Correlation between MRI results and intraoperative findings in patients with silicone breast implants

Abstract

BackgroundSilicone gel breast implants may silently rupture without detection. This has been the main reason for magnetic resonance imaging (MRI) of the augmented or reconstructed breast. The aim of the present study was to investigate the accuracy of MRI for implant rupture.MethodsFifty consecutive patients with 85 silicone gel implants were included in the study. The mean age of the patients was 51 (range 21–72) years, with a mean duration of implantation of 3.8 (range 1–28) years. All patients underwent clinical examination and breast MRI. Intraoperative implant rupture was diagnosed by the operating surgeon.ResultsNineteen of the 50 patients suffered from clinical symptoms. An implant rupture was diagnosed by MRI in 22 of 85 implants (26%). In seven of 17 removed implants (41%), the intraoperative diagnosis corresponded with the positive MRI result. However, only 57% of these patients were symptomatic. Ultrasound imaging of the harvested implants showed signs of interrupted inner layers of the implant despite integrity of the outer shell. By microsurgical separation of the different layers of the implant shell, we were able to reproduce this phenomenon and to produce signs of implant rupture on MRI.ConclusionOur results show that rupture of only the inner layers of the implant shell with integrity of the outer shell leads to a misdiagnosis on MRI. Correlation with clinical symptoms and the specific wishes of the patient should guide the indication for implant removal.

Acellular Dermal Matrix, the Breast, and the FDA

“…The findings generally support MRI as the gold standard imaging modality for assessing silicone implant integrity. However, several reports have challenged the role of MRI as a screening tool for the evaluation of silent rupture citing concerns related to compliance, cost and reimbursement (Adams et al, 2017;Bengtson & Eaves, 2012;Juanpere et al, 2011;Lindenblatt et al, 2014;Lourenco et al, 2018;C. M. McCarthy et al, 2008;Paetau et al, 2010;Sardanelli et al, 2010;Song et al, 2011).…”

Imaging of common breast implants and implant-related complications: A pictorial essay

“…[ 11 ] MRI has evolved to be most accurate tool in detecting free silicone, its relationship to surrounding structures, and in evaluating implant ruptures. [ 12 ]…”

“…Gel bleed is the normal transudation of microscopic amounts of silicone through an intact breast prosthesis membrane into the surrounding tissues and lymphatics. [ 12 ] Gel bleed is difficult to identify on USG and MRI unless it is extensive.…”

Einsatzgebiet der Magnetresonanztomografie (MRT) in der Abklärung von Brustläsionen

“…Ein weiteres in letzter Zeit sehr stark wachsendes Einsatzgebiet ist die Verlausfsbeobachtung von Brustkarzinomen während neoadjuvanter Therapien. Für alle Indikationen wird multiparametrischen Techni-ken der Vorzug gegeben [5][6][7][8][9][10]. Zusätzlich wird in Österreich die MRT breit zur Abklärung unklarer oder diskrepanter konventioneller (klinische Untersuchung, Mammografie, Ultraschall) Befunde (BI-RADS-0-Situation) angewandt.…”

“…Erwiesen anhand einheitlicher systematischer Reviews der Literatur inklusive Metaanalysen ist die klare Überlegenheit der MRT gegenüber konventionellen bildgebenden Verfahren bezüglich der Ausdehnungsdiagnostik, insbesondere beim Nachweis bzw. Ausschluss von kontralateralen und multizentrischen Karzinomen [7,12,13]. Zusätzliche, für das Patientenmanagement relevante Befunde werden insbesondere bei dichter Brust, prämenopausalen Frauen, invasiv lobulären Karzinomen und DCIS erhoben [1-4, 12, 13].…”