From the Department of Surgery, Division of Plastic Surgery, Pennsylvania State University, College of Medicine; and the Departments of Plastic Surgery and Diagnostic Radiology, M. D. Anderson Cancer Center, University of Texas.
Plast Reconstr Surg. 2020 Jun;145(6):1381-1387. doi: 10.1097/PRS.0000000000006812.
Device rupture is considered a major complication associated with breast implants. The U.S. Food and Drug Administration recommends magnetic resonance imaging (MRI) surveillance 3 years after implantation and then every 2 years, but adherence to these recommendations is poor. The authors identified current practice management for breast implant rupture surveillance by surveying practicing U.S. plastic surgeons.
An online survey of all active members of the American Society of Plastic Surgeons was performed. Questions analyzed imaging practice patterns related to breast implants. Logistic regression models were used to analyze determinants for radiographic imaging in breast implant patients.
The survey had a response rate of 16.5 percent. For patients with breast implants, 37.7 percent of respondents recommended MRI at the recommended intervals. Fifty-five percent perform imaging only if there is a problem with the implant. Academic surgeons more frequently recommended MRI (56.3 percent and 39.3 percent; p = 0.0002). Surgeons with less than 5 years of experience are four times more likely to order MRI than surgeons with over 25 years' experience (60.8 percent and 28.1 percent; p < 0.0001). Furthermore, lower volume surgeons recommend significantly more MRI (45.2 percent and 27.3 percent; p = 0.001). Respondents are almost two times more likely to recommend MRI in reconstructive versus cosmetic patients (51.2 percent and 35.6 percent; p = 0.0004).
MRI limitations include high costs, time commitments, and equipment constraints. Fewer than 40 percent of survey respondents suggest the recommended screening frequency to their patients; however, academic, low-volume, early-career surgeons are more likely to recommend MRI implant monitoring. Screening recommendations need to be evidence based and align with common practices to prevent undue system, provider, and patient burden.
设备破裂被认为是与乳房植入物相关的主要并发症。美国食品和药物管理局建议在植入后 3 年进行磁共振成像（MRI）监测，然后每 2 年进行一次，但对这些建议的遵守情况很差。作者通过调查美国的执业整形医生，确定了当前乳房植入物破裂监测的实践管理方法。
对美国整形外科学会的所有活跃成员进行了在线调查。问题分析了与乳房植入物相关的成像实践模式。使用逻辑回归模型分析了乳房植入患者进行放射成像的决定因素。
该调查的回复率为 16.5%。对于乳房植入患者，37.7%的受访者建议按建议的间隔进行 MRI。55%的人只有在植入物出现问题时才进行成像。学术型外科医生更频繁地建议进行 MRI（56.3%和 39.3%；p = 0.0002）。经验不足 5 年的外科医生比经验超过 25 年的外科医生更有可能开 MRI（60.8%和 28.1%；p < 0.0001）。此外，低容量外科医生推荐的 MRI 明显更多（45.2%和 27.3%；p = 0.001）。受访者推荐 MRI 的可能性是重建患者的两倍多，而美容患者则为 51.2%和 35.6%（p = 0.0004）。
MRI 的局限性包括成本高、时间长和设备限制。不到 40%的受访者建议他们的患者进行推荐的筛查频率；然而，学术型、低容量、早期职业外科医生更有可能建议进行 MRI 植入物监测。筛查建议需要基于证据，并与常见实践相一致，以防止不必要的系统、提供者和患者负担。
