中年期に施行されたシリコーン豊胸術後に重篤な合併症を生じた後期高齢者の2例

Two Elderly Patients with Severe Complications That Developed Long After Silicone Breast Augmentation Performed in Their Middle-Age Years

はじめに

　美容目的の乳房増大術（豊胸術）は2017年に日本で1万件以上 1），2022年に世界で217万件以上 2）が行われている，件数の多い美容手術である。古くは1950年代のパラフィンやワセリンの注入に始まり，その後はインプラントバッグ挿入が主流となり，ヒアルロン酸注入，脂肪注入も普及している 3）。豊胸術の合併症としては術後数日～数カ月で発症する急性期合併症と，術後数年～数十年経過後に発生する慢性期合併症がある。合併症としては感染，出血や血腫，漿液腫，知覚異常，慢性疼痛，皮膚浸潤，カプセル拘縮，インプラントの破損・漏出，インプラントの移動・位置異常，異物肉芽腫，ヒトアジュバンド病，breast implant-associated anaplastic large cell lymphoma（BIA-ALCL）などが知られている 4）。1950年代以降，若年～中年期に豊胸術を受けた患者が現在は後期高齢者となり，重篤な慢性期合併症を発症するケースが報告されている 5）6）。今回著者らは，中年期にシリコーン豊胸術を受け，後期高齢者になってから重篤な合併症を呈した2例を経験したため，文献的考察を加えて報告する。

　Over 10,000 breast augmentation surgeries for cosmetic purposes were performed in Japan in 2017, and over 2.17 million such surgeries were performed worldwide in 2022. The potential complications of breast augmentation include acute complications that occur from a few days to a few months after surgery and chronic complications that occur years to decades after surgery. The acute complications include infection, bleeding, and hemorrhage. Other complications include infection, bleeding or hematoma, seroma, paresthesia, chronic pain, skin infiltration, capsular contracture, implant breakage or leakage, implant migration or malposition, human adjuvant disease, and breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). Since the 1950s, there have been reports of patients who underwent silicone breast augmentation in their youth or middle age who are now in their late elderly years and have developed serious chronic complications. We describe our treatment of a 78-year-old patient who had undergone silicone breast augmentation at the age of 50 and developed severe complications, i.e., bleeding, hematoma, chronic pain, and implant breakage. at the age of ~76. We also provide the case details of two patients who underwent silicone breast augmentation in their middle-age years and developed severe complications in late life, and we provide a review of the literature.