Guest guest Posted February 4, 2006 Report Share Posted February 4, 2006 I can't find the post now, but someone was asking about a Dr.Copeland in New York, and I went through our archives to see what was posted about her previously. We have a Dr. Copeland on our recommended list, but we don't always get updates on what women are hearing when they go to these docs. Anyway, I wanted to post what I found, and hope that will help you. Here are two posts from a former member, followed by a study that Dr. Copeland was involved in regarding scar capsules: This one was from March 1, 2004: Hey there Kim. How are you doing? It is $200.oo for consultation with Dr. Copeland, and YES she does the 'proper' removal. I think Patty posted that Copeland is on the groups Dr. list for explant, so there are other women who have gone to her. I would check her out, and at least go for the consultation with her. If you do not feel comfortable with her, then do not use her, but my friend really liked her work. I did not see any implant removal pictures on her web site, but maybe she has some in her office, scince she is experienced.IF you go to her, bring a list of questions that you want to ask, and ask to see pictures! Usually they have pictures in the office. Just trying to help you find something close to home. I know going out of State can be $$$$$. But at least go to someone who will remove them properly.(make sure it is done ENBLOC!!) Hope this helps you Kim....'hugs' dimonds68. Let me know how it goes. In the meantime do your research! This one was from Nov 25, 2003: Hello Neena..sorry to hear of your troubles. My thoughts and prayers go out to you. I am in the NY area. I personally did NOT use this surgeon for explant, but I have a friend of mine who went to Manhattan to a Dr. Copeland (call information for her #...under New York, New York/Manhattan) I know this women RAVES about her work, and how she does enbloc technique and knows her stuff. My freind is no longer active in the Breast implant community/support groups. I think it would be worth a try to check her out. If I would have known about her when I was ready for explant, I would have checked her out myself. My friend had implants that the shell disinegated and broke, and made her sick, and she said this surgeon cleaned her out, and her breasts look good. Ok Neena .Hope this helps you out..it may be worth a try. You have nothing to loose, if she can help you..good luck, and hang in there. I know what you are going thru..xoxoxox peace.dimonds68 There is also a 1993 paper that Dr. Copeland was involved in that was published regarding: SYSTEMIC INFLAMMATORY DISORDER RELATED TO FIBROUS BREAST CAPSULES AFTER SILICONE IMPLANT REMOVAL Author: Copeland M, Kressel A, Spiera H, Hermann G, Bleiweiss IJ Address: Dept. Surgery, Mt Sinai School of Medicine, City Univ of New York, NY Source: Plastic & Reconstructive Surgery Journal, Nov., 1993, 92:6, 1179-81 Silicone breast implants have been implicated in inflammatory disorders of connective tissue. The fibrous capsules that form around these implants are usually inert and are not generally removed when the prostheses are explanted. We report patient in whom reactive bilateral submammary cysts and systemic inflammation developed when intact silicone breast implants were removed without capsulectomy. The improvement in systemic symptoms which followed excision of the capsules and the histopathologic findings raise the possibility that retained silicone material within the wall of the capsule may contribute to adverse reactions in susceptible patients. CASE REPORT A 56 year old Caucasian woman underwent bilateral augmentation mammaplasty with silicone implants in the submammary position 16 years before reevaluation. Firmness of both breasts had developed in the first year postoperatively, and closed capsulotomies, were performed three times with softening of breast texture. Six years after implantation, open capsulotomies were carried out along with insertion of new silicone implants. Nine years later, though the breasts remained supple, polyarthralgias developed. Rheumatologic evaluation revealed an antinuclear antibody, and the erythrocyte sedimentation rate was accelerated at 40 mm/h. Six months after the onset of arthralgia, the fibrous walls of the breast capsules were incised and the implants removed; the capsular shells were left in situ. Intraoperatively, gel " bleed " was observed extending into the walled breast cavities. Postoperatively, arthralgia subsided, but a month later spiking fevers developed, reaching a peak of 105 F. Physical examination revealed bilateral axillary lymphadenopathy and mammary erythema without wound purulence. The hemogram, blood chemistry profile, and urinalysis were unremarkable. Fever persisted despite empirical antibiotic therapy, and blood cultures grew no pathogens. Computed tomography of the thorax revealed a 5 x 3 x 5 cm cystic lucency in the region of the right breast capsule containing radiopaque densities and a similar structure measuring 4.5 x 1.5 x 5 cm on the left (Figure not included). Six months after open capsulotomies, there was bilateral breast tenderness, and submammary masses were palpable. Axillary lymphadenopathy was more prominent on the right than on the left. Mammography revealed fluid- filled masses in the right and left submammary positions, 5 and 3.5 cm in diameter, respectively, incorporating radiopaque densities (Figure not included). The breasts were