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Kim JH, Kim YG, Song KY, Lim HG, Jeong JP, Sung JY, Lee AS, Park HK. Exploration of Point-of-Care Ultrasonography for Silicone Breast Implant Rupture Detection and Classification. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:306. [PMID: 38399593 PMCID: PMC10890578 DOI: 10.3390/medicina60020306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/21/2023] [Accepted: 02/08/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: The surge in breast-related surgeries in Korea underscores the critical need for an accurate early diagnosis of silicone breast implant-related issues. Complications such as BIA-ALCL and BIA-SCC add complexity to breast health concerns, necessitating vigilant monitoring. Despite advancements, discrepancies persist between ultrasonographic and pathologic classifications of silicone implant ruptures, highlighting a need for enhanced diagnostic tools. This study explores the reliability of ultrasonography in diagnosing silicone breast implant ruptures and determining the extent of silicone migration, specifically with a focus on guiding potential capsulectomy based on pathology. Materials and Methods: A comprehensive review of medical records encompassing 5557 breast implants across 2790 patients who underwent ultrasound-assisted examinations was conducted. Among the screened implants, 8.9% (249 cases) were diagnosed with silicone breast implant rupture through ultrasonography. Subsequently, 89 women underwent revisional surgery, involving capsulectomy. The pathological analysis of 111 periprosthetic capsules from these cases aimed to assess the extent of silicone migration, and the findings were juxtaposed with the existing ultrasonographic rupture classification. Results: The diagnostic agreement between preoperative sonography and postoperative findings reached 100% for silicone breast implant ruptures. All eighty prosthetic capsules exhibiting a snowstorm sign in ultrasonography demonstrated silicone migration to capsules upon pathologic findings. Conclusions: High-resolution ultrasonography emerged as a valuable and reliable imaging modality for diagnosing silicone breast implant ruptures, with a notable ability to ascertain the extent of free silicone migration to capsules. This diagnostic precision is pivotal in informing decisions about potential capsulectomy during revisional surgery. The study advocates for an update to the current binary ultrasonographic classification, suggesting a more nuanced categorization into three types (subcapsular, intracapsular, and extracapsular) based on pathology.
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Affiliation(s)
| | - Yun-Gyoung Kim
- Department of Surgery, Bundang Jesaeng General Hospital, Seongnam 13590, Republic of Korea
| | - Keun-Yeong Song
- Department of Breast Surgery, Gwangju Suwan Hospital, Gwangju 62247, Republic of Korea
| | - Hyung-Guhn Lim
- Department of Radiology, Gwangju Suwan Hospital, Gwangju 62247, Republic of Korea
| | | | - Jung-Youp Sung
- BBC Plastic Surgery Clinic, Changwon 51209, Republic of Korea
| | - Angela-Soeun Lee
- Korean Society of Breast Implant Research, Seoul 03186, Republic of Korea
| | - Heung-Kyu Park
- Department of Surgery, Breast Cancer Center, Gachon University Gil Medical Center, 21, Namdong-daero 774beon-gil, Namdong-gu, Incheon 21565, Republic of Korea
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Chetlen A, Niell BL, Brown A, Baskies AM, Battaglia T, Chen A, Jochelson MS, Klein KA, Malak SF, Mehta TS, Sinha I, Tuscano DS, Ulaner GA, Slanetz PJ. ACR Appropriateness Criteria® Breast Implant Evaluation: 2023 Update. J Am Coll Radiol 2023; 20:S329-S350. [PMID: 38040459 DOI: 10.1016/j.jacr.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
This document discusses the appropriate initial imaging in both asymptomatic and symptomatic patients with breast implants. For asymptomatic patients with saline implants, no imaging is recommended. If concern for rupture exists, ultrasound is usually appropriate though saline rupture is often clinically evident. The FDA recently recommended patients have an initial ultrasound or MRI examination 5 to 6 years after initial silicone implant surgery and then every 2 to 3 years thereafter. In a patient with unexplained axillary adenopathy with current or prior silicone breast implants, ultrasound and/or mammography are usually appropriate, depending on age. In a patient with concern for silicone implant rupture, ultrasound or MRI without contrast is usually appropriate. In the setting of a patient with breast implants and possible implant-associated anaplastic large cell lymphoma, ultrasound is usually appropriate as the initial imaging. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Alison Chetlen
- Penn State Health Hershey Medical Center, Hershey, Pennsylvania.
| | - Bethany L Niell
- Panel Chair, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Ann Brown
- Panel Vice-Chair, University of Cincinnati, Cincinnati, Ohio
| | - Arnold M Baskies
- Virtua Willingboro Hospital, Willingboro, New Jersey; American College of Surgeons
| | - Tracy Battaglia
- Boston University Schools of Medicine and Public Health, Boston, Massachusetts, Primary care physician
| | - Andrew Chen
- University of Connecticut School of Medicine, Farmington, Connecticut; American Society of Plastic Surgeons
| | | | | | | | - Tejas S Mehta
- UMass Memorial Medical Center/UMass Chan Medical School, Worcester, Massachusetts
| | - Indranil Sinha
- Harvard Medical School, Boston, Massachusetts; American Geriatrics Society
| | | | - Gary A Ulaner
- Hoag Family Cancer Institute, Newport Beach, California, and University of Southern California, Los Angeles, California; Commission on Nuclear Medicine and Molecular Imaging
| | - Priscilla J Slanetz
- Specialty Chair, Boston University School of Medicine, Boston, Massachusetts
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3
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Wu HH, Weng YT, Chou YY, Wang CH. Rupture of 40-year-old silicone gel breast implants: a case report. BMC Geriatr 2023; 23:589. [PMID: 37742002 PMCID: PMC10517471 DOI: 10.1186/s12877-023-04293-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 09/08/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Implant rupture is one of the complications of breast augmentation surgery. The rupture of silicone implants is often insidious, potentially causing problems at any time. This is a case report of the rupture of 145-cc breast implants manufactured by Dow Corning Corporation and their removal at 40 years after augmentation. CASE PRESENTATION A 70-year-old female patient was admitted for the removal of a lump in the upper and inner quadrants of the right breast. After a detailed examination, a rupture of the bilateral breast implants was diagnosed. Explantation without replacement was performed; the entire procedure proceeded smoothly. Immunohistochemical staining revealed siliconoma with lymphoid hyperplasia and calcification in the bilateral breasts with no signs of malignancy. CONCLUSIONS Silicone breast augmentation is one of the most popular aesthetic surgical procedures worldwide. Therefore, it is important to educate patients on the need for close monitoring of their implants after augmentation through magnetic resonance imaging or ultrasound to facilitate early detection of any changes before a rupture occurs. Early detection of the implant rupture, in turn, will facilitate early and effective management.
