Next to orthopedic surgery, plastic surgery as a medical
specialty uses a significant number of implants and implant
materials to help achieve its surgical outcomes. Whether it
is breast implants or an injectable filler, the use of
synthetic or foreign materials is common in plastic
surgery. Often when a plastic surgery patient needs an
implant for their procedure, they will ask the
question....'What if my body rejects the implant?'. This
understandable concern is indicative of a basic
misunderstanding of how the body reacts to implanted
foreign materials and what type of complications can
develop.
In reality, the rejection of an implanted synthetic
material (that has been evaluated and approved for human
implantation by the FDA), in the most scientific sense,
does not happen. A true rejection reaction in humans is an
autoimmune response to an 'implant' that is composed of
live or organic material. Therefore, you will develop a
rejection or autoimmune reaction, for example, in any type
of organ transplant which is from other human or animal
origins. Your body's cells mount a massive response to what
it recognizes as foreign or an invading organic source. The
body is quite smart and protective as this type of response
is necessary for survival.
Synthetic implants are composed of inorganic materials,
which do not cause a true allergic or autoimmune response.
These are not live materials and were never composed of
living organic materials. As a result, they can not elicit
an allergic response. They may never become part of you or
integrate into your body's tissues, but they can safely
occupy a space to do their job. Synthetic implants, while
not causing allergic responses, can cause a different set
of problems which patients mistakenly interpret as
'rejection'. Synthetic implants can get infected, exposed,
or migrate, all of which are complications of the surgical
implantation process not due to rejection. If bacteria
inadvertently get on the surface of the implant, an
infection can later develop.Most implant infections occur
within weeks of the surgery as it takes time for the
bacteria to multiply and become evident. Synthetic implants
can migrate or move from their location where they were
surgically placed if the implant material is very smooth or
the tissue pocket into which it is placed is very big. This
potential migration can be eliminated if the implant is
secured into its desired location by some method such as
sutures or metal screws. Implant exposure can result from
migration of the implant, getting close to the original
incision through which it is placed. Or implant exposure
can result from not having enough good tissue closed over
it or tissue that breaks down over the implant due to too
much pressure that the implant exerted on it or the
overlying tissue is of poor quality and it doesn't heal
well and then breaks down, thus exposing the implant.
The patient will understandably interpret these synthetic
implant complications as 'rejecting the implant'. In
reality, the patient's body has little to do with the
development of these complications. They are more a
function of surgical technique and not due to a patient's
immune response to them. The risk of these potential
implant complications can be reduced by pre-surgery
antibiotics, a properly sized implant that does not stress
the surrounding tissues, and careful surgical implantation
technique.
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Dr Barry Eppley, board-certified plastic surgeon of
Indianapolis, operates a private practice at Clarian North
and West Medical cenetrs in suburban Indianapolis. He
writes a daily blogs on topics and trends in plastic
surgery at http://www.exploreplasticsurgery.com
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