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WIREs Nanomed Nanobiotechnol
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Breast implants: the good, the bad and the ugly. Can nanotechnology improve implants?

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Abstract This advanced review will discuss the history of implants used in breast reconstruction and augmentation, the most frequently performed plastic surgery today. Currently, only silicone rubber‐based silica nanocomposite implants are available in the United States. The most prevalent issues involving breast implants include capsular contracture, gel bleed, implant rupture, and infection. In the past, studies have also been reported which linked breast implants to increased incidence of systemic diseases such as autoimmune disease, various forms of cancer, and psychological disease. The goal of this review is to survey the literature from the perspective of material science. It is also largely unnoticed that nanotechnology is involved: the silicone rubber shell is reinforced with nanosilica so implants appear to be homogeneous and crystal clear. We are hoping that this review will contribute to a better understanding of the controversial issues and motivate material scientists and medical doctors to work together to develop alternatives based on new nanotechnology for the women who opt for a device made of synthetic materials. WIREs Nanomed Nanobiotechnol 2012, 4:153–168. doi: 10.1002/wnan.164 This article is categorized under: Implantable Materials and Surgical Technologies > Nanomaterials and Implants Implantable Materials and Surgical Technologies > Nanotechnology in Tissue Repair and Replacement

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An explanted polyurethane foam‐coated breast implant in which the foam layer has delaminated from the silicone after removal because of a hematoma. Significant amounts of polyurethane are present in the capsule after 7 years of implantation with much of the porous structure still intact. (Reprinted with permission from Ref 20. Copyright 2006 Sage Publications)

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Anatomical diagram of the structure of the human breast, including the suspensory Cooper's ligaments. (Reprinted with permission from Ref 110. Copyright 2007 IOS Press)

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Silicone particulates are shown (a) to be present in the capsule of a breast implant after 122 months of implantation with particle dimensions on the order of 10s of µm (b). (Reprinted with permission from Ref 87. Copyright 2003 Elsevier)

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Silicone gel is shown after having seeped through an intact silicone breast implant shell. (Reprinted with permission from Ref 85. Copyright 1997 Elsevier)

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A calcified capsule is shown (a) before and (b) after removal from the encased implant with the distortion of the implant visible. (Reprinted with permission from Ref 7. Copyright 2005 Elsevier)

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The shape retention and resistance to flow is shown for a highly cohesive silicone gel‐filled breast implant in comparison to a more traditional and less viscous silicone gel filler. (Reprinted with permission from Ref 44. Copyright 2007 Springer)

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A smooth‐surface, Mentor silicone gel‐filled breast implant is shown demonstrating the transparency of the nanosilica‐filled, silicone elastomer shell.

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The Dacron patches of a Dow Corning seamless silicone gel breast implant are shown after 28 years of implantation both through the capsule (a) and after the capsule is removed (b). (Reprinted with permission from Ref 34. Copyright 2004 Sage Publications)

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The rupture site of a failed NovaGold implant. (Reprinted with permission from Ref 26. Copyright 2007 Elsevier)

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Two iatrogenically ruptured Trilucent implants are shown demonstrating the commonly observed patch delamination and emulsified soybean‐based filler oil after unspecified implant duration. (Reprinted with permission from Ref 30. Copyright 2002 Elsevier)

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Implantable Materials and Surgical Technologies > Nanotechnology in Tissue Repair and Replacement
Implantable Materials and Surgical Technologies > Nanomaterials and Implants

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