Daher M, Rizkallah P, Abdel-Hak E
Service de Chirurgie générale, Hôpital Saint-Georges, Beyrouth.
J Med Liban. 1994;42(1):32-6.
We present a case of breast cancer 9 years after subcutaneous mastectomy for bilateral phylloid tumor with silicone implants. The patient had a stage III adenocarcinoma (T4 N1 M0) at diagnosis; a modified radical mastectomy was done, followed by radiotherapy and chemotherapy. Later on, Tamoxifen was prescribed (positive hormone receptors). Reviewing the literature about this subject in a context of a moratorium of the Food and Drug Administration (FDA) in the United States recommending suspension of silicone breast implantation, we can propose several conclusions: Previous and recent studies did not show any direct relation between cancer and silicone implants for augmentation mammoplasty; on the contrary, a lower incidence of breast cancer is noted. Breast cancer incidence with silicone implants seems to be higher with reconstructive mammoplasty after mastectomy for benign disease (fibrocystic disease, dysplasia, phylloid tumor), or prophylactic reason, or malignancy (carcinoma in situ, lobular and multifocal carcinoma, early breast cancer...). This can be related to recurrence or cancer development on residual breast tissue. Breast cancer with silicone implants is of poorer prognosis because of the later diagnosis of the disease.
我们报告一例在因双侧叶状肿瘤行皮下乳房切除并植入硅胶假体9年后发生乳腺癌的病例。患者诊断为III期腺癌（T4 N1 M0）；行改良根治性乳房切除术，随后进行放疗和化疗。后来，患者接受他莫昔芬治疗（激素受体阳性）。在美国食品药品监督管理局（FDA）暂停硅胶乳房植入的背景下回顾有关该主题的文献，我们可以得出几个结论：既往和近期研究均未显示癌症与用于隆乳的硅胶假体之间存在任何直接关联；相反，乳腺癌发病率较低。硅胶假体植入后发生乳腺癌的情况似乎在因良性疾病（纤维囊性疾病、发育异常、叶状肿瘤）、预防性原因或恶性肿瘤（原位癌、小叶癌和多灶性癌、早期乳腺癌……）行乳房切除术后进行乳房重建时更高。这可能与残留乳腺组织的复发或癌症进展有关。因疾病诊断较晚，硅胶假体植入后发生的乳腺癌预后较差。
