Silicone-selective multishot echo-planar imaging for rapid MRI survey of breast implants

Complicated breast augmentation via self-injection of ultrasound gel and shoe glue: A case report

Various types of dermal fillers have been developing for soft tissue augmentation. Even though many fillers have been approved and strictly regulated by authorities, homemade products for body contouring procedures are widely available and easily purchased on websites without prescriptions. It is challenging for radiologists to interpret radiological findings of complicated breast augmentation of unknown origin. While ultrasound is the modality of choice for initial work-up, magnetic resonance imaging (MRI) plays a role as the gold standard in evaluating the integrity of prosthetic implants. Using silicone or water-only MRI sequences may also be able to distinguish them. We report a rare case of breast abscess of a young female patient after self-injection of the mixture of ultrasound gel and shoe glue. The clinical and imaging aspect, especially MRI imaging, will be discussed.

MRI for Evaluation of Complications of Breast Augmentation

Breast augmentation is one of the most common aesthetic procedures performed in the United States. Several techniques of breast augmentation have been developed, including the implantation of breast prostheses and the injection of autologous fat and other materials. The most common method of breast augmentation is to implant a prosthesis. There are different types of breast implants that vary in shape, composition, and the number of lumina. The rupture of breast implants is the leading cause of implant removal. The rupture rate increases substantially with the increasing age of the implant. Most implant ruptures are asymptomatic. Implant complications can be grouped into two categories: local complications in the breast and adjacent soft tissue, and systemic complications associated with rheumatologic or neurologic symptoms. The onset of local complications may be early (infection and periprosthetic collections including seromas, hematomas, or abscesses) or late (capsular contraction, implant rupture, gel bleed, or breast implant-associated anaplastic large cell lymphoma). Although mammography is the imaging modality for breast cancer screening, noncontrast breast MRI is the imaging modality of choice for evaluation of the integrity of breast implants and the complications of breast augmentation, for equivocal findings at conventional imaging, and as a supplement to mammography in patients with free injectable materials. The fifth edition of the Breast Imaging Reporting and Data System (BI-RADS) provides a systematic outline for MRI evaluation of patients with breast implants. Silicone- and water-selective sequences provide useful supplemental information to confirm intracapsular and extracapsular rupture. Breast MRI for evaluation of implant integrity does not require intravenous contrast material. The use of MRI contrast material in patients with breast augmentation is indicated when infection or malignancy is suspected. Radiologists should have a thorough understanding of the different techniques for breast augmentation, normal imaging features, and complications specific to breast augmentation. An invited commentary by Ojeda-Fournier is available online. ^©RSNA, 2022.

The Value of Ultrasound in the Evaluation of the Integrity of Silicone Breast Implants

Background and Objective: Breast implant surgery for cosmetic purposes is the most popular plastic surgery and it has been performed for over 100 years. Rupture of silicone gel-filled breast implants usually is asymptomatic and is one of the more dangerous complications due to free silicone migration. The aim of our study was to evaluate the diagnostic value of ultrasound (US) in the evaluation of the integrity of silicone breast implants and identify the main sign of intact and ruptured breast implants. Patients and Methods: In this retrospective study, the medical documentation of women who underwent breast implant surgery and US checkups at Tautrimas Aštrauskas Clinic in Kaunas, Lithuania, during 2015–2020 was analyzed. The patients were divided into two groups: patients with intact and ruptured breast implants. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) as well as the signs of implant integrity of US examination were evaluated. Results: In this study, 76 women with bilateral breast implants (n = 152) were reviewed. On a US examination, ruptured implants were found in 41.1% (n = 61) of the cases; of them, 78.7% (n = 48) of the cases had ≥2 US signs of a ruptured implant, and in all these cases, implant rupture was confirmed at surgery. Overall, one US sign of a ruptured implant was found in 21.3% (n = 13) of the cases. Of them, inhomogeneous content in all cases (n = 3) was found in the intact implant group, and an abnormal implant shell was documented more often in the ruptured implant group, not intact one (n = 9, 90% vs. n = 1, 10%). US had a diagnostic accuracy of 94.7%, sensitivity of 98.3%, specificity of 89.2%, PPV of 93.4%, and NPV of 97.1% in the evaluation of implant integrity. Conclusions: Our results show that US is a very reliable alternative in evaluating breast implant integrity and could be the investigation of choice for implant rupture, while MRI could be advocated only in inconclusive cases. Uneven implant shell was found to be the most important US sign of breast implant rupture. Based on the findings, we recommend performing US examination after breast augmentation surgery with silicone gel-filled implants annually.

A review of data in medical request and the patient questionnaire for magnetic resonance evaluation of silicone breast implants

Objective

To analyze the quality and quantity of data in the questionnaires and in request forms for magnetic resonance imaging.

Methods

This retrospective study was conducted with data from 300 medical records. The research used the following data from the questionnaires: patient age, reason for the magnetic resonance imaging, reason for placing the breast implant, report of any signs or symptoms, time elapsed since surgery to place the current breast implant, replacement implant surgery, chemotherapy, and/or radiation therapy treatments. From the magnetic resonance imaging request forms, information about the breast implant, the implant placement surgery, patient clinical information and ordering physician specialty were verified.

Results

The mean age of patients was 48.8 years, and the mean time elapsed since breast implant surgery was 5 years. A total of 60% of women in the sample were submitted to aesthetic surgery, while 23.7% were submitted to chemotherapy and/or radiation therapy. In the request forms, 23.7% of physicians added some piece of information about the patient, whereas 2.3% of them informed the type of implant and 5.2% informed about the surgery.

Conclusion

The amount of information in the magnetic resonance imaging request forms is very limited, and this may hinder quality of radiological reports. Institutional and technological measures should be implemented to encourage the requesting physicians and radiologists to share information.

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

The number of women undergoing breast implant procedures is increasing exponentially. It is, therefore, imperative for a radiologist to be familiar with the normal and abnormal imaging appearances of common breast implants. Diagnostic imaging studies such as mammography, ultrasonography, and magnetic resonance imaging are used to evaluate implant integrity, detect abnormalities of the implant and its surrounding capsule, and detect breast conditions unrelated to implants. Magnetic resonance imaging of silicone breast implants, with its high sensitivity and specificity for detecting implant rupture, is the most reliable modality to asses implant integrity. Whichever imaging modality is used, the overall aim of imaging breast implants is to provide the pertinent information about implant integrity, detect implant failures, and to detect breast conditions unrelated to the implants, such as cancer.

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.

Imaging of breast implants-a pictorial review

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 well-known 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 cancer.