Breast Implant Technology - Essay Example

MRI /Breast Implant Technology Q1. The changes of the breast tissues during the cycle of menstruation is influenced by both Progesterone and estrogen hormones in the female body. These changes occur in two phase luteal and follicular phase. The latter is the first phase which is imposed by presence of estrogen hormone while the former is the second phase of the 28 days during the menstruation cycle and is caused by the progesterone hormone. During the menstruation period the histological changes of the breast goes through five phases of change (Vogel et al., 1981). These changes are characterized by:- Phase 1- proliferative (early follicular): This is usually the first stage which runs from the third up to the seventh day. This phase characterized by well formed connective tissues, non-well defined Lumina which are compacted by alveoli. On observation the breast shows one cell of epithelial containing salient nucleoli in a rounded nucleus and a light cytoplasm. During this stage the apoptotic and mitoses cells also increase. Phase 2- follicular phase This period runs from the eighth day to the fourteenth day of the cycle. This phase is characterized by presence of myopithelial, the intermediate pale and luminal basophilic cell. In this stage the lumen can be well distinguished and has cellular collagenous stroma which is quite dense. The mitoses cells clear out and are less detected in this stage. Phase 3- luteal phase This phase runs from the 15th to 20th day of the whole period. This stage is defined by alveoli-Lumina expansion, stroma loss, myoepithelial cell are easily seen and the lobular size increases due to production of some secretion. Phase 4-secretory phase This phase runs from the 21st to 27th day of the female human cycle. During this stage, the luminal cells actively secrete apocrine. There is high level of mitotic activity and basal cells are clearly seen as vacuolized. Phase 5-menstrual phase This period brings the ultimate end of the menstrual cycle and occurs as from the 28th day to the 2nd day of the following month of the cycle. The breast tissues still appear dense and sort of swollen lumen which in turn results in reduction of apocrine secretion. During this stage the cells of the basal are seen to be highly vacuolized while on the other hand the cytoplasm in the cells of lumina is scarce. The way these two reproductive hormones influence the physiological change of the breast during the 28 days, is critical for the radiographers in the imaging centers for it is used to give a clear period of when to carry out an MRI among the premenopausal women so as to diagnose the presence or absence of malignant cell in the breast tissue (Vogel et al., 1981). Research has shown that, the long the female menstruates the higher the risk of Vogel developing cancer. This has been charged from the point that long menstruating women are highly exposed to endogenous estrogen. For effective results MRI should be carried in the follicular stage since the progesterone is quite low. This is because the hormonal interaction and fluctuation during the cycle affect how gadolinium used in the MRI produces results of a normal breast tissue. As a result the accuracy of the MRI is also affected and may as well give bogus outcome especially during the luteal phase when the progesterone is high. This is because during this stage the breast tissues is enlarged and tender with increased blood flow giving the same appearance as that of breast MRI with malignant cells. The diagnosis therefore brings a greater challenge of differentiating between the normal cells and abnormal cells of the breast hence calling for another MRI procedure repeat. To mitigate this challenge the radiographers together with the client are encouraged to schedule the procedure during the period of follicular (Ellis, 2009). Q2. BRCA stands for Breast Cancer Susceptibility Genes there are two classes of these genes designated as BRCA 1 and BRCA 2. They are naturally found in the body of human beings and exist as normal cells that have the primary function of preventing and controlling cancer through a process of synthesizing a protein that acts as an ‘antibody’ to the foreign cells. Initially the BRCA 1 is associated with a 17q chromosome and BRCA 2 on the other hand is known to associate with 17q sex cells (chromosome). Both 13q and 17q have effect on the breast and ovary. The 13q chromosome is an indicator of high risk of developing cancer of the breast and lesser chances of developing the ovarian malignancy. The 17q sex cell contrarily, pinpoints that; the chances of developing both ovarian and breast cancer are high ((Brown, et al., 2000).). The genetical materials of 17q and 13q are inheritable. The persons who do inherit the mutative BRCA gene remain highly susceptible to developing either breast or ovarian caner or both in their lifetime. In addition they are more than any other group of persons likely to develop prostrate and colon cancer before they clock their 50th year. Women are more likely to develop either cancer of the ovary due to the influence of BRCA 1 while prostrate and breast cancer in men is often caused by BRCA 2 unlike BRCA1. Research has shown that of all the men population developing cancer, while only a third is attributed to gene 1 the other two thirds are caused by gene 2. Among the BRCA carriers of both sexes breast cancer risk is quite high estimating to be 85% in lifetime of the individual while the risk of ovarian malignancy has shown