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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 . . . [Full Text of this Article]

Deborah J. Steiner, MD, MS
Research Testing Laboratories Inc
Great Neck, NY

Robert G. Schwager, MD
New York Hospital/Cornell Medical Center
New York, NY

Don J. Lewittes, PhD
New York

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