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Specific issues to consider about breast surgery

Mammography

Women with breast implants who are in an age group where routine mammograms are recommended should be sure to have these examinations at the recommended regularly scheduled times. Some women who undergo reconstruction will have some breast tissue remaining, and some have all of their breast tissue removed. It is important that a woman with remaining breast tissue continue to have mammography of that breast, as well as of the other breast, to detect breast cancer. (Those who have had breast cancer surgery on both breasts should ask their doctors whether mammograms are still necessary.)

Women should be aware that breast implants may interfere with the detection of cancer and that breast compression (hard pressure) during mammography may cause implant rupture/deflation.
Interference with mammography by breast implants may delay or hinder the early detection of breast cancer either by hiding suspicious lesions (wounds or injuries or tumors) or by making it more difficult to include them in the image (x-ray, ultrasound). Implants increase the difficulty of both taking and reading mammograms.

Mammography requires breast compression, which could contribute to implant rupture.

In addition to special care taken by the radiological technologist to reduce the risk of implant rupture during this compression, other techniques are used to maximize what is seen of the breast tissue during mammography.

Because of the extra views and time needed, women with implants should always inform the receptionist or scheduler that they have breast implants when making an appointment for mammography. They should also tell the radiological technologist about the presence of implants before mammography is performed. Then, the radiological technologist will use these special displacement techniques and take extra care when compressing the breasts to avoid rupturing the implant.

The displacement procedure involves pushing the implant back and pulling the breast tissue into view. Several factors that may affect the success of this special technique in imaging the breast tissue in women with breast implants include the location of the implant, the hardness of the capsular contracture, and the amount of the breast tissue compared to the implant size.
Also, when reading the mammogram, the radiologist may find it difficult to distinguish calcium deposits in the scar tissue around the implant from a breast tumor. Occasionally, it is necessary to remove and examine a small amount of tissue (biopsy) to see whether or not it is cancerous. Frequently, this can be done without removing the implant.

As a last note, FDA does not consider mammograms an adequate means of detecting implant rupture/deflation for silicone gel filled breast implants. FDA believes that MRI is currently the best method for detecting implant rupture for silicone gel filled breast implants.

Breast Feeding

Women of childbearing age should know that they may not be able to breast feed after breast implantation. Some women who undergo breast augmentation can successfully breast feed and some cannot. Women who undergo a mastectomy will be unable to breast feed on the affected side due to loss of breast tissue and glands that produce milk.

Effects on Children

There are two concerns associated with the effects on children:
• the safety of the milk from mothers with breast implants for breast feeding children
• the effects of silicones and other chemicals on children born of mothers with breast implants (second-generation effects).
It is not known if a small amount of silicone may pass from the silicone shell of an implant into breast milk. If this occurs, it is not known what effect it may have on the nursing infant. There are no current methods for detecting silicone levels in breast milk.

Concerns have been also raised about the potential damaging effects on children born of mothers with implants.

Gel Bleed

A concern related specifically to silicone-gel filled breast implants is that small amounts of the silicone fluid or oil may bleed through the shell and travel into the surrounding tissue. This escaped silicone fluid or oil might cause local complications. There is inadequate information to determine whether or not gel bleed is a problem because there have been no studies that measure the amount of gel bleed and relate it to local complications.

Silicone Sensitivity

Currently, there are no FDA-approved tests to detect silicone in the body or to determine whether or not a woman's immune system is sensitive to any component of silicone breast implants.
Determining that silicon or silicone is present in body fluids does not indicate whether a person is sensitive to these substances or at risk for any specific disease. (Silicon is an element that is one component of the polymer silicone and is one of the most abundant elements on the earth. Everyone is exposed to silicon.) Some researchers claim to have a test that can detect antibodies to silicone in blood; however, the proven accuracy and usefulness of the test has not been determined. Some researchers have also claimed that a test called the Anti-Polymer Antibody Assay (APA) is able to distinguish signs and symptoms of disease ranging from mild to severe in women with implants. However, a recent report61 failed to find an increased level of APA activity in women who had silicone breast implants and health complaints compared with healthy women without implants. The accuracy of this test, the clinical usefulness of the test results, and the biological basis for the assay has not been established.

Even if antibodies to silicone were detected, the importance would be unclear. Antibodies to silicone would not necessarily mean that silicone is harmful or that a person would necessarily have an adverse reaction to it. Some researchers have also reportedly developed a test to detect if a woman's immune system is sensitive to silica, a component found in silicone breast implants. The accuracy of this test also has been questioned, and it is not clear at this time whether the results of this test have clinical usefulness.

 

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