STEM CELLS - THE WAVE OF THE FUTURE

■Stem cells from fat might hold promise for reconstructive therapies


Much research is being done to determine the viability of using stem cells from a patient's own fat to regenerate injured bone or cancer-damaged breast tissue. Some cosmetic surgeons claim to already be using fat stem cells to reduce wrinkles, but the machine used to make the stem cell-enriched fat is approved only for research purposes. "It's unlikely that these cells will cause harm [and] there are really great applications that can come out of this, but we need to be careful and deliberate in how we use these therapies," says Dr. Peter Rubin, associate professor of plastic surgery at the University of Pittsburgh. ABC News (4/5)

BE CAREFUL WHAT YOU HAVE INJECTED INTO YOUR BODY

■FDA: Claims for lipodissolve products are "false and misleading"


The FDA this week warned several spas and at least one online retailer to stop using claims that their lipodissolve injections dissolve small fat deposits. Customers have reported permanent scars, hard lumps and dark skin spots after receiving the injections. MSNBC/The Associated Press (4/7)

Along these lines, I recently came across an interesting report entitled:
BATHROOM CAULK BUTTOCK ENHANCEMENT SENDS SIX WOMEN TO THE HOSPITAL

Six women were hospitalized in Essex County, N.J. this past February after receiving buttock "enhancement" that reportedly consisted of injections of diluted bathtub-grade silicone caulk from unlicensed practitioners.

CHECK THE CREDENTIALS OF YOUR COSMETIC SURGEON

■Study: Untrained "cosmetic surgeons" pose health hazards


A recent study involving 1,876 cosmetic practitioners in Southern California found that only 495 had plastic surgery training. Although it is not illegal for untrained doctors to perform certain cosmetic procedures, such as facial fillers and liposuction, the lack of training can increase the risk of serious complications. Los Angeles Times

BREAST PROSTHESIS, INFECTION AND BIOFILMS

Infection that occurs around a breast prosthesis or any implantable medical device is a challenging and difficult problem.  Rates of infection are higher in breast reconstruction using a prosthetic implant (1-35.4%) compared to augmentation mammoplasty (0.4-2.5%).  Although salvage of an infected prosthesis is always the goal, it is seldom successful. The typical methods used to try to save an infected prosthesis include oral &/or systemtic (I.V.) antibiotics based on culture and sensitivity results, irrigation and drainage procedures, antibiotic pulsed lavage, removal of the capsule surrounding the implant, exchanging the implant, and possible post-operative continuous antibiotic irrigation.
There is a higher percentage of infection associated with smoking, chemotherapy and radiation therapy. There is less likely to be a successful salvage of the prosthesis if the wound culture organisms are methicillin-resistant Staphylococcus Aureus (M.R.S.A.), gram negative rods such as Pseudomonas Aeruginosa, mycobacteria or yeast. I have also found that patients with significant erythema in the mastectomy skin, thin tissues and implant exposure are in a poor prognostic group for salvage.
Why is it so difficult to treat infection around a prosthetic medical device?  One theory is that certain bacteria form a Biofilm.  A Biofilm is a mucopolysaccharide "slime layer" that adheres to a breast implant and forms a "protective barrier" for the bacteria which isolates them from antibiotics and from the infection-fightening capabilities of the immune system.  The molecular mechanisms of biofilm formation are beyond my understanding and involve a complicated process that is being looked at carefully in the research labs. Of interest, it has been also shown that biofilms may play a role in certain burn infections that show multi-drug resistance and in certain non-healing wounds.
An infection around a breast prosthesis is a major problem!  This results in prolonged treatment and recovery, additional surgeries, more expense, central lines for weeks of I.V. antibiotics (with the risk of line sepsis), additional hospitalization and psychological issues for both the patient and doctor. As with many things in life, prevention is the key.  Before, during and after surgery we take extra precautions above and beyond our normal sterile technique to try to reduce the chances of infection around a breast prosthesis.