Appropriate Use of Magnetic Resonance Imaging and Ultrasound to Detect Early Silicone Gel Breast Implant Rupture in Postmastectomy Reconstruction

Rietjens, Mario; Villa, Giulia; Toesca, Antonio; Rizzo, Stefania; Raimondi, Sara; Rossetto, Fabio; Sangalli, Claudia; Lorenzi, Francesca De; Manconi, Andrea; Matthes, Ângelo Gustavo Zucca; Chahuán, Badir; Brenelli, Fabrício; Bellomi, Massimo; Petit, Jean Yves

doi:10.1097/prs.0000000000000291

Cited by 47 publications

(48 citation statements)

References 17 publications

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“…A recent study of 102 post-mastectomy patients from the European Institute of Oncology concludes the MRI should be the modality of choice to diagnose rupture in asymptomatic women due to the superior accuracy compared to ultrasound. However, the authors recommend routine screening with ultrasound and confirmation with MRI (27).…”

Section: Diagnosis Of Implant Rupturementioning

confidence: 99%

Silicone breast implant rupture: a review

et al. 2017

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Silicone breast implants have been in use for nearly 6 decades. In this time they have undergone significant changes in design and use. They have been subject to intense scrutiny with regard to safety and efficacy, including an almost 10 years moratorium on their use. The current generations of implants have been followed via the manufacturer's Core studies in order to obtain long term data regarding safety and complications. The results of the more recent studies are compiled in this review. Rupture rates are initially very low and begin to increase after 6-8 years of implantation. Implant rupture may be detected by physical exam, ultrasound or magnetic resonance imaging (MRI). The majority of silicone implant ruptures are clinically undetectable. Symptomatic patients may present with capsular contracture, breast lumps or changes in breast shape. The most common cause of implant rupture is instrument damage during placement. Implant rupture may be confined to the peri-prosthetic capsule or may extravasate into the breast tissue. Patients with ruptured implants have been studied closely and the consensus of the literature states there are no health risks associated with implant rupture. Symptomatic patients with ruptured implants should be offered the choice of observation, or explantation and capsulectomy with or without replacement.

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Section: Diagnosis Of Implant Rupturementioning

confidence: 99%

Silicone breast implant rupture: a review

et al. 2017

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“…Several studies comparing US with mammography and MR imaging have found the sensitivity of US to be superior to that of mammography but inferior to that of MR imaging for detection of implant rupture, with the reported sensitivity of US ranging from 30% to 75% (15)(16)(17)(21)(22)(23)(24). The negative predictive value of US tends to be higher (in the 50%-90% range), which suggests that US may be useful in the initial evaluation of suspected rupture, given that US is usually faster, cheaper, easier for the patient to undergo, and more readily available than MR imaging (25).…”

Section: Ultrasonographymentioning

confidence: 99%

Multimodality Imaging-based Evaluation of Single-Lumen Silicone Breast Implants for Rupture

et al. 2017

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Breast implants are frequently encountered on breast imaging studies, and it is essential for any radiologist interpreting these studies to be able to correctly assess implant integrity. Ruptures of silicone gel-filled implants often occur without becoming clinically obvious and are incidentally detected at imaging. Early diagnosis of implant rupture is important because surgical removal of extracapsular silicone in the breast parenchyma and lymphatics is difficult. Conversely, misdiagnosis of rupture may prompt a patient to undergo unnecessary additional surgery to remove the implant. Mammography is the most common breast imaging examination performed and can readily depict extracapsular free silicone, although it is insensitive for detection of intracapsular implant rupture. Ultrasonography (US) can be used to assess the internal structure of the implant and may provide an economical method for initial implant assessment. Common US signs of intracapsular rupture include the "keyhole" or "noose" sign, subcapsular line sign, and "stepladder" sign; extracapsular silicone has a distinctive "snowstorm" or echogenic noise appearance. Magnetic resonance (MR) imaging is the most accurate and reliable means for assessment of implant rupture and is highly sensitive for detection of both intracapsular and extracapsular rupture. MR imaging findings of intracapsular rupture include the keyhole or noose sign, subcapsular line sign, and "linguine" sign, and silicone-selective MR imaging sequences are highly sensitive to small amounts of extracapsular silicone. RSNA, 2017.

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“…The overall accuracy for magnetic resonance imaging was 94%, whereas that for ultrasound was 72% [17,18]. Although MRI has a higher specificity and sensitivity and is considered by many to be the method of choice in such patients [17], it still has false positives.…”

Section: Discussionmentioning

confidence: 99%

Suspected breast implant rupture: our experience, recommendations on its management and a proposal for a model of informed consent

et al. 2019

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Background Implant rupture may be detected by physical examination, ultrasound or magnetic resonance imaging (MRI); the majority of silicone implant ruptures are clinically undetectable. The absence of guidelines for behaviour in the face of a suspected implant rupture often entails sending these patients for prosthetic revision surgery rather than carrying out in-depth radiodiagnostics to confirm implant rupture. The aim of this paper is to report our multicentric experience, to indicate the correct diagnostic-therapeutic procedure and to propose a model of informed consent. Methods We conducted a multicentric retrospective analysis of 183 women submitted to prosthetic revision surgery due to radiological diagnosis of suspected implant rupture after breast augmentation or post-mastectomy reconstruction, admitted to three different Plastic Surgery Departments between 2002 and 2018. We correlated surgical findings with purpose of examination, symptoms, physical examination, imaging and device specifications. Results Two hundred and twenty-one explanted implants were preoperatively suspected as ruptured. One-third were intact and unjustifiably explanted. US associated with MRI evaluation was the most accurate method. Patient's age, comorbidities, smoking, medications, symptoms presented, implant duration and volume did not correlate with implant rupture. Conclusions Our study confirms that the association of US and MRI represents the mode of diagnosis with fewest false positives. Given the high number of errors associated with suspected intracapsular implant rupture, it seems necessary to submit an appropriate and specific informed consent that takes into account the emotional component and clearly and completely explains the possible alternatives and complications associated with possible prosthetic revision surgery. Level of evidence: Level III, risk/prognostic study

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Appropriate Use of Magnetic Resonance Imaging and Ultrasound to Detect Early Silicone Gel Breast Implant Rupture in Postmastectomy Reconstruction

Abstract: Diagnostic, II.

Cited by 47 publications

References 17 publications

Silicone breast implant rupture: a review

Silicone breast implant rupture: a review

Multimodality Imaging-based Evaluation of Single-Lumen Silicone Breast Implants for Rupture

Suspected breast implant rupture: our experience, recommendations on its management and a proposal for a model of informed consent

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