Is explantation of silicone breast implants useful in patients with complaints?
Is explantation of silicone breast implants useful in patients with complaints?
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DOI：
10.1007/s12026-016-8813-y
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发表时间：
2017-02
影响因子：
4.4
通讯作者：
Cohen Tervaert JW
中科院分区：
文献类型：
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作者：
de Boer M;Colaris M;van der Hulst RRWJ;Cohen Tervaert JW
在这篇综述中，我们对现有的反映硅胶乳房植入物在患有硅胶相关疾病和/或自身免疫性疾病的患者中的结果的文献进行了批判性的回顾。通过文献检索来讨论以下问题：哪些临床表现和自身免疫性疾病在移植后有所改善，以及这些症状在移植后的进程如何。接下来，我们回顾了植入物对硅胶乳房植入物患者实验结果的影响的研究，最后，我们回顾了描述植入物或自体组织在植入物后重建乳房的影响的研究。我们从文献中计算出，硅胶乳房植入术改善了75%的患者(622人中有469人)与硅胶相关的症状。然而，在自身免疫性疾病的患者中，如果没有额外的免疫抑制治疗，改善的情况很少见，即16%的患者(3/18)。移植效果不影响ANA等自身抗体检测。我们讨论了几种可能性，这些可能性可以阐明为什么患者在植入术后有所改善。首先，移植后的炎症反应可以减轻。其次，植入植入物可能会消除伤害性刺激，这可能是许多抱怨的原因。重建移植乳房的选择是自体组织和/或水/水纤维填充的乳房植入物。不幸的是，很少有研究关注重建的可能性。因此，对这一问题无法得出适当的结论。总而言之，植入术有助于改善75%的患者的硅胶相关症状，而对于发生自身免疫性疾病的患者，只有在植入术和免疫抑制治疗相结合的情况下才能观察到改善。对于有硅胶相关症状且考虑植入术的患者，应咨询患者植入术后不同的重建选择。
In this review, we present a critical review of the existing literature reflecting the results of explantation of silicone breast implants in patients with silicone-related complaints and/or autoimmune diseases. A literature search was performed to discuss the following issues: which clinical manifestations and autoimmune diseases improve after explantation, and what is the course of these complaints after explantation. Next, we reviewed studies in which the effect of explantation on laboratory findings observed in patients with silicone breast implants was studied, and lastly, we reviewed studies that described the effect of reconstruction of the breast with a new implant or autologous tissue after explantation. We calculated from the literature that explantation of the silicone breast improved silicone-related complaints in 75 % of the patients (469 of 622). In patients with autoimmune diseases, however, improvement was only infrequently observed without additional therapy with immunosuppressive therapy, i.e., in 16 % of the patients (3 of 18). The effect of explantation did not influence autoantibody testing such as ANA. We discuss several possibilities which could clarify why patients improve after explantation. Firstly, the inflammatory response could be reduced after explantation. Secondly, explantation of the implants may remove a nociceptive stimulus, which may be the causative factor for many complaints. Options for reconstruction of the explanted breast are autologous tissue and/or water-/hydrocellulose-filled breast implant. Unfortunately, in very few studies attention was paid to reconstructive possibilities. Therefore, no adequate conclusion regarding this issue could be drawn. In conclusion, explantation is useful for improvement of silicone-related complaints in 75 % of the patients, whereas in patients who developed autoimmune diseases improvement is only observed when explantation is combined with immunosuppressive therapy. In a patient with silicone-related complaints in which explantation is considered, the patient should be counseled for the different options of reconstruction after explantation.