Infection and capsular contracture are two of the most significant complications of breast-implant surgery. Both complications are associated with bacterial contamination of the implant surface. Plasma activation of the surface of a silicone breast implant changes its surface properties from water repelling (hydrophobic) to water absorbing (hydrophilic), thus making it possible for antibacterial irrigants to temporarily adsorb onto the implant surface. To support our hypothesis that by changing the surface properties we could render antibacterial irrigation more effective in inhibiting bacterial growth on a breast implant shell. An in-vitro study using silicone discs cut from a textured silicone breast implant shell was performed by treating some of the discs with plasma activation and then exposing the discs to contamination with either Staphylococcus aureus or Pseudomonas aeruginosa and then variously treating the discs with 10% povidone iodine, Cefazolin, or Gentamicin. Bacterial contamination was verified and counted using contact plates as well as culture media. Plasma activation changed the wetting properties of the disc’s surface from hydrophobic to hydrophilic. Non-plasma activated contaminated discs demonstrated clear bacterial growth both in the untreated group and in the antibacterial-treated group. Combining antibacterial treatment with plasma activation resulted in complete inhibition of bacterial growth in each of the groups treated with antibacterial irrigants. Combining plasma activation with topical antibacterial irrigants can inhibit the growth of bacteria on implant shell discs. By changing the properties of the surface from hydrophobic to hydrophilic, the adsorption of the antibacterial irrigants is enhanced.

Background Postmastectomy radiation therapy (PMRT) is a widely accepted treatment for locally advanced breast cancer. Some patients require additional boost radiation to the internal mammary nodes as the part of regional nodal irradiation (RNI). Delayed breast reconstruction with an autologous free flap using the internal mammary vessels for microvascular flap anastomosis is a common practice for these patients. The aim of our study was to evaluate the effect of RNI on autologous microvascular breast reconstruction. Patients and Methods A retrospective study was performed on 57 patients (69 flaps) undergoing deep inferior epigastric perforator (DIEP) flap for delayed breast reconstruction after radiation therapy. The study group included 37 patients (65%) who received PMRT and RNI to the internal mammary nodes. The control group included 20 patients (35%) who received PMRT alone. Early and delayed surgical complications, including wound complications, fat necrosis, and flap loss, were compared between the groups. Results The patient demographics in both groups were similar. Complication rate showed a higher trend in the study group for flap loss (8.3% versus 0%) and vascular anastomosis failure (5.6% versus 0%), but with no statistical difference (p = 0.54, 0.53, respectively). The control group showed a higher trend in fat necrosis (25% versus 8.3%, p = 0.11). Conclusions DIEP flap breast reconstructions with internal mammary vessels anastomosis should be performed with cautious in patients who had received RNI to internal mammary nodes because of potential added risk for surgical complications.

Background: Breast reduction is a common procedure with growing rates in the United States of America, aimed at alleviating the physical and psychological burdens of macromastia. Despite high success rates, it carries a risk of complications, with incidence rates ranging from 6.2% to 43%. Objectives: The authors developed a machine learning model using gradient-boosting decision trees to predict severe breast reduction complications up to 30 days following surgery requiring inpatient care. Methods: This retrospective study included 322 cases of breast reduction surgery performed at the Tel Aviv Medical Center from 2017 to 2024. Model performance was evaluated using 5-fold cross-validation, and key metrics such as area under the receiver operating characteristic curve, accuracy, sensitivity, and specificity were reported. An interpretability tool was also created to visualize complication risks based on clinical features. Results: Severe complications occurred in 7.4% of cases. Key predictive factors included specimen weight, SN-N distance, and liposuction volume. The model achieved an area under the receiver operating characteristic curve (AUC-ROC) of 0.83, with an accuracy of 0.93 and a negative predictive value (NPV) of 0.95. The interpretability tool clearly visualized complication risks, aiding preoperative counseling. Conclusions: This is the first study to use artificial intelligence (AI) to predict severe complications in breast reduction surgery. In this study, the AI model, with an AUC-ROC of 0.83 and NPV of 0.95, offers a reliable tool for surgical planning and patient education. Further validation across diverse populations is recommended to confirm its clinical utility. Level of Evidence: 4 (Risk):

Background: Round nano-surface Ergonomix (Motiva, Establishment Labs; Alajuela, Costa Rica) implants were developed to address concerns regarding capsular contracture and textured anatomical breasts implants. Objectives: The authors describe their early experience with Ergonomix implants in breast reconstruction. Methods: The authors retrospectively reviewed the charts of 212 patients (321 breasts) who underwent breast reconstruction employing round nano-surface Ergonomix implants between June 2017 and December 2020. Patients were followed for at least 12 months postoperatively. Demographics, surgical data, and postoperative surgical outcomes were recorded. Postoperative physical well-being and satisfaction with the breasts and implant were evaluated with Breast-Q questionnaires. Results: Of 211 patients, 75.4% had surgery due to cancer, and 24.6% underwent prophylactic surgery. Major complications occurred in 21 breasts (6.5%), of which 20 underwent revision operations. Reconstruction failed in 1 case (0.3%). Eleven breasts (3.4%) had minor complications. Immediate breast reconstruction, irradiated breasts, and smokers had higher rates of complications (P = 0.009, 0.02, 0.022, respectively). Rippling was more common in the pre-pectoral implant plane compared with sub-pectoral reconstruction (9% vs 1.2%, P = 0.001). Capsular contracture rate was 0.9% and occurred only in irradiated breasts. Implant malposition (inferiorly and laterally) occurred in 6.5% of the breasts, with no association between implant malposition and implant plane. Early follow-up demonstrated high patient satisfaction with the implant and breasts, and high scores in terms of patients’ physical well-being. Conclusions: Breast reconstruction employing the round nano-surface Ergonomix implant yielded low complication rates and high patient satisfaction. The transition from macro-textured to nano-surface implants has operative implications requiring a learning curve and surgical adjustments. Level of Evidence: 4: