An Unusual Finding of Silicone Bleed From Different Generations of Silicone Breast Implants ── Cases Report and Literature Review

矽膠滲出現象發生於不同世代之矽膠義乳──病例報告及文獻回顧

蔡岳錤(Yueh-Chi Tsai) ； 陳伊呈(I-Chen Chen) ； 賴志昇(Chih-Sheng Lai) ； 呂俊德(Chen-Te Lu) ； 顏榮信(Jung-Hsing Yen) ； 宋定宇(Ding-Yu Song)

《臺灣整形外科醫學會雜誌》 25卷1期 (2016/03) Pp. 76-85

摘要

背景：矽膠滲出現象係指低分子量矽膠聚合物從完整之義乳彈性體外殼滲透或擴散至外部之情形；從義乳滲出之矽膠微粒被認為可能會引起局部或全身性之免疫及發炎反應，並加速夾膜攣縮之形成。目的及目標：膠體及鹽水雙層義乳、低滲出性矽膠義乳及高聚合性果凍矽膠義乳等產品係由製造商開發及設計來減少矽膠滲出現象之發生。然而，在以往的研究中，矽膠滲出現象仍然被發現於不同世代的產品中。因此，這些不同技術及設計的有效性依然無法被精確地評估及確定。本文中將描述矽膠滲出現象發生於一位乳房切除後以高聚合性果凍矽膠義乳重建之病患並針對此現象進行相關文獻之回顧材料及方法：第五代矽膠義乳係以長鏈矽膠聚合物作填充，亦稱為“高聚合性果凍矽膠義乳＂。該產品被設計成具有抵抗矽膠滲出現象及減少於彈性體外殼發生故障時矽膠滲漏之情形。三位以不同症狀表現之矽膠滲出病例將於文章中被報告。結果：病例一被診斷為矽膠滲出現象發生於高聚合性果凍矽膠義乳；大量矽膠滲漏從完整之彈性體外殼則被發現於病例二；如珍珠般的矽膠囊腫則被發現沉積於病例三之雙側乳房及胸大肌組織中。結論：診斷矽膠滲出現象最可靠的工具是核磁共振成像。由於矽膠微粒被認為會加速夾膜攣縮之形成並引起局部或全身性之免疫及發炎反應，即使是最新一代之產品仍有發生之可能性；因此，應向病人做好術前之衛教以及強調術後追蹤之重要性。

並列摘要

Background: Silicone bleed refers to a phenomenon whereby low-molecular-weight gel polymers diffuse or migrate through an intact silicone elastomer shell. Silicone particles from breast implants are considered to induce local and distant immunological tissue responses and promote capsule contracture. Aim and Objectives: Gel-saline double lumen implants, low bleed ＂barrier＂ implants and highly cohesive gel implants were designed by implant manufacturers to reduce silicone bleed. However, silicone bleed from different generation breast implants were still found in previous studies. The effectiveness of these technologies could not be accurately determined. Here, three cases are reported, each with different results of silicone bleed. Material and Methods: The fifth-generation silicone breast implants, filled with longer silicone chains and termed ＂highly cohesive gel implants,＂ are designed to both resist silicone gel bleed through the shell and minimize leakage in the event of shell failure. One case of silicone bleed from a highly cohesive silicone gel implant and another two cases of silicone bleed from third and fourth-generation silicone implants were described and a literature review is presented. Results: Silicone bleed from a highly cohesive silicone gel implant was diagnosed in Case 1. Massive silicone extravasation from a macroscopically intact shell was found after exploration in Case 2. Multiple pearl-like siliconomas disseminated in bilateral breast tissue and the pectoralis major muscle with an intact implant shell were found in Case 3. Conclusion: The most reliable tool for diagnosing silicone bleed is magnetic resonance imaging, because silicone bleed may contribute to capsular contracture and inflammatory response, which were found even in the newest breast implants. (J Taiwan Soc of Plast Surg 2016;25:76～85)

並列關鍵字

silicone bleed ； silicone gel bleed ； highly cohesive gel implant