Effect of breast augmentation on the accuracy of mammography and cancer characteristics

Bridging Gaps: Analyzing Breast Imaging-Reporting and Data System (BI-RADS) 0 Rates and Associated Risk Factors in Disproportionally Affected Communities

Introduction Disparities in access to breast cancer screening led to the creation of the Linda Fenner 3D Mobile Mammography Center (LFMMC), successfully increasing screening for uninsured women in Miami-Dade. However, a higher-than-expected rate of inconclusive mammograms (Breast Imaging-Reporting and Data System (BI-RADS) 0) was found, which could lead to unnecessary procedures, stress, costs, and radiation. Methods In this retrospective cross-sectional study, we analyzed data from 3,044 uninsured women aged over 40 (younger if positive family history of breast cancer) from Miami-Dade without breast symptoms or breast cancer history. Women's demographic characteristics, primary language spoken, body mass index (BMI), use of hormone replacement therapy and birth control, history of benign biopsy, breast surgery, family breast cancer, and menopausal status were assessed as potential risk factors for an inconclusive (BI-RADS 0) screening mammogram result. Multivariable logistic regression analyses were used to evaluate associations. Results The average age of women was 51 years (SD = 9); 59% were White, and 30% were African American. The overall frequency of BI-RADS 0 was 35%. Higher odds of BI-RADS 0 were found for women who were younger, single, premenopausal, and with benign biopsy history. Conversely, obesity and breast implant history decreased the odds of BI-RADS 0. Conclusion We found a high frequency of BI-RADS 0 in the LFMMC sample. Potential reasons include a higher risk for breast cancer or a younger sample of women screened. Future research should explore radiologists' reasoning for assigning BI-RADS 0 results and testing alternative screening strategies for younger women.

Screening the Implant-Augmented Breast with Digital Breast Tomosynthesis: Is Tomosynthesis Necessary for Non-implant-Displaced Views?

OBJECTIVE

To determine cancer visualization utility and radiation dose for non-implant-displaced (ID) views using standard protocol with digital breast tomosynthesis (DBT) vs alternative protocol with 2D only when screening women with implant augmentation.

METHODS

This retrospective cohort study identified women with implants who underwent screening DBT examinations that had abnormal findings from July 28, 2014, to December 31, 2021. Three fellowship-trained breast radiologists independently reviewed examinations retrospectively to determine if the initially identified abnormalities could be visualized on standard protocol (DBT with synthesized 2D (S2D) for ID and non-ID views) and alternate protocol (DBT with S2D for ID and only the S2D images for non-ID views). Estimated exam average glandular dose (AGD) and associations between cancer visualization with patient and implant characteristics for both protocols were evaluated.

RESULTS

The study included 195 patients (mean age 55 years ± 10) with 223 abnormal findings. Subsequent biopsy was performed for 86 abnormalities: 59 (69%) benign, 8 (9%) high risk, and 19 (22%) malignant. There was no significant difference in malignancy visualization rate between standard (19/223, 8.5%) and alternate (18/223, 8.1%) protocols (P = .92), but inclusion of the DBT for non-ID views found one additional malignancy. Total examination AGD using standard protocol (21.9 mGy ± 5.0) was significantly higher than it would be for estimated alternate protocol (12.6 mGy ± 5.0, P <.001). This remained true when stratified by breast thickness: 6.0-7.9 cm, 8.0-9.9 cm, >10.0 cm (all P <.001).

CONCLUSION

The inclusion of DBT for non-ID views did not significantly increase the cancer visualization rate but did significantly increase overall examination AGD.

Contrast-enhanced breast imaging: Current status and future challenges

BACKGROUND

Contrast-enhanced breast MRI and recently also contrast-enhanced mammography (CEM) are available for breast imaging. The aim of the current overview is to explore existing evidence and ongoing challenges of contrast-enhanced breast imaging.

METHODS

This narrative provides an introduction to the contrast-enhanced breast imaging modalities breast MRI and CEM. Underlying principle, techniques and BI-RADS reporting of both techniques are described and compared, and the following indications and ongoing challenges are discussed: problem-solving, high-risk screening, supplemental screening in women with extremely dense breast tissue, breast implants, neoadjuvant systemic therapy (NST) response monitoring, MRI-guided and CEM- guided biopsy.

RESULTS

Technique and reporting for breast MRI are standardised, for the newer CEM standardisation is in progress. Similarly, compared to other modalities, breast MRI is well established as superior for problem-solving, screening women at high risk, screening women with extremely dense breast tissue or with implants; and for monitoring response to NST. Furthermore, MRI-guided biopsy is a reliable technique with low long-term false negative rates. For CEM, data is as yet either absent or limited, but existing results in these settings are promising.

CONCLUSION

Contrast-enhanced breast imaging achieves highest diagnostic performance and should be considered essential. Of the two contrast-enhanced modalities, evidence of breast MRI superiority is ample, and preliminary results on CEM are promising, yet CEM warrants further study.

Prevalence of women with breast implants in Sweden: a study based on the population-based mammography screening programme

BACKGROUND

Knowledge about the prevalence of women with breast implants is paramount in calculations of risks and in estimations of effects on screening and breast cancer treatment. Most of the estimations of prevalence made to date are rough and often based on sales data. The main aim of this study was to  calculate the prevalence of breast implants in Swedish women. The secondary aim was to investigate if it is feasible to establish the occurrence of breast implants with the help of the public mammography screening programme, in a country with a publicly funded welfare-type healthcare system and with a clear documentation of screening.

METHODS

Information on implants was prospectively collected from all screening attendants from 1st of February 2022 to 1st of August 2022 based on a question from the radiographer to the woman and later verified on the mammogram.

RESULTS

During the study period 4,639 women were screened, of which 182 had implants (3.9%). The  frequency varies between 1.6 and 6.4% in different age groups.

CONCLUSION

The prevalence of breast implants in Swedish women is estimated to be around 4%. The population-based mammography screening programme in countries with a publicly funded welfare-type healthcare system and a clear documentation of mammography screening attendance, seems to be a feasible way to establish the prevalence of breast implants in the population. The large number of women with breast implants warrants further studies regarding the best diagnostic and treatment alternatives for this group. Pre-registration: ClinicalTrials.Gov identifier NCT05222100.