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Affiliation(s)
- Hsin-Hsuan Wu
- Department of General Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, 114, Taiwan.
| | - Yu-Tse Weng
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, 114, Taiwan
| | - Yu-Yu Chou
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, 114, Taiwan
| | - Chih-Hsin Wang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, 114, Taiwan
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Montemurro P, Pellegatta T, Burton H, Pafitanis G. Silicone Migration From Breast Implants: A Case of Ocular Siliconoma and Literature Review. Aesthet Surg J 2023; 43:972-977. [PMID: 36991214 DOI: 10.1093/asj/sjad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Breast augmentation with implants is one of the most popular cosmetic surgery operations performed worldwide. Complications of breast implants are well recognized, and include capsular contracture, implant rupture, and infrequently distant migration of silicone, resulting in siliconoma. Distant migration of silicone can present many years after implantation with a wide variety of signs and symptoms. OBJECTIVES The aim of this study was to describe the authors' experience of orbital silicone migration and to review the literature describing documented cases of distant silicon migration from breast implants, both ocular and nonocular. METHODS In January 2022, a case of breast implant augmentation presented with silicone migration into the right orbit. This rare case was monitored and diagnosed with ocular muscle palsy and diplopia. Here, the authors present the patient's presenting complaint, symptomatology, working investigations, and outcomes. A comprehensive report of all available cases of distant silicone migration is presented along with their associated complications and more specifically ocular silicone migration. RESULTS Systemic migration of silicone from breast implants to the orbital region is extremely rare: a total of 4 previous cases of ocular silicone migration from breast implants have been described previously; the authors describe the fifth case herein. CONCLUSIONS Silicone implant rupture can present with a wide variety of clinical symptoms that may mimic different clinical pathologies. In every patient with a history of breast augmentation with silicone implants, the possibility of silicone migration should be always taken into consideration during the differential diagnosis process. LEVEL OF EVIDENCE: 5
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Kim HB, Han HH, Eom JS. Magnetic Resonance Imaging Surveillance Study of Silicone Implant-based Breast Reconstruction: A Retrospective Observational Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5031. [PMID: 37305200 PMCID: PMC10256406 DOI: 10.1097/gox.0000000000005031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/06/2023] [Indexed: 06/13/2023]
Abstract
This study aimed to evaluate the results of magnetic resonance imaging (MRI) surveillance of implant-based breast reconstruction in patients with breast cancer. Methods This retrospective observational study analyzed patients who underwent implant-based breast reconstruction and MRI surveillance by a single surgeon from March 2011 to December 2018, in a single center. All patients were informed about the recommendation of the Food and Drug Administration for MRI surveillance, and they choose to undergo MRI 3 years after surgery. Results The compliance rate for MRI surveillance was 56.5% (169/299). MRI surveillance was performed at a mean of 45.8 (4.04 years) ± 11.5 months after surgery. One patient (0.6%) showed an abnormal finding of an intracapsular rupture of the silicone implant. Conclusions MRI surveillance for implant rupture in implant-based breast reconstruction showed a low incidence of silent implant rupture (0.6%), whereas the compliance of MRI was relatively high (56.5%). These results raise questions about whether taking an MRI in 3-4 years is suitable for imaging surveillance of breast silicone implants. Screening recommendations should be more evidence-based, and more studies are needed to prevent unnecessary screening and patient burden.
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Affiliation(s)
- Hyung Bae Kim
- From the Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyun Ho Han
- From the Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin Sup Eom
- From the Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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6
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Ojeda-Fournier H. Invited Commentary: High-Quality MRI after Breast Augmentation. Radiographics 2022; 42:E113-E114. [PMID: 35559664 DOI: 10.1148/rg.210215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Haydee Ojeda-Fournier
- From the Division of Breast Imaging, University of California, San Diego Health, Koman Family Outpatient Pavilion, 9400 Campus Point Dr, La Jolla, CA 92037
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Santanelli di Pompeo F, Clemens MW, Atlan M, Botti G, Cordeiro PG, De Jong D, Di Napoli A, Hammond D, Haymaker CL, Horwitz SM, Hunt K, Lennox P, Mallucci P, Miranda RN, Munhoz AM, Swanson E, Turner SD, Firmani G, Sorotos M. 2022 Practice Recommendation Updates From the World Consensus Conference on BIA-ALCL. Aesthet Surg J 2022; 42:1262-1278. [PMID: 35639805 PMCID: PMC9924046 DOI: 10.1093/asj/sjac133] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Laboratory and clinical research on breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is rapidly evolving. Changes in standard of care and insights into best practice were recently presented at the 3rd World Consensus Conference on BIA-ALCL. OBJECTIVES The authors sought to provide practice recommendations from a consensus of experts, supplemented with a literature review regarding epidemiology, etiology, pathogenesis, diagnosis, treatment, socio-psychological aspects, and international authority guidance. METHODS A literature search of all manuscripts between 1997 and August 2021 for the above areas of BIA-ALCL was conducted with the PubMed database. Manuscripts in different languages, on non-human subjects, and/or discussing conditions separate from BIA-ALCL were excluded. The study was conducted employing the Delphi process, gathering 18 experts panelists and utilizing email-based questionnaires to record the level of agreement with each statement by applying a 5-point Likert Scale. Median response, interquartile range, and comments were employed to accept, reject, or revise each statement. RESULTS The literature search initially yielded 764 manuscripts, of which 405 were discarded. From the remaining 359, only 218 were included in the review and utilized to prepare 36 statements subdivided into 5 sections. After 1 round, panelists agreed on all criteria. CONCLUSIONS BIA-ALCL is uncommon and still largely underreported. Mandatory implant registries and actions by regulatory authorities are needed to better understand disease epidemiology and address initial lymphomagenesis and progression. Deviation from current diagnosis and treatment protocols can lead to disease recurrence, and research on breast implant risk factors provide insight to etiology. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Fabio Santanelli di Pompeo
- Corresponding Author: Prof Fabio Santanelli di Pompeo, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sant’Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy. E-mail: ; Instagram: @diepflap.it
| | - Mark W Clemens
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA and is a Breast Surgery section editor for Aesthetic Surgery Journal
| | - Michael Atlan
- Aesthetic Plastic Reconstructive Unit/CHU TENON PARIS—APHP, Université Pierre et Marie Curie, Paris, France
| | | | - Peter G Cordeiro
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Daphne De Jong
- Amsterdam UMC-Vrije Universiteit Amsterdam, Department of Pathology and Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Arianna Di Napoli
- Pathology Unit, Department of Clinical and Molecular Medicine, Sapienza University, Sant’Andrea Hospital, Rome, Italy
| | | | - Cara L Haymaker
- Department of Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven M Horwitz
- Lymphoma Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Kelly Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peter Lennox
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, BC, Canada and is a clinical editor for Aesthetic Surgery Journal
| | | | - Roberto N Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alexandre M Munhoz
- Plastic Surgery Department, Hospital Moriah, Hospital Sírio-Libanês, Higienópolis, São Paulo, Brazil
| | | | - Suzanne D Turner
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Guido Firmani
- Faculty of Medicine and Psychology, Sapienza University of Rome, Department of Plastic Surgery, Sant’Andrea Hospital, Rome, Italy
| | - Michail Sorotos
- Faculty of Medicine and Psychology, Sapienza University of Rome, Department NESMOS, Sant’Andrea Hospital, Rome, Italy
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Celik L, Gunes G. Is It Possible To Differentiate Types Of Breast Implants By Imaging In The Era Of Implant Associated Lymphoma? Curr Med Imaging 2022; 18:1135-1139. [PMID: 35410617 DOI: 10.2174/1573405618666220411083530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/13/2022] [Accepted: 01/28/2022] [Indexed: 11/22/2022]
Abstract
Objectives Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) has been recognised in the latest years and there is an ongoing extensive research. Although the exact mechanism and cause are still not clear, we now know that the disease is more associated with textured implants. To the best of our knowledge, no previous study investigating the radiological differential of various implants has been conducted. In this essay, we aimed to demonstrate dicriminating in vitro and in vivo imaging features, if any, of variuos types of breast implant devices using mammography, ultrasound, and Magnetic Resonance Imaging (MRI). METHODS Five different implant devices from various manufacturers with different surface materials which are smooth, microtextured, regular macrotextured, lightweight macrotextured, polyurethane coated were involved. In vitro mammography was performed with a digital mammogram (Amulet Innovality, Fuji, Japan) and in vitro and in vivo sonography was performed with Esaote MyLab9 using a 7.5 MHz linear probe. In vitro MRI was performed with 1.5T magnet (Symphony TIM upgrade and Aera, Siemens Healthcare, Erlangen, Germany), with 7 channel breast coil (Sense coil, Innova, Germany). MRI studies included fat sat T2 weighted sequences (T2WS), non-fat sat T2WS and silicone only sequences. Results Each imaging technique had different contributions for dealing with this challenge. Mammography and MRI were limited on identifying the double bands of the capsule. On mammogram, we could only differentiate the lightweight macrotextured implant as the borosilicate microspheres were represented by tiny, round lucencies within the gel. Ultrasound imaging with the proper technique was very helpful for identfying the surface. On in vitro sonogram, the inner capsule (implant shell) was identified as parallel double echogenic bands. Bands of the smooth implant were better delineated compared to the textured implants. The double echogenic bands of the polyurethane coated implant were not even identified separetely. Reverberation artefact caused by the smooth implant was the main discriminating in vivo sonographic feature of smooth implants. On in vitro MRI, we could identify the hyperintense polyurethane coated capsule on fat sat T2WS and non-fat sat T2WS. The tiny hypointense microspheres of the lightweight implant was also identified on the silicone only sequence of the in vitro MRI. Conclusion In this study, we have showed that breast implant material and type may be differed by the help of in vitro and in vivo imaging characteristics on different radiological modalities. These different imaging features could be used for recognising and labelling the implant type, especially macro textured implants which are reported to be more associated with breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) compared to other types. We believe evaluating these imaging characteristics during daily practice will help radiologists to become aware of the implant type and possible complications or diseases associated with that type.
