title: Shur-clens: an agent to remove silicone gel after breast implant rupture.
abstract: Removal of silicone gel from surrounding tissues after implant rupture is difficult. Local inflammation, infection, and silicone granulomas warrant thorough removal of the silicone gel. Shur-Clens (20% solution of the surfactant poloxamer 188), povidone-iodine, and saline are agents that are used to aid in the removal of silicone gel from tissue. The purpose of this study was to compare the efficacy of silicone gel removal by these three agents in vitro. Shur-Clens, povidone-iodine, and saline were compared as solvents for silicone gel. Four weight increments of silicone gel (0.02 g, 0.04 g, 0.06 g, and 0.08 g) were placed on glass slides. These slides were placed in separate beakers containing 40 ml test solution. The slides were soaked for 1 minute with gentle agitation. The slides were removed, rinsed gently with de-ionized water, and placed in a vacuum desiccator to dry. The slides were weighed to determine the amount of silicone removed after soaking in the solution. Analysis of variance was used to determine the significance between the three solvents. The percentages of silicone gel removed for the four weight increments (0.02 g, 0.04 g, 0.06 g, and 0.08 g) in saline were 5.6%, 2.9%, 2.1%, and 5.8%, respectively. In povidone-iodine solution, the percentages were 18.9%, 25.4%, 28.8%, and 51.9%. In Shur-Clens, the percentages were 31.3%, 43.0%, 63.5%, and 79.9%. The greater percentage of silicone gel removed by Shur-Clens was significant compared with the other solutions (p < or = 0.05). Shur-Clens was shown to be a more effective solvent for removal of silicone gel in vitro. This enhanced efficacy is a result of the fact that Shur-Clens contains 20% of the surfactant poloxamer 188. The authors' clinical experience with 7 patients who underwent ruptured silicone breast implant removal demonstrated the superiority of Shur-Clens. Shur-Clens is a surfactant cleanser that is widely available, is inexpensive, and has a good safety profile. They propose the use of Shur-Clens to clean silicone gel spillage to decrease local complications resulting from residual silicone gel.
authors.affiliation: Department of Plastic Surgery, University of Virginia, Health System Charlottesville, 22908-1351, USA.
authors.forename: George J
authors.initials: GJ
authors.lastname: Bitar
authors.forename: Diem B
authors.initials: DB
authors.lastname: Nguyen
authors.forename: Laura K
authors.initials: LK
authors.lastname: Knox
authors.forename: Mohammed I
authors.initials: MI
authors.lastname: Dahman
authors.forename: Raymond F
authors.initials: RF
authors.lastname: Morgan
authors.forename: George T
authors.initials: GT
authors.lastname: Rodeheaver
mesh_terms: D001940:Breast / Q000601:surgery; D018427:Breast Implants / Q000009:adverse effects*; D066298:In Vitro Techniques; D020442:Poloxamer / Q000627:therapeutic use*; D011206:Povidone-Iodine / Q000627:therapeutic use; D011475:Prosthesis Failure; D020034:Silicone Gels / Q000009:adverse effects*; D012965:Sodium Chloride / Q000627:therapeutic use; D013501:Surface-Active Agents / Q000627:therapeutic use*; D007507:Therapeutic Irrigation
chemical_list: D020034:Silicone Gels; D013501:Surface-Active Agents; D020442:Poloxamer; D012965:Sodium Chloride; D011206:Povidone-Iodine