Imaging Features Following Breast Explant Surgery: A Pictorial Essay

Breast implants can be removed with breast explantation surgery (BES) for various reasons, including patient dissatisfaction, capsular contracture, implant infection or rupture, breast implant-associated anaplastic large cell lymphoma, and a recently emerging phenomenon called breast implant illness. There is very limited data on the imaging appearance after BES. A retrospective chart review was performed for patients with BES findings on imaging reports for the period between October 2016 and October 2021. When assessing BES techniques, a key element is determining whether the implant's fibrous capsule requires removal. The second important question is if the patient requires an additional aesthetic procedure after BES. BES techniques include capsulotomy, and partial, total, or en bloc capsulectomy. Adjunctive aesthetic or reconstructive procedures after BES include fat grafting, mastopexy, augmentation, and reconstruction with flaps. The majority of post-BES breast imaging findings are related to the surgical scar/bed, thereby confirming that the type of explantation surgery is important. Imaging findings after BES include focal and global asymmetries, architectural distortions, calcifications, calcified and non-calcified fat necrosis, masses, hematomas, seromas, capsular calcifications, and silicone granulomas. Most importantly, since these patients have residual breast tissue, paying attention to imaging features that are suspicious for breast cancer is necessary.

The Impact of Prior Breast Augmentation on Breast Reconstruction after Mastectomy

The risk of women developing breast cancer after augmentation mammaplasty may be lower than the general population, with minimal current literature on breast reconstruction in this population. We sought to evaluate the impact of previous augmentation on postmastectomy breast reconstruction.

Methods

Retrospective review of patients who underwent mastectomies from 2017 to 2021 at our institution was performed. Analysis included frequencies and percentages, descriptive statistics, chi-square analysis, and Fisher exact test.

Results

Four hundred seventy patients were included, with average body mass index of 29.1 kg/m², 96% identifying as White, and an average age at diagnosis of 59.3 years. Twenty (4.2%) patients had a prior breast augmentation. Reconstruction was performed in 80% of the previously augmented patients compared to 49.9% of nonaugmented patients (P = 0.01). Reconstruction was alloplastic in 100% of augmented and 88.7% of nonaugmented patients (P = 0.15). All reconstructed augmented patients underwent immediate reconstruction compared with 90.5% of nonaugmented patients (P = 0.37), and two-stage reconstruction was most common (75.0% versus 63.5%; P = 0.42). Of the previously augmented patients, 87.5% increased implant volume, 75% underwent same implant plane reconstruction, and 68.75% underwent same implant-type reconstruction as their augmentation.

Conclusions

Previously augmented patients were more likely to undergo reconstruction after mastectomy at our institution. All reconstructed augmented patients underwent alloplastic reconstruction, with most performed immediately in staged fashion. Most patients favored silicone implants and maintained the same implant type and plane of reconstruction, with increased implant volume. Larger studies are required to further investigate these trends.

Contrast-Enhanced Mammography for Newly Diagnosed Breast Cancer in Women With Breast Augmentation: Preliminary Findings

In 17 women with newly diagnosed breast cancer who underwent contrast-enhanced mammography (CEM) and MRI, both modalities were found to be concordant for the index cancer. In six of the 17 women, CEM showed an additional lesion that was confirmed by MRI. Of these six additional lesions, three were multifocal, one was multicentric, and two were contralateral; two of the six were malignant. MRI did not identify any additional cancers that were not identified on CEM. CEM may have a role in women with breast augmentation and either a contraindication or limited access to MRI.

Screening of women with aesthetic prostheses in dedicated sessions of a population-based breast cancer screening programme

BACKGROUND

Women with aesthetic prostheses must be included in the target population of mammography screening programmes. Breast implants are radiopaque and partially obscure the breast tissue. This can be avoided with the use of the Eklund technique, which causes an increased radiation exposure. In this study, augmented women undergoing a dedicated protocol within a population-based screening programme were compared according to selected indicators with the standard screening population. Essential dosimetric parameters and their time trend were also assessed.

MATERIALS AND METHODS

The study was conducted in a screening centre in Milan in the years 2009-2016. The screening protocol for women with breast implants included a double-read mammography with the Eklund views, ultrasound and clinical breast examination.

RESULTS

A total of 28,794 women were enrolled, including 588 (2%) women with breast implants and 28,206 (98%) undergoing the standard screening protocol. The invasive assessment rate was 9.0‰ for women with breast implants vs. 15‰ in the standard cohort. The surgical referral rate was 2.2% vs. 0.9%. The detection rate was similar in the two groups (4.0 and 4.5‰, respectively). There were significant differences in the average glandular dose according to the mammography equipment. The use of the Eklund views increased over time.

CONCLUSIONS

Screening of augmented women according to a specific protocol in the contexts of population-based programmes is feasible. Observed differences in screening indicators relative to the standard screening population require further research. The increasing use of Eklund views probably results from quality assurance measures associated with screening programmes.

Breast cancer screening in women with and without implants: retrospective study comparing digital mammography to digital mammography combined with digital breast tomosynthesis

OBJECTIVES

Compare four groups being screened: women without breast implants undergoing digital mammography (DM), women without breast implants undergoing DM with digital breast tomosynthesis (DM/DBT), women with implants undergoing DM, and women with implants undergoing DM/DBT.

METHODS

Mammograms from February 2011 to March 2017 were retrospectively reviewed after 13,201 were excluded for a unilateral implant or prior breast cancer. Patients had been allowed to choose between DM and DM/DBT screening. Mammography performance metrics were compared using chi-square tests.

RESULTS

Six thousand forty-one women with implants and 91,550 women without implants were included. In mammograms without implants, DM (n = 113,973) and DM/DBT (n = 61,896) yielded recall rates (RRs) of 8.53% and 6.79% (9726/113,973 and 4204/61,896, respectively, p < .001), cancer detection rates per 1000 exams (CDRs) of 3.96 and 5.12 (451/113,973 and 317/61,896, respectively, p = .003), and positive predictive values for recall (PPV1s) of 4.64% and 7.54% (451/9726 and 317/4204, respectively, p < .001), respectively. In mammograms with implants, DM (n = 6815) and DM/DBT (n = 5138) yielded RRs of 5.81% and 4.87% (396/6815 and 250/5138, respectively, p = .158), CDRs of 2.49 and 2.92 (17/6815 and 15/5138, respectively, p > 0.999), and PPV1s of 4.29% and 6.0% (17/396 and 15/250, respectively, p > 0.999), respectively.

CONCLUSIONS

DM/DBT significantly improved recall rates, cancer detection rates, and positive predictive values for recall compared to DM alone in women without implants. DM/DBT performance in women with implants trended towards similar improvements, though no metric was statistically significant.

