背景:基于植入物的隆胸和重建是美国整形外科医生最常见的外科手术之一,自2000年代以来,它的受欢迎程度迅速增加。硅胶淋巴结病(SL)是乳房植入物的并发症,涉及硅胶迁移到附近的软组织/淋巴结。有关其临床特征和管理的数据很少。
方法:使用与SL相关的搜索词在3个数据库中查找文章。在598篇文章中,101项研究符合纳入标准。人口统计,临床表现,workup,和管理数据进行了分析。
结果:在279例SL和107例有初步诊断信息的病例中,35(33%)是偶然的。最常见的症状是无痛性淋巴结肿大,其次是疼痛的淋巴结病。251例(95%)和13例(5%)患者植入硅胶和生理盐水,分别。149例(68%)患者发生了植入物破裂。腋窝淋巴结病是最受累的区域(136例,72%),其次是内乳(40例,21%),颈椎/锁骨上(36例,19%),和纵隔(24例,13%)区域。25%的患者接受了细针抽吸,12%芯针活检,和59%的切除活检。32%的病例进行了移植和/或植入物交换。最常见的手术指征是植入物破裂。组织学显示多核巨细胞,大组织细胞,和硅胶积累。
结论:SL是与乳房植入物相关的并发症。大多数患者无症状,大多数病例都是保守管理的。由于成像异常,少数需要活检和手术干预,持续的症状,和/或植入物破裂。应对和管理应根据患者量身定制。
BACKGROUND: Implant-based breast augmentations and reconstructions are one of the most common surgical procedures performed by plastic surgeons in the United States, which has rapidly increased in popularity since the 2000s. Silicone lymphadenopathy (SL) is a complication of breast implants that involves migration of silicone to nearby soft tissue/lymph nodes. Data on its clinical features and management is scarce.
METHODS: SL-related search terms were used to find articles in 3 databases. Of 598 articles, 101 studies met the inclusion criteria. Demographics, clinical presentation, workup, and management data were analyzed.
RESULTS: Of 279 cases of SL and 107 with information on initial diagnosis, 35 (33%) were incidental. The most common symptom was painless lymphadenopathy, followed by painful lymphadenopathy. 251 (95%) and 13 (5%) patients had silicone and saline implants, respectively. 149 (68%) patients had implant rupture. Axillary lymphadenopathy was the most affected region (136 cases, 72%), followed by internal mammary (40 cases, 21%), cervical/supraclavicular (36 cases, 19%), and mediastinal (24 cases, 13%) regions. 25% of patients underwent fine-needle aspiration, 12% core needle biopsy, and 59% excisional biopsy. 32% of cases underwent explantation and/or implant exchange. The most common indication for surgery was implant rupture. Histology showed multinucleated giant cells, large histiocytes, and silicone accumulation.
CONCLUSIONS: SL is a complication associated with breast implants. The majority of patients are asymptomatic, and most cases are managed conservatively. Minority need a biopsy and surgical interventions due to abnormal imaging, persistent symptoms, and/or implant rupture. Workup and management should be tailored to the patient.