How Should We Investigate Breast Implant Rupture?

Abstract

We aimed to examine a cohort of patients presenting with breast implant complications to establish the sensitivity and specificity of clinical examination, Ultrasound Scanning (US) and Magnetic Resonance Imaging (MRI) in the diagnosis of implant rupture, and to examine the correlation between US and MRI. We performed a 26-month retrospective review. Patients underwent US and MRI to exclude rupture. Results of US and MRI were compared prospectively for concordance, then retrospectively to clinical findings and surgical diagnosis. Thirty-four patients with 60 implants were reviewed. The sensitivities of clinical diagnosis, US, and MRI for rupture was 42%, 50%, and 83%, respectively, while the specificities were 50%, 90%, and 90%. The concordance between US and MRI was 87%. MRI is the investigation of choice for implant rupture. US is a valuable alternative with good concordance with MRI. When US is positive for implant rupture an MRI is not necessary to confirm the diagnosis. Knowledge of the sensitivity and specificity as well as the concordance between the two investigations is useful to ensure the appropriate use of available resources.

Diagnosing PIP breast implant failure: A prospective analysis of clinical and ultrasound accuracy

“…20 The sensitivity we found for clinical impression to predict implant failure correlates with the 30e42% previously reported. 18,26,27 Our specificity of 89.3% was higher than previous studies. Hold documented a specificity of 50%.…”

“…Hold documented a specificity of 50%. 18 In this retrospective study however, the cohort comprised 34 symptomatic patients with only 14 proceeding to explantation, thereby introducing significant verification bias. Our study not only provides a larger cohort that improves the confidence, but all patients proceeded to explantation.…”

“…Studies from recent years, where highresolution ultrasound was likely used, did not find such high accuracy when reporting on other brands. 18 Furthermore different implants brands are known to display different ultrasound characteristics of failure depending on fill volume to shell ratio, viscosity of silicone, and pattern of rupture. 10,22 The Department of Health's PIP final report confirmed the use of industrial silicone and documented concerns of shell weakening.…”

“…Hold et al reported the lowest ultrasound sensitivity of 50% in a retrospective review of 34 symptomatic patients. 18 Again, only 14 patients proceeding to surgery. Berry et al most recently reported the highest accuracy in a cohort of PIP patients of 92.9%.…”

Poly implant breast implants (PIP) and the rupture risk in asymptomatic patients: a warning for greater clinician suspicion in assessment and counselling

“…Radiological assessment can be performed by ultrasound (US) or MRI, with the literature supporting MRI as the more accurate method for identification of breast implant rupture [5]. MRI certainly has a greater sensitivity for detecting rupture whilst the specificity may be argued to be similar with reported US sensitivity and specificity of 30–50 and 81–83%, respectively, and MRI sensitivity and specificity 64–90 and 77–90%, respectively [6,7]. In this case, MRI was also able to quantify the extent of silicone spread in the thorax which US may not have been able to.…”