KEY POINTS

• Digital mammography with tomosynthesis improved recall rates, cancer detection rates, and positive predictive values for recall compared to digital mammography alone for women without implants. • Digital mammography with tomosynthesis trended towards improving recall rates, cancer detection rates, and positive predictive values for recall compared to digital mammography alone for women with implants, but these trends were not statistically significant - likely related to sample size.

Routine Screening for Transgender and Gender Diverse Adults Taking Gender-Affirming Hormone Therapy: a Narrative Review

Despite the growing number of adult transgender and gender diverse (TGD) patients seeking health services, there are many unknowns regarding how routine screening recommendations should be applied to TGD persons receiving gender-affirming hormone therapy (GAHT). Patients taking GAHT may have disease risks that differ from what is expected based on their sex assigned at birth or affirmed gender identity. We discuss two patient cases, one transgender man and one transgender woman who present for routine medical care, to review several conditions that may be impacted by the hormones utilized in masculinizing and feminizing GAHT and for which screening recommendations are available for TGD adults: cardiovascular risk factors, osteoporosis, breast cancer, cervical cancer, and prostate cancer. We reviewed the TGD-specific screening recommendations from several major medical organizations and programs and found them to be largely based upon expert opinion due to a lack of evidence. The goal of this narrative review is to assist healthcare professionals in counseling and screening their TGD patients when and where appropriate. Not all TGD adults have the ability or need to receive routine medical care from a specialized TGD health clinic; therefore, it is essential for all healthcare professionals involved in routine and gender-affirming care to have knowledge about these conditions and screenings.

Current practices of plastic surgeons at King Abdulaziz University Hospital in requesting breast imaging studies prior to non-oncological breast surgeries

Background

In the context of the high incidence of breast cancer and the high frequency of breast cosmetic surgeries, malignant and/or premalignant lesions are frequently detected incidentally in postoperative histopathology specimens. The current literature does not provide clear practice guidelines for the use of preoperative imaging prior to non-oncological breast surgeries.

Objectives

In this study, we aimed to determine the current practices of plastic surgeons at King Abdulaziz University Hospital (KAUH) and their use of preoperative breast imaging before non-oncological breast surgeries.

Design

Non-intervention/ retrospective record review.

Settings

Department of Radiology at King Abdulaziz University Hospital (KAUH).

Methods

In 08/06/2017 at King Abdulaziz University Hospital, we conducted a single-center, retrospective chart review of the medical files of candidates for non-oncological breast surgery in order to examine preoperative imaging requests by plastic surgeons in the period 01/01/2013 to 08/06/2017.

Main outcome measures

The practice of plastic surgeons at KAUH in requesting preoperative imaging prior non-oncological breast surgeries.

Sample size

104 patients.

Results

We found that, in the period 2013 to 2017, 104 women who underwent non-oncological breast surgeries were evaluated for recent preoperative breast imaging. Only 37 patients (35.6%) were found to have had preoperative imaging, and only less than one fifth (19.4%) of those 37 patients had abnormal preoperative imaging results, all of which were negative for malignancy.

Conclusions

Although the yield of malignancy on preoperative breast imaging was zero in women seeking non-oncological breast surgeries at KAUH, we recommend the establishment of unified practice guidelines to be followed by plastic surgeons for better postoperative screening in different risk groups.

Limitations

Lack of follow up of patients postoperatively for any development of malignancy.

Breast implant illness: a topic in review

Recently, the term breast implant illness has become popularized in social media to describe a constellation of symptoms which have been attributed to a patient's breast implants. These symptoms include fatigue, chest pain, hair loss, headaches, chills, photosensitivity, rash, and chronic pain amongst others. While physicians aim to treat these physical symptoms, currently the evidence supports the safety of silicone breast implants. This article entitled "Breast implant illness: a topic in review" presents an up-to-date review focusing on the safety of silicone breast implants. Patients retain the right to decide to keep or remove their breast implants and for those who choose to pursue explantation, they should be advised to seek the care of a board-certified plastic surgeon. As a scientific community is our duty to continue to conduct well-designed scientific studies to gain more insight into the safety of breast implants as it related to cancer detection, autoimmune disease, and other health concerns to improve patient safety, awareness, and education. This review article aims to delineate both the content and timing of all research and evidence as it pertains to the newly coined phrase "breast implant illness". The authors of this study support that currently there have not been any concrete or evidence-based studies which support the formation of a new syndrome "silicone implant illness".

Current practice in mammographic imaging of the augmented breast in Australia

AIM

This study seeks to document the imaging series used in contemporary Australian practice for imaging the augmented breast, with a secondary focus on differences in practice and opinion between BreastScreen Australia and diagnostic imaging services.

METHODS

A SurveyMonkey link was distributed through the Australian Society of Medical Imaging and Radiation Therapy (ASMIRT) and was assessable during December 2017 and January 2018. The questionnaire investigated: years of experience, facility type and location, image acquisition systems, appointment times, patients imaged per week, technique and imaging series used, use of limited compression views, rationale for variation in imaging series and the use of ultrasound. Descriptive statistics were produced for all variables with chi-squared tests used for comparisons between categorical variables.

RESULTS

The most frequently used series was the eight-image Eklund ID technique 64% and 59% (submuscular) and 68% and 58% (subglandular) for BSA and diagnostic services, respectively. Eighteen different combinations of projections were reported with eight combinations common to both subglandular and submuscular imaging. The majority of participants attributed imaging series preferences to dose reduction and radiologist preference.

CONCLUSION

This research has demonstrated varied approaches to the routine imaging of women with breast implants and identified the need for the establishment of dedicated evidence-based imaging protocols to ensure that regardless of which setting a woman attends that they receive standardised imaging with minimal dose and maximum breast coverage. This is a reassurance that is not applicable to current practice.

Analysis of Surgical Trends for Axillary Lymph Node Management in Patients with Ductal Carcinoma In Situ Using the NSQIP Database: Are We Following National Guidelines?

BACKGROUND

For patients with ductal carcinoma in situ (DCIS), multiple national cancer organizations recommend that sentinel lymph node biopsy (SLNB) be offered when treated with mastectomy, but not when treated with breast-conserving surgery (BCS). This study analyzes national surgical trends of SLNB and axillary lymph node dissection (ALND) in DCIS patients undergoing breast surgery with the aim to quantify deviations from national guidelines.

