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Chapter 33: Plastic and Reconstructive Surgery

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A 42-year-old female is seen in clinic with swelling of her left breast 3 years after undergoing augmentation mammoplasty. She reports the swelling has been persistent for a few weeks, and she has no recent history of trauma. Mammogram is negative. Ultrasound and magnetic resonance imaging (MRI) demonstrate a fluid collection around the implant. What is the most likely diagnosis?

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(A) Hematoma

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(B) Breast cancer

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(C) Autoimmune disorder

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(D) Anaplastic large cell lymphoma (ALCL)

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(D) There is no evidence that breast implants cause breast cancer or autoimmune disorders. ALCL is a rare form of non-Hodgkin lymphoma that has been reported rarely in women after breast augmentation. The typical presenting symptom is a late-onset, persistent seroma. When there is a suspicion, fresh seroma fluid and representative portions of the capsule should be collected and sent for pathology tests to rule out ALCL. ALCL associated with an implant typically has an indolent clinical course with favorable prognosis.

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BIBLIOGRAPHY

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Bengtson B, Brody GS, Brown MH, Glicksman C, Hammond D, Kaplan H, et al., and Late Periprosthetic Fluid Collection After Breast Implant Working Group. Managing late periprosthetic fluid collections (seroma) in patients with breast implants: a consensus panel recommendation and review of the literature. Plast Reconstr Surg 2011;128(1):1–7.

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Jewell M, Spear SL, Largent J, et al. Anaplastic large T-cell lymphoma and breast implants: a review of the literature. Plast Reconstr Surg 2011 Sep;128(3):651–661.

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A 62-year-old female is seen in clinic for her postoperative visit following a lumpectomy for ductal carcinoma in situ (DCIS). Her daughter accompanies her and recently had an augmentation mammoplasty with silicone implants. What are the appropriate screening tests for the daughter for breast cancer and silicone leaks?

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(A) Standard mammography views (craniocaudal [CC], mediolateral-oblique [MLO])

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(B) Standard mammography views (CC, MLO) plus Eklund technique

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(C) CC, MLO, Eklund mammography technique, and MRI at 3 years and every 2 years thereafter

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(D) CC, MLO, Eklund mammography technique, and ultrasound at 3 years and every 2 years thereafter

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(C) Breast implants can interfere with visualization of breast tissue on mammography. The interference is higher for subglandular versus submuscular implants. In addition to the standard views, the Eklund technique can be used for improved visualization and increased sensitivity. This technique compresses the breast tissue anteriorly and displaces the implant posteriorly.

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Patients with silicone implants should undergo additional screening to detect a silent rupture. The Food and Drug Administration (FDA) recommends MRI ...

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