title: Stereoscopic Analysis of Silicone Breast Implant Shells Damaged by Surgical Instruments.
abstract: BACKGROUND
  Iatrogenic shell injury during the implantation and explantation of silicone gel breast implants may lead to eventual device failure. Identification of the patterns of injury caused by surgical instruments is important when attempting to characterize the cause of shell rupture. Understanding the true causes of device failure may help with its prevention. The purpose of this study was to microscopically characterize patterns of shell injury induced by various surgical instruments.
  
  
  METHODS
  Textured and smooth silicone gel implants were intentionally damaged with a variety of surgical instruments. Various scalpels and surgical scissors ranging in fineness were used to create full-thickness injuries in the implant shell. Optical microscopy and scanning electron microscopy were then used to image the injured area to determine patterns of injury.
  
  
  RESULTS
  Full-thickness striations across the thickness of the shell could be seen with damage caused by scissors. The density of these striations correlated directly with the fineness of scissors used. No striations were seen with injuries caused by scalpels.
  
  
  CONCLUSIONS
  Striations were only observed in injuries caused by scissors and suture needles. Striation density correlated with the coarseness of the cutting edge. No such striations were seen in shells damaged by a scalpel even when the angle of approach was changed. This difference can be of assistance in distinguishing between scissors versus scalpel injury of an implant shell.
authors.affiliation: Grand Rapids, Mich. From Grand Rapids Medical Education Partners/Michigan State University Plastic Surgery Residency; and Partners in Plastic Surgery of Western Michigan.
authors.forename: Derek A
authors.initials: DA
authors.lastname: Rapp
authors.forename: Keith C
authors.initials: KC
authors.lastname: Neaman
authors.forename: Dennis C
authors.initials: DC
authors.lastname: Hammond
mesh_terms: D018427:Breast Implants; D019544:Equipment Failure Analysis; D008855:Microscopy, Electron, Scanning; D010780:Photogrammetry; D011475:Prosthesis Failure / Q000209:etiology*; D020034:Silicone Gels; D013525:Surgical Instruments / Q000009:adverse effects*
chemical_list: D020034:Silicone Gels