METHODS

A retrospective cohort analysis of the American College of Surgeons' National Surgical Quality Improvement Program (ACS NSQIP) database from 2005 to 2017 identified patients with DCIS. Patients were categorized by their primary method of breast surgery, i.e. mastectomy or BCS, then further categorized by their axillary lymph node (ALN) management, i.e. no intervention, SLNB, or ALND. Data analysis was conducted via linear regression and a non-parametric Mann-Kendall test to assess a temporal trend and Sen's slope.

RESULTS

Overall, 43,448 patients with DCIS met the inclusion criteria: 20,504 underwent mastectomy and 22,944 underwent BCS. Analysis of DCIS patients from 2005 to 2017 revealed that ALND decreased and SLNB increased in every subgroup, regardless of surgical treatment modality. Evaluation in the mastectomy group increased overall: mastectomy alone increased from 57.1 to 65.8% (p < 0.01) and mastectomy with immediate reconstruction increased from 58.5 to 72.1% (p < 0.01). Increases also occurred in the total BCS population: partial mastectomy increased from 14.0 to 21.1% and oncoplastic surgery increased from 10.5 to 23.0% (both p < 0.01).

CONCLUSIONS

Despite national guideline recommendations for the management of ALN surgery in DCIS patients, approximately 20-30% of cases continue to not follow these guidelines. This warrants further education for surgeons and patients.

Assessment of Radiologist Performance in Breast Cancer Screening Using Digital Breast Tomosynthesis vs Digital Mammography

Importance

Many US radiologists have screening mammography recall rates above the expert-recommended threshold of 12%. The influence of digital breast tomosynthesis (DBT) on the distribution of radiologist recall rates is uncertain.

Objective

To evaluate radiologists' recall and cancer detection rates before and after beginning interpretation of DBT examinations.

Design, Setting, and Participants

This cohort study included 198 radiologists from 104 radiology facilities in the Breast Cancer Surveillance Consortium who interpreted 251 384 DBT and 2 000 681 digital mammography (DM) screening examinations from 2009 to 2017, including 126 radiologists (63.6%) who interpreted DBT examinations during the study period and 72 (36.4%) who exclusively interpreted DM examinations (to adjust for secular trends). Data were analyzed from April 2018 to July 2019.

Exposures

Digital breast tomosynthesis and DM screening examinations.

Main Outcomes and Measures

Recall rate and cancer detection rate.

Results

A total of 198 radiologists interpreted 2 252 065 DM and DBT examinations (2 000 681 [88.8%] DM examinations; 251 384 [11.2%] DBT examinations; 710 934 patients [31.6%] aged 50-59 years; 1 448 981 [64.3%] non-Hispanic white). Among the 126 radiologists (63.6%) who interpreted DBT examinations, 83 (65.9%) had unadjusted DM recall rates of no more than 12% before using DBT, with a median (interquartile range) recall rate of 10.0% (7.5%-13.0%). On DBT examinations, 96 (76.2%) had an unadjusted recall rate of no more than 12%, with a median (interquartile range) recall rate of 8.8% (6.3%-11.3%). A secular trend in recall rate was observed, with the multivariable-adjusted risk of recall on screening examinations declining by 1.2% (95% CI, 0.9%-1.5%) per year. After adjusting for examination characteristics and secular trends, recall rates were 15% lower on DBT examinations compared with DM examinations interpreted before DBT use (relative risk, 0.85; 95% CI, 0.83-0.87). Adjusted recall rates were significantly lower on DBT examinations compared with DM examinations interpreted before DBT use for 45 radiologists (35.7%) and significantly higher for 18 (14.3%); 63 (50.0%) had no statistically significant change. The unadjusted cancer detection rate on DBT was 5.3 per 1000 examinations (95% CI, 5.0-5.7 per 1000 examinations) compared with 4.7 per 1000 examinations (95% CI, 4.6-4.8 per 1000 examinations) on DM examinations interpreted before DM use (multivariable-adjusted risk ratio, 1.21; 95% CI, 1.11-1.33).

Conclusions and Relevance

In this study, DBT was associated with an overall decrease in recall rate and an increase in cancer detection rate. However, our results indicated that there is wide variability among radiologists, including a subset of radiologists who experienced increased recall rates on DBT examinations. Radiology practices should audit radiologist DBT screening performance and consider additional DBT training for radiologists whose performance does not improve as expected.

Patient-Awareness Survey: Do Breast Implants Affect the Acquisition and Accuracy of Screening Mammography?

OBJECTIVE

Breast implant augmentation is the most common cosmetic surgical procedure performed in the United States. The purpose of this study was to determine if patients with breast augmentation surgery are aware of the effect of breast implants on the mammographic detection of cancer.

METHODS

An institutional review board exempt patient awareness survey was distributed at a single breast imaging facility to women undergoing screening mammography. Comparative statistical analyses were performed between patients with and without breast implants.

RESULTS

The respondents were divided into three groups: no prior breast surgery (74%; 524/711), breast surgery with implants (21%; 152/711), and breast surgery without implants (5%; 35/711). Patients with breast implants were more aware that implants decrease the amount of breast tissue seen on a mammogram (75%; 105/141) and that implants result in the need for more mammogram views (70%; 103/147), as compared with patients with no surgery (46%; 221/484 and 31%; 147/478, respectively) (P < 0.001). More women with breast implants reported learning from breast imaging staff rather than from their surgeon that implants decrease the amount of breast tissue seen on a mammogram (46%; 49/106 vs. 38%; 40/106). Of 137 respondents, 35% (n = 48) reported that the effect of implants on their mammogram was discussed preoperatively. Of those who did not recall a preoperative discussion, 42% (16/38) indicated this knowledge would have factored into their decision to get breast implants.

CONCLUSION

This study highlights an opportunity for providers to engage in more education and shared decision-making with patients considering breast augmentation surgery to ensure preoperative counseling includes discussion of the effect of implants on mammography.

