title: Effects of silicone expanders and implants on echocardiographic image quality after breast reconstruction.
abstract: BACKGROUND
  Use of silicone expanders and implants is the most common breast reconstruction technique after mastectomy. Postmastectomy patients often need echocardiographic monitoring of potential cardiotoxicity induced by cancer chemotherapy. The impairment of the echocardiographic acoustic window caused by silicone implants for breast augmentation has been reported. This study investigates whether the echocardiographic image quality was impaired in women reconstructed with silicone expanders and implants.
  
  
  METHODS
  The records of 44 consecutive women who underwent echocardiographic follow-up after breast reconstruction with expanders and implants at the authors' institution from January of 2000 to August of 2012 were reviewed. The population was divided into a study group (left or bilateral breast expanders/implants, n=30) and a control group (right breast expanders/implants, n=14). The impact of breast expanders/implants on echocardiographic image quality was tested (analysis of covariance model).
  
  
  RESULTS
  Patients with a breast expander/implant (left or bilateral and right breast expanders/implants) were included. The mean volume of the breast devices was 353.2±125.5 cc. The quality of the echocardiographic images was good or sufficient in the control group; in the study group, it was judged as adequate in only 50 percent of cases (15 patients) and inadequate in the remaining 15 patients (p<0.001). At multivariable analysis, a persistent relationship between device position (left versus right) and image quality (p=0.001) was shown, independent from other factors.
  
  
  CONCLUSIONS
  Silicone expanders and implants in postmastectomy left breast reconstruction considerably reduce the image quality of echocardiography. This may have important clinical implications, given the need for periodic echocardiographic surveillance before and during chemotherapy.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Modena, Italy From the Department of Plastic and Reconstructive Surgery, Policlinico di Modena, and the Department of Cardiology, Policlinico Hospital, University of Modena and Reggio Emilia.
authors.forename: Marco
authors.initials: M
authors.lastname: Pignatti
authors.forename: Francesca
authors.initials: F
authors.lastname: Mantovani
authors.forename: Luca
authors.initials: L
authors.lastname: Bertelli
authors.forename: Andrea
authors.initials: A
authors.lastname: Barbieri
authors.forename: Lucrezia
authors.initials: L
authors.lastname: Pacchioni
authors.forename: Pietro
authors.initials: P
authors.lastname: Loschi
authors.forename: Giorgio
authors.initials: G
authors.lastname: De Santis
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D019928:Breast Implantation / Q000009:adverse effects / Q000379:methods*; D018427:Breast Implants; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D017024:Chemotherapy, Adjuvant; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D015999:Multivariate Analysis; D012016:Reference Values; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D020034:Silicone Gels; D015625:Tissue Expansion Devices; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D020034:Silicone Gels
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