Role of US in evaluating breast implant integrity

Abstract

US can be used as the first examination in patients with breast implants. US intra-capsular rupture detection requires further evaluation by MRI; in case of extra-capsular rupture US diagnosis, surgical implant removal could be proposed without further investigations.

Diagnostic value of a spiral breast computed tomography system equipped with photon counting detector technology in patients with implants

“…Therefore, ultrasound remains an indispensable, complementary method for the further classification of lesions detected on mammography or CT, in symptomatic women, women with dense breasts and for the assessment of implant integrity. [ 11 , 28 , 29 ] Although ultrasound has undergone remarkable improvement in recent years with increased resolution and the utilization of additional parameters, such as elastic modules, it is by itself not sufficient for breast cancer screening and diagnosis as a stand-alone method due to its decreased sensitivity in detecting DCIS and small tumors in breasts characterized by shadowing and fibrocystic changes. [ 29 – 31 ] B-CT covers these limitations.…”

“…Ultrasound presents a moderately good modality in augmented breasts as implant integrity can be assessed, [ 11 ] but it is not sufficient for breast cancer screening as a stand-alone method. [ 12 ]…”

Breast Ultrasound Past, Present, and Future

“…The appearance of an intact breast implant on ultrasound is similar to a large cyst, with presence of an anechoic implant lumen surrounded by a hyperechoic linear shell [13]. The "stepladder sign," which appears as horizontal, hyperechoic, straight, or curvilinear lines across the implant lumen, is characteristic of intracapsular silicone implant rupture (Figure 4) [13]. The "snowstorm sign" is reportedly the most significant sonographic finding for extracapsular rupture and appears as hyperechoic nodules with defined anterior margin and posterior acoustic shadowing within the breast parenchyma or axillary lymph nodes [13].…”

“…While MRI is the imaging modality of choice to evaluate for silicone implant integrity, there are characteristic sonographic appearances associated with silicone implant rupture. The appearance of an intact breast implant on ultrasound is similar to a large cyst, with presence of an anechoic implant lumen surrounded by a hyperechoic linear shell [13]. The "stepladder sign," which appears as horizontal, hyperechoic, straight, or curvilinear lines across the implant lumen, is characteristic of intracapsular silicone implant rupture (Figure 4) [13].…”

“…The "stepladder sign," which appears as horizontal, hyperechoic, straight, or curvilinear lines across the implant lumen, is characteristic of intracapsular silicone implant rupture (Figure 4) [13]. The "snowstorm sign" is reportedly the most significant sonographic finding for extracapsular rupture and appears as hyperechoic nodules with defined anterior margin and posterior acoustic shadowing within the breast parenchyma or axillary lymph nodes [13]. The ability to diagnose extracapsular rupture on sonography approaches accuracy of MRI, with one study finding 100% diagnostic accuracy for extracapsular rupture with ultrasound ( Figure 5) [13].…”