Health considerations for transgender women and remaining unknowns: a narrative review

Transgender (trans) women (TW) were assigned male at birth but have a female gender identity or gender expression. The literature on management and health outcomes of TW has grown recently with more publication of research. This has coincided with increasing awareness of gender diversity as communities around the world identify and address health disparities among trans people. In this narrative review, we aim to comprehensively summarize health considerations for TW and identify TW-related research areas that will provide answers to remaining unknowns surrounding TW's health. We cover up-to-date information on: (1) feminizing gender-affirming hormone therapy (GAHT); (2) benefits associated with GAHT, particularly quality of life, mental health, breast development and bone health; (3) potential risks associated with GAHT, including cardiovascular disease and infertility; and (4) other health considerations like HIV/AIDS, breast cancer, other tumours, voice therapy, dermatology, the brain and cognition, and aging. Although equally deserving of mention, feminizing gender-affirming surgery, paediatric and adolescent populations, and gender nonbinary individuals are beyond the scope of this review. While much of the data we discuss come from Europe, the creation of a United States transgender cohort has already contributed important retrospective data that are also summarized here. Much remains to be determined regarding health considerations for TW. Patients and providers will benefit from larger and longer prospective studies involving TW, particularly regarding the effects of aging, race and ethnicity, type of hormonal treatment (e.g. different oestrogens, anti-androgens) and routes of administration (e.g. oral, parenteral, transdermal) on all the topics we address.

Application of Periareolar Mammaplasty with the Tissue Folding Technique in Breast Reshaping following Polyacrylamide Hydrogel Removal

Background

Polyacrylamide hydrogel (PAAG) was used as an injectable implant for augmentation mammoplasty for over 30 years, but its use was ceased due to various related complications. The only way to treat these complications is PAAG removal, but this causes breast ptosis, nipple retraction, breast asymmetry, and skin laxity.

Objectives

This article reports a new technique for breast reshaping after PAAG removal without prosthesis implantation.

Method

From January 2015 to June 2018, twenty-three patients underwent periareolar mammoplasty with the tissue folding technique (PMTFT) for breast reshaping after PAAG removal. Postoperative breast shape and the degree of satisfaction of the patients were evaluated during follow-up.

Results

All patients recovered well without severe complications. All patients were satisfied with their postoperative breast shape and their symptoms were relieved after surgery.

Conclusions

PMTFT provides satisfactory postoperative breast shape results. Economical, practical, and technical advantages were found over traditional prosthesis-mediated breast reconstruction. PMTFT can be an ideal surgical choice in appropriate cases.

Detection Rates for Benign and Malignant Diagnoses on Breast Cancer Screening With Digital Breast Tomosynthesis in a Statewide Mammography Registry Study

OBJECTIVE

The objective of our study was to determine whether detection rates of specific benign and malignant diagnoses differ for breast cancer screening with digital breast tomosynthesis (DBT) versus full-field digital mammography (FFDM) alone.

MATERIALS AND METHODS

We analyzed observational data from the Vermont Breast Cancer Surveillance System, including 86,349 DBT screening examinations and 97,378 FFDM screening examinations performed at eight radiology facilities in Vermont that adopted DBT screening during 2012-2016. We determined the most severe diagnosis made within 6 months after positive screening examinations. Multivariable-adjusted logistic regression was used to compare detection rates for specific diagnoses on DBT versus FFDM.

RESULTS

Compared with FFDM, DBT had a lower recall rate (adjusted odds ratio [OR], 0.81; 95% CI, 0.77-0.85) but comparable biopsy rate (OR = 1.05; 95% CI, 0.93-1.17), benign biopsy rate (OR = 1.12; 95% CI, 0.97-1.29), and cancer detection rate (OR = 0.94; 95% CI, 0.78-1.14). Among benign diagnoses, DBT and FFDM had comparable detection rates for nonproliferative lesions (OR = 1.19; 95% CI, 0.92-1.53), fibroepithelial proliferations (OR = 1.24; 95% CI, 0.85-1.81), proliferative lesions without atypia (OR = 1.13; 95% CI, 0.90-1.42), atypical lesions (OR = 0.77; 95% CI, 0.43-1.38), and lobular carcinoma in situ (LCIS) (OR = 0.92; 95% CI, 0.53-1.61). Among malignant diagnoses, DBT and FFDM had comparable detection rates for ductal carcinoma in situ (OR = 1.05; 95% CI, 0.70-1.57) and invasive breast cancer (OR = 0.92; 95% CI, 0.74-1.13), with no statistically significant differences in detection of invasive ductal carcinoma (OR = 0.83; 95% CI, 0.66-1.06), invasive lobular carcinoma (OR = 1.11; 95% CI, 0.59-2.07), or invasive mixed ductal-lobular carcinoma (OR = 1.49; 95% CI, 0.65-3.39).

CONCLUSION

Compared with FFDM, breast cancer screening with DBT has a lower recall rate while detecting a similar distribution of benign and malignant diagnoses.

Breast imaging for aesthetic surgery: British Society of Breast Radiology (BSBR), Association of Breast Surgery Great Britain & Ireland (ABS), British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS)

This is an overview of the guidelines for breast imaging before and after aesthetic (cosmetic) breast surgery, which includes but is not limited to implants, lipomodelling and mammoplasty procedures. The guidelines are based on a review of the literature and consensus of breast imaging and aesthetic breast surgery specialists. 1. Pre-aesthetic surgery 2. Post-aesthetic surgery If breast imaging or breast assessment is required, it should be performed in a designated breast facility with access to specialist breast imaging and a complete breast multidisciplinary team in accordance with national guidelines and recommendations.

The Impact of Implant Location on Breast Cancer Characteristics in Previously Augmented Patients: A Systematic Literature Analysis

Background

There is a paucity of data comparing the oncologic properties of breast cancer among patients previously having undergone breast augmentation in either the subglandular or subpectoral planes. The objective of the present systematic review was to evaluate whether implant location influenced the characteristics of breast tumors in previously augmented women.

Methods

A systematic literature search was performed to identify relevant articles reporting tumor characteristics in augmented patients. The search included published articles in three electronic databases; Ovid MEDLINE, EMBASE, and PubMed. Comparative studies (subglandular vs. subpectoral) were included.

Results

Analysis of data pooled from the included studies showed that subglandular implants had a higher frequency of tumors between 2 to 5 cm (26.5% vs. 9.9%, P = 0.0130). Subglandular implants also had a higher frequency of stage 2 tumors (42.9% vs. 23.7%, P = 0.0308). There was no significant difference in lymphovascular invasion between the 2 groups. These results of this systematic review suggest that the prognosis of patients undergoing augmentation is unaffected by implant location (subpectoral vs. subglandular).

Conclusions

With the absence of large randomized controlled trials, our study provides surgeons with an evidence-based reference to improve informed consent with regards to implant placement.

Breast Cancer following Augmentation Mammaplasty: A Case-Control Study

BACKGROUND

The purpose of this study was to determine whether augmentation mammaplasty, implant type, and implant location affect breast cancer detection, stage, and treatment.

