A

Clinical Problem

Augmentation mammoplasty

A1

Ref No. in MBUR4 (if any)

J11

A2

Section in MBUR4

Breast disease

B

Search strategy: databases used; period; MeSH headings; other key words.

Medline 1966-June 2001, EMBASE 1988-2001, hand search relevant journals, augmentation mammoplasty, mammography, diagnostic imaging

C

Search results: no. found;

no. used.

24 found, 4 used

D

Reference numbers of cited references in attached master list.

J11, 1-4

E

Summarised results from each of the cited references

Goodman et al (J11,1) undertok a meta ananlysis of articles examining diagnostic imaging to identify implant rupture. Mammography has an overall sensitivity of 28.4% when details of 1,099 implants which were imaged and then removed were reviewed. Barloon et al (J11,2) support the use of mammography in women with implants who present with symptoms suggestive of carcinoma such as a palpable lump, as is conventional. In women with TRAM flap reconstruction Helvie et al (J11,3) reviewed findings in 6 with local recurrence, all 8 cancers in these 6 women were visible on standard 2 view mammography. Eidelman et al (J11, 4) reviewed mammograms in 15 women with symptoms after TRAM flap reconstruction. They had a mixture of benign and suspicious findings on imaging and the authors conclude that mammography is a useful diagnostic tool in these women.

F

Statement (= the conclusion drawn from E)

Mammography is not useful in the investigation of implant integrity. Mammography is indicated in the investigation of symptoms suspicious of malignancy in women with implants or those who have had TRAM flap reconstruction.

G

Evidence level of F classified I - IV

2 Goodman et al, 5 Barloon et al, 3 Eidelman et al and Helvie et al

H

Investigation

Mammography

I

Recommendation *

4 Not indicated for implant integrity.
1 Indicated if symptoms of malignancy

J

Grade of Recommendation

A - C

B

K

Comment (if any) to go in booklet version of MBUR5

L

Any other comments on this problem (e.g. caveats; suggestions for research or systematic review; cost or opportunity cost; users' views.

Erika Denton