HLA typing in women with breast implants.

Since the 1970s, anecdotal reports have described a relatively small number of women who received silicone gel breast implants and later developed either a recognized rheumatologic disease or unexplained symptoms suggestive of an autoimmune disorder. The study reported here examined whether there is any association between the symptoms seen in implant patients and HLA molecules. One-hundred and ninety-nine subjects were evaluated by HLA typing: symptomatic patients with implants (group I, n = 77), asymptomatic women with implants (group II, n = 37), healthy female volunteers without implants (group III, n = 54), and fibromyalgia patients without implants (group IV, n = 31). A statistically significant 68 percent of group I were positive for HLA-DR53, compared with 35 percent of group II and 52 percent of group III. The fibromyalgia patients were strikingly similar to group I women in terms of HLA-DR molecules, with 65 percent of group IV being positive for DR53. Group I also had a statistically significant increased frequency of HLA-DQ2. Asymptomatic women with implants (group II) had an increased frequency of DR1 and DQ1. In addition, 42 percent of symptomatic patients with implants formed autoantibodies to their own B cells; of these, 81 percent were DR53-positive. Although frequencies of capsular contracture and implant rupture were not significantly different in the two groups with implants, there were statistically significant associations in group I between contractures and ruptures and the presence of DR53 and B-cell autoantibodies. These data suggest that symptomatic patients with implants share important genetic characteristics (primarily HLA-DR53 positivity) that differentiate them from their asymptomatic counterparts. DR53 may be a marker of women who are predisposed by their HLA genotype to develop symptoms following exposure to silicone gel breast implants.

The efficacy of breast augmentation: breast size increase, patient satisfaction, and psychological effects.

In this study designed to quantify the degree of breast enlargement produced by augmentation mammaplasty, 112 women who underwent breast augmentation were interviewed. The size increase that typically resulted from various implant volumes was measured by comparing preoperative and postoperative bra sizes. For the study group as a whole, the average increase was two bra sizes (either increased cup size or a combination of increased cup size and chest circumference), regardless of the implant volume inserted. Patients also were asked a series of questions to evaluate the impact of the surgery on various psychological parameters, including body image, feelings of self-confidence, and interpersonal relationships. Along with having a very positive body image, the group reported decreased self-consciousness (86 percent) and heightened self-confidence (88 percent); in addition, 95 percent said they felt better about themselves after surgery. The women's satisfaction with the results of augmentation and the success of surgery in meeting their expectations also were measured. Eighty-six percent reported being completely or mostly satisfied with the postoperative results, 86 percent felt the operation was a complete success, and 95 percent said that augmentation met their expectations.

Diagnosis and treatment of accessory parotid gland masses.

Accessory parotid glands are true parotid tissue lying distinctly separate from the parotid gland proper. They lie along and drain into Stensen's duct. Although literature describing the accessory parotid gland is limited, its anatomy and pathology have been described. Controversies exist in the literature regarding the diagnosis and management of pathological changes seen in these glands. We have found magnetic resonance imaging to be extremely helpful in their diagnosis and treatment. A review of the literature and an illustrative example are presented.

Indications for prophylactic mastectomy.

This article reviews the current state of knowledge regarding factors which put women at highest risk for developing breast cancer and identifies that population we consider as potential candidates for prophylactic mastectomy. Specifically, we focus on the concept of cumulative predisposition and the relative risk assigned to more significant factors that increase a woman's chances of developing breast cancer: family history, proliferative breast histology, and previous cancer in one breast. In addition to outlining the results of reconstruction, the article also examines the controversy surrounding the issue of whether any mastectomy can be truly prophylactic. We conclude with advice to physicians who must counsel women concerned about their breast cancer risk so they can help their patients make fully informed choices.

Quantitative three-dimensional assessment of face-lift with an optical facial surface scanner.

Three-dimensional computed tomographic scan images of facial deformities provide information that has been useful in planning and evaluating therapy. However, the benefits of computed tomographic imaging in cosmetic plastic surgery are often insufficient to justify exposing the patient to radiation. This report describes application of an optical, noncontact, three-dimensional surface digitizer with subsecond scanning time for 360-degree examination of the human head. The resultant three-dimensional surface data are suitable for computer graphics display and manipulation, and for noncontact skin surface measurement. The scanner provides accurate and complete coverage of complex facial surfaces. This system was applied to digitization of the human head in the planning and evaluation of facial plastic surgery. The results indicate that the resulting image is accurate enough to detect subtle dimensional changes resulting from surgery, including postoperative edema and surface changes due to face-lift. This type of scanning can assist in a number of tasks performed by plastic surgeons, including collecting anthropomorphic measurements, preoperative and postoperative assessment, volume monitoring, customizing of implants, and interactive planning.

Screening mammography in 350 women with breast implants: prevalence and findings of implant complications.

OBJECTIVE: A series of screening mammograms in asymptomatic women with breast implants was reviewed to determine the prevalence of clinically silent sequelae of breast augmentation and to analyze the mammographic findings. MATERIALS AND METHODS: The screening mammograms of 350 consecutive women with implants were reviewed retrospectively by experienced mammographers. Any women who reported problems had a diagnostic examination and therefore were not included in our sample. Mammographic features of sequelae specific to implantation such as development of a fibrous capsule, periprosthetic calcification, implant herniation, and silicone leaks were tabulated. Additionally, modified compression (push-back) views, when obtained, were evaluated for their usefulness. RESULTS: Fibrous encapsulation of breast implants was seen in 257 (73%) of 350 women. Periprosthetic calcification was seen in 90 (26%), and 60 women (17%) had implant herniations. Sixteen women (5%) had implant failure as evidenced by silicone leak. Two of these women had bilateral implant failures. Surgical confirmation was attainable in only five of 16 women. Analysis of modified compression views demonstrated an overall improvement in visualization of breast tissue with this technique. Although the sample size is small, there was a significant increase in the amount of breast tissue seen with push-back views in women with submuscular implants. CONCLUSION: Our analysis revealed a wide range of mammographic findings in this group of asymptomatic women with breast augmentation. Especially worrisome is the 5% prevalence of unsuspected silicone extravasation. Additionally, we have demonstrated the usefulness of push-back views in this screening group, especially in women with submuscular implants.

Cumulative trauma disorders: An overview of the problem.

Cumulative trauma disorders-which result from highly-repetitive job activities, sustained loads, and exposure to vibratory forces-are rapidly spreading through the industrialized world. As their prevalence increases, so do the economic and social consequences. This paper provides an overview of the problem to illustrate the fact that addressing the rising incidence of CTDs requires a multidisciplinary approach involving research and programmatic efforts directed on many fronts, most notably medicine, engineering, management, occupational health, and government. After a review of the diagnosis and treatment of cumulative trauma disorders is presented, the importance of ergonomic analysis for identifying workers at risk is discussed. Some prevention strategies currently being implemented in workplaces around the country are also described. Finally, we raise important industry and public policy issues which need to be confronted if the incidence of CTDs is to be reduced and costs of the workers' compensation system contained.