Prof. Plamen Gatsov to FACTS: Silicone implants interfere with good echocardiography

Breast implants in ladies are placed for various reasons – medical, aesthetic, etc. But it is also important to know what the pros and cons are. What cardiologists face… Cardiologist Prof. Plamen Gatsov spoke to FACTS.

- Prof. Gatsov, you are a cardiologist, but it turns out that in recent years you have been facing a very interesting and strange problem. It is about women who have had breast implants. What's the problem?
- We are talking about the implants themselves, not the ladies, because the ladies are not a problem. First, I want to open a bracket on the so-called plastic and aesthetic surgery, because it is something very important, which is definitely an achievement of medicine. Especially in cases where this is required because of existing problems, either congenital defects or acquired due to some disease. Placing a breast implant is an operation that changes the appearance of people, and from this point of view it is extremely important, as well as many other things. This type of manipulation makes ladies more attractive to the male sex, with the corresponding benefits of this, ladies have increased self-esteem, improved family and why not social status. All this is the basis of such a decision. And that's why people think it and do it. But in such cases, when such a decision is made, the benefit to health and beauty must be carefully assessed. Beauty in most cases is leading. But here it is about the following. When a woman gets silicone implants, which is the most common option, she should know that they make diagnostic evaluation difficult when any heart disease occurs, and not just heart disease. Sometimes it is also about lung diseases. What do I mean? The silicone implant itself, which is placed in both breasts, makes the ultrasound evaluation, the ultrasound visibility of the heart, difficult. Silicone prevents ultrasound rays from penetrating and is practically invisible behind it. So we – cardiologists, sometimes we are forced in strange ways to reach some good image to be able to judge if the heart has some problem.

- How often do you encounter this problem and is every woman who has had implants not a good candidate for an ultrasound examination?
- Implants make it difficult for us. In my experience with all the ladies who come to me with breast implants, I have difficulty with ultrasound assessment. The same goes for x-rays. These implants are visible as white spots in the frontal x-ray and this can make it difficult to assess the condition of the lungs, respectively diseases and processes in these areas that are behind the silicone are not well seen. They remain hidden. To put it simply - these implants represent some bright fields on the photo or on the ultrasound, which hide part of the true structure of the lung. Practically in all women who have such implants, there is a difficulty in diagnosis. And the strangest thing is that when they go to a cardiologist for an examination, they hear this fact for the first time.

- Understanding that there is no clear communication beforehand to assess whether it is suitable, how much, how and so on…
- Apparently, it is not explained to them that such a problem can arise from the team that places these implants. They should be told right there that such a problem is occurring. I don't know to what extent the surgeons themselves are aware of all this, but they should know, because they are doctors, specialists. They should know this is a problem. I have spoken and explained that this complicates the diagnosis of the heart, but only afterwards. This thing is not commented on the websites of hospitals and centers that do this type of surgery. You won't see it there.

- Does the problem you are having with this shadow that you see at the implant site depend on the size, on the place where it is placed?
- Implants are placed in the most usual and normal place in relation to the location of the breast. Unfortunately, the problem comes especially with the left implant because it covers the left side of the heart - specifically the left ventricle, and it can't be viewed very well. Especially if there is some pathology there. Usually, ladies get implants and are very enthusiastic, but they should know that it also leads to problems.
----------------------
Prof. Plamen Gatsov graduated in medicine in 1987 at the Medical University – Pleven. Since 1990, after winning a competition, he has been successively an assistant, senior assistant and chief assistant at the National Center for Cardiovascular Diseases (currently MBAL “NCB”), Sofia. In 2005, he defended his thesis for the acquisition of the ONS “Doctor” in the field of coronary physiology, and in 2007 he received the academic position of “Associate Professor”. From January 2010, he worked at UB “Lozenets”, Sofia, and from November 2010 to August 2015, he was the head of the cardiology clinic in the same hospital. Since September 2015, he has been the deputy head, and from April 2018 to April 2021, he has been the head of the cardiology clinic of the Second Medical Center-EAD, Sofia. In 2015, he defended the scientific degree “Doctor of Sciences”, and since 2017 he has been elected Professor at the MU – Pleven. Specialist in internal medicine and cardiology. Echocardiography Certified – expert level and invasive cardiology. Prof. Gatsov is the author of over 200 scientific papers – monographs, textbook chapters, collections and articles that have been published in Bulgarian and world-famous scientific cardiology publications. He has presented reports at Bulgarian and international scientific forums in Europe, the USA and Japan. He specialized in Greece (research scholarship of the European Society of Cardiology), Japan (scholarship of the “Kinki” Institute, Osaka), USA (scholarship of the Ministry of Health of the Republic of Bulgaria). Member of Bulgarian and European scientific organizations. Member of the editorial boards of Bulgarian and European magazines. Editor-in-Chief of the magazine “Bulgarian Cardiology” (2014-2020). Editor-in-Chief of the journal "Forum for Interventional Cardiology". Awarded the Medal of Merit by the European Heart Failure Association.