Commentary on: Breast Explantation With Simultaneous Mastopexy and Volume Restoration: An Analysis of Clinical Outcomes and Prospective Quality of Life
Bibliographic record
Abstract
Requests for breast explantation surgery have been steadily increasing in recent years.Concerns secondary to risk of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL; with textured devices) as well as breast implant illness along with the changing trends in breast aesthetics have led many patients to request implant removal without replacement.Due to the long-term effects of a breast implant on the breast tissue, implant removal can be a challenging procedure with variable aesthetic results.Capsulectomy can increase the complexity of this procedure and lead to an increased risk of complications.Therefore, when approaching these patients, it is important to have a reliable and safe approach to maximize outcomes while modifying potential risks.In this paper by Messa IV and Messa III entitled "Breast Explantation With Simultaneous Mastopexy and Volume Restoration: An Analysis of Clinical Outcomes and Prospective Quality of Life," the authors present a thorough and thoughtful discussion that summarizes the literature with respect to implant safety and outcomes following explantation. 1They describe their approach for simultaneous mastopexy, explantation, and capsulectomy, utilizing autoaugmentation and/or autologous fat grafting to improve aesthetic outcomes.Their discussion includes important references relating to the improvement of symptoms following explantation along with possible etiologies for this improvement.They assess patient-reported outcomes, in terms of satisfaction (breast shape and size) and quality of life and in relation to the procedure and breast implant illness symptomatology, with an author-generated nonvalidated tool.The authors present 4 cases with very good postoperative aesthetic results; however, it is important to note that these cases all include patients with good quality and quantity of tissue, which is often not the case in this patient population.All patients in this study underwent capsulectomy for various indications, with 51.1% of patients undergoing this procedure because of concerns related to breast implant illness.The authors refer to their approach as a "precise total capsulectomy en masse," and this was performed on all patients.Indications for this procedure included "textured breast implants, ruptured implants, a calcified capsule and patients with symptoms attributed to breast implant illness."Currently, the literature does not support an absolute indication for total capsulectomy in the treatment of breast implant illness.In fact, an important recent paper demonstrated an improvement in patient symptoms following implant removal irrespective of the way in which the capsule was managed. 2 As well, there is controversy regarding the management of capsules when removing textured breast implants due to
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".