to range between 40-60% (Copeland& Bland, 2004). Of the total breast cancer diagnosed these genes have been found to cause 2-5%. The chances of developing either ovarian or breast cancer in women has shown to increase with age. As a result research indicates that 85% of these gene 1 and 2 carrier women by the time they celebrate their 70th birthday they are likely to develop the cancer of the breast and ovarian risk is estimated to be 40-60% and 15% for BRCA1 and 2 respectively (Copeland& Bland, 2004). To mitigate this challenge, the BRCA 1 and 2 mutative gene carriers, are advocated to undergo risk-reducing mastectomy (Copeland & Bland2004), (Paige & Rita). Therefore, both men and women carriers of these genes are recommended to have massive and extensive cancer screening which not only involves breast, ovary, colon, prostrate but all other types of cancers prone to human beings. The advantages of this surveillance is that it may result to early identification of malignant cell and hence in time treatment. The screening of the breast will include MRI, ultrasound, mammogram annually, and both clinical and self examination of the breast. On the other hand, the screening of the ovarian cancer involves CA-125 biochemical test of the blood and Trans-Vaginal Ultrasound (TVU) per year geared at early detection of ovarian cancer cells in women. In men, antigen testing and digital rectal examination is carried on prostrate screening while mammogram and both self and clinical examination of the breast is carried for all BRCA mutative gene carrier men including other cancer forms associated with human. This is because BRCA carriers are more likely to develop any other type of abnormal cells in their lifetime as compared to their non-BRCA carriers counterpart of either sexes and age. Such additional screening include and not limited to colon cancer which is done either or both using the colonoscopy and fecal occult blood test advocated in every five to seven years repeat test. Yearly endoscopic ultrasound is advised for pancreas cancer diagnosis and the diagnosis of melanoma in the skin is carried through examining the whole body annually (Paige & Rita). The patients found to have BRCA mutative genes are also recommended to go for chemo treatment as another mitigation measure. The chemotherapy commonly used drug is Tamoxifen. This remedy is known to modulate the hormones which in turn lower the rate at which the cancer cells multiply hence lowering the chances of developing the breast cancer. Moreover, this drug also lowers the chances of redevelopment of breast cancer for women continuing with management following previous tumor of the breast (Researchers Trial New Drug for Women with Hereditary Breast and Ovarian Cancer, 2011). Tamoxifen is also recommended and used for both BRCA 1 and 2 mutative gene carrier women so as to lower the chances of developing the cancer of the breast. Studies show that the utilization of this drug in prevention and control of cancer positive women for both BRCA 1 and BRCA 2 was 95% effective (Copeland& Bland, 2004). In addition to Tamoxifen, for the postmenopausal women with both BRCA 1 and 2 mutative genes, Raloxifene chemotherapy is used to lower the opportunity of developing the bellicose cancer cells of the breast. Patients showing high risk of cancer development resulting from BRCA 1 and 2 mutative genes are recommended to have prophylactic surgery. This procedure involves PBSO and PBM which stands for Bilateral Salpingo-Oophorectomy and Prophylactic Bilateral Mastectomy respectively (Copeland & Bland, 2004, Paige & Rita, 2010). PBM involves the surgical removal of all the healthy breast tissues for high risk patients to the breast cancer. Studies show that PBM reduced the risk of breast cancer development in 2% of BRCA carrier women by 90% while those failed to undergo the procedure remained at 59% of developing the cancer. In addition, if both PBM and PBSO procedure are carried concurrently or at the same time the risk is reduced to 95%. PBSO involves the surgical removal of both the health ovaries and fallopian tubes of women found to be at high risk of developing cancer from the BRCA mutative genes. The PBSO reduces the chances of cancer development following the presence of these genes by 80-90%. However, when this PBSO procedure is carried on premenopausal women the reduction rate of breast cancer development is estimated to be 50% (Copeland& Bland, 2004). According to Copeland& Bland, (2004) Studies shows that also the use of Oral contraceptive reduces the development of the cancer of the ovary among the women population who are BRCA gene carriers. Lifestyle and behavioral modification may be a mitigation measure towards prevention of cancer development among the BRCA carriers. Studies show that the rate of breast cancer has shown to increase with increase in the amount of energy absorbed and accumulated in terms of weight in the body. In addition, women in this group who do smoke are more prone to developing breast cancer before they clock the 50th year in their lifetime as compared to women counterparts who are non-smokers. In conclusion, behavior modification regarding these practices may be a contributing factor towards breast cancer reduction (Paige & Rita, 2010). Q3. Breast implant rupture is classified into two the extra capsular and intra capsular implant rupture (Middleton & McNamara, 2000). The latter occurs when the shell of the implant opens up and the silicone gel either leaks and remains within the breast connective tissue