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Spontaneous autoinflation

Article-Spontaneous autoinflation

Key iconKey Points

  • Autoinflation may be the result of a faulty leaflet valve in older models of saline-filled implants or of the injection of a hypertonic filling solution
  • However, newer products may make this adverse event a thing of the past

Dr. Peters
TORONTO, CANADA — Spontaneous autoinflation is a rare adverse event that occurs with saline-filled implants. But with newer products, this adverse event may become a thing of the past, one Toronto plastic surgeon tells Cosmetic Surgery Times . Speaking at the recent 7th Annual Toronto Breast Surgery Symposium, Walter Peters, M.D., Ph.D., a member of the Division of Plastic Surgery in the Faculty of Medicine at the University of Toronto in Toronto, Canada, noted that the side effect was first observed in Italy with bilumen devices that had silicone gel in the central core and saline in the outer lumen. Italian investigators described double-lumen implants that had undergone a significant, spontaneous volume increase in the outer lumens of the implants two to 18 months after surgery. In seven of the nine cases, the autoinflation was unilateral; it was bilateral in the other two. In total, 20 cases of autoinflation with saline implants have been reported worldwide.

UNILATERAL PRESENTATION Because the autoinflation that has occurred has been predominantly unilateral, clinicians have considered alternate diagnoses, according to Dr. Peters. "There is an asymmetry that occurs with unilateral breast enlargement," he explains. "A late infection would be a different differential diagnosis for unilateral enlargement." Other possible causes for a unilateral breast enlargement after insertion of saline-filled implants include late capsular hematoma and breast lymphoma, and clinicians should consider these rare conditions before concluding autoinflation has occurred, Dr. Peters advises. Small changes in implant size can occur with saline implants once they have been inserted because of variations in concentrations in sodium chloride injection, the solution that is generally recommended for saline-filled implants. The response of the surgeon to this rare adverse event has been removal and replacement if a patient wishes to continue to augment with implants, notes Dr. Peters. "There is really nothing a surgeon can do [pre-operatively or intra-operatively]," he says. "You have to take out the implants and replace them."

STUDY CASES In a paper published in the Canadian Journal of Plastic Surgery, Dr. Peters describes his own experiences with three cases of autoinflation of saline-filled inflatable breast implants. The unilateral inflation in all instances occurred with smooth, single-lumen, round, saline-filled implants anywhere from four to 23 years after implantation. The implants were of two types: the Simaplast implant and the Mentor style 1800 leaflet valve implant, which is no longer manufactured. The probable cause of the auto-inflation with the Simaplast implant was an injection of a hypertonic filling solution, which is twice as concentrated as normal saline. Such a potent injection would create an osmotic gradient, which would have been conducive to autoinflation via diffusion. In one patient, there was a volume gain of 45 percent over a 23-year period and the appearance of the fluid was transparent and watery. The patient underwent explantation and had 275-mL Mentor style 1600 inflatable implants inserted. With the leaflet valve implants, autoinflation likely resulted due to mechanical alterations of the valve mechanism, according to Dr. Peters. In those two instances, the volume rose 88 percent and 49 percent, respectively. In the case where volume nearly doubled, the gain occurred in the left implant, measuring 620 mL compared to 305 mL in the right breast ten years following surgery. The patient had her implants removed, but not replaced.

In the second leaflet valve implant case, the volume on the right side rose to 418 mL from an initial 280 mL. Meanwhile, the implant on the left side deflated to 150 g. The gain in the right implant and deflation in the left occurred four years after placement. The patient had the implants removed and new 275-mL, Mentor style 1600, smooth, round implants inserted and inflated to 300 mL. In this case, Dr. Peters theorizes that the same mechanism that triggered partial deflation might have permitted fluid from the implant pocket to pass through the valve into the lumen of these implants. Consequently, glucose, protein and cellular elements could enter into the lumen, creating an osmotic gradient, allowing water to enter the elastomeric shell by diffusion. The fluid in the leaflet valve implants was brownish yellow, very viscous and turbid, containing heightened levels of glucose and uric acid that would not have passed through the elastomeric shell.

"The effect has been attributed to the quality of the product," Dr. Peters says. "It's thought that the effect is related to the valves, but we can't pinpoint exactly what it is. The valves are somehow faulty." Newer saline implant models are not resulting in such incidents, Dr. Peters adds. "I have not seen a case for close to a decade."

Reference

Peters W. Autoinflation of saline-filled inflatable breast implants. Can J Plastic Surg. 2006;14:219-226.

For more information
Walter Peters, M.D., Ph.D.
[email protected]

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