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Affiliation(s)
- Levent Celik
- Maltepe University Hospital, Department of Radiology
| | - Gozde Gunes
- Baskent University Hospital, Department of Radiology
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9
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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. Aesthetic Plast Surg 2022; 46:1668-1678. [PMID: 35296929 DOI: 10.1007/s00266-022-02844-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/12/2022] [Indexed: 11/01/2022]
Abstract
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 .
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10
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Diesch ST, Jung F, Prantl L, Jung EM. Surface imaging of breast implants using modern high-frequency ultrasound technology in comparison to high-end sonography with power analyses for B-scan optimization1. Clin Hemorheol Microcirc 2021; 80:487-495. [PMID: 34897080 DOI: 10.3233/ch-219204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM This study aims to evaluate optimized breast implant surface-structure analysis by comparing high-end ultrasound technology with a new high frequency technique. This comparative study used new breast implants with different surfaces in an in vitro setting. METHODS Nine idle silicon or polyurethane (PU) breast implants were examined by two investigators in an experimental in vitro study using two high-end ultrasound devices with multi-frequency transducers (6-15 MHz, 9-16 MHz, 12.5-33 MHz).The ultrasound B-Mode was optimized using tissue harmonic imaging (THI), speckle reduction imaging (SRI, level 0-5), cross beam (high, medium, low) and photopic.Using a standardized ultrasound protocol, the implants were examined in the middle (point of highest projection) and lateral, by two independent examiners.Image evaluation was performed on anonymized digital images in the PACS. The aim was to achieve an artifact-free recording of the surface structure, the surface coating, the total image structures and, as far as possible, an artifact-free internal representation of the implants.For independent surface evaluation a score was used (0 = undetectability of surface structures, rich in artifacts, 5 = best possible, artifact free image quality). RESULTS The quality of ultrasound imaging of breast implant surfaces after the optimization of B-Scan differed significantly comparing high-end ultrasound technology with modern high-frequency ultrasound technology (p < 0,05).The following setting has been found to be the best setting with the highest image quality:B-Mode, SRI value 3, Crossbeam high level with color coded imaging for B- mode. In the total examined frequency range of 6-33 MHz, the highest image quality was found in the average frequency range of 12.5-33 MHz at both measured points. For both devices, device 1 (high-end) and device 2 (high frequency) ultrasound, the image quality was in the12.5-33 MHz frequency range with an average image quality of 3.236. It was significantly higher, than in the lower frequency ranges and the same frequency range with THI. (p < 0,05). The image quality of the high-end sonography device was superior to the conventional high-frequency ultrasound device in all frequency ranges. CONCLUSION High-end ultrasound imaging technology was superior in the quality of implant surface evaluation in comparison to high-frequency ultrasound sonography. The gained knowledge can serve as a basis for further multicenter clinical application and studies with the aim to develop an objective, precise tool to evaluate the implant and the surrounding tissue with ultrasound.
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Affiliation(s)
- S T Diesch
- Center for Plastic, Aesthetic, Hand & Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany.,Institute of Biotechnology, Molecular Cell Biology, Brandenburg University of Technology, Senftenberg, Germany.,Department of Diagnostic Radiology and Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
| | - F Jung
- Center for Plastic, Aesthetic, Hand & Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany.,Institute of Biotechnology, Molecular Cell Biology, Brandenburg University of Technology, Senftenberg, Germany.,Department of Diagnostic Radiology and Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
| | - L Prantl
- Center for Plastic, Aesthetic, Hand & Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany.,Institute of Biotechnology, Molecular Cell Biology, Brandenburg University of Technology, Senftenberg, Germany.,Department of Diagnostic Radiology and Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
| | - E M Jung
- Center for Plastic, Aesthetic, Hand & Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany.,Institute of Biotechnology, Molecular Cell Biology, Brandenburg University of Technology, Senftenberg, Germany.,Department of Diagnostic Radiology and Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
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11
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Bae J, Jeon BJ, Mun GH, Bang SI, Pyon JK, Lee KT. Predictors for Implant Rupture in Two-Stage Tissue Expander-Based Breast Reconstruction: A Retrospective Cohort Study. Ann Surg Oncol 2021; 29:1100-1108. [PMID: 34591225 DOI: 10.1245/s10434-021-10773-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 08/27/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Two-stage tissue expander/implant-based method has been used predominantly for breast reconstruction. Implant rupture is one of the bothersome complications, inducing additional morbidity including reoperation. The present study aimed to identify the independent factors associated with development of implant rupture. PATIENTS AND METHODS Patients who underwent immediate two-stage prosthetic breast reconstruction between 2010 and 2016 were reviewed. Inserted implants were followed up using magnetic resonance imaging every 2 years and/or ultrasound/computed tomography scans every 6 or 12 months that were conducted for cancer surveillance. Associations of perioperative and intraoperative variables with the development of implant rupture were evaluated. RESULTS In total, 797 cases (744 patients) were analyzed. During a median follow-up of 43 months after second-stage operation, implant rupture was identified in 22 cases. The 5-year cumulative incidence was 3.1%. Multivariable analyses showed that the interval between the first- and second-stage operations was inversely associated with the risk of implant rupture. Maximal discrimination was observed at the interval of 6.5 months. Cases with an interval ≤ 6 months were associated with higher risks for implant rupture than those with ≥ 7 months, after adjusting for other variables. Type of implant was associated with the development of implant rupture, showing that using two kinds of fourth-generation implant (Allergan Biocell textured round and Allergan smooth round implants) was associated with a significantly increased risk of implant rupture compared with that of Mentor MemoryShape implants (fifth-generation implant). CONCLUSION Several operation-related variables appear to be associated with implant rupture in two-stage prosthetic reconstruction.
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Affiliation(s)
- Juyoung Bae
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung-Joon Jeon
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Goo-Hyun Mun
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sa Ik Bang
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jai Kyong Pyon
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Kyeong-Tae Lee
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Powell LE, Andersen ES, Nigro LC, Pozez AL, Shah PA. Breast Implants: A Historical Review With Implications for Diagnosis and Modern Surgical Planning. Ann Plast Surg 2021; 87:211-221. [PMID: 34253702 DOI: 10.1097/sap.0000000000002731] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ABSTRACT Modern breast surgery was first introduced in the United States in 1962 with the use of silicone gel-filled breast implants. Over the past 6 decades, development of breast implants has been challenged by a variety of influencers including aesthetic appeal in shape, texture, and material; challenges in managing outcomes such as contracture, disease, and rupture; and public perception of risks associated with implants. In 1992, silicone breast prostheses were banned by the US Food and Drug Administration with exception for use in breast reconstruction, congenital deformities, or to replace existing implants.The ban led to heightened concerns about implants and possible disease manifestations. Knowledge of the historical evolution of breast prostheses is useful for understanding the associated risks and outcomes unique to each breast implant era. This article aimed to explore characteristics of breast implants by generation, with implications for diagnosis and assistance to modern surgical planning for novice plastic surgeons.
