Disorders of the Augmented Breast

At least 4 million American women have had breast implants. Breast augmentation is performed by placing implants usually under the pectoralis muscle or, less desirably, in the subcutaneous tissue of the breast. Most implants are made of an outer silicone shell filled with a silicone gel, saline, or some combination of the two. About 15-25% of the patients develop capsule contraction or scarring around the implant, leading to a firmness and distortion of the breast that can be painful. Some require removal of the implant and capsule.

Implant rupture may occur in as many as 5-10% of women, and bleeding of gel through the capsule is noted even more commonly. Although silicone gel may be an immunologic stimulant, there is no increase in autoimmune disorders in patients with such implants. The Food and Drug Administration (FDA) has advised symptomatic women with ruptured implants to discuss possible surgical removal with their physicians. However, women who are asymptomatic and have no evidence of rupture of a silicone gel prosthesis should probably not undergo removal of the implant. Women with symptoms of autoimmune illnesses should address the possibility of removal.

Studies have failed to show any association between implants and an increased incidence of breast cancer. However, breast cancer may develop in a patient with a silicone gel prosthesis, as it does in women without them. Detection in patients with implants is made more difficult since mammography is less able to detect early lesions. However, local recurrence after breast reconstruction for cancer is usually cutaneous or subcutaneous and is easily detected by palpation. If a cancer develops, it should be treated in the same manner as in women without implants. Such women should be offered the option of mastectomy or breast-conserving therapy, which may require removal or replacement of the implant. Radiotherapy of the augmented breast often results in marked capsular contracture. Adjuvant treatments should be given for the same indications as for women who have no implants.

THE BREAST -Neoplasms of the Breast

• Bening Breast Disorders