Journal Title
Title of Journal: Insights Imaging
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Abbravation: Insights into Imaging
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Publisher
Springer Berlin Heidelberg
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Authors: Sergi Juanpere Elsa Perez Oscar Huc Naiara Motos Josep Pont Salvador Pedraza
Publish Date: 2011/08/07
Volume: 2, Issue: 6, Pages: 653-670
Abstract
The number of women with breast implants is increasing Radiologists must be familiar with the normal and abnormal findings of common implants Implant rupture is a wellknown complication after surgery and is the main cause of implant removal Although mammography and ultrasonography are the standard first steps in the diagnostic workup magnetic resonance imaging MRI is the most useful imaging modality for the characterisation of breast implants because of its high spatial resolution and contrast between implants and soft tissues and absence of ionising radiation MRI has the highest sensitivity and specificity for implant rupture thanks to its sequences that can suppress or emphasise the signal from silicone Regardless of the technique used the overall aim of imaging breast implants is to provide essential information about tissue and prosthesis integrity detect implant abnormalities and detect breast diseases unrelated to implants such as breast cancerAn increasing number of patients have breast implants for cosmetic augmentation of the breast reconstruction after mastectomy or correction of congenital malformations 1 Implant rupture is the main cause of implant removal Implant rupture can have various causes but most ruptures have no obvious traumatic origin and sometimes occur in asymptomatic patients Most implant ruptures occur 10 to 15 years after implantation 2 The incidence of rupture increases with implant age the average incidence is approximately 2 implant ruptures per 100 implantyears with an estimated probability of being intact after 5 and 10 years of implantation of 98 and 83–85 respectively 3 4 5 6Clinical diagnosis is difficult being based solely on nonspecific findings such as palpable nodules asymmetry or tenderness 7 Free silicone from ruptured implants has in rare cases spread to distant body regions giving rise to symptoms If implant rupture is accompanied by loss of the shape of the breast the diagnosis of breast implant rupture at physical examination is feasible However clinical evaluation may fail to detect breast implant rupture that occurs over time without loss of breast volume and misshapenness Breast pain on the clinical examination of implants is a strong predictor of rupture but the absence of pain does not exclude rupture 3 According to Tark et al 8 the most common symptom in breast implant rupture is contour deformity 44 followed by displacements 20 mass formations 17 pain 13 and inflammation 3 However physical examination fails to diagnose implant rupture in more than 50 of casesMagnetic resonance imaging MRI mammography ultrasonography US and exceptionally computed tomography CT have all been used to diagnose silicone breast implant rupture Each technique has specific strengths and weaknesses that may make a particular technique the study of choice for an individual patient 9 Familiarity with both the typical and atypical findings for implants is essential to enable abnormalities to be detected Many factors can influence which imaging technique should be used to evaluate the integrity of silicone breast implants in a particular patient These factors include the cost of the examination the availability of an imaging technique the expertise of the radiologist performing and interpreting the study and potential contraindications or limitations of a patient that would prevent the use of a specific imaging technique 9Furthermore knowing which implant the patient has can help determine the type of imaging findings to expect in case of rupture Each type of silicone gelfilled implant has slightly different imaging findings for implant failure related to the manufacturing process and viscosity of the silicone gelFinally another surgical breast reconstruction technique uses autologous myocutaneous flaps Flaps are most commonly either transverse rectus abdominis musculocutaneous TRAM flaps or latissimus dorsi flaps and are used to reform the breast either alone or in conjunction with an implant Another alternative more rarely encountered in clinical practice is direct silicone gel injection in the breast
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