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Affiliation(s)
- Lauren E Powell
- From the Division of Plastic and Reconstructive Surgery, Virginia Commonwealth University Health System, Richmond, VA
| | - Emily S Andersen
- From the Division of Plastic and Reconstructive Surgery, Virginia Commonwealth University Health System, Richmond, VA
| | - Lauren C Nigro
- From the Division of Plastic and Reconstructive Surgery, Virginia Commonwealth University Health System, Richmond, VA
| | - Andrea L Pozez
- From the Division of Plastic and Reconstructive Surgery, Virginia Commonwealth University Health System, Richmond, VA
| | - Priti A Shah
- Department of Diagnostic Radiology, Virginia Commonwealth University Health System, Richmond, VA
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Khakbaz E, Lang C, Lelkaitis G, Grønhøj C. Late migration of silicon as a complication to breast transplant rupture: Case report and literature review. Int J Surg Case Rep 2021; 85:106241. [PMID: 34333256 PMCID: PMC8346674 DOI: 10.1016/j.ijscr.2021.106241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/21/2021] [Accepted: 07/24/2021] [Indexed: 11/24/2022] Open
Abstract
Silicone implants have been used for breast augmentations, both cosmetically and in reconstructive surgery since the 1960s. Rupture of breast implants and silicone migration is a well-known complication. In this case report and literature review, we present a case of a 53-year-old woman with bilateral cosmetic silicone gel breast implant in 1986, and a replacement with saline gel in 2005. The patient had no breast complaints and observed no change in breast volume during this period. In 2020, silicone was randomly identified in a right-sided cervical lymph node in an attempt to remove suspicious lymphadenopathy. The source of the silicone is still doubted; that is, it is not known if the silicone originated from the saline implant or the silicone gel implant. In our literature review, we find that distant migration of silicone and lymphadenopathy have occurred for silicone breast implants although very rare for saline gel breast implants. A case of cervical lymphadenopathy caused by silicone breast migration is described. The patient had primarily long-standing silicone gel breast implant and has saline breast implant afterwards. The origin of the silicone conglomerate in the cervical lymph node remains unknown.
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Affiliation(s)
- Elham Khakbaz
- Department of Head and Neck Surgery, Rigshospitalet, Denmark
| | - Christian Lang
- Department of Plastic Surgery, Herlev University Hospital, Denmark
| | | | - Christian Grønhøj
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark.
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Agilinko J, Raj D, Wong KV, Fanelli D, Ng N, Agilinko B, Hasan M. Hepatobiliary complications from ruptured silicone breast implants - a comprehensive literature review. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2021; 19:Doc05. [PMID: 34108850 PMCID: PMC8167373 DOI: 10.3205/000292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/18/2020] [Indexed: 11/30/2022]
Abstract
Cronin and Gerow first introduced silicone breast implants in 1962; they now serve as first-line for breast augmentation. Breast augmentation is effective in restoring both physical and psychological well-being in women post-mastectomy. Many studies in the literature on complications of silicone breast implant rupture focus on lymphomas and capsular contractures. Only a few studies discuss the hepatobiliary complications. By reviewing the literature over the past 30 years, the authors aim to analyse the clinical presentation, diagnostic findings, as well as management outcomes amongst women with ruptured silicone implant-related hepatobiliary complications. To the best of our knowledge, this is the first comprehensive review on this topic.
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Affiliation(s)
- Joshua Agilinko
- Department of General Surgery, North Middlesex University Hospital, London, United Kingdom.,Department of General Surgery, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Dharshanan Raj
- Department of General Surgery, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Ken Vin Wong
- Department of General Surgery, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Daniele Fanelli
- Department of General Surgery, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Nicklaus Ng
- University of Aberdeen School of Medicine and Dentistry, Aberdeen, United Kingdom
| | | | - Mohammad Hasan
- Department of General Surgery, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
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Rahme J, Liu D, Chew G, Zinn R. Silicone nipple discharge: A case report of an unusual presentation of breast implant rupture. Int J Surg Case Rep 2020; 74:73-76. [PMID: 32823059 PMCID: PMC7452585 DOI: 10.1016/j.ijscr.2020.07.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/16/2020] [Accepted: 07/27/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Breast implant rupture is a well-documented complication of breast implant surgery. Diagnosis of ruptured silicone implants can be difficult due to the lack of overt symptoms. This is the first reported case of a patient with silicone breast implant rupture presenting with clear nipple discharge and is presented in line with SCARCE 2018 Guidelines [1]. PRESENTATION OF CASE A 45-year-old-female was referred to a breast surgeon with viscous clear nipple discharge, on a background of bilateral mastopexy-augmentation surgery 10 years prior. Imaging revealed extensive intraductal and free silicone causing significant stromal deformity secondary to breast implant rupture. Cytology of the nipple discharge was consistent with silicone gel. The patient was also found to have fibroadenoma without atypia in the right breast. She underwent an oncoplastic excision of free silicone and change of bilateral breast implants by a team of breast and plastic surgeons. DISCUSSION With breast implants being an increasingly common procedure worldwide, we can expect an increase in these unusual presentations. Clinicians and patients need to be aware of these in order to avoid an unnecessary delay in diagnosis. CONCLUSION Silicone implant rupture is a well-known complication and the rate of rupture increases over the life of the implant. Diagnosis of ruptured silicone implants is rare on clinical examination however remains an essential component of a doctor's examination of the patient and nipple discharge must be considered a symptom of rupture.
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Affiliation(s)
- Jessica Rahme
- General Surgery Unit, Austin Hospital, Melbourne, Victoria, Australia.
| | - David Liu
- Flinders Medical Centre, South Australia, Australia
| | - Grace Chew
- Breast Surgery Unit, Austin Hospital, Melbourne, Victoria, Australia
| | - Richard Zinn
- Plastic Surgery Unit, Northern Hospital, Melbourne, Victoria, Australia
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Bogetti P, Fraccalvieri M, Cappello G, Balocco P, Mariscotti G, Durando M, Mangia A, Gianfala A, Ruka E, Bruschi S. Novel decision algorithm for the diagnosis of silicone gel breast implant ruptures. EUROPEAN JOURNAL OF PLASTIC SURGERY 2018. [DOI: 10.1007/s00238-018-1434-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Lourenco AP, Moy L, Baron P, Didwania AD, diFlorio RM, Heller SL, Holbrook AI, Lewin AA, Mehta TS, Niell BL, Slanetz PJ, Stuckey AR, Tuscano DS, Vincoff NS, Weinstein SP, Newell MS. ACR Appropriateness Criteria ® Breast Implant Evaluation. J Am Coll Radiol 2018; 15:S13-S25. [DOI: 10.1016/j.jacr.2018.03.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 10/17/2022]
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Silicone Migration after Buttock Augmentation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 5:e1583. [PMID: 29632764 PMCID: PMC5889456 DOI: 10.1097/gox.0000000000001583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 10/03/2017] [Indexed: 11/29/2022]
Abstract
We present the case of a 30-year-old woman who presented with enlarged inguinal lymph nodes and sacral hyperpigmentation 4 months after gluteal augmentation with silicone implants. Inguinal lymph node biopsy revealed granulomatous lymphadenitis due to foreign material. Upon right buttock implant revision, a 1.5-cm-thick capsule was noted with the absence of peri-implant inflammatory fluid and no macroscopic implant defects. Analysis of the implant by the manufacturer revealed a microscopic silicone leak. The patient’s recovery was uneventful, and her symptoms resolved shortly after her reoperation.
