Mammography: breast implants--types, complications, and adjacent breast pathology

Medical Imaging of Inflammations and Infections of Breast Implants

Breast implants are widely used for reconstructive and/or cosmetic purposes. Inflammations and infections of breast implants represent important complications in clinical practice. The proper management of complications is necessary: diagnostic imaging plays a key role in detecting sites of inflammation and/or infection. The present review aims to illustrate the radiological findings of these conditions with different imaging techniques, such as mammography (MX), ultrasound (US), magnetic resonance imaging (MRI), and nuclear medicine imaging. A knowledge of these findings is essential for radiologists and nuclear medicine physicians to provide helpful information for the clinical management of these complications.

A case report of breast cancer in silicone-injected breasts diagnosed by an emerging technique of contrast-enhanced mammography-guided biopsy

Background

Breast cancer in silicone-injected breasts is often obscured in conventional mammography and sonography. Contrast-enhanced magnetic resonance imaging (CE-MRI) is an optimal modality for cancer detection. This case report demonstrates the use of contrast-enhanced spectral mammography (CESM) and CESM-guided biopsy (CESM-Bx) to diagnose breast cancer in silicone-injected breasts. However, there is no relevant report in the literature.

Case Presentation

A 59-year-old woman who received a liquid silicone injection for breast augmentation 30 years ago was transferred to our hospital for a CE-MRI-guided biopsy due to a suspicion of cancer in her right breast. The CE-MRI showed a 3.1-cm irregular enhanced mass and a 1.1-cm circumscribe mass in the upper outer quadrant of the right breast. Unfortunately, the CE-MRI-guided biopsy had to wait for 1 month due to a busy schedule. The CESM revealed two masses that were consistent with CE-MRI findings. CESM-Bx was performed, and the patient was diagnosed with invasive lobular carcinoma with an irregular mass and fibroadenoma of the circumscribed mass. The patient underwent substantial surgery.

Conclusions

CESM-Bx is a simple emerging technique that can be used feasibly to obtain tissue proof on the concerned enhanced lesion on CESM. In such cases of silicone-injected breasts, the CESM-Bx can be used as an alternative to MRI-guided biopsy for cancer diagnosis.

Breast carcinoma originating from a silicone granuloma: a case report

Breast carcinoma rarely occurs in cases of foreign body granulomas following liquid silicone injection. Although the Food and Drug Administration (FDA) banned the use of all silicone injection products in 1992, liquid silicone injection for breast augmentation continues to be performed illegally. We herein report a case of breast carcinoma following liquid silicone injection in a 67-year-old female.

A total of 45 years after liquid silicone injection, the patient had felt a breast mass in the right breast. Mammography showed a smooth mass that retracted the right nipple. Due to the presence of a marked acoustic shadow caused by the granulomas, evaluating the mass on ultrasonography was difficult. However, magnetic resonance imaging (MRI) showed a lobulated mass under the right nipple. The mass exhibited low signal intensity (SI) on T1-weighted images and intermingled high and low SI on T2-weighted images. Heterogeneous early enhancement with central low intensity was noted on dynamic contrast-enhanced MRI. Several oval-shaped low SI structures in the adipose tissue and disruption of the pectoralis major muscle were also observed. We diagnosed the patient with invasive ductal carcinoma based on a stereotactic-guided Mammotome® (a vacuum-assisted biopsy system manufactured by DEVICOR MEDICAL JAPAN, Tokyo, Japan) biopsy and subsequently performed mastectomy and axillary lymph node dissection (with a positive result for the sentinel node biopsy). Histologically, invasive ductal carcinoma was observed in the silicone granuloma.

The development of foreign body granulomas following breast augmentation usually makes it difficult to detect breast cancer; thus, various devices are required to confirm the histological diagnosis of breast lesions. The stereotactic-guided Mammotome® biopsy system may be an effective device for diagnosing breast cancer developing in the augmented breast.

Enhanced MRI and MRI-guided interventional procedures in women with asymptomatic silicone-injected breasts

Asymptomatic women who have received silicone injection for breast augmentation have a risk of underestimating breast cancer by palpation, mammography, or breast sonography. Enhanced breast MRI is sensitive to display certain nonspecific enhanced lesions or suspicious lesions. Such nonspecific MRI-detected lesions could be managed by American College Radiology BI-RADS lexicon and selectively with MRI-guided techniques biopsy to prevent unnecessary surgery.

