Growth Factor by Silicone Gel Sheeting in Early-Stage Scarring

BACKGROUND: Hypertrophic scars and keloids are associated with abnormal levels of growth factors. Silicone gel sheets are effective in treating and preventing hypertrophic scars and keloids. There has been no report on the change in growth factors in the scar tissue following the use of silicone gel sheeting for scar prevention. A prospective controlled trial was performed to evaluate whether growth factors are altered by the application of a silicone gel sheet on a fresh surgical scar. METHODS: Four of seven enrolled patients completed the study. Transforming growth factor (TGF)-beta1, platelet-derived growth factor (PDGF), and basic fibroblast growth factor (bFGF) were investigated immunohistochemically in biopsies taken from five scars at 4 months following surgery. RESULTS: In both the epidermis and the dermis, the expression of TGF-beta1 (P=0.042 and P=0.042) and PDGF (P=0.043 and P=0.042) was significantly lower in the case of silicone gel sheet-treated scars than in the case of untreated scars. The expression of bFGF in the dermis was significantly higher in the case of silicone gel sheet-treated scars than in the case of untreated scars (P=0.042), but in the epidermis, the expression of bFGF showed no significant difference between the groups (P=0.655). CONCLUSIONS: The levels of TGF-beta1, PDGF, and bFGF are altered by the silicone gel sheet treatment, which might be one of the mechanisms of action in scar prevention.