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Celik L, Cubuk R, Arslan G, Atasoy MM, Celik L. Accidental injection of autologous fat into the breast implant: a case report highlighting radiological findings. EUROPEAN JOURNAL OF PLASTIC SURGERY 2017. [DOI: 10.1007/s00238-017-1319-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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20
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Marcon M, Becker AS, Ulbrich EJ, Frauenfelder T, Boss A. Water-fat Dixon sequences in the evaluation of breast implants: proposal of a time effective rapid approach in the clinical practice. Clin Radiol 2017; 72:799.e9-799.e15. [PMID: 28438322 DOI: 10.1016/j.crad.2017.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 01/26/2017] [Accepted: 03/21/2017] [Indexed: 10/19/2022]
Abstract
AIM To evaluate the diagnostic accuracy achieved from a fat-water Dixon sequence alone compared to a combination of a silicone-specific magnetic resonance imaging (MRI) sequence and a water-specific MRI sequence in the assessment of breast implants. MATERIALS AND METHODS In this institutional review board (IRB)-approved study the integrity of breast implants was assessed retrospectively in 27 patients undergoing breast MRI at 3 T. A qualitative evaluation of (set 1) a silicon-selective water-saturated short tau inversion recovery (STIR) sequence in combination with a water-only Dixon dataset (total acquisition time 7 minutes 17 seconds), and of (set 2) fat-only and water-only Dixon datasets (4 minutes 8 seconds) was performed by two readers independently evaluating the following features: margin definition of the implant, water suppression homogeneity, image quality, presence of artefacts and their effects on the imaging interpretation, and diagnostic confidence. Diagnostic accuracy in implant rupture detection was determined and either surgical confirmation or diagnosis from the radiological report was used as a standard of reference. RESULTS In both sequences, margin definition of the implant wall, water suppression homogeneity, and overall image quality were rated good-excellent in most of cases. Water suppression homogeneity was moderate-poor in a greater number of cases in set 1. Movement artefacts were more frequent in set 1 whereas five cases (18.5%) exhibited swap artefacts between silicone and water in set 2. Diagnostic confidence was rated high-very high with both sequences in most of cases. Diagnostic accuracy was 100% for both readers using set 1 and 96.2% and 100% using set 2. CONCLUSION A single Dixon sequence allows an accurate diagnostic evaluation of breast implants and concomitant shortening of the overall acquisition time.
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Affiliation(s)
- M Marcon
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland.
| | - A S Becker
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland
| | - E J Ulbrich
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland
| | - T Frauenfelder
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland
| | - A Boss
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland
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21
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Efficacy of ultrasound, mammography and magnetic resonance imaging in detecting breast implant rupture: A retrospective study of 175 reconstructive and aesthetic sub-pectoral breast augmentation cases. J Plast Reconstr Aesthet Surg 2017; 70:1520-1526. [PMID: 28739171 DOI: 10.1016/j.bjps.2017.05.051] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 05/03/2017] [Accepted: 05/24/2017] [Indexed: 12/17/2022]
Abstract
To date, the effectiveness of radiological imaging in detecting silicone breast implant rupture is uncertain. The purpose of this study is to retrospectively evaluate the effectiveness of radiological imaging when diagnosing a rupture. In this study, 175 patients with 242 breast implants were included, of which 168 and 74 implants were used for breast reconstruction and aesthetic augmentation, respectively. All patients who underwent revision surgery, between January 2015 and June 2016, following breast augmentation or reconstruction were included, regardless of any pre-operative diagnosis of rupture that had been made. The diagnosis of intracapsular rupture was verified intraoperatively and compared to the pre-operative findings. With regard to pre-operative diagnostic imaging methods, we compared magnetic resonance imaging (MRI), mammography, and ultrasonography (US) findings. Among the 242 implants that were explanted, 35 clinical ruptures were confirmed and compared with the related radiological findings. We reported 22 false positives and 15 false negatives. US was the least specific and least accurate method because of its lowest positive predictive value (PPV) and negative predictive value (NPV). Mammography was the most specific and most accurate method, with the highest PPV (96%). Surprisingly, MRI was the most sensitive; however, it was neither the most specific nor the most accurate method despite having the highest NPV (98%). After comparing these three radiological techniques, we conclude that US along with MRI can be useful for young patients. Mammography, which was characterised by high specificity and accuracy, could be useful along with MRI in investigating patients over the age of 40.
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22
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Nava MB, Rancati A, Angrigiani C, Catanuto G, Rocco N. How to prevent complications in breast augmentation. Gland Surg 2017; 6:210-217. [PMID: 28497025 DOI: 10.21037/gs.2017.04.02] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
No high-level evidences about the best technique or the best implant to use for obtaining the best outcomes in aesthetic breast augmentation, with low complications and re-interventions rates exist from available literature. In this paper we present the actual best evidence about the etiopathogenesis of main complications in aesthetic breast augmentation, identifying some basic rules to follow in order to reduce complication rates in our daily activity, minimizing re-interventions, obtaining long lasting results and high women's satisfaction levels.
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Affiliation(s)
- Maurizio Bruno Nava
- Valduce Hospital, Como, Italy.,Department of Plastic Surgery, University of Milan, Milan, Italy
| | | | | | - Giuseppe Catanuto
- Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Catania, Italy
| | - Nicola Rocco
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
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Hillard C, Fowler JD, Barta R, Cunningham B. Silicone breast implant rupture: a review. Gland Surg 2017; 6:163-168. [PMID: 28497020 DOI: 10.21037/gs.2016.09.12] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Silicone breast implants have been in use for nearly 6 decades. In this time they have undergone significant changes in design and use. They have been subject to intense scrutiny with regard to safety and efficacy, including an almost 10 years moratorium on their use. The current generations of implants have been followed via the manufacturer's Core studies in order to obtain long term data regarding safety and complications. The results of the more recent studies are compiled in this review. Rupture rates are initially very low and begin to increase after 6-8 years of implantation. Implant rupture may be detected by physical exam, ultrasound or magnetic resonance imaging (MRI). The majority of silicone implant ruptures are clinically undetectable. Symptomatic patients may present with capsular contracture, breast lumps or changes in breast shape. The most common cause of implant rupture is instrument damage during placement. Implant rupture may be confined to the peri-prosthetic capsule or may extravasate into the breast tissue. Patients with ruptured implants have been studied closely and the consensus of the literature states there are no health risks associated with implant rupture. Symptomatic patients with ruptured implants should be offered the choice of observation, or explantation and capsulectomy with or without replacement.