capsule (Holmich, Lipworth, McLaughlin, & Friis, 2007). Contrarily, the former form of rupture happens if gel of silicone moves to the surrounding breast tissue and to even extreme cases to the lymph nodes (Cunningham, 2007). It is however, noting that the extra capsular rupture is rare. The chances for the implant rupture increases as the implant stays within the breast tissues. MRI technique is the most efficient diagnoses detector for implant rupture and has shown to be quite accurate. Its sensitivity on implant rupture detection ranges from 80-90% and the ability to identify this case is estimated to be 90-97% (Juanpere.S.et al, 2011). Non-contrast MRI enhancement has been found to be the most effective diagnosis for the reliability of the breast implant and leakage of the gel silicone. However this technique has also shown to be inappropriate in presence of breast tumor (Beekman et. al., 1998). The MRI scans portrays the focal area with high-signal-intensity and free gel of silicone is seen outside the capsule in examination for the extra capsular rupture (Jin-Wei, Haesun, Jingfei, & Michael, 2006). The diagnosis and identification of intra capsular remains a challenge using the MRI on as much as it is the recommendable technique in this case. On MRI, the intra capsular implant is shown to have multiple curvilinear which indicate lines of low signal strength that are inside the silicone gel. These curvilinear appearances of implant are known as “linguine sign” and are also recorded in diagnosis of extra capsular implant rupture. This signs are also not specific and may as well be misinterpreted to mean normal radial folds of the implant shell in case where they occur as complex (Ma, et al., 2004). For effective findings, multiple plane imaging is encouraged so as to differentiate the collapsed implant shell from that of radial folds (Juanpere.et al, 2005). In addition to the curvilinear lines, enfolding shell is also seen to have collected the gel and the inner capsule lumen will appear to have been totally shrunken (Beekman et. al., 1998). Intra capsular rupture implant will appear in T2-weighted images as high concentrated foci while on water-suppression will appear as hypo concentrated foci as seen from the implant lumen and also un-collapsed silicone implant in this case may as well be considered an intra-capsular rupture (Jin-Wei I., Haesun Jingfei & Michael, 2006). On the other hand the MRI will indicate this as a silicone free gel surrounding the implant shell from the outside and may as well indicate the same characteristics of bleeding gel. Gel bleed is said to be a situation where the gel leaks outside the shell and silicone may spread to other body organs such as upper limbs, skin, lymph nodes and the liver (Juanpere.et al, 2005). Pictures 1 and 2 below show how the two types of rupture appear in MRI Figure 1: Intracapsular breast implant rupture showing “linguine sign” (Safvi, 2000) Figure 2: Extracapsular breast implant rupture indicating silicone gel on the outside fibrous capsule (http://www.radpod.org) References 1. Beekman W.H., Straalen W.R., Hage J. J. Mulder J.W. et. al., (1998). Imaging signs and radiologists jargon of ruptured breast implants. PlasteReconstrSurg 102:1281-1289 2. Brown S.L., Pennello G., Soo M. S., Berg W.A. & Middleton M.S. (2000). Rupture prevalence of Silicone Gel Breast Implants Revealed on MRI in a Population of Women. Alabama: Birmigham 175:1057-1064 3. Copeland E. M. & Bland K.I. (2004). The Breast: Comprehensive Management of Benign and Malignant Disorder. Saunders; St. Louis 4. Cunningham B. (2007).The Mentor study on contour profile gel silicone MemoryGel breast implants. Plast Reconstr surg: 120:33S-39S 5. Ellis R.L. (2009). Optimal timing of breast MRI examinations for premenopausal women who do not have a normal menstrual cycle. American Journal of Roentenology, 193(6), 1738-1740.doi: 10.2214/AJR.09.2657 6. Holmich L.R., Lipworth l., McLaughlin J. K., & Friis S. (2007). Breast Implant Rupture and Connective Tissue Disease: A review of the Literature. PlastReconstr Surg. 7. Jin-Wei I., Haesun C., Jingfei M., & Michael J.M. (2006). Gel-Gel Double-Lumen Silicone Breast Implant. Intracapsular Implant Rupture. Doi:10.2214/AJR.05.2237 vol.187 8. Juapere S., E., Perez. et al., “Imaging of breast implants-a pictorial review.” Insights into imaging: 1-18 9. Juapere S., E., Perez. et al., Magnetic Resonance Imaging In Women With Breast Implants 238-255. New York: Springer. Doi:10.1007/0-387-27595-9-15/Breast MRI Intervention E-Book 10. Ma J., Choi H., Stafford R. J & Miller M. (2004). Three-point Dixon technique of inversion recovery: Silicone-specific imaging. J MagnReson imaging 19:298-302 11. Middleton M. S. & McNamara M. P. (2000). Breast Implants Classification with MRI Correlation. Radio-Graphics 20:El. Retrieved from http://radiographis.rsnajnls.org/cgi/content/full/20/3/el , 26th august, 2012 12. Paige T., & Rita K. (2010), Management of the Asymptomatic BRCA Mutation Carriers: The application of clinical genetic 13. Researchers Trial New Drug for Women with Hereditary Breast and Ovarian Cancer (2011), press release, UK: cancer research 15. Safvi A. (2000). Linguine sign. Radiology 216:838-839. Retrieved from http://www.radpod.org, 30th August, 2012 16. Vogel P.M., Georgide N. G., Fetter B. F., Vogel F. S. & McCarty J. (1981). Correlation of histologic changes in the human breast with the menstrual cycle. The American journal of pathology, 104(1), 23-34. Retrived from, www.cancer.gov on 23rd August, 2012 Read More