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Biomedical subjects

L Gylbert

Publications and source records attributed to L Gylbert.

10 recordsLinked to original sources
PubMed1996

Textured or smooth implants for submuscular breast augmentation: a controlled study.

Capsular contracture consistently has been the most frequently noted complication of submuscular and subglandular breast augmentation. The etiology of this complication is still unknown, although silicone bleed, hematoma, infection, foreign bodies, and surgical trauma have been implicated. In this prospective, double-blind study, 61 women undergoing submuscular breast augmentation were randomized between Dow Corning textured and smooth-walled silicone gel implants. Any consequent capsular contracture was assessed by an independent plastic surgeon and also by the patients themselves. Objective evaluation was made by applanation tonometry. It was found that depending on doctors, patients, and objective method used, 3 to 9 percent grade III and IV encapsulation followed submuscular augmentation with textured implants and 10 to 20 percent with smooth-walled implants after 1 year. The differences were significant according to both patient assessment and applanation tonometry but not according to the physicians' evaluations. There was no correlation of capsular contracture with the age of the patient, duration of the operation, or degree of blood loss. There was a small but inconclusive difference in capsular contracture rate that favored the placement of textured rather than smooth implants in the submuscular pocket.

Adult↗
PubMed1994

Pedicled compared with free transverse rectus abdominis myocutaneous flaps in breast reconstruction.

Two groups of patients who had undergone breast reconstruction with the transverse rectus abdominis myocutaneous (TRAM) flap after modified radical or partial mastectomy were evaluated. The type of reconstruction was either pedicled (n = 27, one of which bilateral) or free flap transfer (n = 11). In both groups there were both primary and secondary reconstructions. Flap complications were more common with the pedicled TRAM flap. There were nine partial flap necroses in the pedicle group, but only one in the free flap group. The only flap loss was a pedicled flap. In the free flap group, revision of the anastomosis was required in two patients. The free TRAM flap took longer to do than the pedicled flap. In conclusion, the two procedures yield acceptable results, but the free TRAM flap seems to be safer than the pedicled flap, thanks to the better blood supply from the inferior epigastric artery. It also allows greater freedom and versatility in moulding the reconstructed breast.

Female↗
PubMed1990

Capsular contracture after breast reconstruction with silicone-gel and saline-filled implants: a 6-year follow-up.

A major problem after breast reconstruction with augmentation mammaplasty is contracture of the fibrous capsule around the prosthesis. In a series of 72 breasts in 65 women, silicone-gel and saline-filled implants were randomly selected prior to breast reconstruction. The results were judged with respect to consistency, tenderness, wrinkles, and sounds by two independent plastic surgeons according to the breast augmentation classification (BAC) and by the patients themselves. Capsular contracture was found by the surgeons in 50 percent of the gel implant group and in 16 percent of the saline implant group, which is in conformity with the results of the follow-up 5 years earlier. The incidence of deflation was 16 percent in the saline group and occurred in different sizes of both overinflated and underinflated prostheses. The degree of slow leakage from saline implants will be discussed. Despite the high rate of contractures in the gel group, 85 percent of all patients were satisfied with the result of the reconstruction.

Adult↗
PubMed1990

Preoperative antibiotics and capsular contracture in augmentation mammaplasty.

The main drawback with augmentation mammaplasty using implants is capsular contracture. The cause of this complication is still unknown. Silicone particles, hematoma, and bacterial contamination are some of the etiologic factors discussed. In this randomized, double-blind study on 76 breast-augmented women, 50 percent of the patients had preoperative prophylaxis with benzylpenicillin and dicloxacillin. Bacteria samples were taken intraoperatively. The number of negative cultures increased significantly with antibiotic prophylaxis. In four follow-ups during the first postoperative year, the rate of contractures was evaluated by subjective and objective methods. The results showed no statistically significant difference between the placebo and the antibiotic group with respect to the incidence of capsular contracture.

Adult↗
PubMed1989

Results of subglandular breast augmentation using a new classification method--18-year follow-up.

The main problem after augmentation mammaplasty is the formation of capsular contractures. The frequency of this complication varies in different reports. In this study the results in 60 women 15-21 years after subglandular breast augmentation are presented. The patients completed a questionnaire and the breasts were judged according to a new Breast Augmentation Classification (BAC) scale. Of all breasts examined 79% had grade III or IV, but 77% of the patients were satisfied with the final result. However, 84% thought that their breasts were too hard. Breast cancer had not developed in any patient. Rheumatoid arthritis developed in one patient 4 years after the operation. Capsular contracture and unacceptable results after subglandular breast augmentation were found in the major portion of the patients in this study.

Adult↗
PubMed1989

Constant compression caliper for objective measurement of breast capsular contracture.

The main problem with silicone implants in augmentation mammaplasty and breast reconstruction is the development of capsular contracture. The universal method for evaluating the degree of firmness of the breast is the subjective palpation technique and the classification according to Baker. Many objective methods using calipers for measurements of compression, different devices for indentation and discs for applanation tonometry have been described, but none of these have been widely accepted. In this paper a new measuring instrument is presented based on the principle of a constant compression force between two caliper jaws applied to the breast. The inverse value of the compressibility of the breast is read on a scale on the device. This objective method correlates acceptably with the palpation technique according to the Breast Augmentation Classification (BAC) (12), which is a modification of Baker's classification (1978), except for the first follow-up.

Adult↗
PubMed1987

Reconstruction in the head and neck regions with free radial forearm flaps and split-rib bone grafts.

Fifty patients with wound defects in the head and neck region underwent reconstruction with the free radial forearm flap. Mandible defects in 17 patients were reconstructed by split-rib bone grafts. Radiotherapy was administered to 44 patients preoperatively. The free flap was successful in 49 patients, and there was one case of partial flap necrosis. The free flap is soft, thin, and movable. The split-rib bone graft was successful in 15 patients, and there was one case of partial graft necrosis and one case of complete necrosis. Postoperative complications were decreased by 50 percent when compared with the complication rate when split ribs were covered by forehead flaps, deltopectoral flaps, or oral mucosa. Finally, the functional and cosmetic results were excellent.

Bone Transplantation↗
PubMed1985

Bacteria in the female breast.

Subclinical infection may play a role in capsular formation around silicone breast implants. To assess the possibility of antibiotic prophylaxis for prevention of capsular formation, knowledge of bacteria present in the female breast tissue and the resistance pattern of these bacteria is needed. Samples were taken from 25 patients (49 breasts) peroperatively during reduction mammaplasty with an impression pad method. The samples were placed in agar plates and incubated both aerobically and anaerobically. In more than 90% of the samples bacteria were found. The species of bacteria found were mainly Staphylococcus epidermidis and propionibacteria. These bacteria were sensitive to penicillin G and/or isoxapenicillin. It remains to be shown that prophylactic antibiotic treatment will decrease capsular formation following augmentation mammaplasty.

Adolescent↗