METHODS

An institutional case-control study was performed of patients with prior breast augmentation undergoing breast cancer treatment from 2000 to 2013. Controls were propensity matched and randomized, and data were retrospectively reviewed.

RESULTS

Forty-eight cases and 302 controls were analyzed. Palpable lesions were detected at a smaller size in augmentation patients (1.6 cm versus 2.3 cm; p < 0.001). Fewer lesions in augmented patients were detected by screening mammography (77.8 percent of cases versus 90.7 percent of controls; p = 0.010). Patients with implants were more likely to undergo an excisional biopsy for diagnosis (20.5 percent versus 4.4 percent; p < 0.001), rather than image-guided core needle biopsy (77.3 percent versus 95.3 percent; p < 0.001). Earlier staging in augmented patients approached but did not reach statistical significance (p = 0.073). Augmented patients had higher mastectomy rates (74.5 percent versus 57.0 percent) and lower rates of breast-conservation therapy (25.5 percent versus 43 percent; p = 0.023). Neither implant fill type nor anatomic location affected method of diagnosis, stage, or treatment.

CONCLUSIONS

Palpable detection of breast cancer is more likely at a smaller size in augmented patients, yet it is less likely on screening mammography than in controls. Augmentation breast cancer patients have a comparable disease stage and are more likely to undergo mastectomy rather than lumpectomy. Both silicone and saline implants, whether placed submuscularly or subglandularly, have comparable effects on breast imaging, biopsy modality, and surgical intervention.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, III.

Errors in Mammography Cannot be Solved Through Technology Alone

Mammography has been the frontline screening tool for breast cancer for decades. However, high error rates in the form of false negatives (FNs) and false positives (FPs) have persisted despite technological improvements. Radiologists still miss between 10% and 30% of cancers while 80% of woman recalled for additional views have normal outcomes, with 40% of biopsied lesions being benign. Research show that the majority of cancers missed is actually visible and looked at, but either go unnoticed or are deemed to be benign. Causal agents for these errors include human related characteristics resulting in contributory search, perception and decision-making behaviours. Technical, patient and lesion factors are also important relating to positioning, compression, patient size, breast density and presence of breast implants as well as the nature and subtype of the cancer itself, where features such as architectural distortion and triple-negative cancers remain challenging to detect on screening. A better understanding of these causal agents as well as the adoption of technological and educational interventions, which audits reader performance and provide immediate perceptual feedback, should help. This paper reviews the current status of our knowledge around error rates in mammography and explores the factors impacting it. It also presents potential solutions for maximizing diagnostic efficacy thus benefiting the millions of women who undergo this procedure each year.

Breast Cancer after Augmentation: Oncologic and Reconstructive Considerations among Women Undergoing Mastectomy

BACKGROUND

Breast augmentation with subglandular versus subpectoral implants may differentially impact the early detection of breast cancer and treatment recommendations. The authors assessed the impact of prior augmentation on the diagnosis and management of breast cancer in women undergoing mastectomy.

METHODS

Breast cancer diagnosis and management were retrospectively analyzed in all women with prior augmentation undergoing therapeutic mastectomy at the authors' institution from 1993 to 2014. Comparison was made to all women with no prior augmentation undergoing mastectomy in 2010. Subanalyses were performed according to prior implant placement.

RESULTS

A total of 260 women with (n = 89) and without (n = 171) prior augmentation underwent mastectomy for 95 and 179 breast cancers, respectively. Prior implant placement was subglandular (n = 27) or subpectoral (n = 63) (For five breasts, the placement was unknown). Breast cancer stage at diagnosis (p = 0.19) and detection method (p = 0.48) did not differ for women with and without prior augmentation. Compared to subpectoral augmentation, subglandular augmentation was associated with the diagnosis of invasive breast cancer rather than ductal carcinoma in situ (p = 0.01) and detection by self-palpation rather than screening mammography (p = 0.03). Immediate two-stage implant reconstruction was the preferred reconstructive method in women with augmentation (p < 0.01).

CONCLUSIONS

Breast cancer stage at diagnosis was similar for women with and without prior augmentation. Among women with augmentation, however, subglandular implants were associated with more advanced breast tumors commonly detected on palpation rather than mammography. Increased vigilance in breast cancer screening is recommended among women with subglandular augmentation.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, III.

Assessment and Management of Challenging BI-RADS Category 3 Mammographic Lesions

Breast Imaging Reporting and Data System (BI-RADS) category 3 lesions are probably benign by definition and are recommended for short-interval follow-up after a diagnostic workup has been completed. Although the original lexicon-derived BI-RADS category 3 definition applied to lesions without prior imaging studies (when stability could not be determined), in clinical practice, many lesions with prior images may be assigned to BI-RADS category 3. Although the BI-RADS fifth edition specifically delineates lesions that are appropriate for categorization as probably benign, it also specifies that the interpreting radiologist may use his or her discretion and experience to justify a "watchful waiting" approach for lesions that do not meet established criteria. Examples of such lesions include evolving masses or calcifications suggestive of prior trauma and instances when stability cannot be ascertained because of image quality. Although interval change is an important feature of malignancy, many benign lesions also change over time; thus, use of prior imaging studies and ongoing imaging surveillance to demonstrate the evolution of a probably benign lesion is justified. Some examples of common pitfalls associated with inappropriate BI-RADS category 3 assessment include failure to use proper BI-RADS descriptors, failure to perform a complete diagnostic workup, and overreliance on negative ultrasonographic findings. When appropriately used, short-interval follow-up saves many patients from undergoing biopsy of benign lesions, without decreasing the rate of cancer detection. (©)RSNA, 2016.

Magnetic resonance imaging of breast augmentation: a pictorial review

Abstract

The increasing prevalence of breast augmentation presents new challenges in breast imaging interpretation. Magnetic resonance imaging (MRI) is recognized as the gold standard for the evaluation of augmented breasts. This article reviews the MRI features of different breast augmentation techniques, their associated complications, and the role of MRI in the assessment of concurrent breast abnormalities.

Teaching Points

• MRI has the highest sensitivity and specificity for implant rupture detection.

• MRI is able to discriminate the nature of implanted prosthesis or injected materials.

• Sensitivity of cancer detection by MRI is not reduced through implants.

Disparities in the use of screening magnetic resonance imaging of the breast in community practice by race, ethnicity, and socioeconomic status

BACKGROUND

Uptake of breast magnetic resonance imaging (MRI) coupled with breast cancer risk assessment offers the opportunity to tailor the benefits and harms of screening strategies for women with differing cancer risks. Despite the potential benefits, there is also concern for worsening population-based health disparities.