surgically explored and the submammary collections removed. Well-encapsulated cystic masses were encountered in continuity with dense fibrous and mammary tissue. The cysts contained serosanguineous fluid with fragments of silicone embedded in the walls. The cyst walls and surrounding fibrous material were excised, and suction drainage was provided through the inframammary incisions. A single 8-mg dose of dexamethasone was given intraoperatively; a cephalosporin antibiotic was administered preoperatively and continued orally for 10 days postoperatively. The drains were removed on the second postoperative day. Breast tenderness and pain subsided along with axillary lymphadenopathy, and there were no further episodes of fever. Grossly, the excised specimen consisted of multiple fragments of thick, fibrous capsular wall with surrounding fatty tissue and small amounts of interspersed breast tissue. Microscopically, the capsule appeared densely fibrotic and hyalinized, lined by organized hematoma. Many vacuolated histiocytes were present within and next to fibrous tissue; these cells contained refractile, nonstaining, nonpolarizable material, consistent with foreign-body reaction (Figure not included). This material also was present in the extracellular spaces in large and small aggregates. Areas of granulation tissue, fat necrosis, and a minimal lymphoplasmacytic inflammatory infiltrate were identified in the scant breast tissue. DISCUSSION While identification of silicone gel in the capsules around mammary implants has been described previously, the fate of retained fibrous capsules after removal of silicone implants is not widely recognized. Review of the literature yielded only a single case report of a serous cyst that developed after replacement of a subglandular silicone implant in the submuscular position because of capsule contraction. Silicone leakage was not described, and the authors speculated that cyst formation was a reaction to residual fibrous capsular material, termed a pseudosheath. Cyst formation as a consequence of retained silicone implant capsules has not been reported previously. Although silicone is a chemically inert substance, the biologic response to silicone granuloma.3-6 Histologically, such granulomas are characterized by macrophage accumulation, fibroblastic reaction, and giant-cell infiltration. This cellular response produces chronic inflammation, which is thought to mediate the immune phenomena associated with silicone breast implants. Silicone implants have been associated with an inflammatory syndrome characterized by pain, swelling, palpable capsular contracture, arthralgia, systemic symptoms, or serologic abnormalities, as well as manifestations of systemic sclerosis or other immune disorders of connective tissue.7- 11 Thomsen et al described dense fibroblast accumulation in the fibrous capsules around silicone implants and related the local inflammatory response to the concentration of silicone. In contract, Jennings et al found no consistent relationship between the amount of silicone in adjacent breast tissue and the extent of capsular contracture. Silicone leached from the implants was limited to the inner 2 mm of the capsule, and the amount of silicone in the capsules was different in the right and the left breasts of the same individual. We cannot exclude the possibility that silicone that dispersed to other body locations than the capsule in our patient might have contributed to the systemic inflammatory response, but the amount detected in the capsule seems sufficient to have been responsible, and symptoms subsided once this was removed. The American Society of Plastic and Reconstructive Surgeons has recommended that fibrous capsules be left in place when silicone implants are removed, unless thickening of the capsule produces breast distortion or rupture of the implant is complicated by extrusion of silicone contents. SUMMARY Silicone breast implants have been associated with connective-tissue inflammatory syndromes such as systemic sclerosis, and as with other artificial breast prostheses, fibrous capsules tend to form around the implants. The capsular tissue is generally considered inert and typically is left in situ when the prostheses are explanted. We report a patient who formed symptomatic bilateral submammary cysts associated with pain, swelling, arthralgia, fever, axillary lymphadenopathy, accelerated erythocyte sedimentation rate, and antinuclear antibody following removal of intact silicone breast implants without capsulectomy. Clinical improvement followed removal of the capsules, which histologically displayed fragments of silicone, fibrous tissue, and inflammatory cells. Our experience suggests that when silicone breast implants are thought to be the cause of a clinical inflammatory syndrome characterized by mammary pain, swelling, arthralgia, or serologic abnormalities, consideration should be given to removing the capsules entirely so that the chance of a perpetuating reaction will be reduced. Copeland, D.M.D., M.D. Mount Sinai Medical Center, Box 126 Fifth Avenue at 100th Street New York, NE 10029 http://www.drcopeland.com/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 4, 2006 Report Share Posted February 4, 2006 Thank you so much for the information. I appreciate you looking that up. Lynn > > I can't find the post now, but someone was asking about a > Dr.Copeland in New York, and I went through our archives to see what > was posted