Fundamentals of High-Resolution Ultrasound in Breast Implant Screening for Plastic Surgeons

Anatomical Breast Implant Assessment Using Ultrasound: A Case Series from the International Breast Implant Check Clinic

Background

Breast augmentation with anatomic implants can achieve a natural look, but over time, implant-related complications can occur. This includes a risk of potential rotation, which can cause a change in breast shape. Reported rates of rotation vary widely (0%-42%). Implant rotation is often detected by physical examination only or as a perioperative finding. Change in breast shape after augmentation requires clinical evaluation. In-office ultrasound allows for detailed assessment of implants for rotation and other complications.

Methods

Women with anatomical breast implants seeking follow-up at the International Breast Implant Check Clinic in Stockholm, Sweden, from April 2020 to July 2022 were included in the study. Using a standardized protocol, subjective symptoms were recorded, and a physical examination followed by an ultrasound assessment was performed by a single board-certified plastic surgeon (M.J.) trained in implant assessment via ultrasound. Rotation was defined as an implant rotated past 30 degrees off the breast midline at 6 o'clock.

Results

The study included 308 women (mean age 40.1, range 20-78) with bilateral anatomical implants. Overall, 40 women (13.0%) reported a change in breast shape; 35 had one or more implant-related complications, including five with rotation on ultrasound. Of the 308 women, 11 (3.6%) had rotations upon physical examination, and an additional 10 cases were identified using ultrasound.

Conclusions

Rotation is a potential complication of anatomical breast implants. However, in this study, change in breast shape was more commonly caused by other implant-related complications. Ultrasound is a valuable tool in evaluating causes of change in breast shape.

[Reliable diagnosis of implant rotation in high-resolution ultrasound depending on the implant manufacturer]

Rotation of an anatomical breast implant may require revisional surgery. High-resolution ultrasound can help determine the exact implant alignment. However, the directional markings of anatomical implants are implemented very inconsistently by manufacturers. Therefore, a definite diagnosis is often not possible without precise knowledge of the expected imaging. The aim of this work is a differentiation of the imaging of common implant brands in high-resolution ultrasound. Methods To simulate an authentic imaging, anatomical implants were viewed through abdominal skin thinned to 1.5-2 cm, which was obtained during a classic abdominoplasty. Implants from the companies Allergan, Eurosilicone, Mentor, Motiva, Nagor, Polytech and Sebbin were compared. The marking positions and dimensions were documented by ultrasound. Results Based on placement and shape, a clear allocation between alignment and manufacturer is basically possible among the implants used. The base plate and caudal markers could be clearly visualised for all brands. In Polytech implants, however, the visible structural change is limited to a very small central area. The visualisation of directional marks, base plate and implant shell also allow conclusions to be drawn about the manufacturer. In high-resolution ultrasound, a fast and reliable diagnosis of implant alignment is possible for all implants examined. Also it was possible to make a clear allocation between implant and manufacturer in this context. Flip over of the implant can also be reliably depicted. The cataloguing of the markings summarised here can be used to determine the exact alignment of the implant and thus provide diagnostic certainty, especially if the brand is unknown.

A Surgeon's Empirical Perspectives on Use of High-resolution Ultrasound in Preoperatively Detecting a Rupture in the Context of Breast Implant Crisis in Korea

BACKGROUND

We previously proposed a novel method for detecting a rupture of a breast implant using high-resolution ultrasound (HRUS). We therefore conducted this retrospective, observational study to describe its feasibility in making a preoperative diagnosis of rupture of the device in patients receiving an implant-based augmentation mammaplasty.

METHODS

We initially evaluated the medical records of the patients who had received primary or secondary augmentation mammaplasty using a breast implant at other hospitals for aesthetic or reconstructive purposes between August 31, 2017, and August 31, 2020. The patients underwent breast US using the Aplio i600 (Canon Medical System, Otawara, Tochigi, Japan) system with a 7-18 MHz linear transducer. Through a retrospective review of the patients' medical records, we analyzed their baseline and clinical characteristics. Then, we compared an agreement between preoperative diagnosis of rupture on HRUS and findings at reoperation.

