Michelle Copeland

Silicone breakdown and capsular synovial metaplasia in textured-wall saline breast prostheses.

Saline-filled prostheses are currently the only type of prostheses available for cosmetic use in the United States because of concerns raised about the possibility of systemic toxicity of silicone-filled artificial mammary implants. Although the approved implants are saline-filled, their potential to release silicone particles from the shells has not been systematically evaluated. We performed microscopic examination of the pericapsular tissue of 54 patients with textured-surface implants and compared these with 51 patients with smooth-walled implants over a 2-year period. The capsules that had formed around virtually all textured-surface implants had silicone fragments present either in extracellular spaces, in vacuolated histiocytes, or in the form of foreign-body granulomas in surrounding fibroadipose tissue but not in capsules associated with smooth-walled implants. In 87 percent of samples of pericapsular tissue from textured saline implants, the contact surface displayed exuberant reactive synovial metaplasia, a histologic pattern not previously described with these devices. Our findings suggest that smooth-walled prostheses are associated with less silicone fragmentation than textured devices in the peri-implant tissue capsules that tend to form around artificial surfaces used for this purpose.

Ganglions of the temporomandibular joint: case report and review of literature.

We present the third reported case of a ganglion cyst arising from the temporomandibular joint. Like the previous two cases, this lesion occurred in a woman over the age of 40. Unlike the lesions in previous reports, the cyst in our patient was not associated with pain or tenderness, making the diagnosis of parotid tumor more likely. Nevertheless, the case serves to illustrate the need for including ganglion in the differential diagnosis of well-encapsulated preauricular masses in the region of the temporomandibular joint.

Systemic inflammatory disorder related to fibrous breast capsules after silicone implant removal.

Silicone breast implants have been associated with connective-tissue inflammatory syndromes such as systemic sclerosis, and as with other artificial breast prostheses, fibrous capsules tend to form around the implants. The capsular tissue is generally considered inert and typically is left in situ when the prostheses are explanted. We report a patient who formed symptomatic bilateral submammary cysts associated with pain, swelling, arthralgia, fever, axillary lymphadenopathy, accelerated erythrocyte sedimentation rate, and antinuclear antibody following removal of intact silicone breast implants without capsulectomy. Clinical improvement followed removal of the capsules, which histologically displayed fragments of silicone, fibrous tissue, and inflammatory cells. Our experience suggests that when silicone breast implants are thought to be the cause of a clinical inflammatory syndrome characterized by mammary pain, swelling, arthralgia, or serologic abnormalities, consideration should be given to removing the capsules entirely so that the chance of a perpetuating reaction will be reduced.

Combined Liposuction and Excision of Lipomas: Long-Term Evaluation of a Large Sample of Patients

Background. Lipomas are benign tumors of mature fat cells. They can be removed by liposuction, yet this technique is seldom employed because of concerns that removal may be incomplete and recurrence may be more frequent than after conventional excision. Objectives. We assessed the short- and long-term clinical outcomes and recurrence of combined liposuction and limited surgical excision of subcutaneous lipomas. Methods. From 2003 to 2012, 25 patients with 48 lipomas were treated with liposuction followed by direct excision through the same incision to remove residual lipomatous tissue. Initial postoperative follow-up ranged from 1 week to 3 months, and long-term outcomes, complications, and recurrence were surveyed 1 to 10 years postoperatively. Results. Lipomas on the head, neck, trunk, and extremities ranged from 1 to 15 cm in diameter. Early postoperative hematoma and seromas were managed by aspiration. Among 23 survey respondents (92%), patients were uniformly pleased with the cosmetic results; none reported recurrent lipoma. Conclusions. The combination of liposuction and excision is a safe alternative for lipoma removal; malignancy and recurrence are uncommon. Liposuction performed through a small incision provides satisfactory aesthetic results in most cases. Once reduced in size, residual lipomatous and capsular tissue can be removed without expanding the incision. These favorable outcomes support wider application of this technique in appropriate cases.

Absent Silicone Shell in a MEME Polyurethane Silicone Breast Implant: Report of a Case and Review of the Literature

olyurethane-covered silicone mammary implants P were introduced in 1970 and reported by Ashley to produce softer fibrous capsule tissue reaction than silicone-covered prostheses (1). The MEME polyurethane implant system became the most widely used by 1991, because of decreased capsular contracture (2-8) particularly for patients with a history of capsular contracture after removal of a silicone mammary prosthesis. The lower incidence of capsular contracture with the polyurethane implants has been attributed to tissue ingrowth into the coating, leading to phagocytosis and local degradation of polyurethane fragments. Microencapsulation has been proposed, in which multidirectional contractile forces cancel one another, resulting in a softer type of capsular contracture (9-11). The prolonged inflammatory response that this process entails, however,