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al. (1989b) analyzed capsular calcifications and found them to be calcium phosphate, similar to cancerous calcifications. Rolland et al. (1989b) also reported zinc, which they speculated came from the implants, but Peters et al. (1998) and Raso et al. (1999) did not find this and pointed out that surrounding tissue probably contains much more zinc as a source for possible zinc-containing deposits than a breast implant. Consideration of whether calcifications are low or high density and comparison (in ex-planted breasts) with preexplant mammograms, among other things, may help to differentiate capsular from cancer-associated calcification (Raso et al., 1999; Rolland et al., 1989b). The above suggests that capsular calcification would constitute a strong indication for capsulectomy at the time of explantation (Peters et al., 1995d).

Although silicone breast implants definitely obscure some of the breast tissue which in theory at least might reduce visualization of breast tumors, the committee noted that some studies of cancer detection in women with silicone breast implants found the implants hindering and some studies found them not hindering detection. Special attention to detection is required in women with silicone breast implants. No studies have addressed whether there is differential mortality from breast cancer due to any differences in detection in women with or without breast implants.

Conclusions

The committee finds magnetic resonance imaging to be the most accurate imaging modality for the detection of intra- and extracapsular rupture. Mammography is of limited usefulness in detecting implant rupture in women with silicone implants. There is scant anecdotal evidence of rupture during mammography, and there are no data to support limiting screening or diagnostic mammography which would otherwise be indicated because of this concern. Implants placed in a subpectoral position do not interfere with mammography to the same extent as subglandular implants. Data on whether cancer detection is impaired by implants do not allow definite conclusions, although it is clear that implants do interfere with screening mammography by obscuring a variable part of breast tissue, distorting breast architecture, and especially in the presence of firm contractures, making a proper examination with proper compression of the breast more difficult and occasionally impossible.



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