Silicone Induced Granuloma of Breast Implant Capsule (SIGBIC) diagnosis: Breast Magnetic Resonance (BMR) sensitivity to detect silicone bleeding

Abstract

Objective To evaluate the sensitivity (S) of BMRI to detect silicone gel bleeding in a prospective observational study, including consecutive patients referred for BMRI scan. Methods From January 2017 to March 2018, we evaluated patients with breast implants referred for BMRI in a prospective observational study. For SIGBIC diagnosis, we adopted three new original imaging features: black drop signal; T2* hyper signal mass; and delayed contrast enhancement, considered as irrevocable signs to detect gel bleeding (GB). Histology confirmed the presence of a silicone corpuscle in breast implant capsular specimens. The accuracy of BMRI SIGBIC findings to predict GB was determined. We also compared SIGBIC diagnosis criteria to those features proposed by the BI-RADS lé xicon, considered as equivocal findings. Results 208 patients had SIGBIC diagnosis at BMRI, and the histology confirmed GB in all cases. There were no false-positive results. Compared to the BI-RADS equivocal findings (S = 0.74), SIGBIC criteria had better sensitivity for GB diagnosis. Conclusion SIGBIC diagnosis has high sensitivity to predict GB by the three irrevocable BMRI features described by the authors. We suppose GB is underdiagnosed in clinical practice by BI-RADS features.

The Breast Tumor Microenvironment: Could Silicone Breast Implant Elicit Breast Carcinoma?

“… 8 The main result of this deterioration is the gel bleeding or shedding. 6 The proposed theory describes the possibility of pericapsular breast carcinomas development in patients with breast implants.…”

“… 5 We explained that this disease was triggered by an immune response to silicone bleeding from the prosthesis within the external environment. 6 We also described the disease’s pathophysiology and related the most indolent cases to the presence of extracellular silicone (giant cells) and the most aggressive cases to intracellular silicone (foamy histiocytes). The latter presentation was always associated with the presence of intracapsular fluid collection (seroma).…”

“…Given the history of immunological reactions, replacement with a new implant is usually not possible. 6 However, the breast tissue injuries caused by this inflammatory reaction are currently not sufficiently understood.…”

Side effects in breast implants related to radiotherapy in breast cancer reconstructive surgery

“…Recently, we demonstrated that silicone's extravasation in macroscopic intact breast implants could be diagnosed by BMRI [10] . We describe the intracapsular finding of extravasated silicone as silicone induced granuloma of breast implant capsule (SIGBIC).…”

“…The diagnosis of SIGBIC is performed adopting three diagnostic criteria: intracapsular mass with high signal in the T2-weighted sequence, a late enhancement to intravenous contrast, and black-drop signal. The BMRI granuloma image reflects the granulation tissue formed by the fibrous capsule's reaction to the gel bleeding [10] , [11] .…”