William P Adams1,2, Eric J Culbertson1,2, Anand K Deva1,2, Mark R Magnusson1,2, Craig Layt1,2, Mark L Jewell1,2, Patrick Mallucci1,2, Per Hedén1,2. 1. Dallas, Texas; Sydney, Toowoomba, and Gold Coast, Australia; Portland, Ore.; London, United Kingdom; and Stockholm, Sweden. 2. From the Department of Plastic Surgery, University of Texas Southwestern Medical Center; Macquarie University and Integrated Specialist Healthcare; private practice; Oregon Health Science University; and Royal Free Hospital.
Abstract
BACKGROUND: Bacteria/biofilm on breast implant surfaces has been implicated in capsular contracture and breast implant-associated anaplastic large-cell lymphoma (ALCL). Macrotextured breast implants have been shown to harbor more bacteria than smooth or microtextured implants. Recent reports also suggest that macrotextured implants are associated with a significantly higher incidence of breast implant-associated ALCL. Using techniques to reduce the number of bacteria around implants, specifically, the 14-point plan, has successfully minimized the occurrence of capsular contracture. The authors hypothesize that a similar effect may be seen in reducing the risk of breast implant-associated ALCL. METHODS: Pooled data from eight plastic surgeons assessed the use of macrotextured breast implants (Biocell and polyurethane) and known cases of breast implant-associated ALCL. Surgeon adherence to the 14-point plan was also analyzed. RESULTS: A total of 42,035 Biocell implants were placed in 21,650 patients; mean follow-up was 11.7 years (range, 1 to 14 years). A total of 704 polyurethane implants were used, with a mean follow-up of 8.0 years (range, 1 to 20 years). The overall capsular contracture rate was 2.2 percent. There were no cases of implant-associated ALCL. All surgeons routinely performed all 13 perioperative components of the 14-point plan; two surgeons do not routinely prescribe prophylaxis for subsequent unrelated procedures. CONCLUSIONS: Mounting evidence implicates the role of a sustained T-cell response to implant bacteria/biofilm in the development of breast implant-associated ALCL. Using the principles of the 14-point plan to minimize bacterial load at the time of surgery, the development and subsequent sequelae of capsular contracture and breast implant-associated ALCL may be reduced, especially with higher-risk macrotextured implants. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
BACKGROUND: Bacteria/biofilm on breast implant surfaces has been implicated in capsular contracture and breast implant-associated anaplastic large-cell lymphoma (ALCL). Macrotextured breast implants have been shown to harbor more bacteria than smooth or microtextured implants. Recent reports also suggest that macrotextured implants are associated with a significantly higher incidence of breast implant-associated ALCL. Using techniques to reduce the number of bacteria around implants, specifically, the 14-point plan, has successfully minimized the occurrence of capsular contracture. The authors hypothesize that a similar effect may be seen in reducing the risk of breast implant-associated ALCL. METHODS: Pooled data from eight plastic surgeons assessed the use of macrotextured breast implants (Biocell and polyurethane) and known cases of breast implant-associated ALCL. Surgeon adherence to the 14-point plan was also analyzed. RESULTS: A total of 42,035 Biocell implants were placed in 21,650 patients; mean follow-up was 11.7 years (range, 1 to 14 years). A total of 704 polyurethane implants were used, with a mean follow-up of 8.0 years (range, 1 to 20 years). The overall capsular contracture rate was 2.2 percent. There were no cases of implant-associated ALCL. All surgeons routinely performed all 13 perioperative components of the 14-point plan; two surgeons do not routinely prescribe prophylaxis for subsequent unrelated procedures. CONCLUSIONS: Mounting evidence implicates the role of a sustained T-cell response to implant bacteria/biofilm in the development of breast implant-associated ALCL. Using the principles of the 14-point plan to minimize bacterial load at the time of surgery, the development and subsequent sequelae of capsular contracture and breast implant-associated ALCL may be reduced, especially with higher-risk macrotextured implants. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
Authors: Joshua Vorstenbosch; Colleen M McCarthy; Meghana G Shamsunder; Thais O Polanco; Stefan Dabic; Itay Wiser; Evan Matros; Joseph Dayan; Joseph J Disa; Andrea L Pusic; Michele R Cavalli; Elizabeth Encarnacion; Meghan Lee; Babak J Mehrara; Jonas A Nelson Journal: Plast Reconstr Surg Date: 2021-11-01 Impact factor: 5.169
Authors: Andrés E Quesada; L Jeffrey Medeiros; Mark W Clemens; Maria C Ferrufino-Schmidt; Sergio Pina-Oviedo; Roberto N Miranda Journal: Mod Pathol Date: 2018-09-11 Impact factor: 7.842
Authors: Adriano Santorelli; Marco Bernini; Lorenzo Orzalesi; Stefano Avvedimento; Paolo Palumbo; Ashutosh Kothari; Alfonso Fausto; Cesare Magalotti; Giuseppina Buzzi; Sara Sandroni; Claudio Calabrese Journal: Aesthet Surg J Open Forum Date: 2021-05-04