[Sequelae after illegal injection of liquid silicone for breast augmentation: report of two cases]

The use of liquid silicone for breast augmentation was widespread in the 1960s but was abandoned at the end of the decade due to numerous studies describing the development of a large number of local complications, as well as remote migration of small amounts of silicone. The use of liquid silicone also leads to enormous difficulty in the early diagnosis of breast cancer; these patients are precluded from routine screening programs and must undergo exhaustive periodic examinations. Magnetic resonance imaging has become the most effective test for the early detection of breast cancer in these patients. Indications for subcutaneous mastectomy are the presence of local complications, suspicion of a malignant lesion, or the patient's desire to prevent both these potential problems.

Sonographic features with histologic correlation in two cases of palpable breast cancer after breast augmentation by liquid silicone injection

Sonography is rarely used to evaluate the breasts in patients who have undergone liquid silicone injections for breast augmentation because strong acoustic shadowing from the resulting silicone granulomas hampers the examination. We report on 2 patients who underwent silicone injection 18 and 20 years earlier and in whom breast cancers (1 invasive ductal carcinoma and 1 carcinosarcoma) were diagnosed by sonographically guided core-needle biopsy. On sonograms, both cancers had a peripheral hypoechoic rim surrounding an echogenic center. The echogenic center corresponded histologically to a silicone granuloma in 1 patient and to a large area of necrosis in the other; the hypoechoic rims corresponded to areas of cancer in both patients.

Lumpy silicone-injected breasts: enhanced MRI and microscopic correlation

Clinical images emphasizing on magnetic resonance imaging (MRI) characteristics of silicone-injected breasts with microscopic correlation were presented. A total of 16 patients with a history of silicone injection breast augmentation received MRI examinations due to palpable masses were reviewed. MRI enables the demonstration of the characteristic MR intensities in silicone-injected breasts. Four breast cancers were accurately detected by the enhancement technique including the cancers admixing within the fibrosis and silicone granuloma. This article can document the excellent ability of MRI with high microscopic correlation in examining these clinical, mammographic and ultrasonographic difficult cases. Understanding the MRI features is helpful to approach these patients. On the other hand, these illustrations indicated the importance of enhancement technique in detecting the cancers and in differentiating the angiogenic lesions from nonenhanced silicone granulomas.

Silicone breast implant rupture: pitfalls of magnetic resonance imaging and relative efficacies of magnetic resonance, mammography, and ultrasound

The objective of this study was to evaluate the relative efficacies of magnetic resonance (MR) imaging, ultrasonography, and mammography in implant rupture detection and to illustrate pitfalls in MR image interpretation. Thirty patients referred by plastic surgeons with suspected breast implant rupture were prospectively evaluated using MR, ultrasonography, and mammography. Imaging examinations were interpreted independently and blindly for implant rupture and correlated to operative findings. Surgical correlation in 16 patients (53 percent) with 31 implants showed 13 (42 percent) were intact, 5 (16 percent) had severe gel bleed, and 13 (42 percent) were ruptured. MR sensitivity was 100 percent and specificity was 63 percent. Accuracy for rupture was 81 percent with MR, higher than with ultrasonography and mammography (77 and 59 percent, respectively). We describe a specific pitfall in MR interpretation, the "rat-tail" sign, composed of a medial linear extension of silicone along the chest wall. Seen in eight cases (four intact, three ruptures, one gel bleed), the rat-tail sign may lead to misdiagnosis of implant rupture if seen in isolation. Magnetic resonance imaging is more accurate and sensitive than ultrasonography and mammography in detecting breast implant rupture. We describe a new sign (rat-tail sign) composed of medial compression of the implant simulating silicone extrusion as a potential false-positive MR finding for rupture. This article presents clinical experience with magnetic resonance, mammography, and ultrasound in the diagnosis of implant rupture and defines and illustrates potential pitfalls of MR interpretation, including the new rat-tail sign.