title: Managing the mammary gland infiltrated with foreign substances: different surgical alternatives.
abstract: BACKGROUND
  In spite of the numerous reports that exist in reference to the damage produced by injecting foreign substances trying to improve different areas of the body economy, these substances are still being used indiscriminately. The breast is one of the most affected areas.
  
  
  OBJECTIVE
  To present our experience in managing the breast infiltrated with different foreign substances.
  
  
  METHODS
  Over a 10-year period, between July 1997 and June 2007, operations were performed on 90 patients presenting different alterations of the breast, secondary to the infiltration of foreign substances for esthetic purposes. The time of infiltration was from 8 months to 22 years (mean, 6 years 4 months), 95% of patients being transsexual and most not knowing the substance used. The main symptoms were hardening (94%), pain (80%), skin alterations (51%), and breast deformity (33%).
  
  
  RESULTS
  Patients were treated with 4 surgical modalities, depending on their own characteristics and the alterations presented. Subcutaneous mastectomy and placement of implants were performed on 84%. Seven percent required subcutaneous mastectomy with skin extirpation and placement of implants. Seven percent received a partial mastectomy without placement of implants, and a total mastectomy was performed on the remaining 2% with a nipple-areola complex graft and placement of implants. In every case, the implants used were round, textured, of cohesive silicon gel, and placed at the same surgical time-46% of them on a subcutaneous plane and 54% on a partial or completely in submuscular plane. Two patients presented hemorrhaging within 12 hours postsurgically and required reintervention. Two presented extrusion of the implant at 3 weeks postsurgically. There were no infections or necrosis.
  
  
  CONCLUSIONS
  In spite of the great damage caused by infiltration of foreign substances into the breast for esthetic purposes, these substances are still being used indiscriminately. Treatment in these cases should focus on eliminating the largest possible amount of the foreign material, at the same time providing the best esthetic result. For that, diverse surgical techniques should be used in accordance with the characteristics of each case.
authors.affiliation: Jalisco Institute of Reconstructive Surgery, International Confederation for Plastic Reconstructive and Aesthetic Surgery, Jalisco College of Plastic Surgeons, Jalisco, México. plassurg@mail.udg.mx
authors.forename: Lázaro
authors.initials: L
authors.lastname: Cárdenas-Camarena
mesh_terms: D000328:Adult; D001940:Breast; D019928:Breast Implantation; D018427:Breast Implants; D005260:Female; D005547:Foreign Bodies; D005549:Foreign-Body Reaction / Q000601:surgery*; D006801:Humans; D008297:Male; D016462:Mammaplasty; D042361:Mammary Glands, Human / Q000601:surgery*; D008408:Mastectomy; D008875:Middle Aged; D009821:Oils / Q000008:administration & dosage*; D014189:Transsexualism
chemical_list: D009821:Oils