Effects of silicone expanders and implants on echocardiographic image quality after breast reconstruction

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 report- ed. 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 echocardio- graphic 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 expand- ers/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 suf cient 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 re- maining 15 patients (p < 0.001). At multivariable analysis, a persistent relation- ship 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 echocardiogra- phy. This may have important clinical implications, given the need for pe- riodic echocardiographic surveillance before and during chemotherapy.