METHODS

Among 316,172 women aged 35 to 69 years from 5 Breast Cancer Surveillance Consortium registries (2007-2012), the authors examined 617,723 negative screening mammograms and 1047 screening MRIs. They examined the relative risks (RRs) of MRI use by women with a <20% lifetime breast cancer risk and RR in the absence of MRI use by women with a ≥20% lifetime risk.

RESULTS

Among women with a <20% lifetime risk of breast cancer, non-Hispanic white women were found to be 62% more likely than nonwhite women to undergo an MRI (95% confidence interval, 1.32-1.98). Of these women, those with an educational level of some college or technical school were 43% more likely and those who had at least a college degree were 132% more likely to receive an MRI compared with those with a high school education or less. Among women with a ≥20% lifetime risk, there was no statistically significant difference noted with regard to the use of screening MRI by race or ethnicity, but high-risk women with a high school education or less were less likely to undergo screening MRI than women who had graduated from college (RR, 0.40; 95% confidence interval, 0.25-0.63).

CONCLUSIONS

Uptake of screening MRI of the breast into clinical practice has the potential to worsen population-based health disparities. Policies beyond health insurance coverage should ensure that the use of this screening modality reflects evidence-based guidelines.

Managing the stigma: Exploring body image experiences and self-presentation among people with spinal cord injury

Using modified constructivist grounded theory, the purpose of this study was to explore body image experiences in people with spinal cord injury. Nine participants (five women, four men) varying in age (21-63 years), type of injury (C3-T7; complete and incomplete), and years post-injury (4-36 years) took part in semi-structured in-depth interviews. The following main categories were found: appearance, weight concerns, negative functional features, impact of others, body disconnection, hygiene and incontinence, and self-presentation. Findings have implications for the health and well-being of those living with a spinal cord injury.

Breast carcinoma in augmented breasts: MRI findings

OBJECTIVE

The objective of our study was to characterize the MRI features of breast carcinomas detected in augmented breasts.

MATERIALS AND METHODS

A review of the MRI database identified 54 patients with biopsy-proven breast carcinoma in augmented breasts. The images were reviewed for the type and location of the implant and for the characteristics of the carcinoma. The cases included 46 (85%) invasive cancers (invasive ductal carcinoma, n = 35; invasive lobular carcinoma, n = 7; and mixed features, n = 4) and eight (15%) ductal carcinomas in situ.

RESULTS

The median age of the patients at diagnosis was 49 years (range, 28-72 years). Thirty-eight of the 54 cancers (70%) were palpable. The mean tumor size was 2.8 cm (range, 0.6-9.6 cm). Of the 54 cancers, 34 (63%) presented as masses and 20 (37%) as nonmass enhancement on MRI. There was no detectable difference between implant position and lesion morphology (p = 0.55) or tumor size (p = 1.00). Twenty of 54 (37%) carcinomas abutted the implant, 13 (24%) abutted the pectoralis major muscle, and two (4%) invaded the pectoralis major muscle. Of the tumors abutting the implant, 18 of 20 (90%) spread along the implant capsule for more than 0.5 cm. This pattern of tumor spread was more common in breasts with retroglandular implants (9/16, 56%) than in those with retropectoral implants (9/38, 24%) (p = 0.03). MRI detected the index carcinoma in 16 of 54 (30%) cases, showed a greater extent of disease than was visible on mammography or ultrasound in 21 of 52 (40%) cases, and detected an unsuspected contralateral carcinoma in three of 54 (6%) cases.

CONCLUSION

In augmented breasts, breast cancer often contacts either the implant or the pectoralis major muscle. Tumor spread along the implant contour is more often seen with retroglandular implants than with retropectoral implants. MRI should be considered to assess disease extent in women with augmented breasts before surgery.

Update on imaging of the postsurgical breast

Oncologic, reconstructive, and cosmetic breast surgery has evolved in the last 20 years. Familiarity with cutting-edge surgical techniques and their imaging characteristics is essential for radiologic interpretation and may help avert false-positive imaging findings. Novel surgical techniques include skin- and nipple-sparing mastectomies, autologous free flaps, autologous fat grafting, and nipple-areola-complex breast reconstruction. These techniques are illustrated and compared with conventional surgical techniques, including modified radical mastectomy and autologous pedicled flaps. The role of magnetic resonance (MR) imaging in surgical planning, evaluation for complications, and postsurgical cancer detection is described. Breast reconstruction and augmentation using silicone gel-filled implants is discussed in light of the Food and Drug Administration's recommendation for MR imaging screening for "silent" implant rupture 3 years after implantation and every 2 years thereafter. Recent developments in skin incision techniques for reduction mammoplasty are presented. The effects of postsurgical changes on the detection of breast cancer are discussed by type of surgery.

Polyacrylamide gel breast augmentation: report of two cases and review of the literature

Polyacrylamide gel (PAAG) injection remains an uncommon method of breast augmentation. Providers must recognize the clinical and radiological manifestations to optimize management. The clinical and radiological findings of PAAG injection may mimic malignancy and silicone breast augmentation. We described two patients with prior PAAG breast augmentation with physical exam and imaging findings concerning for malignancy. We reviewed the literature on PAAG breast augmentation and compare PAAG to silicone breast augmentation. The management of such patients is discussed.

Magnetic resonance imaging of breast implants

Silicone breast implants have significantly evolved since their introduction half a century ago, yet implant rupture remains a common and expected complication, especially in patients with earlier-generation implants. Magnetic resonance imaging is the primary modality for assessing the integrity of silicone implants and has excellent sensitivity and specificity, and the Food and Drug Administration currently recommends periodic magnetic resonance imaging screening for silent silicone breast implant rupture. Familiarity with the types of silicone implants and potential complications is essential for the radiologist. Signs of intracapsular rupture include the noose, droplet, subcapsular line, and linguine signs. Signs of extracapsular rupture include herniation of silicone with a capsular defect and extruded silicone material. Specific sequences including water and silicone suppression are essential for distinguishing rupture from other pathologies and artifacts. Magnetic resonance imaging provides valuable information about the integrity of silicone implants and associated complications.

MR evaluation of breast implants

This article describes the rationale and indications for breast implant-related magnetic resonance (MR) imaging, alone or in combination with breast cancer-related MR imaging. Basic silicone chemistry, implant styles, and normal appearances of breast implants are described. The various presentations of breast implant rupture are described, and a 4-point staging scheme for intracapsular rupture is reviewed. Finally, a discussion of what the reviewing physician needs to know is presented, both before breast implant MR examinations are requested and afterward, when results are reported.