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Affiliation(s)
- Christopher Hillard
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA
| | - Jason D Fowler
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA
| | - Ruth Barta
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA
| | - Bruce Cunningham
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA
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Seiler SJ, Sharma PB, Hayes JC, Ganti R, Mootz AR, Eads ED, Teotia SS, Evans WP. Multimodality Imaging-based Evaluation of Single-Lumen Silicone Breast Implants for Rupture. Radiographics 2017; 37:366-382. [DOI: 10.1148/rg.2017160086] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Stephen J. Seiler
- From the Departments of Radiology (S.J.S., P.B.S., J.C.H., R.G., A.R.M., E.D.E., W.P.E.) and Plastic Surgery (S.S.T.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8896
| | - Pooja B. Sharma
- From the Departments of Radiology (S.J.S., P.B.S., J.C.H., R.G., A.R.M., E.D.E., W.P.E.) and Plastic Surgery (S.S.T.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8896
| | - Jody C. Hayes
- From the Departments of Radiology (S.J.S., P.B.S., J.C.H., R.G., A.R.M., E.D.E., W.P.E.) and Plastic Surgery (S.S.T.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8896
| | - Ramapriya Ganti
- From the Departments of Radiology (S.J.S., P.B.S., J.C.H., R.G., A.R.M., E.D.E., W.P.E.) and Plastic Surgery (S.S.T.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8896
| | - Ann R. Mootz
- From the Departments of Radiology (S.J.S., P.B.S., J.C.H., R.G., A.R.M., E.D.E., W.P.E.) and Plastic Surgery (S.S.T.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8896
| | - Emily D. Eads
- From the Departments of Radiology (S.J.S., P.B.S., J.C.H., R.G., A.R.M., E.D.E., W.P.E.) and Plastic Surgery (S.S.T.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8896
| | - Sumeet S. Teotia
- From the Departments of Radiology (S.J.S., P.B.S., J.C.H., R.G., A.R.M., E.D.E., W.P.E.) and Plastic Surgery (S.S.T.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8896
| | - W. Phil Evans
- From the Departments of Radiology (S.J.S., P.B.S., J.C.H., R.G., A.R.M., E.D.E., W.P.E.) and Plastic Surgery (S.S.T.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8896
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Maisel Lotan A, Retchkiman M, Tuchman I, Binenboym R, Gronovich Y. Analysis of 109 Consecutive Explanted Breast Implants: Correlation Between Suspected Implant Rupture and Surgical Findings. Aesthetic Plast Surg 2016; 40:739-44. [PMID: 27514822 DOI: 10.1007/s00266-016-0689-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 07/29/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The use of breast implants is on the rise due to increases in breast reconstructive and aesthetic surgery. Implant rupture is a possible complication. Among assessment modalities for implant rupture detection, MRI is considered the gold standard. METHODS We conducted a prospective analysis of 57 women after breast augmentation or postmastectomy reconstruction (109 implants), admitted to our department between 2010 and 2015 due to suspected implant rupture. We correlated surgical findings with symptoms, physical examination, imaging, and device specifications. RESULTS Seventy-four explanted implants were preoperatively suspected as ruptured. Over a third were intact and unjustifiably explanted. MRI evaluation was the most accurate modality. Interestingly, 61 % of ruptured implants were left-sided. Patient's age, comorbidities, smoking, medications, presenting symptoms, implant duration, and volume did not correlate with implant rupture. CONCLUSIONS Our study confirmed preexisting data regarding the importance of imaging diagnosis, with MRI being the most accurate modality in both diagnosing and ruling out implant rupture. Interestingly, our study showed that MRI was accurate in detecting all intact implants, unlike lower detection rates reported in previous studies, thus preventing unnecessary explantation. Another unique finding was that the left-sided implants were significantly prone for rupture. As iatrogenic damage is the most common cause of implant rupture, with most surgeons being right-handed, awareness during surgery must be augmented, with further investigation required for potential causes of this unexpected difference. Our study emphasizes the importance of understanding the causes of rupture and the need for evidence-based indications regarding imaging and replacement of implants. 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 .
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Affiliation(s)
- Adi Maisel Lotan
- Department of Plastic & Reconstructive Surgery, Shaare Zedek Medical Center, POB 3235, 91031, Jerusalem, Israel.
| | - Meir Retchkiman
- Department of Plastic & Reconstructive Surgery, Shaare Zedek Medical Center, POB 3235, 91031, Jerusalem, Israel
| | - Izhak Tuchman
- Department of Plastic & Reconstructive Surgery, Shaare Zedek Medical Center, POB 3235, 91031, Jerusalem, Israel
| | - Rami Binenboym
- Department of Plastic & Reconstructive Surgery, Shaare Zedek Medical Center, POB 3235, 91031, Jerusalem, Israel
| | - Yoav Gronovich
- Department of Plastic & Reconstructive Surgery, Shaare Zedek Medical Center, POB 3235, 91031, Jerusalem, Israel
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Kuehlmann B, Prantl L, Michael Jung E. Imaging of idle breast implants with ultrasound-strain elastography- A first experimental study to establish criteria for accurate imaging of idle implants via ultrasound-strain elastography. Clin Hemorheol Microcirc 2016; 61:645-56. [DOI: 10.3233/ch-151963] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Britta Kuehlmann
- Center for Plastic, Aesthetic, Hand &Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Lukas Prantl
- Center for Plastic, Aesthetic, Hand &Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Ernst Michael Jung
- Department of DiagnosticRadiology and Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
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Wiedenhoefer JF, Shahid H, Dornbluth C, Otto P, Kist K. MR imaging of breast implants: Useful information for the interpreting radiologist. APPLIED RADIOLOGY 2015. [DOI: 10.37549/ar2222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
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.
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29
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Telegrafo M, Moschetta M. Role of US in evaluating breast implant integrity. J Ultrasound 2015; 18:329-33. [PMID: 26550071 DOI: 10.1007/s40477-015-0170-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 01/12/2015] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To assess the diagnostic accuracy and inter-observer variability of ultrasound (US) in recognizing signs of intra or extra-capsular rupture of silicone breast implants by using the magnetic resonance imaging (MRI) findings as the reference standard. METHODS 150 patients for a total of 300 implants underwent breast US and subsequently MR examination searching for signs of intra or extra-capsular rupture. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated for breast US having MRI findings as the reference standard. Cohen's kappa statistics was used in order to assess inter-observer agreement for US. RESULTS 170/300 (57 %) implant ruptures were detected at US (intra-capsular n = 110, extra-capsular n = 60). By comparing US findings with MR results, overall sensitivity, specificity, accuracy, PPV, and NPV of 79, 63, 70, 65, and 77 %, respectively, were found for breast US. In case of intra-capsular rupture, sensitivity, specificity, accuracy, PPV, and NPV of 63, 63, 63, 45, and 77 %, respectively, were obtained; 100 % values were found for extra-capsular rupture US diagnosis. CONCLUSION US can be used as the first examination in patients with breast implants. US intra-capsular rupture detection requires further evaluation by MRI; in case of extra-capsular rupture US diagnosis, surgical implant removal could be proposed without further investigations.
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Affiliation(s)
- Michele Telegrafo
- DIM - Interdisciplinary Department of Medicine - Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Marco Moschetta
- DIM - Interdisciplinary Department of Medicine - Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124 Bari, Italy
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Stachs A, Dieterich M, Hartmann S, Stubert J, Reimer T, Gerber B. Diagnosis of ruptured breast implants through high-resolution ultrasound combined with real-time elastography. Aesthet Surg J 2015; 35:410-8. [PMID: 25804504 DOI: 10.1093/asj/sju057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Implant rupture as a late complication of breast implant surgery is often a silent phenomenon that is difficult to diagnose. Sonoelastography is a new ultrasound-based technique that allows assessment of tissue elasticity. OBJECTIVES This study was undertaken to evaluate elastographic findings in normal and ruptured breast implants. METHODS This prospective study included 28 implants in 16 patients, all of whom underwent high-resolution ultrasound and real-time elastography. The diagnosis of implant rupture was confirmed by surgery. RESULTS Implant rupture was diagnosed in 5 out of 28 implants (17.9%). In those patients with ruptured implants, 3 had no symptoms, 1 presented with pain, and 1 complained of ipsilateral axillary lymph node swelling. Implants with a homogenous anechoic interior were considered to be intact. Ultrasound findings indicating implant rupture included multiple parallel echogenic lines in the implant interior in 2 cases and a mix of hyperechoic and hypoechoic masses in 3 cases. The feasibility of real-time elastography of implants was demonstrated in all cases. Elastograms of intact implants revealed a typical blue-green-red pattern familiar from cystic lesions. In all 5 ruptured implants, elastography revealed yellow-green figures without typical layering. CONCLUSIONS To the authors' knowledge this is the first series to combine high-resolution ultrasound with real-time elastography for the diagnosis of implant rupture. Since there are distinct differences between elastograms of intact and ruptured implants, addition of real-time elastography to conventional ultrasound may improve implant surveillance and obviate the need for magnetic resonance imaging.
