Diagnosis of Silicone Gel Breast Implant Rupture by Ultrasonography

Abstract

To prospectively evaluate the efficacy of ultrasonography in the diagnosis of ruptured silicone gel breast implants, 98 patients (192 implants) underwent preoperative breast ultrasonography prior to silicone gel breast implant removal. The prevalence of implant rupture confirmed at surgery in this group of patients was 62 of the 192 implants (32 percent). Of the 60 implants diagnosed as ruptured by ultrasonography, 46 were confirmed as having visible defects at surgery (true positive) for a positive predictive value of 77 percent. Of the 132 implants diagnosed as intact by ultrasonography, 116 were confirmed as intact at surgery (true negative) for a negative predictive value of 88 percent. Overall, the sensitivity of ultrasonography for implant rupture was 74 percent, and the specificity was 89 percent. These findings demonstrate that ultrasonography is an effective imaging modality for the diagnosis of silicone gel breast implant rupture. Compared with mammography, ultrasonography appears to offer superior sensitivity and specificity without radiation exposure or discomfort. Although magnetic resonance imaging has shown considerable promise in the diagnosis of implant rupture, ultrasonography provides comparable sensitivity at a fraction of MRI's cost.

Evaluation of the rupture of silicone breast implants by mammography, ultrasonography and magnetic resonance imaging in asymptomatic patients: correlation with surgical findings

“…16,22,23 The falsenegative and false-positive rates found in the present work were 25% and 12%, respectively, with 30% sensitivity, 81.13% specificity and a likelihood ratio of 1.59. These rates are related to the high prevalence of non-specific echographic signs in both ruptured and nonruptured implants.…”

“…It was observed that, in studies that included samples that were asymptomatic for rupture, the sensitivity was lower than what was described in the present study. 16,19,22,23 In our study, ultrasound showed limitations, thereby indicating that in patients with major folds it is extremely difficult to rule out rupture and that this should be investigated through magnetic resonance imaging. Ultrasonography can be used as the first test in the assessment of breast implants in asymptomatic patients, followed by mammography.…”

“…A great variety of ultrasound signs suggesting rupture have been described. [3][4][5][6][7][12][13][14][15][16][17][18][19][20][21][22][23][24][25] The most useful of these signs is the "echodense noise" or snowstorm appearance, which shows the occurrence of diffusely increased free silicone echogenicity in the mammary tissues. 15 This sign (Figure 1) was present in 10% of the ruptured implants.…”

A Prospective Study on Silicone Breast Implants and the Silicone-Related Symptom Complex

“…In augmented breasts the sensitivity ranged from 75% to 80% and from 70% to 75% for MRI and ultrasound, respectively; the specificity for implant rupture is 95% and 90%, respectively [21][22][23]. Furthermore, MRI is useful for evaluating capsular contracture.…”

Die Magnetresonanztomographie in der Diagnostik von Brustimplantaten: Eine Übersicht

“…Ein Nachteil der Mammasonographie liegt in der eingeschränkten Beurteilbarkeit des Ausmasses einer Kap-selruptur und in der Abhängigkeit vom jeweiligen Untersucher [7,8] . In Studien wird im Nachweis von Implantatrupturen daher über eine variable Sensitivität von 59-89% und eine Spezifität von 69-98% berichtet [7,10,11] .…”