Comparison of Allergan, Mentor, and Sientra Contoured Cohesive Gel Breast Implants: A Single Surgeon’s 10-Year Experience
Plastic
& Reconstructive Surgery: November 2015 - Volume 136 - Issue 5 - p 957–966
Doren,
Erin L.
Background:
Contoured cohesive gel breast implants have been recently approved in the
United States. These implants have been available for premarket approval
studies for selected surgeons. The purpose of this study was to assess a single
surgeon’s outcomes in three specific clinical situations—breast augmentation,
secondary augmentation, and breast reconstruction—using implants of all three
contoured cohesive gel implant manufacturers (Allergan, Mentor, and Sientra)
over a 10-year period.
Methods: The authors performed a prospective study of
contoured cohesive silicone gel breast implants. Demographic and outcomes data
were recorded. Complication rates were compared among the three implant
manufacturers.
Results: From 2001 to 2013, 695 patients were included from U.S.
Food and Drug Administration clinical trials......................
Breast Implant–Associated Infections: The Role of the National Surgical Quality Improvement Program and the Local Microbiome
Plastic
& Reconstructive Surgery: November 2015 - Volume 136 - Issue 5 - p 921–929
Cohen,
Justin B. et al
Background:
The most common cause of surgical readmission after breast implant surgery
remains infection. Six causative organisms are principally involved:
Staphylococcus epidermidis and S. aureus, Escherichia, Pseudomonas,
Propionibacterium, and Corynebacterium. The authors investigated the infection
patterns and antibiotic sensitivities to characterize their local microbiome
and determine ideal antibiotic selection.
Methods: A retrospective review of
2285 consecutive implant-based breast procedures was performed. Included
surgical procedures were immediate and delayed breast reconstruction, tissue
expander exchange, and cosmetic augmentation. Patient demographics,
chemotherapy and/or irradiation status, implant characteristics, explantation
reason, time to infection, microbiological data, and antibiotic sensitivities
were reviewed.
Results: Forty-seven patients (2.1 percent) required inpatient
admission for antibiotics, operative explantation, or drainage by
interventional radiology. The infection rate varied depending on surgical
procedure, with the highest rate seen in mastectomy and immediate tissue
expander reconstruction (6.1 percent). The mean time to explantation was 41
days. Only 50 percent of infections occurred within 30 days of the indexed
National Surgical Quality Improvement Program operation. The most commonly
isolated organisms were coagulase-negative Staphylococcus (27 percent),
methicillin-sensitive S. aureus (25 percent), methicillin-resistant S. aureus
(7 percent), Pseudomonas (7 percent), and Peptostreptococcus (7 percent). All
Gram-positive organisms were sensitive to vancomycin, linezolid, tetracycline,
and doxycycline; all Gram-negative organisms were sensitive to gentamicin and
cefepime.
Conclusions: Empiric antibiotics should be vancomycin (with the
possible inclusion of gentamicin) based on their broad effectiveness against
the authors’ unique microbiome. Minor infections should be treated with
tetracycline or doxycycline as a second-line agent. National Surgical Quality
Improvement Program data are adequate for monitoring and comparing breast
infections but certainly not comprehensive. CLINICAL QUESTION/LEVEL OF
EVIDENCE: Therapeutic, IV.
Discussion: Use of Acellular Dermal Matrix in Postmastectomy Breast Reconstruction: Are All Acellular Dermal Matrices CreatedEqual?
Plastic
& Reconstructive Surgery: October 2015 - Volume 136 - Issue 4 - p 654–656
A
discussion article about the use of acellular dermal matrix.
A Comparison of Elliptical Mastectomy to Inverted-T Pattern Mastectomy in Two-Stage Prosthetic Breast Reconstruction
Plastic
& Reconstructive Surgery: October 2015 - Volume 136 - Issue 4 - p 426e–433e
Kilgo,
Matthew S et al.
Background:
Patients with large or ptotic breasts undergoing mastectomy followed by tissue
expander/implant-based reconstruction may benefit from a Wise (inverted-T)
pattern reduction mammaplasty incision compared with the traditional horizontal
elliptical incision. The authors compared these two groups of patients with
regard to complication rates and outcomes.
Methods: Sixty-nine patients (117
breasts) were identified who underwent Wise pattern mastectomy and two-stage
reconstruction. A control group of 89 patients (136 breasts) who underwent
reconstruction after horizontal elliptical mastectomy were selected over the
same period. Patient demographics, clinical characteristics, and complication
rates were recorded and analyzed statistically.
Results: Patient demographics
(age, body mass index, diabetes, smoking, and irradiation history) and clinical
characteristics (laterality, expander size and fill volume, and time to
expansion) were similar, with the exception of body mass index (control, 26.7
kg/m2; inverted-T, 28.7 kg/m2; p = 0.04) and mean intraoperative fill volume
(control, 158.7 cc; inverted-T, 196.9 cc; p = 0.02). Of all complications
(infection, seroma, flap necrosis, expander loss, and salvage), only the rate
of mastectomy flap necrosis was significantly greater (p = 0.002) in patients
undergoing inverted-T mastectomy (25.6 percent versus 11.0 percent). This
difference did not result in a significantly higher rate of expander loss or
need for salvage surgery.
Conclusions: The inverted-T mastectomy approach can
be performed safely with acceptable complication rates. When compared with an
internal control group, complication rates were similar, with the exception of
mastectomy flap necrosis. Despite a higher rate of flap necrosis, 91 percent of
inverted-T patients successfully completed the expansion process. CLINICAL
QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
