Celina Kerschbaumer

Introduction: Breast reconstruction and breast augmentation via silicone breast implants are among the most commonly performed implant surgeries worldwide. However, these surgeries entail notable risks for postoperative implant complications, including implant rupture or capsular contracture. This study investigates the significance of microbial contamination regarding the development of peri-implant inflammation and its impact on implant-related complications. Methods: A total of 125 breast implant revisions in 97 patients with a history of breast cancer or prior cosmetic breast augmentation were analyzed at the Clinical Department of Plastic, Aesthetic, and Reconstructive Surgery, University Clinic of St. Poelten, between February 2021 and August 2023. Microbial contamination and subclinical inflammation were assessed using histological and microbiological analysis of implant surfaces and capsules. The implants were grouped by their initial indication for surgery, along with presence of contamination, inflammation, and complications, and then compared using a Chi² test, Fisher’s exact test and two-sided t-tests. Results: Microbial contamination was found in 27 implants (21.6%), and 58 implants (48.74%) showed histological evidence of inflammation. Peri-implant inflammation was significantly more often observed in contaminated implants (p = 0.049). Implants displaying histological signs of peri-implant inflammation showed significantly higher rates of complications, particularly implant rupture (p < 0.001 each). In a subgroup analysis, cosmetic patients presented a significantly higher rate of peri-implant inflammation compared to breast cancer patients (p < 0.001). Cosmetic patients also showed significantly longer implant inlay times compared to breast cancer patients (14.32 vs. 3.76 years, p < 0.001), suggesting that prolonged implant inlay duration may contribute to the occurrence of peri-implant inflammation. Conclusion: Subclinical microbial contamination appears to accelerate the inflammatory reactions to silicone implants that subsequently increase the risk for complications and thus surgical removal. Additionally, prolonged implant inlay time seems to be a major independent contributor to chronic, low-grade inflammation, even in the absence of microbial contamination.

Background: The global rise in obesity rates has led to an increase in bariatric procedures, resulting in more patients needing relief from excess skin through body contouring surgeries (BCS), such as abdominoplasty. Although these procedures are generally considered safe, they can be associated with notable perioperative complications, including increased Hb-loss (hemoglobin loss) and drainage fluid volumes. Thus, this study analyzed risk factors for prolonged fluid secretion after abdominoplasty. Methods: We retrospectively analyzed 505 body contouring procedures performed between January 2018 and December 2023 at the Department of Plastic Surgery at the University Clinic of St. Poelten. The investigation focused on postoperative Hb-loss, drainage fluid volumes and hemoglobin levels in patients, comparing those with and without prior bariatric surgery. Statistical analyses utilized the t-test for Equality of Means, while correlation analyses were conducted using Spearman Rho and the Mann–Whitney U test. Results: Bariatric patients demonstrated markedly reduced hemoglobin levels both preoperatively (13.24 g/dL) and postoperatively (10.68 g/dL) compared to their non-bariatric counterparts (14.02 g/dL preoperatively and 11.71 g/dL postoperatively; p < 0.001). The prevalence of anemia was likewise substantially higher in the bariatric cohort, rising from 14.52% preoperatively to 82.48% postoperatively, versus 6.25% and 61.25%, respectively, in the non-bariatric group (p = 0.001). Moreover, prior bariatric surgery was significantly associated with increased postoperative drainage volume (p = 0.009) and prolonged operative time (p = 0.002). Notably, extended hospital stays exhibited a strong correlation with postoperative anemia (p = 0.005). Conclusions: Collectively, our findings underscore the potential risk of increased hemoglobin loss at BCS after bariatric weight loss. Tailored hemoglobin management and nutritional strategies are essential to improve the outcomes and safety of post-bariatric BCS. Meticulous preoperative identification of hematological discrepancies and adequate patient preparation are imperative for positive postoperative patient safety.

Background: Women undergoing a mastectomy often suffer severely from the sequelae of losing one or both breasts. Implant-based breast reconstruction restores female body integrity but can result in significant postoperative pain. The use of paravertebral catheters has been shown to aid significantly in pain management during the postoperative recovery. However, the vasodilation that is induced by paravertebral blocks may lead to prolonged drainage fluid secretion, blood loss and increased likelihood of revision surgery. Therefore, we analyzed the effects of paravertebral blocks after combined mastectomy and immediate breast reconstruction. Methods: We analyzed 115 breast surgeries at the department of Plastic Surgery at the University clinic of St. Poelten between 1 August 2018 and 31 December 2022. Patients were analyzed regarding postoperative hemoglobin loss and drainage fluid volumes and their correlation with paravertebral blocks. Statistical analyses were performed using Levene’s Test for Equality of Variances within our cohort. Results: The postoperative hemoglobin loss did not differ significantly between our groups (p = 0.295). Furthermore, a paravertebral block did not increase the amount of postoperative drainage fluid volumes (p = 0.508). Women receiving paravertebral blocks also did not stay longer in hospitals (p = 0.276). No paravertebral block-associated complication was seen. Conclusions: In this study, we demonstrated paravertebral blocks to be safe adjuncts in breast reconstruction to minimize pain without leading to increased blood loss or seroma formation. This indicated that vasodilatation induced by paravertebral blocks did not negatively influence the postoperative recovery. In conclusion, postoperative pain management using paravertebral blocks can be a beneficial therapeutic adjunct in surgical management of breast cancer patients.

Background: Breast-implant-based reconstruction is one of the most performed procedures in plastic surgery. Despite the high durability of breast implants, various complications are accompanied with prolonged inlay duration, particularly implant rupture. Many aftereffects can be associated with implant rupture, especially siliconoma and BIA-ALCL. Without regular implant check-ups, implant-related issues may remain underrecognized. Here, we analyzed the number of breast implant carriers needing revisions and if patients adhered to annual implant follow-up recommendations. Methods: We reviewed 1128 breast procedures at the department of plastic surgery at the University Clinic of St. Poelten between August 1^st 2018 and December 31^st 2023. Patients were analyzed to see whether regular check-ups of their breast implants were performed. Additionally, implant-related complications were investigated, as well as if they were noticed by implant carriers. Results: Only 15.46% of breasts implants were regularly checked at least once a year in our cohort. The remaining 84.54% of patients consulted our department due to pain or aesthetic discomfort without periodical follow-ups. Most implant ruptures (73.8%) were diagnosed in patients consulting acutely due to pain or capsular contraction after an average of 17.36 ± 10.57 years. Routine examination uncovered 26.2% of silent implant ruptures without patients yet complaining of clinical symptoms as early as 15.44 ± 11.17 years. Conclusions: Most implant ruptures develop clinical symptoms as an indicator that removal is warranted. However, only regular follow-ups can identify implant complications several years earlier and possibly reduce severe sequalae such as BIA-ALCL. This highlights the significance and necessity of annual breast implant controls by surgeons and radiologic imaging to prevent devastating implant-associated aftereffects.