Re: The life span of silicone gel breast implants.
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Biomedical subjects
Publications and source records attributed to E P Melmed.
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A review of 240 women who were explanted is presented. The analysis reviewed physical problems, systemic complaints, and whether explantation relieved symptoms and improved patients.
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Capsular contracture around gel and gel-saline implants is the most common complication following breast augmentation and reconstruction. Thirty-one patients with postaugmentation gel-implant contractures were treated with open capsulotomy and replacement with polyurethane-covered implants. Eighty-seven percent remain soft after a minimum follow-up of 14 months. Results of replacement after subcutaneous mastectomy and reconstruction are more varied and less successful. Results in 14 patients are presented.
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The author reviews 6 years of experience and 416 patients in whom polyurethane implants were used for augmentation and reconstruction of the breast. As with many other plastic surgeons, early use was confined to "salvage cases." Owing to the impressive results, use was extended to routine augmentation. Polyurethane implants are now used exclusively for aesthetic breast surgery. Results are evaluated for replacement of gel capsules and simple and radical mastectomy reconstruction. Gel capsules (Baker stages III to IV), in which prostheses were removed and replaced with polyurethane-covered implants, improved in 29 of 32 patients (87 percent). For reconstruction, placement of polyurethane implants in unscarred situations gives far superior results than following repeated procedures. The incidence of infection is no higher than with gel implants. Removal without capsulectomy was not a problem in most instances. However, on two recent occasions capsulectomy was extremely difficult.
During a 5-year period, 909 fractures of the mandible were treated by the Department of Plastic Surgery at Groote Schuur Hospital in Cape Town. A simple technique based on Gilmer wiring was evolved to deal with those fractures where sufficient teeth were present. This technique is extremely simple and proved efficacious.
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