Which of the following is true of breast implants?
Saline implants have a lower capsular contracture rate than silicone. Capsular contracture rates increase in the presence of foreign material and infection. As such, silicone leak increases rates of contracture (A is true), as does the presence of bacteria (subglandular) (D is false). Whilst silicone implants may rupture, they are unlikely to deflate. Quoted contracture rates are 58% for smooth silicone implants and 8% for textured.
References: 1. Coleman, DJ, Foo ITH, Sharpe DT. Textured or smooth implants for breast augmentation? A prospective controlled trial. Br J Plast Surg 1991; 44(6): 444-8
Theories regarding formation of capsular contracture include:
All of the above. Each of these has been hypothesised as contributing factors to capsular contracture.
Botulinum toxin:
Is derived from spore-forming anaerobic bacteria (Clostridium botulinum). Other clostridia include C. tetani (tetanus), C. perfringens (gas gangrene).
Two hours after blepharoplasty a 60-year-old hypertensive man complains of a swollen, painful right eye and decreased visual acuity. On examination, he has proptosis of the right eye with decreased vision when compared to the left eye. The most appropriate management includes:
Canthotomy, mannitol and acetazolamide. This man has a retrobulbar haematoma which if not treated immediately will lead to blindness. This is a true emergency and if the patient’s eyesight is to be saved, immediate and decisive treatment is imperative. There is no time to wait for an ophthalmology consult. Head elevation and ice packs, diuretics and pain medication, and hypertensives are of no immediate value. There is no time to even return to the operating room. Immediate canthotomy to decompress the orbit, with intravenous infusion of acetazolamide and mannitol to reduce intra-ocular pressure, are the emergency treatment. After that, consultation with ophthalmology and all the other options are certainly appropriate. However, for the immediate handling of this acute emergency, D is the only appropriate option.
A 45-year-old woman who recently underwent Lasik vision correction is seen in consultation for blepharoplasty. How long following the Lasik procedure would it be appropriate to operate on her?
18 months. One of the problems associated with Lasik vision correction surgery is the risk of dry eyes. The procedure affects the protective film over the cornea. It is advisable to wait at least 18 months between such a procedure and a blepharoplasty in order to minimise the risk of postoperative dry eyes.
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