Breast care in the transgender individual

INTRODUCTION

Transgender individuals undergo hormone therapy and/or alter their breasts or genitals to facilitate a transition from male to female or female to male. Changes in the breast tissue from hormone therapy, breast binding, mastectomy, or breast augmentation are of specific interest to women's health care providers. To provide competent care, providers must be knowledgeable about unique aspects of breast health in this vulnerable population, including screening guidelines and client education. The purpose of this integrative literature review is to compile the current research on breast health for transgender individuals and to serve as a resource for providers.

METHODS

A search of the literature was performed using CINAHL, Ovid, and PubMed. Results were reviewed for relevant articles, and the reference lists of these were reviewed for additional resources. When available, studies specific to the transgender population are presented; studies of other populations are also included when relevant. Theories of human endocrinology, physiology, and anatomy will provide the foundation for the review and discussion.

RESULTS

Research into breast care for transgender individuals is limited. Often, practitioners must draw conclusions for practice from scattered case studies or research with nontransgender populations. Many of the procedures and practices transgender individuals choose to undergo, such as implantation, injection, binding, and mastectomy, carry serious risks.

DISCUSSION

Transgender individuals should be counseled on all the possible outcomes of their decisions, so they are capable of making informed choices. They must also be followed with careful consideration of these choices. More research in many areas of transgender breast care is necessary.

Mammographic density and estimation of breast cancer risk in intermediate risk population

It is not clear to what extent mammographic density represents a risk factor for breast cancer among women with moderate risk for disease. We conducted a population-based study to estimate the independent effect of breast density on breast cancer risk and to evaluate the potential of breast density as a marker of risk in an intermediate risk population. From November 2006 to April 2009, data that included American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) breast density categories and risk information were collected on 52,752 women aged 50-69 years without previously diagnosed breast cancer who underwent screening mammography examination. A total of 257 screen-detected breast cancers were identified. Logistic regression was used to assess the effect of breast density on breast carcinoma risk and to control for other risk factors. The risk increased with density and the odds ratio for breast cancer among women with dense breast (heterogeneously and extremely dense breast), was 1.9 (95% confidence interval, 1.3-2.8) compared with women with almost entirely fat breasts, after adjustment for age, body mass index, age at menarche, age at menopause, age at first childbirth, number of live births, use of oral contraceptive, family history of breast cancer, prior breast procedures, and hormone replacement therapy use that were all significantly related to breast density (p < 0.001). In multivariate model, breast cancer risk increased with age, body mass index, family history of breast cancer, prior breast procedure and breast density and decreased with number of live births. Our finding that mammographic density is an independent risk factor for breast cancer indicates the importance of breast density measurements for breast cancer risk assessment also in moderate risk populations.

The European Society of Breast Cancer Specialists recommendations for the management of young women with breast cancer

EUSOMA (The European Society of Breast Cancer Specialists) is committed to writing recommendations on different topics of breast cancer care which can be easily adopted and used by health professionals dedicated to the care of patients with breast cancer in their daily practice. In 2011, EUSOMA identified the management of young women with breast cancer as one of the hot topics for which a consensus among European experts was needed. Therefore, the society recently organised a workshop to define such recommendations. Thirteen experts from the different disciplines met for two days to discuss the topic. This international and multidisciplinary panel thoroughly reviewed the literature in order to prepare evidence-based recommendations. During the meeting, two working groups were set up to discuss in detail diagnosis and loco-regional and systemic treatments, including both group aspects of psychology and sexuality. The conclusions reached by the working groups were then discussed in a plenary session to reach panel consensus. Whenever possible, a measure of the level of evidence (LoE) from 1 (the highest) to 4 (the lowest) degree, based on the methodology proposed by the US Agency for Healthcare Research and Quality (AHRQ), was assigned to each recommendation. The present manuscript presents the recommendations of this consensus group for the management of young women with breast cancer in daily clinical practice.

Unilateral hydronephrosis and hydroureter by foreign body in urinary bladder: a case report

Foreign bodies inserted through the urethra are often found in the urinary bladder. We presently report the first case of hydronephrosis and hydroureter due to direct compression in the urinary bladder by silicon, which had been introduced by the patient himself 2 yr prior to presentation with severe right flank pain. Computed tomography indicated a convoluted, high-attenuation mass in the urinary bladder; unilateral hydronephrosis and hydroureter were also present due to direct compression by the mass. The foreign body was removed using a cystoscope. This foreign body was proven to be silicon.

[Special considerations in breast cancer treatment of an augmented breast]

Breast augmentation surgery involving the use of implants has been one of the most popular plastic surgical procedures for decades. As the multi-million female population who received breast implants ages, the risk of cancer is increasing rapidly, therefore the incidence of malignant disease in association with breast implants will increase as well. Although there is no relationship between tumor development and implants, these cases require special considerations in diagnostics, therapy and follow-up methods. Appropriate multidisciplinary treatment of tumors in augmented breasts corresponding with modern oncoplastic principles can only be accomplished based on adequate oncological, breast and plastic surgical knowledge. Supposing a possible increase of this condition in Hungary, too, authors provide a wide review of the literature on the special oncological and esthetic considerations, for the first time in Hungarian language.

Prosthetic breast implant rupture: imaging--pictorial essay

In recent years, requests for breast implant surgery have occurred for several reasons. First, the number of diagnosed breast cancer cases has increased, and the number of reconstructive surgeries consequently has multiplied. Second, the number of patients who constantly try to achieve a better physical shape, corresponding in Western countries to the common image of prosperous and tonic breasts, has proliferated. These circumstances have led to an increasingly frequent need for more accurate and sophisticated imaging methods to study prosthetic breast implants and their integrity. Diagnostic imaging for the study of patients with suspected breast implant ruptures uses different techniques of radiologic investigation such as mammography and ultrasonography, even if the current gold standard is magnetic resonance imaging (MRI). This study aimed to draw attention to the main MRI signs capable of highlighting contractures or ruptures of the implants that are not always clinically detectable and thus to provide plastic surgeons with an adequate instrument for discerning any possible alterations in prosthetic implants. Furthermore, it was necessary to stress the importance of teamwork. In fact, proper cooperation and coordination between radiologists and dedicated plastic surgeons are fundamental for the proper management of patients and the complications they may experience.