about her previously. We have a Dr. Copeland on > our recommended list, but we don't always get updates on what women > are hearing when they go to these docs. Anyway, I wanted to post > what I found, and hope that will help you. Here are two posts from > a former member, followed by a study that Dr. Copeland was involved > in regarding scar capsules: > > This one was from March 1, 2004: > Hey there Kim. How are you doing? It is $200.oo for consultation > with Dr. Copeland, and YES she does the 'proper' removal. I think > Patty posted that Copeland is on the groups Dr. list for explant, so > there are other women who have gone to her. I would check her out, > and at least go for the consultation with her. If you do not feel > comfortable with her, then do not use her, but my friend really > liked her work. I did not see any implant removal pictures on her > web site, but maybe she has some in her office, scince she is > experienced.IF you go to her, bring a list of questions that you > want to ask, and ask to see pictures! Usually they have pictures in > the office. Just trying to help you find something close to home. I > know going out of State can be $$$$$. But at least go to someone who > will remove them properly.(make sure it is done ENBLOC!!) Hope this > helps you Kim....'hugs' dimonds68. Let me know how it goes. In the > meantime do your research! > > This one was from Nov 25, 2003: > Hello Neena..sorry to hear of your troubles. My thoughts and prayers > go out to you. I am in the NY area. I personally did NOT use this > surgeon for explant, but I have a friend of mine who went to > Manhattan to a Dr. Copeland (call information for her #...under New > York, New York/Manhattan) I know this women RAVES about her work, and > how she does enbloc technique and knows her stuff. My freind is no > longer active in the Breast implant community/support groups. I think > it would be worth a try to check her out. If I would have known about > her when I was ready for explant, I would have checked her out > myself. My friend had implants that the shell disinegated and broke, > and made her sick, and she said this surgeon cleaned her out, and her > breasts look good. Ok Neena .Hope this helps you out..it may be worth > a try. You have nothing to loose, if she can help you..good luck, and > hang in there. I know what you are going thru..xoxoxox > peace.dimonds68 > > There is also a 1993 paper that Dr. Copeland was involved in that > was published regarding: > > SYSTEMIC INFLAMMATORY DISORDER RELATED TO FIBROUS BREAST CAPSULES > AFTER SILICONE IMPLANT REMOVAL > > > > Author: Copeland M, Kressel A, Spiera H, Hermann G, Bleiweiss IJ > Address: Dept. Surgery, Mt Sinai School of Medicine, City Univ of > New York, NY Source: Plastic & Reconstructive Surgery Journal, Nov., > 1993, 92:6, 1179-81 > > Silicone breast implants have been implicated in inflammatory > disorders of connective tissue. The fibrous capsules that form > around these implants are usually inert and are not generally > removed when the prostheses are explanted. We report patient in whom > reactive bilateral submammary cysts and systemic inflammation > developed when intact silicone breast implants were removed without > capsulectomy. The improvement in systemic symptoms which followed > excision of the capsules and the histopathologic findings raise the > possibility that retained silicone material within the wall of the > capsule may contribute to adverse reactions in susceptible patients. > > CASE REPORT > > A 56 year old Caucasian woman underwent bilateral augmentation > mammaplasty with silicone implants in the submammary position 16 > years before reevaluation. Firmness of both breasts had developed in > the first year postoperatively, and closed capsulotomies, were > performed three times with softening of breast texture. Six years > after implantation, open capsulotomies were carried out along with > insertion of new silicone implants. > > Nine years later, though the breasts remained supple, > polyarthralgias developed. Rheumatologic evaluation revealed an > antinuclear antibody, and the erythrocyte sedimentation rate was > accelerated at 40 mm/h. Six months after the onset of arthralgia, > the fibrous walls of the breast capsules were incised and the > implants removed; the capsular shells were left in situ. > Intraoperatively, gel " bleed " was observed extending into the walled > breast cavities. > > Postoperatively, arthralgia subsided, but a month later spiking > fevers developed, reaching a peak of 105 F. Physical examination > revealed bilateral axillary lymphadenopathy and mammary erythema > without wound purulence. The hemogram, blood chemistry profile, and > urinalysis were unremarkable. Fever persisted despite empirical > antibiotic therapy, and blood cultures grew no pathogens. > > Computed tomography of the thorax revealed a 5 x 3 x 5 cm cystic > lucency in the region of the right breast capsule containing > radiopaque densities and a similar structure measuring 4.5 x 1.5 x 5 > cm on the left (Figure not included). Six months after open > capsulotomies, there was bilateral breast tenderness, and submammary > masses were palpable. Axillary lymphadenopathy was more prominent on > the right than on the left. Mammography revealed fluid- filled > masses in the right and left submammary positions, 5 and 3.5 cm in > diameter, respectively, incorporating radiopaque densities (Figure > not included). > > The breasts were surgically