Cohen B E, Biggs T M, Cronin E D, Collins D R
St. Joseph Hospital Plastic Surgery Residency Training Program, Houston, Texas, USA.
Plast Reconstr Surg. 1997 May;99(6):1597-601.
Many patients are now consulting plastic surgeons for evaluation of their silicone gel breast implants. This study assesses the accuracy of a clinician's ability to determine if a silicone gel breast implant has failed. In addition, it sheds light on the long-term integrity of the silicone gel breast implant. This study examined the condition of 350 silicone gel breast implants in a group of 159 of the authors' patients who previously had undergone augmentation mammaplasty or breast reconstruction. These women underwent secondary open procedures including capsulotomy or capsulectomy for fibrous capsule contractures, exchange of implants, or other revisional surgery. The condition of the implant was noted at the time of this secondary operation. The preoperative evaluation, which included the patient's history and physical examination and often mammography, was then matched against the operative findings to determine the pertinent factors that predict the integrity of a silicone gel breast implant. A history of trauma and/or a reported change in shape of a patient's breast correlated with implant failure. An analysis of implant failure as a function of implant age revealed that 63 percent of silicone gel breast implants in place 12 years or greater in this study population were not intact. A change in the patient's physical examination, including a softened breast consistency and/or the presence of a nodule or mass adjacent to an implant, also was suggestive of implant failure. Several different mammographic presentations of implants that were not intact were identified. This modality predicted implant failure in 89 percent of implants studied. It is hoped that this information will help clinicians to make a more accurate assessment of the condition of a patient's silicone gel breast implant. It should be noted that all women in our study underwent secondary procedures, as stated above. The results obtained apply to this patient group but may not specifically pertain to the general implant-bearing population.
现在许多患者向整形外科医生咨询，以评估其硅胶乳房植入物的情况。本研究评估临床医生判断硅胶乳房植入物是否失败的能力的准确性。此外，它还揭示了硅胶乳房植入物的长期完整性。本研究检查了作者的159例患者的350个硅胶乳房植入物的情况，这些患者之前接受过隆乳术或乳房重建术。这些女性接受了二次开放性手术，包括因纤维囊挛缩进行的包膜切开术或包膜切除术、植入物置换或其他修复手术。在这次二次手术时记录了植入物的情况。然后将术前评估（包括患者病史、体格检查，通常还有乳房X线摄影）与手术结果进行比对，以确定预测硅胶乳房植入物完整性的相关因素。创伤史和/或患者乳房形状的报告变化与植入物失败相关。对植入物失败与植入物使用年限关系的分析表明，在本研究人群中，使用12年或更长时间的硅胶乳房植入物有63%已不完整。患者体格检查的变化，包括乳房质地变软和/或植入物附近出现结节或肿块，也提示植入物失败。识别出了几种不同的乳房X线摄影显示的不完整植入物表现。这种检查方式在89%的研究植入物中预测了植入物失败。希望这些信息能帮助临床医生更准确地评估患者硅胶乳房植入物的情况。应该注意的是，如上文所述，我们研究中的所有女性都接受了二次手术。所获得的结果适用于该患者群体，但可能并不特别适用于一般的植入物佩戴人群。