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Affiliation(s)
- Angrit Stachs
- From the Breast Unit, Department of Gynecology and Obstetrics, University of Rostock, Rostock, Germany
| | - Max Dieterich
- From the Breast Unit, Department of Gynecology and Obstetrics, University of Rostock, Rostock, Germany
| | - Steffi Hartmann
- From the Breast Unit, Department of Gynecology and Obstetrics, University of Rostock, Rostock, Germany
| | - Johannes Stubert
- From the Breast Unit, Department of Gynecology and Obstetrics, University of Rostock, Rostock, Germany
| | - Toralf Reimer
- From the Breast Unit, Department of Gynecology and Obstetrics, University of Rostock, Rostock, Germany
| | - Bernd Gerber
- From the Breast Unit, Department of Gynecology and Obstetrics, University of Rostock, Rostock, Germany
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Santos DC, Barroso MDL, Gomes N, Ramião N, Martins P, Dias CC, Costa H. PIP breast implant rupture—A retrospective study from Portugal. EUROPEAN JOURNAL OF PLASTIC SURGERY 2015. [DOI: 10.1007/s00238-015-1071-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Soft, Brown Rupture: Clinical Signs and Symptoms Associated with Ruptured PIP Breast Implants. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2014; 2:e249. [PMID: 25506532 PMCID: PMC4255892 DOI: 10.1097/gox.0000000000000212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 09/04/2014] [Indexed: 12/01/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Preoperative signs and symptoms of patients with Poly Implant Prothese (PIP) implants could be predictive of device failure. Based on clinical observation and intraoperative findings 4 hypotheses were raised: (1) Preoperative clinical signs including acquired asymmetry, breast enlargement, fullness of the lower pole, decreased mound projection, and change in breast consistency could be indicative of implant rupture. (2) Device failure correlates with a low preoperative Baker grade of capsule. (3) Brown-stained implants are more prone to implant failure. (4) The brown gel could be indicative of iodine ingression through a substandard elastomer shell. Methods: Preoperative clinical signs were compared with intraoperative findings for 27 patients undergoing PIP implant explantation. Results: Acquired asymmetry (P = 0.0003), breast enlargement (P = 0.0002), fuller lower pole (P < 0.0001), and loss of lateral projection (P < 0.0001) were all significantly predictive of device failure. Capsule Baker grade was lower preoperatively for ruptured implants. The lack of palpable and visible preoperative capsular contracture could be secondary to the elastic nature of the capsular tissue found. Brown implants failed significantly more often than white implants. Analysis of brown gel revealed the presence of iodine, suggesting povidone iodine ingression at implantation. Conclusions: Preoperative signs can be predictive of PIP implant failure. Brown-stained implants are more prone to rupture. The presence of iodine in the gel suggests unacceptable permeability of the shell early in the implant’s life span. A noninvasive screening test to detect brown implants in situ could help identify implants at risk of failure in those who elect to keep their implants.
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Diagnosing PIP breast implant failure: a prospective analysis of clinical and ultrasound accuracy. J Plast Reconstr Aesthet Surg 2014; 68:540-5. [PMID: 25496719 DOI: 10.1016/j.bjps.2014.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 11/11/2014] [Accepted: 11/13/2014] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The risk of Poly Implant Prosthesis (PIP) breast implant failure has been quantified by the Department of Health as 2-6 times greater than other brands. In the UK, removal of PIP breast implants is recommended when failure is suspected from patient history or clinical findings. Owing to conflicting reports of accuracy in current literature, ultrasound is not recommended as a routine investigation. We aimed to evaluate the accuracy of patient history, clinical impression, and ultrasound at diagnosing implant failure in a large consecutive series of women against the reference standard. We aimed to provide evidence in response to current guidelines and help guide best practice. METHODS All patients from January 2012-January 2013 who underwent PIP breast implant explantation at the Spire Murrayfield Hospital were prospectively evaluated. Operative findings were correlated to pre-operative results of patient history, clinical impression and ultrasound imaging. Sensitivity, specificity and accuracy were calculated with 95% confidence intervals. RESULTS A total of 192 women who underwent 384 PIP implant explantations from January 2012 to January 2013 were included. Twenty-three patients (12.0%) reported a positive patient history pre-operatively. In 35 patients (18%), failure was pre-operatively diagnosed clinically. Intra-operatively, 80 implants (21%) in 63 women (33%) had failed. The sensitivity of patient history, clinical impression and ultrasound was 12%, 34%, and 91%, respectively. The specificity was 88%, 89%, and 97%, respectively. Ultrasound was 96% accurate at diagnosing PIP implant failure, whilst patient history and clinical impression were 63% and 71% accurate, respectively. CONCLUSION Ultrasound provides a far more reliable test of implant failure than patient history or clinical impression. Considering the availability, cost and number of women in the UK with PIP implants, we would recommend high-resolution ultrasound be implemented as a routine investigation.
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Abstract
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.
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A retrospective analysis of ruptured breast implants. Arch Plast Surg 2014; 41:734-9. [PMID: 25396188 PMCID: PMC4228218 DOI: 10.5999/aps.2014.41.6.734] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 06/20/2014] [Accepted: 06/23/2014] [Indexed: 11/26/2022] Open
Abstract
Background Rupture is an important complication of breast implants. Before cohesive gel silicone implants, rupture rates of both saline and silicone breast implants were over 10%. Through an analysis of ruptured implants, we can determine the various factors related to ruptured implants. Methods We performed a retrospective review of 72 implants that were removed for implant rupture between 2005 and 2014 at a single institution. The following data were collected: type of implants (saline or silicone), duration of implantation, type of implant shell, degree of capsular contracture, associated symptoms, cause of rupture, diagnostic tools, and management. Results Forty-five Saline implants and 27 silicone implants were used. Rupture was diagnosed at a mean of 5.6 and 12 years after insertion of saline and silicone implants, respectively. There was no association between shell type and risk of rupture. Spontaneous was the most common reason for the rupture. Rupture management was implant change (39 case), microfat graft (2 case), removal only (14 case), and follow-up loss (17 case). Conclusions Saline implants have a shorter average duration of rupture, but diagnosis is easier and safer, leading to fewer complications. Previous-generation silicone implants required frequent follow-up observation, and it is recommended that they be changed to a cohesive gel implant before hidden rupture occurs.
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Lindenblatt N, El-Rabadi K, Helbich TH, Czembirek H, Deutinger M, Benditte-Klepetko H. Correlation between MRI results and intraoperative findings in patients with silicone breast implants. Int J Womens Health 2014; 6:703-9. [PMID: 25114595 PMCID: PMC4124066 DOI: 10.2147/ijwh.s58493] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Silicone gel breast implants may silently rupture without detection. This has been the main reason for magnetic resonance imaging (MRI) of the augmented or reconstructed breast. The aim of the present study was to investigate the accuracy of MRI for implant rupture. Methods Fifty consecutive patients with 85 silicone gel implants were included in the study. The mean age of the patients was 51 (range 21–72) years, with a mean duration of implantation of 3.8 (range 1–28) years. All patients underwent clinical examination and breast MRI. Intraoperative implant rupture was diagnosed by the operating surgeon. Results Nineteen of the 50 patients suffered from clinical symptoms. An implant rupture was diagnosed by MRI in 22 of 85 implants (26%). In seven of 17 removed implants (41%), the intraoperative diagnosis corresponded with the positive MRI result. However, only 57% of these patients were symptomatic. Ultrasound imaging of the harvested implants showed signs of interrupted inner layers of the implant despite integrity of the outer shell. By microsurgical separation of the different layers of the implant shell, we were able to reproduce this phenomenon and to produce signs of implant rupture on MRI. Conclusion Our results show that rupture of only the inner layers of the implant shell with integrity of the outer shell leads to a misdiagnosis on MRI. Correlation with clinical symptoms and the specific wishes of the patient should guide the indication for implant removal.
