David P. Gorczyca

The Diagnosis of Silicone Breast Implant Rupture

Summary: Magnetic resonance imaging of the breast in the diagnosis of silicone breast implant rupture is widely accepted to be the imaging study of choice for most women. Magnetic resonance imaging in the detection of silicone implant failure has been shown to have the highest sensitivity and specificity and has the ability to image the entire implant without the use of ionizing radiation. Unfortunately, some women are unable to have a magnetic resonance imaging examination of the breast because of contraindications such as cardiac pacemakers, aneurysm clips, and claustrophobia. Therefore, mammography, ultrasonography, and computed tomography will have roles in the diagnosis of silicone breast implant ruptures. This article illustrates the spectrum of imaging appearances of normal silicone gel implants and the appearances of silicone breast implant ruptures.

Definitive diagnosis of breast implant rupture using magnetic resonance imaging

Breast implant rupture is an important complication of augmented and reconstructed breasts. Although several techniques such as mammography, xeromammography, ultrasound, thermography, and computed tomographic (CT) scanning have been proven to be useful to detect implant rupture, they have several disadvantages and lack specificity. In the current study, we have established magnetic resonance imaging (MRI) as a definitive, reliable, and reproducible technique to diagnose both intracapsular and extracapsular ruptures. The study was conducted in 100 symptomatic patients. Our imaging parameters were able to identify ruptures in implants with silicone shells. All the ruptures showed the presence of wavy lines, free-floating silicone shell within the gel (“free-floating loose-thread sign” or “linguine sign”). We had a 3.75 percent incidence of false-positive and false-negative results. The sensitivity for detection of silicone implant rupture was 76 percent, with a specificity of 97 percent. In addition, we also were able to identify the artifacts that may interfere with the definitive diagnosis of implant rupture. (Plast. Reconstr. Surg. 92: 681, 1993.)

Evaluation of autogenous tissue breast reconstruction using MRI.

Recent controversy encountered with silicone breast implants has increased the use of autogenous tissue for breast reconstruction following mastectomy. Surveillance of patients who have undergone autogenous tissue reconstruction is important in the evaluation of recurrent or new cancer. Magnetic resonance imaging (MRI) has proven to be a useful technique in the delineation of soft tissues and provides excellent resolution. Recently, MRI has been reported to be a valuable diagnostic imaging modality for the evaluation of augmented breast implant patients with regard to implant rupture detection, silicone granuloma identification, and silicone gel migration delineation. In this study, various autologous tissue donor sites currently available for breast reconstruction were imaged by MRI. The following donor flaps were included: fleur-de-lis, TRAM, gluteal, and tensor fasciae latae. A total of 10 clinical cases were investigated. The anatomic basis of each flap type is illustrated, and various tissue components of flap tissue (skin, fat, and muscle) are demonstrated on MRI scan. Anatomic knowledge of autogenous tissue types and MRI appearance of the flap-breast-chest-wall interface are critical in the surveillance and follow-up of breast cancer patients.

Silicone implant rupture diagnosis using computed tomography: a case report and experience with 22 surgically removed implants.

Silicone elastomer shell rupture is a complication of silicone implants. To date, the rate of implant rupture has not been well documented. Magnetic resonance imaging and sonography are noninvasive breast implant imaging modalities that have been shown to be useful in evaluating the integrity of implants. We present a case of rupture detection using a follow-up computed tomographic (CT) scan of a breast cancer patient, which prompted us to use CT scans to evaluate explants of patients undergoing implant removal surgery. The purpose of the investigation was to evaluate the effectiveness of CT scan in detecting rupture. CT scan was performed on 22 explants with intact capsules, for which 17 ruptures were confirmed: 16 true-positive ruptures, 5 true-negative ruptures, O false-positive ruptures, and 1 false-negative rupture were identified. CT scan was shown to be highly sensitive and specific in rupture detection, comparable to magnetic resonance imaging. Although CT scans are consistently reliable, patients are exposed to ionizing radiation; therefore, it is not recommended for patients with augmentation mammoplasty. This study characterizes the appearance of implant rupture on CT scan, which may be useful in evaluating breast cancer patients reconstructed with silicone implants.

Residual silicone detection using MRI following previous breast implant removal : case reports

The current controversy surrounding the safety of silicone gel breast implants has resulted in an increasing number being removed. Although previous reports have suggested that remnants of the implant capsule are reabsorbed after explantation surgery, the persistence of the capsule in fact may be associated with implant fragments and silicone gel leakage. In this study we have used magnetic resonance imaging (MRI) to identify residual silicone gel and silicone granulomas following the removal of silicone gel breast implants. Four representative clinical case reports are presented. These patients, who had residual silicone present in their bodies, presented to us with breast pain, palpable masses, or abnormal calcific mass densities apparent on a mammogram. High-resolution MRI images were found to be helpful in identifying local and remote collections of silicone gel, silicone granulomas, and residual capsules that were incompletely removed from previous explantation surgery. MRI breast images demonstrated high resolution and provided the accurate anatomical locations of residual silicone gel and silicone granulomas in all the regions of breast parenchyma, chest wall muscles, and axillae. Patients with persistent local symptoms following explantation surgery may benefit from an evaluation of the breast using MRI.