The Uprooted Implant: A Multimodality Review of … · The Uprooted Implant: A Multimodality Review of Breast Implant Rupture and Associated Complications Nancy Resteghini DO, MS,

The Uprooted Implant: A Multimodality Review of Breast Implant Rupture and Associated

Complications

Nancy Resteghini DO, MS, Glenn Hoots MD, Carolynn DeBenedectis MD

Division of Breast Imaging, University of Massachusetts Memorial Medical Center, Worcester, MA

http://pubweb.fccc.edu/cancerconversations/2013/12/the-truth-about-breast-implants-saline-vs-silicone/silicone-vs-saline-breast-implant/

Breast augmentation is an increasingly common cosmetic

procedure. There are approximately 5-10 million women world

–wide who have prosthetic breast implants (1). Many women

who have undergone breast augmentation present for both

screening and diagnostic mammographic evaluation. As the

number of women with breast implants is increasing, it is

crucial for radiologists to be familiar with the normal and

abnormal findings of common breast implants.

Breast augmentation has been performed with the injection

of foreign materials into the breast tissue, transplantation of

autologous tissue, and use of prosthetic devices (2). The

imaging appearances of breast augmentation complications

are varied. Early postoperative complications of breast

augmentation include hematoma and infection. Late

postoperative complications include capsular contracture,

silicone granuloma formation, and implant rupture.

Capsular contracture is the abnormal constriction of the

fibrous capsule that surrounds the breast implant. It can occur

anytime after surgery, but capsular contracture most

commonly occurs within the first few post-operative months

and is more frequently observed with smooth-surfaced silicone

implants and subglandular implants. Breast implants may

become spheric and firm, and the breast may become visibly

distorted, painful, and inflamed. Radiographic findings include

a change in the shape of the implant or thickening of the

fibrous capsule. Understanding the many manifestations of

breast implant complications will ultimately allow for maximal

detection of breast pathology during screening and diagnostic

examinations.

Background

References

Normal Breast Implant

1.To review normal breast implant anatomy including both

implant location as well as different types of implants commonly

encountered.

2. To discuss abnormal presentations of implant devices on

mammography and MRI, including classic signs of intracapsular

and extracapsular rupture.

3.To highlight the importance of detecting implant complications,

including post-operative peri-implant fluid collections, infection,

and implant associated tumors.

SALINE

SILICONE

Learning Objectives

Normal Breast Anatomy

Types of Breast Implants

Location of Breast Implant

http://medicalcenter.osu.edu/patientcare/healthcare_services/womens_health/breast/anatomy/Pages/index.aspx

Types of

Augmentation:

-Saline

-Silicone gel

-Free silicone liquid

-Autologous fat

-Polyacrylamide gel

Breast implants can be surgically introduced using a variety of different

approaches and are most commonly positioned either deep to the glandular

tissue (subglandular or retroglandular) or deep to the pectoralis major muscle

(retropectoral or subpectoral).

Implant Complications:

-Post-operative

-Hematoma

-Infection

-Capsular contraction

-Rupture

-Intracapsular

-Extracapsular

-Silicone injections

-Implant associated tumors

-Silicone Granuloma

-Ductal and lobular

carcinomas

-Implant associated

mesenchymal tumor

(IAMT)

-Anaplastic Large T-

cell Lymphoma

1.Update on the Safety of Silicone Gel-Filled Breast Implants (2011) - Executive Summary.

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resonance imaging: correlation with surgical findings. Breast J 2008; 14:532–537

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Implant Rupture

Free Silicone Injection Silicone injection was

commonly used for breast

augmentation, but has been

discontinued because of health

potential hazards and patient

safety. Other breast injections

include paraffin and autologous

fat. Free silicone injection is no

longer performed in the United

States, as it was banned by the

U.S. Food and Drug

Administration in 1992 (9).

Free silicone injections may be

seen in older patients and

immigrants. There have been

varied complications, including

inflammation with formation of

silicone granulomas, fibrosis,

and lymphadenopathy. Silicone

granulomas are palpable, hard

lumps and can distort the breast

parenchyma and ultimately

obscure visualization of breast

pathology.

Associated Complications