Silverstein M J, Handel N, Gamagami P, Gierson E D, Furmanski M, Collins A R, Epstein M, Cohlan B F
Breast Center, Van Nuys, California 91405.
Eur J Cancer. 1992;28(2-3):635-40. doi: 10.1016/s0959-8049(05)80115-7.
62 healthy women were studied mammographically before and after augmentation mammoplasty. Postaugmentation mammograms were done using both the implant compression and implant displacement technique. The amount of visualisable tissue was measured in all films before and after augmentation. We concluded: State-of-the-art film-screen mammography is extremely difficult to obtain in most patients augmented with silicone-gel-filled prostheses. On average, there is a decrease in measurable visualised breast tissue after augmentation mammoplasty with silicone-gel-filled prostheses. The area of mammographically measurable tissue is no different whether smooth or textured implants are used. Textured implants are less likely to form an early capsular contracture and are therefore preferred. However, the cancer-causing potential of polyurethane in humans is currently unknown. Anterior breast tissue is generally seen better with displacement mammography; posterior breast tissue with compression mammography. Better films are generally obtained when the implant is in the subpectoral position rather than subglandular. The more severe the capsular contracture, the poorer the mammogram. In addition 42 previously augmented patients developed breast carcinomas an average of 8.4 years after augmentation with silicone-gel-filled implants; 95% had palpable lesions (only 60% of which could be seen on mammography), 90% had infiltrating carcinomas, 45% had metastases to axillary nodes, and 7 patients have recurred, 5 of whom have died. We concluded: Augmented women who develop breast cancer are similar, in terms of tumour size and nodal positivity, to non-augmented breast cancer patients who present with palpable masses. When compared with non-augmented women whose breast cancers are found with screening mammography, augmented patients with breast cancer present with a higher percentage of invasive lesions and involved axillary lymph nodes, resulting in a poorer prognosis. The 40% false negative rate for mammography in this series is unduly high and alarming. Augmentation mammoplasty with silicone-gel-filled implants should be discouraged in women with a high risk of developing breast cancer.
对62名健康女性在隆乳术前和术后进行了乳房X线摄影检查。术后乳房X线摄影采用植入物压迫和植入物移位技术。在隆乳前后的所有片子上测量可显示组织的量。我们得出结论：对于大多数使用硅胶填充假体隆乳的患者来说，很难获得最先进的屏-片乳房X线摄影图像。平均而言，使用硅胶填充假体隆乳术后，可测量的可见乳腺组织会减少。无论使用光面还是毛面植入物，乳房X线摄影可测量组织的面积没有差异。毛面植入物形成早期包膜挛缩的可能性较小，因此更受青睐。然而，聚氨酯对人类的致癌潜力目前尚不清楚。乳房前侧组织通常在移位乳房X线摄影时显示得更好；乳房后侧组织在压迫乳房X线摄影时显示得更好。当植入物位于胸大肌下而不是乳腺下时，通常能获得更好的片子。包膜挛缩越严重，乳房X线摄影图像质量越差。此外，42名先前接受过隆乳手术的患者在使用硅胶填充植入物隆乳后平均8.4年发生了乳腺癌；95%有可触及的病变（其中只有60%在乳房X线摄影中可见），90%为浸润性癌，45%有腋窝淋巴结转移，7名患者复发，其中5人死亡。我们得出结论：患乳腺癌的隆乳女性在肿瘤大小和淋巴结阳性方面与出现可触及肿块的未隆乳乳腺癌患者相似。与通过筛查乳房X线摄影发现乳腺癌的未隆乳女性相比，患乳腺癌的隆乳患者浸润性病变和腋窝淋巴结受累的比例更高，预后更差。该系列中乳房X线摄影40%的假阴性率过高，令人担忧。对于有高乳腺癌发病风险的女性，应不鼓励使用硅胶填充植入物进行隆乳手术。
