Rochira Dario, Cavalcanti Pietro, Ottaviani Antonio, Tambasco Damiano
From the *Casa di Cura Villa Valeria; †Department of Plastic Surgery, and ‡Department of Plastic and Reconstructive Surgery, Catholic University of "Sacro Cuore", University Hospital Rome, Italy.
Ann Plast Surg. 2016 Feb;76(2):150-4. doi: 10.1097/SAP.0000000000000539.
Silicone gel-filled implants as opposed to saline-filled breast implants are the most commonly used breast implants in Europe, and this has recently also become the case in the United States. Modern implants have a multiple layer silicone shell and high to very high levels of cohesive silicone gel inside. Although breast magnetic resonance imaging is at present considered the gold standard imaging method for breast implant rupture detection, breast ultrasound (US) imaging is still the first-step investigation in Europe. The aim of this study was to verify whether or not the stepladder sign at US is still associated to intracapsular rupture among the last generation silicone breast implant.
In this study, 156 patients presenting for breast augmentation, mastopexy with implants and breast reconstruction for a total number of 303 breast implants inserted were enrolled. A preoperative breast ultrasonography was performed, and patients underwent a routine US scan every 6 months for 24 months to evaluate the implant status. A final US evaluation 6 years after implantation was also performed.
Stepladder signs were seen at 6 years in 170 implants (56%) of the examined implants at US scan, and only 2 implants showed signs of possible rupture because of severe distortion of the implant profile with or without external silicone collection. A third ruptured implant was detected at magnetic resonance imaging by the presence of breach of the shell at the posterior surface of the implant with small external silicon collection and was eventually confirmed at surgery. Therefore, the overall rupture rate found at the United States at 6 years was about 1% (3 of 303 implants). According to our findings, the stepladder sign at the United States is no longer associated to intracapsular rupture.
Plastic surgeons, patients, and financial departments of hospitals would also be delighted to know that surgeons should not take patients back to theater for implant explantation when aging signs are not associated with a visible breach of the implant shell or external silicone collections.
与盐水填充式乳房植入物相比，硅胶填充式植入物是欧洲最常用的乳房植入物，最近在美国也是如此。现代植入物有多层硅胶外壳，内部填充高至非常高粘性的硅胶凝胶。尽管目前乳房磁共振成像被认为是检测乳房植入物破裂的金标准成像方法，但乳房超声（US）成像在欧洲仍是第一步检查方法。本研究的目的是验证在美国，超声检查中的阶梯征是否仍与最新一代硅胶乳房植入物的囊内破裂相关。
本研究纳入了156例因隆乳、植入物乳房上提术和乳房重建而植入303枚乳房植入物的患者。术前进行乳房超声检查，患者在24个月内每6个月接受一次常规超声扫描以评估植入物状态。植入后6年还进行了最终的超声评估。
在超声扫描中，170枚（56%）被检查的植入物在6年后出现了阶梯征，只有2枚植入物因植入物轮廓严重变形（无论有无外部硅胶聚集）而显示出可能破裂的迹象。在磁共振成像中，通过植入物后表面外壳破裂并伴有少量外部硅胶聚集检测到第三枚破裂的植入物，最终在手术中得到证实。因此，在美国6年后发现的总体破裂率约为1%（303枚植入物中的3枚）。根据我们的研究结果，在美国，阶梯征不再与囊内破裂相关。
整形外科医生、患者和医院财务部门也会很高兴地知道，当老化迹象与植入物外壳明显破裂或外部硅胶聚集无关时，外科医生不应让患者返回手术室取出植入物。
