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Aesthetic Surgery Journal Open Forum - Regional Pain Blocks and Perioperative Pain Control in Patients Undergoing Breast Implant Removal with Capsulectomy

Abstract

Background:
Demand for breast implant removal with capsulectomy is on the rise, with more than 36,000 explants performed in 2020, an increase of nearly 7.5% from previous years. Postoperative analgesia is an important consideration in this patient group due to scar tissue surrounding the implant and the potential for extensive dissection during capsulectomy.

Objectives:
We sought to compare perioperative pain control between several different types of ultrasound-guided regional anesthetic techniques in patients undergoing implant removal with capsulectomy.

Methods:
We reviewed all patients who received an ultrasound-guided block and underwent breast implant removal with capsulectomy at our outpatient surgical center over a two-year period. We compared intraoperative, postoperative opioid requirement, and patient-reported pain on the first postoperative day (POD1) between three different block techniques using chi-square analysis. A p-value <0.05 was considered statistically significant.

Results:
352 patients met inclusion criteria. 26 patients (7.4%) underwent a serratus plane block (SP), 13 (3.7%) underwent an erector spinae combined with pectointercostal fascial plane block (ES+PIFP), and 313 (88.9%) underwent an erector spinae combined with pectoral nerve block (ES+PECS1). ES+PECS1 was associated with less intraoperative and postoperative opioid use compared with SP and ES+PIFP (1.9% vs 19.2% vs 61.5%, p<0.001 for intraoperative, 26.8% vs 34.6% vs 38.5% postoperative, p<0.001). ES+PECS1 block was associated with mild pain on POD1 compared with the other two regional block techniques (p=0.001).

Conclusions:
Regional pain blocks, and specifically the ES block offer effective pain control for patients undergoing breast implant removal with capsulectomy, demonstrating high patient satisfaction in the postoperative period with low opioid requirements.

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Outcomes of Implant Removal and Capsulectomy for Breast Implant Illness in 248 Patients

Abstract

Background:
Breast implant illness (BII) is a term popularized by social media to describe systemic symptoms that patients ascribe to their breast implants. Though the concept of implants as an underlying cause for a systemic illness remains controversial, few studies have delineated the implant characteristics, capsular histology, and outcomes of patients who undergo explantation for BII.

Methods:
We retrospectively reviewed the demographics, presenting symptoms, outcomes, capsular histology, and culture results of all women who presented to the senior author with symptoms attributed to BII and underwent breast implant removal with capsulectomy from August 2016 to February 2020. Chi-square and logistic regression analyses were performed to evaluate association between implant type, composition, and findings of inflammation on capsule pathology.

Results:
Among 248 patients, 111 (23%) capsules demonstrated inflammatory changes on permanent pathology. Capsular inflammation was independently associated with silicone versus saline (right odds ratio [OR] = 2.18 [1.16–4.11], P = 0.016, left OR = 2.35 [1.08–5.12], P = 0.03) and textured versus smooth implants (right OR = 2.18 [1.16–4.11], P = 0.016, left OR = 2.25 [1.17–4.31], P = 0.01). Silicone material was present in the capsules of 12 patients (4.8%). Fourteen patients had positive cultures. There was one pneumothorax (0.4%), three hematomas requiring evacuation (1%), and two DVTs (0.8%). Of 228 patients, 206 (90.4%) reported high satisfaction with the outcome of the procedure.

Conclusions:
In a large cohort of BII patients, we found that capsular inflammation is significantly associated with silicone and textured implants. Implant removal with capsulectomy can be safely performed in patients with BII with a low complication rate and high patient satisfaction.

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Burn Fat and Build Muscle with Non-Invasive Treatments

By Dr. Anna Buinewicz

Burn Fat and Build Muscle With Non-Invasive Treatments! We know that following a healthy diet and exercising regularly plays the most important part of regaining your health but also achieving a look that you desire. But there comes a point where you may feel ‘stuck’ and that extra fat just doesn’t seem to budge. This is the point where we come in and save the day! Emsculpt Neo’s treatment is more effective than any treatment that has been available before, and likely is exactly what you need to build muscles and eradicate stubborn pockets of body fat. Oh, and by the way…it tightens the skin in the treated area too!

Emsculpt treatments are an ideal option for anyone who wants to quickly and safely develop muscles in the core, buttocks, and legs. Within weeks of your first set of appointments, you could notice amazing changes to your appearance as your body becomes firm and sculpted.

What About Traditional Diets and Exercise Programs?

Don’t stop your diet plan and exercise, they have a big impact on an individual’s appearance. As long as you continue to burn more calories than you consume, you should lose weight. Unfortunately, there is no way to target specific pockets of fat with certain exercises, and that is one of the reasons why so many people struggle with stubborn body fat in the abdomen, flanks, hips, and legs, etc. Luckily, toning those areas of your body is easier than ever with advanced cosmetic treatments like Emsculpt NEO.

Some FACTS about EMSCULPT NEO 

Clinical studies showed on average a 30% reduction in subcutaneous fat and a 25% growth in muscle volume.

Frequently Asked Questions

What areas can be treated with EMSCULPT NEO?

EMSCULPT NEO can be applied over the abdomen, buttocks, arms & calves.

Am I A Candidate?

Anyone can benefit from the EMSCULPT NEO procedure. EMSCULPT NEO has broad appeal as it can treat patients up to a BMI of 35!

What does EMSCULPT NEO therapy feel like?

You can feel intense muscle contractions together with a heating sensation in the treated area which is comparable to a warm stone massage. It really IS comfortable.

How is Emsculpt NEO procedure performed?

There is no pre-preparation required for this procedure. You will lay down while the applicators are applied over the treatment area for 30 minutes. During the treatment you may feel a tolerable heating sensation along with muscle contractions. Once the procedure is completed, you can immediately get back to your daily routine.

Workout Smarter Not Harder

Achieving a slimmer, more sculpted appearance is possible with the help of EMSCULPT NEO. If you are interested in discussing this procedure or need more information please call Buinewicz Cosmetic Surgery and Med Spa (215) 647-9668

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