Godwin Yvette, Duncan Robert T, Feig Christine, Reintals Michelle, Hill Sarah
Department of Plastic and Reconstructive Surgery, Morriston Hospital, Morriston, Swansea, United Kingdom; University of Cambridge, CRUK-Cambridge Institute, Robinson Way, Cambridge, United Kingdom; Dr Jones and Partners Medical Imaging, Adelaide, South Australia; and Science & Innovation, LGC, Teddington, Middlesex, United Kingdom.
Plast Reconstr Surg Glob Open. 2014 Dec 5;2(11):e249. doi: 10.1097/GOX.0000000000000212. eCollection 2014 Nov.
Preoperative signs and symptoms of patients with Poly Implant Prothese (PIP) implants could be predictive of device failure. Based on clinical observation and intraoperative findings 4 hypotheses were raised: (1) Preoperative clinical signs including acquired asymmetry, breast enlargement, fullness of the lower pole, decreased mound projection, and change in breast consistency could be indicative of implant rupture. (2) Device failure correlates with a low preoperative Baker grade of capsule. (3) Brown-stained implants are more prone to implant failure. (4) The brown gel could be indicative of iodine ingression through a substandard elastomer shell.
Preoperative clinical signs were compared with intraoperative findings for 27 patients undergoing PIP implant explantation.
Acquired asymmetry (P = 0.0003), breast enlargement (P = 0.0002), fuller lower pole (P < 0.0001), and loss of lateral projection (P < 0.0001) were all significantly predictive of device failure. Capsule Baker grade was lower preoperatively for ruptured implants. The lack of palpable and visible preoperative capsular contracture could be secondary to the elastic nature of the capsular tissue found. Brown implants failed significantly more often than white implants. Analysis of brown gel revealed the presence of iodine, suggesting povidone iodine ingression at implantation.
Preoperative signs can be predictive of PIP implant failure. Brown-stained implants are more prone to rupture. The presence of iodine in the gel suggests unacceptable permeability of the shell early in the implant's life span. A noninvasive screening test to detect brown implants in situ could help identify implants at risk of failure in those who elect to keep their implants.
聚植入假体（PIP）植入患者的术前体征和症状可能预示着假体故障。基于临床观察和术中发现，提出了4种假设：（1）术前临床体征，包括后天性不对称、乳房增大、下极饱满、乳房隆起度降低和乳房质地改变，可能提示假体破裂。（2）假体故障与术前较低的贝克包膜分级相关。（3）褐色染色的假体更容易出现假体故障。（4）褐色凝胶可能提示碘通过不合标准的弹性体外壳进入。
对27例接受PIP假体取出术的患者，将术前临床体征与术中发现进行比较。
后天性不对称（P = 0.0003）、乳房增大（P = 0.0002）、下极更饱满（P < 0.0001）和外侧隆起丧失（P < 0.0001）均显著预示着假体故障。破裂假体术前的包膜贝克分级较低。术前缺乏可触及和可见的包膜挛缩可能继发于所发现的包膜组织的弹性性质。褐色假体比白色假体故障明显更频繁。对褐色凝胶的分析显示存在碘，提示在植入时聚维酮碘进入。
术前体征可预示PIP假体故障。褐色染色的假体更容易破裂。凝胶中碘的存在提示在假体寿命早期外壳存在不可接受的通透性。一种用于原位检测褐色假体的非侵入性筛查试验，可能有助于识别那些选择保留假体的有假体故障风险的患者。
