Download - Fuga silente del implante
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Ultrasonido en la fuga silente del implante
II CONGRESO INTERNACIONAL IMUMR
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supervivencia
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En enero de 2011 la agencia norteamericana responsable de la vigilancia de medicamentos y dispositivos médicos, U.S. Food and Drug Administration también conocida como FDA, emite un informe preliminar acerca de la posible asociación entre un raro tipo de cáncer linfático, el Linfoma Anaplásico de Células Grandes (LACG o ALCL en inglés) y las mujeres portadoras de implantes mamarios.
Linfoma Anaplásico de Células Grandes (LACG) o Anaplastic Large Cell Lymphoma (ALCL) en mujeres portadoras de implantes mamarios: evidencias de cáncer tras aumento de mamas
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PARA FINES COSMÉTICOS:
EN LA ACTUALIDAD SE ESTIMA QUE MÁS DE 7 MILLONES DE MUJERES HAN SIDO SOMETIDAS A CIRUGÍA DE
IMPLANTES
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Se espera que con lo accesible y la vanidad femenina en ascenso, cada vez sea
mayor el número de implantes estéticos colocados por día en el mundo
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Técnica
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PROTEINA NO BIODEGRADABLE PROVOCA UNA POBRE REACCION INMUNOLOGICA INFLAMATORIA LOCAL EN LA MAYORIA
DE LAS PESONAS .
SILICON
POLIMERO DIMETILSILOXANE DE CADENA CORTA ES GEL Y CADENA LARGA ES LIQUIDO
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COMPLICACIONES
REACCION GRANULOMATOSA Y MIGRACION
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SILENTE
Migración
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PROMEDIO DE COMPLICACIONES
NINGUNO ROTO DE 1 A 5 AÑOS
CON EXUDADO 11.3 AÑOS
CON RUPTURA 11.7 AÑOS
Ann Plast Surg 2006;56: 243–247) Anna Cilotti, MD,
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Mammography is not considered the ideal tool for studying breast implant because of low sensitivity in the detection of implant rupture.
Ann Plast Surg 2006;56: 243–247) Anna Cilotti, MD,
Métodos dx
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Currently, magnetic resonance (MR) is considered the gold standard, with a sensitivity higher than 90%.
Ann Plast Surg 2006;56: 243–247)
Anna Cilotti, MD,
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Su exactitud es controversial, pero en manos de un experto es altamente seguro
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TABLE 2. Results of Ultrasonographic Diagnosis Relevant to Each Pattern of Complication
• Sensitivity Specificity PPV NPV
• Capsular contracture 100% 100% 100% 100%
• Intracapsular rupture 91% 100% 100% 96%
• Extracapsular rupture 84% 100% 100% 94%
• PPV, positive predictive value; NPV, negative predictive value.
Ann Plast Surg 2006;56: 243–247) Anna Cilotti, MD,
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EVALUACION Todos los cortes Desplazamiento axila
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4 AÑOS FUGA SILENTE
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-Contractura
-Ruptura intra capsular
-Ruptura extra capsular
-Migración
EVALUACIÓN
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PIEL
GRASA
TEJIDO MAMARIO
PIEL
ROJO CAPSULA FIBROSA
AZUL LINFOCITOS
LINFOCITOS EN EL FLUIDO
IMPLANTE
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Normal
• FORMA REGULAR SIN ONDULACIONES O CURVA DISCRETA GEL HOMOGENEO DOBLECES ELASTOMERICOS
• BURBUJAS EN EL INTERIOR DEL GEL
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Sintomatologia
ASINTOMATICO MASTODINEA, DOLOR DE CUELLO, DE AXILA, DE LA PARED TORAXICA, ENDURECIMIENTO DEFORMACION PROTUBERANCIAS , MIGRACION ACUMULO GANGLIONAR
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CONTRACTURA
SIGNOS DE CONTRACTURA:
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Fuga
•Fuga de silicona líquida o (gel bleed). •(NO HAY
RUPTURA)
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•DEL 80 AL 90 % SON RUPTURAS
INTRACAPSULARES
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RUPTURA INTRACAPSULAR • Irregularidad marginal
• con protuberancias
• “ stepladder sign
• líquido peri implante mayor de 4 mm.
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Gel extravasado
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Ruptura intracapsular.“signo de la escalera”
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Ruptura intracapsular.
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RUPTURA EXTRACAPSULAR
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RUPTURA EXTRACAPSULAR
• Morfologia irregular, con o sin perdida del volumen, irregularidad marginal con abultamientos la luz heterogénea y nodulos hipoecogénicos periféricos;
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Ruptura extracapsular. Imagen de un granuloma de silicona con el clásico aspecto en “nevada”.
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RUPTURA EXTRACAPSULAR
• snowstorm • .
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CUANDO LAS PARTICULAS DE SILICON LOGRAN PASAR LA CAPSULA FIBROSA, SON TRANSPORTADOS POR LOS MACROFAGOS A LOS GANGLIOS LINFATICOS DANDO LUGAR A REACCION GRANULOMATOSA
Migración
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We think that ultrasonography should be used as the first test in the assessment of breast implants. MR examination is useful in the evaluation of all
uncertain diagnoses or those suggestive for rupture ultrasonographic examinations.
Ann Plast Surg 2006;56: 243–247)
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GRACIAS
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SIGNOS SINTOMAS
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ULTRASONIDO
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GOLD SATANDART
There are four grades of capsular contracture, known as Baker grades. Baker Grading Scale Grade I: Breast is normally soft and looks natural Grade II: Breast is a little firm but looks normal Grade III: Breast is firm and looks abnormal Grade IV: Breast is hard, painful, and looks abnormal
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