explored and the submammary collections > removed. Well-encapsulated cystic masses were encountered in > continuity with dense fibrous and mammary tissue. The cysts > contained serosanguineous fluid with fragments of silicone embedded > in the walls. > > The cyst walls and surrounding fibrous material were excised, and > suction drainage was provided through the inframammary incisions. A > single 8-mg dose of dexamethasone was given intraoperatively; a > cephalosporin antibiotic was administered preoperatively and > continued orally for 10 days postoperatively. The drains were > removed on the second postoperative day. Breast tenderness and pain > subsided along with axillary lymphadenopathy, and there were no > further episodes of fever. > > Grossly, the excised specimen consisted of multiple fragments of > thick, fibrous capsular wall with surrounding fatty tissue and small > amounts of interspersed breast tissue. Microscopically, the capsule > appeared densely fibrotic and hyalinized, lined by organized > hematoma. Many vacuolated histiocytes were present within and next > to fibrous tissue; these cells contained refractile, nonstaining, > nonpolarizable material, consistent with foreign-body reaction > (Figure not included). This material also was present in the > extracellular spaces in large and small aggregates. Areas of > granulation tissue, fat necrosis, and a minimal lymphoplasmacytic > inflammatory infiltrate were identified in the scant breast tissue. > > DISCUSSION > > While identification of silicone gel in the capsules around mammary > implants has been described previously, the fate of retained fibrous > capsules after removal of silicone implants is not widely > recognized. Review of the literature yielded only a single case > report of a serous cyst that developed after replacement of a > subglandular silicone implant in the submuscular position because of > capsule contraction. Silicone leakage was not described, and the > authors speculated that cyst formation was a reaction to residual > fibrous capsular material, termed a pseudosheath. Cyst formation as > a consequence of retained silicone implant capsules has not been > reported previously. > > Although silicone is a chemically inert substance, the biologic > response to silicone granuloma.3-6 Histologically, such granulomas > are characterized by macrophage accumulation, fibroblastic reaction, > and giant-cell infiltration. This cellular response produces chronic > inflammation, which is thought to mediate the immune phenomena > associated with silicone breast implants. Silicone implants have > been associated with an inflammatory syndrome characterized by pain, > swelling, palpable capsular contracture, arthralgia, systemic > symptoms, or serologic abnormalities, as well as manifestations of > systemic sclerosis or other immune disorders of connective tissue.7- > 11 > > Thomsen et al described dense fibroblast accumulation in the fibrous > capsules around silicone implants and related the local inflammatory > response to the concentration of silicone. In contract, Jennings et > al found no consistent relationship between the amount of silicone > in adjacent breast tissue and the extent of capsular contracture. > > Silicone leached from the implants was limited to the inner 2 mm of > the capsule, and the amount of silicone in the capsules was > different in the right and the left breasts of the same individual. > We cannot exclude the possibility that silicone that dispersed to > other body locations than the capsule in our patient might have > contributed to the systemic inflammatory response, but the amount > detected in the capsule seems sufficient to have been responsible, > and symptoms subsided once this was removed. > > The American Society of Plastic and Reconstructive Surgeons has > recommended that fibrous capsules be left in place when silicone > implants are removed, unless thickening of the capsule produces > breast distortion or rupture of the implant is complicated by > extrusion of silicone contents. > > SUMMARY > > Silicone breast implants have been associated with connective- tissue > inflammatory syndromes such as systemic sclerosis, and as with other > artificial breast prostheses, fibrous capsules tend to form around > the implants. The capsular tissue is generally considered inert and > typically is left in situ when the prostheses are explanted. We > report a patient who formed symptomatic bilateral submammary cysts > associated with pain, swelling, arthralgia, fever, axillary > lymphadenopathy, accelerated erythocyte sedimentation rate, and > antinuclear antibody following removal of intact silicone breast > implants without capsulectomy. > > Clinical improvement followed removal of the capsules, which > histologically displayed fragments of silicone, fibrous tissue, and > inflammatory cells. Our experience suggests that when silicone > breast implants are thought to be the cause of a clinical > inflammatory syndrome characterized by mammary pain, swelling, > arthralgia, or serologic abnormalities, consideration should be > given to removing the capsules entirely so that the chance of a > perpetuating reaction will be reduced. > > Copeland, D.M.D., M.D. > > Mount Sinai Medical Center, Box 126 > > Fifth Avenue at 100th Street > > New York, NE 10029 > > http://www.drcopeland.com/ > Quote Link to comment Share on other sites More sharing options...
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