Millions of women worldwide have received silicone breast implants for cosmetic or medical reasons, but there remains considerable controversy about their long-term health effects, particularly for cancer1. The carcinogenic potencial of silicone has been questioned since the 1950’s when silicone and other foreign materials were found to induce sarcomas in rodents. This observation has never been substantiated in epidemiological studies. In addition, it has been debated whether the presence of breast implants may delay diagnosis of breast cancer by interfering with the interpretation of routine mammography examinations, but recent epidemiologic studies do not suggest delayed diagnosis or poorer prognosis of breast cancer among women with breast implants.
Although several studies have found that based on incidence rates in the general population, the observed number of breast cancers was significantly lower than the expected number in average population. No study have ever showed that breast implants can have a protective role, avoiding metastatic cancer. This report describes a unique case of patient with invasive ductal carcinoma in which the breast implants avoided the pectoral muscles commitment.
Methods/Technique:
We report case of 45 years-old patient, showing tumor in the right breast with 1 year of evolution. She had plastic breast augmentation five years ago (260cc silicone prosthesis- submammary). On clinical examination, we found a hard nodule in the upper outer quadrant of right breast (mobile and without skin lesions) with no palpable lymph nodes. The lesion was not visualized on mammography, but the ultrasound showed a nodular lesion of 2.3 X 2.1 X 1.6 cm suspicious of malignancy. According to FIGO criteria, this patient was classified as stage IIA(T2N1aM0). The diagnostic was confirmed by needle biopsy and classified as invasive ductal carcinoma. The patient underwent 4 cycles of neoadjuvant chemotherapy with no reduction in tumor volume. She underwent a modified radical mastectomy by Madden (total mastectomy with preservation of both pectoral muscles). Patient underwent postoperative adjuvant chemoteraphy with doxetaxel (4 cycles).
Results/Complications:
The prosthesis prevented tumor invasion by contiguity. The pathologist confirmed the diagnosis of ductal carcinoma grade II without lymphatic commitment.
The immunohistochemical examination showed negative estrogen and progesterone receptors. Oncoprotein cerb was moderately positive. After 4 years, she developed a papillary follicular (0,6 x0, 5x0, 5cm) and underwent total thyroidectomy. The patient remains in follow-up without manifestation of disease.
Ever since silicone breast implants were first marketed in the early 1960’s, concern has prevailed regarding long-term effects2. It has provoked much interest in the possibility that patients with silicone breast implants have increased rates of connective tissue disorder as well as less defined conditions. Although most attention has focused on the long-term effects of silicone implants on these connective tissue, the range of complications suggests that consideration be given to effects on other chronic diseases, most notably cancers that may arise as a result of immunologic disturbances3. In 2000 an independent review board concluded that the available evidence does not support an association between silicone breast implants and breast carcinoma or sarcoma, multiple myeloma or lymphoma. Similar conclusions have been reached by the International Agency for Research on Carcer (IARC) and by other review panels4. Several biological mechanisms have been suggested in which the implant procedure itself may confer a lower risk of breast cancer. These include: an enhance immune system as a result of receiving a breast implant, whereby carcinogens and transformed cells are more easily destroyed, the weight and the volume of the implant compresses the glandular tissue resulting from lower temperature of the tissue1.
Futhermore, it is well recognized that implants can interferer with the visualization of breast tumors, leading to concern that there may be resultant delays in diagnosing breast cancers3. Implants can distort adjacent breast architecture by compression of fat and glandular elements. This creates a more homogeneous dense tissue that may lack the contrast to detect subtle early features associated with breast cancer, may obscure small lesions, or may cause diagnostic confusion5. It is well known that in several ways implants may affect mammography. Breast ultrasound may be useful for breast cancer detection, however it is not sensitive or specific for detecting parenchymal abnormalities. Currently is more useful for characterizing masses and for measuring tumor size of mass lesion. Magnetic Resonance Imaging (MRI) can be use in detecting implants ruptures, as an adjunct to film screen mammography and for detecting parenchymal abnormalities in augmented women. Nowadays, MRI is a useful tool in pretreatment evaluation of newly diagnosed breast cancer in augmented women6. Our patient had a palpable lesion which have not be seen by mammography but diagnosed by ultrasound.
Conclusion:
In this report, we describe an event that could be just coincidence. The simple presence of the prostheses was enough to avoid the pectoral muscles commitment, allowing a more conservative surgery