RESULTS

A total of 29 patients with rupture (55 breasts) were evaluated for the performance of ultrasound in making a diagnosis of rupture. This showed that they were unaware of rupture but they were diagnosed with it on ultrasound. Preoperatively, there were no cases of rupture in 110 left breasts (80.9%) and 107 right breasts (78.7%), which exactly matched to the number of breasts without rupture on HRUS. Moreover, preoperatively, there were 26 (19.1%) and 29 cases (21.3%) of rupture in the left and right breast, respectively, which exactly matched to the number of breasts with rupture on HRUS.

CONCLUSIONS

In conclusion, patients who are suspected of having rupture of a breast implant should be stringently evaluated for presence of rupture and, if any, its scope using HRUS. Moreover, we propose that surgeons consider using HRUS in making a preoperative diagnosis of rupture of a breast implant.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Role of High Resolution Ultrasonography in Elucidating Features of the Breast Implants in Asymptomatic Patients After Implant-based Augmentation Mammaplasty

BACKGROUND

We conducted this study to describe the feasibility of high-resolution ultrasound (HRUS) in characterizing a breast implant in patients receiving an implant-based augmentation mammaplasty.

METHODS

The current study was conducted in a total of 612 patients (n =6 12) receiving an implant-based augmentation mammaplasty at other hospitals between August 31, 2017 and August 31, 2020. Of these, 136 patients (n = 136; 272 breasts) receiving reoperation were included in the current study. We compared between the patients' subjective awareness of a breast implant and its HRUS findings and an agreement between HRUS findings of a breast implant and its findings at reoperation.

RESULTS

The proportion of the patients receiving a silicone gel-filled breast implant was increased from 65.44% (89/136) to 81.61% (111/136) on HRUS. Moreover, HRUS was effective in identifying a manufacturer of the device.

CONCLUSIONS

In conclusion, our results indicate that HRUS is feasible in characterizing a breast implant in patients receiving an implant-based augmentation mammaplasty. But further prospective, large-scale studies are warranted to corroborate our results.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors. www.springer.com/00266 .

Defining Internal Tissue Closure: High-Resolution Ultrasound Evaluation of Interi-A Novel Internal Tissue Closure System

Background

Seroma remains a leading postsurgical complication in plastic surgery. Conventional drains are ineffective in clearing blood and fluid and closing down surgical spaces. The Interi (Internal Closure System, IC Surgical, Grand Rapids, MI) is comprised of a novel branching internal manifold attached to a self-contained portable pump with a higher, consistent, continuous negative pressure, may reduce this long-standing issue. In addition, high-resolution ultrasound (HRUS) has emerged as an ideal tool to visualize structures, fluid collections, and seromas internally.

Objectives

This study evaluates Interi in full abdominoplasty patients utilizing HRUS to evaluate Interi's ability to evacuate blood and fluid, hold internal tissues together and document, for the first time, what internal tissue healing actually looks like radiographically.

Methods

An IRB approved, Contract Research Organization reviewed retrospective study evaluated consecutive patients undergoing full abdominoplasty utilizing Interi from July 2020 through March 2021 by three plastic surgeons. HRUS visualized and confirmed the presence or absence of fluid collections and healing tissue planes during the postoperative process. Study data and all adverse events were recorded, with HRUS images reviewed by investigators and confirmed by an independent radiologist.

Results

Seventy-one Interi patients were enrolled. Mean age was 43 (range: 21-74) and BMI was 28. Seroma was confirmed clinically and through HRUS in 3/71 patients, and was associated with either clot (2) or failure to activate system (1). Interi's ability to eliminate fluid and approximate/hold surgical tissue planes together was confirmed with HRUS. No other major complications, including abscess, hematomas, or flap necrosis were observed.

Conclusions

This novel Internal Tissue Closure System effectively evacuated blood and fluid, approximated and maintained closure of internal tissue planes in abdominoplasty patients, allowing for primary tissue healing and internal wound closure to occur. Healing tissue planes and any fluid present are easily identified on HRUS visualizing actual internal tissue healing with a simple, widely available radiographic scan.

Level of Evidence 3