Kulber D A, Mackenzie D, Steiner J H, Glassman H, Hopp D, Hiatt J R, Hoffman L
Department of Plastic Surgery, New York Hospital, Cornell Medical Center, NY 10021, USA.
Ann Plast Surg. 1995 Dec;35(6):580-4. doi: 10.1097/00000637-199512000-00004.
Migration of silicone beyond the breast implant capsule may occur as a result of silicone bleed, leak, or rupture, and it may indicate failure of implant envelope integrity. We report a series of 23 patients with silicone implants who had axillary lymph node biopsies for palpable masses. Group 1 (n = 15) had biopsies performed an average of 6 years following aesthetic augmentation, and Group 2 (n = 8) had biopsies performed an average of 5 years after mastectomy reconstruction. All biopsies demonstrated foreign body reaction consistent with silicone migration. Five patients in Group 1 and two in Group 2 also had breast cancer detected by the axillary biopsy. Evaluation of the axilla utilized a combination of one or more techniques, including mammography, ultrasonography, magnetic resonance imaging, and fine-needle aspiration. We conclude that (1) routine evaluation of the axilla is mandatory in all patients with silicone breast implants; (2) an algorithmic approach in diagnosing axillary masses may be helpful, especially in augmentation patients; and (3) axillary masses detected by clinical examination or other means must be biopsied, even in the face of negative screening studies, because breast cancer may be coincidental with a silicone granuloma.
由于硅胶渗出、泄漏或破裂，硅胶可能会迁移至乳房植入物包膜之外，这可能表明植入物包膜完整性出现故障。我们报告了一系列23例接受硅胶植入的患者，这些患者因可触及肿块接受了腋窝淋巴结活检。第1组（n = 15）在美容隆乳术后平均6年进行活检，第2组（n = 8）在乳房切除术后重建平均5年后进行活检。所有活检均显示与硅胶迁移一致的异物反应。第1组有5例患者，第2组有2例患者在腋窝活检中还检测出乳腺癌。腋窝评估采用了一种或多种技术的组合，包括乳房X线摄影、超声检查、磁共振成像和细针穿刺抽吸。我们得出结论：（1）对于所有硅胶乳房植入患者，腋窝的常规评估是必需的；（2）诊断腋窝肿块的算法方法可能会有所帮助，尤其是在隆乳患者中；（3）通过临床检查或其他手段检测到的腋窝肿块必须进行活检，即使筛查研究结果为阴性，因为乳腺癌可能与硅胶肉芽肿同时存在。
