Mammography and breast implants

Recent recommendations by the American Cancer Society have focused attention on the value of screening mammography in the detection of occult breast cancers. This has resulted in a proliferation of "walk in" and mobile mammography screening clinics and a barrage of publicity aimed at women aged 40 and over. Among these are more than a half million women who have had an augmentation mammaplasty; at least another half million are still under 40 but entering this age group incrementally. Opinion is divided as to the value of this procedure because of uncertainty as to the amount of breast tissue obscured by the implant. Calibrated planimetry was used to measure the area of the implant and the glandular portion of the breasts in six sets of mammograms. Utilizing solid geometric calculations, it was found that the percentage of glandular tissue obscured by the implant varied from 22 to 83 percent. This wide variation casts serious doubt on the reliability of routine film screen mammography in these patients.     

Effect of povidone iodine on silicone gel breast implants in vitro: implications for clinical practice

Irrigation of breast implants and breast implant pockets with various solutions, including povidone iodine, has been a common practice among plastic surgeons for many years. Recent reports of potential weakening of silicone tubing have led the Food and Drug Administration to pronounce any contact of povidone iodine with breast implants a contraindication. An in vitro experimental study was undertaken to assess the effect of povidone iodine on the physical properties of silicone breast implant shells. Identical specimens were obtained from the shells of silicone breast implants according to published standards. The specimens were randomly assigned to eight groups of five and incubated in various solutions of decreasing concentration of povidone iodine (10% to 0.01%), and a control group (0.9% saline) was used. The containers were stored in a warming cabinet at 37 degrees C for 4 weeks. Testing of the specimens for tensile strength following 4 weeks of incubation showed no significant difference among any of the groups, including the control group. In addition, no correlation was shown between the concentration of the solution used and the tensile strength of the specimens.     

Fine needle aspiration cytology of seromas of the breast from irradiated lumpectomy sites

OBJECTIVE: To study the cytologic features of cells in breast aspirates of seromas in women who had undergone irradiation at lumpectomy sites. STUDY DESIGN: Cytologic material from 38 females with an age range of 39-72 years who had undergone aspiration of seromas were retrieved to determine tumor recurrence or other atypia. The material was obtained using the conventional method of needle aspiration with a 22-gauge needle and 10-mL syringe, maintaining negative pressure. The syringe and needle contents were washed in a cytology container containing 30% ethyl alcohol in physiologic saline. From half the washings filter preparations were made and stained by the Papanicolaou method, while from the other half cell blocks were made and sections cut after processing and stained with hematoxylineosin. RESULTS: In 2 of 38 patients, filter preparations and cell blocks showed malignant cells of breast carcinoma that were similar to the primary. This was confirmed on core biopsy and subsequent mastectomy. In 21 of 38 cases mildly atypical cells with degenerative effects, mild hyperchromasia, liberal cytoplasm, macrophages, inflammatory cells and a few apocrine cells were seen, while in 11 of 38 patients scanty debris, few inflammatory cells, rare apocrine cells and a few macrophages were found. In 4 of 38 cases highly atypical cells with hyperchromatic nuclei and nucleoli were noted. However, a core biopsy in all 4 patients revealed no evidence of residual tumor. CONCLUSION: Cell atypia in aspirates from seromas should be interpreted with caution to avoid unnecessary, invasive surgery, keeping in mind that radiation can cause misleading changes. However, patients with clinical indications of recurrent tumor or with severe atypia should undergo biopsy to permit appropriate management.