Abstract
Polyurethane (PU) implants are associated with great difficulties in extraction if secondary surgery is needed. The published data are contradictory, often misleading, making the decision for the secondary surgery complicated, the time period and the procedure itself not optimal, thus negatively influencing the final result.
Materials and Methods
Typical videos of PU implant removal in different periods after primary surgeries with polyurethane implants were selected for the study. The videos show the strength and extent of the tissue ingrowth and the manipulations needed for implant extraction in different periods from the initial procedure. Classifications of the types of adhesion and adhesion patterns are introduced.
Conclusions
The data provided in this article facilitate the decision-making process if secondary surgery is indicated. Secondary surgery should be performed in the first 30 days after the initial surgery or in the period after 6 months. The optimal layer for removal of the PU implant depends on the time after the primary surgery. The polyurethane implant should be exchanged after 1 month if the properties of the polyurethane foam are expected to be used.
Level of Evidence IV
This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Similar content being viewed by others
References
Buckspan R (1989) Inserting the polyurethane-covered breast implant. Plast Reconstr Surg 84(5):858–859
Smith M, Durrani A (2011) Aiding the insertion of polyurethane coated breast implants. Ann R Coll Surg Engl 93(7):556
Batich C, Williams J (1989) Toxic hydrolysis product from biodegradable foam implant. J Biomed Mater Res 23:311–319
Chan S, Birdsell D, Gradeen C (1991) Detection of toluenediamines in the urine of a patient with polyurethane-covered breast implants. Clin Chem 37(5):756–758
Chan S, Birdsell D, Gradeen C (1991) Urinary excretion of free toluenediamines in a patient with polyurethane-covered breast implants. Clin Chem 37(12):2143–2145
Brand K (1988) Foam-covered mammary implants. Clin Plast Surg 15(4):533–539
Jabaley M, Das S (1986) Late breast pain following reconstruction with polyurethane-covered implants. Plast Reconstr Surg 78(3):390–395
Hoffman S (1989) Correction of established capsular contractures with polyurethane implants. Aesthet Plast Surg 13(1):33–40
Wang B, Chang B, Sargeant R, Manson P (1998) Late capsular hematoma after breast reconstruction with polyurethane covered implants. Plast Reconstr Surg 102:450–452
Brickman M, Parsa N, Parsa F (2004) Late hematoma after breast implantation. Aesthet Plast Surg 28:80–82
Eyssen J, von Werssowetz A, Middleton G (1984) Reconstruction of the breast using polyurethane-coated prostheses. Plast Reconstr Surg 73:415–421
Pollock H (1984) Polyurethane-covered breast implants. Plast Reconstr Surg 74:729
Okunski WJ, Chowdary RP (1987) Infected meme implants: salvage reconstruction with latissimus dorsi myocutaneous flaps and silicone implants. Aesthet Plast Surg 11(1):49–51
Capozzi A (1991) Long-term complications of polyurethane-covered breast implants. Plast Reconstr Surg 88(3):458–461
Hester T (1990) Diagnosis and treatment of complications occurring with polyurethane-covered breast implants. Perspect Plast Surg 4:105–111
Fleming D, Handel M, Gutierrez J (2012) Polyurethane foam covered breast implants. In: Peters W, Brandon H, Jerina KL, Wolf C, Young VL (eds) Biomaterials in plastic surgery. Elsevier, New York, pp 96–120
Ashley FL (1970) A new type of breast prosthesis. Preliminary report. Plast Reconstr Surg 45(5):421–424
Vázquez G, Pellón A (2007) Polyurethane-coated silicone gel breast implants used for 18 years. Aesthet Plast Surg 31(4):330–336
Frame J (2016) Commentary on: the modern polyurethane-coated implant in breast augmentation: long-term clinical experience. Aesthet Surg J 36(10):1130–1132
Schatten W (1984) Reconstruction of breast following mastectomy with polyurethane-covered, gel-filled prosthesis. Ann Plast Surg 12:147–156
Hester T (1988) The polyurethane covered mammary prosthesis: facts and fiction. Perspect Plast Surg 2:135–164
Handel N, Silverstein M, Jensen J, Collins A, Zierk K (1991) Comparative experience with smooth and polyurethane breast implants using the Kaplan–Meier method of survival analysis. Plast Reconstr Surg 88(3):475–481
Hester T, Cukic J (1991) Use of stacked polyurethane—covered mammary implants in aesthetic and reconstructive breast surgery. Plast Reconstr Surg 88(3):503–509
