To the Editor: Dr Miglioretti and colleagues1 concluded that breast augmentation decreases the sensitivity but not the specificity of screening mammography. In the absence of information on implant type and placement (ie, subglandular or subpectoral) and prevalence of capsular contracture, however, it is difficult to know how to apply these results. For example, Silverstein et al2 reported that women with subglandular implants had a 49% mean decrease in measurable tissue area using compression mammography and a 39% mean decrease using displacement. Women with submuscular implants had a 28% decrease in measurable tissue with compression mammography as compared with a 9% decrease using displacement.
Silverstein et al3 further found that while there was a decrease in the amount of measurable, visualized breast tissue following augmentation with silicone gel–filled implants, the films obtained were superior when the implant was placed in the subpectoral as opposed to the subglandular position. Severity of capsular contracture was positively correlated with poor film quality. In another study by Silverstein et al,4 women with subglandular implants had a 44% mean decrease of measurable breast tissue area with compression mammography as compared with a 36% mean decrease with displacement. In contrast, women with submuscular implants had a 25% mean decrease with the compression technique and a 15% mean decrease with displacement.
Destouet et al5 reported that among 350 women with breast implants who received mammograms,there was overall improvement in breast tissue visualization using the modified compression view and, with submuscular implants, also a significant increase using push-back views. Matory et al6 evaluated 200 mammograms performed following submuscular placement of 25 gel-saline implants and 25 saline-filled tissue expanders. The inflated implant consistently interfered with the visualization of breast tissue in women with grades III or IV capsular contracture.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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