Vasquez G (1999) A ten-year experience using polyurethane covered breast implants. Aesthet Plast Surg 23:189–196
de la Pen˜a-Salcedo J, Soto-Miranda M, Lopez-Salguero J (2012) Back to the future: a 15-year experience with polyurethane foam-covered breast implants using the partial-subfascial technique. Aesthet Plast Surg 36:331–338
Castel N, Soon-Sutton T, Deptula P, Flaherty A, Parsa FD (2015) Polyurethane-coated breast implants revisited: a 30-year follow-up. Arch Plast Surg 42(2):186–193
Duxbury PJ, Harvey JR (2016) Systematic review of the effectiveness of polyurethane-coated compared with textured silicone implants in breast surgery. J Plast Reconstr Aesthet Surg 69(4):452–460
Pompei S, Evangelidou D, Arelli F, Ferrante G (2016) The modern polyurethane-coated implant in breast augmentation: long-term clinical experience. Aesthet Surg J 36(10):1124–1129
Pompei S, Arelli F, Labardi L, Marcasciano F, Evangelidou D, Ferrante G (2017) Polyurethane implants in 2-stage breast reconstruction: 9-year clinical experience. Aesthet Surg J 37(2):171–176
Stan C, Biggs T (2017) The diagon/gel implant: a preliminary report of 894 cases. Plast Reconstr Surg Glob Open 5(7):e1393
Gasperoni C, Salgarello M, Gargani G (1992) Polyurethane-covered mammary implants: a 12-year experience. Ann Plast Surg 29(4):303–308
Frame J, Kamel D, Olivan M, Cintra H (2015) The in vivo pericapsular tissue response to modern polyurethane breast implants. Aesth Plast Surg 39:713–723
O’Connell J (1992) Removal of stacked polyurethane-covered mammary implants. Plast Reconstr Surg 90(5):930–931
Mossaad B, Frame J (2012) Correction of breast contour deformities using polyurethane breast implant capsule in revisional breast surgery. J Plast Reconstr Aesthet Surg 65:1425–1429
Ashley F (1972) A further studies on the natural-Y breast prothesis. Plast Reconstr Surg 49(4):414–419
Melmed E (1988) Polyurethane implants: a 6-year review of 416 patients. Plast Reconstr Surg 82(2):285–290
Hoefflin S (1990) Extensive experience with polyurethane breast implants. Plast Reconstr Surg 86(1):166–167
Miro A (2009) Polyurethane-coated silicone breast implants: evaluation of 14 years experience. Rev Bras Cir Plast 24(3):296–303
Berrino P, Galli A, Rainero M, Santi P (1986) Long-lasting complications with the use of polyurethane-covered breast implants. Br J Plast Surg 39(4):549–553
Dini G, Ferreira L (2006) Early complication with the use of polyurethane-covered breast implants. Plast Reconstr Surg 117(6):2098–2100
Prado A, Andrades P, Benitez S (2006) A word of caution on the explantation of polyurethane breast implants. Plast Reconstr Surg 117(5):1655–1657
Gruver D (1989) Managing the patient with infection around a polyurethane implant. Plast Reconstr Surg 83(5):927
Cohney B, Mitchell S (1997) An improved method of removing polyurethane foam-covered gel prostheses. Aesthet Plast Surg 21:191–192
Dini M, Giordano V, Quattrini L, Mori A, Napoli S (2011) Double capsules:our experience with polyurethane-coated silicone breast implants. Plast Reconstr Surg 128(3):819–820
Hall-Findlay E (2011) Breast implant complication review: double capsules and late seromas. Plast Reconstr Surg 127:56–66
Scarpa C, Borso G, Vindigni V, Bassetto F (2015) Polyurethane foam-covered breast implants: A justified choice? Eur Rev Med Pharmacol Sci 19:1600–1606
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
D. Batiukov received a speaker honorarium from POLYTECH Health & Aesthetics. V. Podgaiski and D. Ladutko declare that they have no conflict of interest.
Human and Animal Rights
This article does not contain any studies with human participants or animals performed by any of the authors
Electronic Supplementary Material
Below is the link to the electronic supplementary material.
Removal of PU implants 9 years, 13, 9.5 and 6 months after primary surgery
Removal of PU implants 3 months after primary surgery
Removal of PU implants 33 and 36 days after primary surgery
Removal of PU implants 21 and 6 days after primary surgery
Separation of the base of the implant from the capsule
Rights and permissions
About this article
Cite this article
Batiukov, D., Podgaiski, V. & Ladutko, D. Removal of Polyurethane Implants. Aesth Plast Surg 43, 70–75 (2019). https://doi.org/10.1007/s00266-018-1254-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00266-018-1254-3