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Affiliation(s)
- Nicole Lindenblatt
- Division of Plastic and Hand Surgery, Department of Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Karem El-Rabadi
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna - General Hospital Vienna, Vienna, Austria
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna - General Hospital Vienna, Vienna, Austria
| | | | - Maria Deutinger
- Department of Plastic and Reconstructive Surgery, Hospital Rudolfstiftung, Vienna, Austria
| | - Heike Benditte-Klepetko
- Department of Plastic and Reconstructive Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
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Ultrasonography: a useful tool for plastic surgeons. Aesthetic Plast Surg 2014; 38:561-71. [PMID: 24643897 DOI: 10.1007/s00266-014-0300-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 02/25/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED Ultrasonography is a diagnostic technique used in many clinical specialties that should also be used by plastic surgeons. The authors have used ultrasonography since 2011 as part of the routine follow-up evaluation for all their patients who have undergone breast augmentation (the main indication), body implants, gynecomastia, fat transfer, or abdominoplasty. The main goal of this study was to correlate normal and pathologic conditions clinically with their respective imaging findings. The secondary aim was to establish the utility of this tool in a plastic surgery setting. With increasing experience, the use of ultrasound evaluation was expanded to include evaluation of seromas and hematomas, determination of the diastasis recti width, and confirmation of the presence of hernias, especially in patients with high adiposity, who are difficult to scan. This report describes several clinical cases of complications associated with breast augmentation and discusses the most significant common problems encountered during the first 2 years of ultrasonography scanner use in a plastic surgeon's office. 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.
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MRI screening for silicone breast implant rupture: accuracy, inter- and intraobserver variability using explantation results as reference standard. Eur Radiol 2014; 24:1167-75. [DOI: 10.1007/s00330-014-3119-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 01/19/2014] [Accepted: 02/07/2014] [Indexed: 10/25/2022]
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Oulharj S, Pauchot J, Tropet Y. PIP breast implant removal: a study of 828 cases. J Plast Reconstr Aesthet Surg 2013; 67:302-7. [PMID: 24522122 DOI: 10.1016/j.bjps.2013.12.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 11/07/2013] [Accepted: 12/17/2013] [Indexed: 11/19/2022]
Abstract
In March, 2010, the French Health Products Safety Agency suspended the sale of prefilled silicone breast implants manufactured by Poly Implants Prosthèse Prothese (PIP) because of a high failure rate and the use of an inappropriate silicone gel that did not comply with CE marking. These findings led to an international medical crisis. In France, 30,000 female patients had PIP implants. In our Department, 1150 PIP breast implants had been implanted in 630 patients since 2001. A retrospective study was conducted to define the rupture rate of these implants and the complications that arise. The women included in the study underwent implant removal from May 2010 to September 2012 for preventive or curative reasons. Data were collected from medical records that included: results of clinical examination, breast ultrasound before removal, rates of implant rupture, results of biopsy of periprosthetic capsule and pericapsule tissue and postoperative complications. A total of 828 PIP breast implants were removed in 455 patients. The rate of ruptured implants was 7.73% (64/828), corresponding to 11.6% of patients. A periprosthetic effusion was associated with rupture in 44% of cases. Breast ultrasound indicated a rupture for 87 implants; 32% were true positives and 3% were false negatives. Periprosthetic capsule biopsy demonstrated the presence of a foreign body, which seemed to be silicone, in 26% of cases and the presence of inflammation in 13% of cases. No siliconoma-type lesion was identified in the pericapsular tissue at biopsy. A total of 14 implants presented perspiration at removal. A statistically significant difference was found between the rates of rupture for texturised implants as compared to the smooth-surfaced implants. There were eight post-revisional-surgery complications (1%) and three cases of breast adenocarcinoma. The preventive explantation of PIP breast implants is justified given the high failure rate (7.73%) and given patients' exposure to silicone gel that did not comply with CE standards in the absence of rupture, through the early perspiration of implants.
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Affiliation(s)
- S Oulharj
- Department of Orthopedics, Traumatology, Plastic and Reconstructive Surgery and Hand Support, Besancon University Hospital, Besancon, France.
| | - J Pauchot
- Department of Orthopedics, Traumatology, Plastic and Reconstructive Surgery and Hand Support, Besancon University Hospital, Besancon, France
| | - Y Tropet
- Department of Orthopedics, Traumatology, Plastic and Reconstructive Surgery and Hand Support, Besancon University Hospital, Besancon, France
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Martindale V, Menache A. The PIP scandal: an analysis of the process of quality control that failed to safeguard women from the health risks. J R Soc Med 2013; 106:173-7. [PMID: 23761525 DOI: 10.1177/0141076813480994] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Bilateral poly implant prothèse implant rupture: an uncommon presentation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2013; 1:e29. [PMID: 25289223 PMCID: PMC4173840 DOI: 10.1097/gox.0b013e318298e026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 04/25/2013] [Indexed: 12/02/2022]
Abstract
Summary: A woman in her 50s underwent delayed bilateral Poly Implant Prothèse implant reconstruction following mastectomy for breast cancer. Symptoms of implant rupture developed 43 months after surgery with an erythematous rash on her trunk. The rash then spread to her reconstructed breast mounds. Initial ultrasound scan and magnetic resonance imaging were normal; however, subsequent magnetic resonance imaging demonstrated left implant rupture only. In theater, following removal of both implants, both were found to be ruptured. The rash on her trunk resolved within 3 weeks in the postoperative period. Chemical analyses of silicone in both implants confirmed a nonauthorized silicone source; in addition, the chemical structure was significantly different between the left and right implant, perhaps explaining the variation in presentation.
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The Clinical and Diagnostic Consequences of Poly Implant Prothèse Silicone Breast Implants, Recalled from the European Market in 2010. Plast Reconstr Surg 2013; 131:394e-402e. [DOI: 10.1097/prs.0b013e31827c70aa] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gu JH, Jeong SH. Rupture of Breast Implants after Augmentation Mammoplasty: A Case Report of Simultaneous Intra-extracapsular Rupture. ARCHIVES OF AESTHETIC PLASTIC SURGERY 2013. [DOI: 10.14730/aaps.2013.19.1.81] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ja Hea Gu
- Department of Plastic Surgery, College of Medicine, Dankook University, Cheonan, Chungnam, Korea
| | - Seong-Ho Jeong
- Department of Plastic Surgery, College of Medicine, Korea University, Seoul, Korea
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Economic analysis of screening strategies for rupture of silicone gel breast implants. Plast Reconstr Surg 2012; 130:225-237. [PMID: 22743887 DOI: 10.1097/prs.0b013e318254b43b] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In 2006, the U.S. Food and Drug Administration recommended screening of all women with silicone gel breast implants with magnetic resonance imaging 3 years after implantation and every 2 years thereafter to assess their integrity. The cost for these serial examinations over the lifetime of the breast implants is an added burden to insurance payers and to women. The authors performed an economic analysis to determine optimal screening strategies by considering the diagnostic accuracy of the screening tests, costs of the tests, and subsequent implant removal. METHODS The authors determined aggregate/pooled values for sensitivity and specificity of the screening tests of ultrasound and magnetic resonance imaging in detecting silicone breast implant ruptures from the data obtained from published literature. They compiled costs, based on Medicare reimbursements for 2011, for the following elements: imaging modalities, anesthesia, and three surgical treatment options for detected ruptures. A decision tree was used to compare three alternate screening strategies of ultrasound only, magnetic resonance imaging only, and ultrasound followed by magnetic resonance in asymptomatic and symptomatic women. RESULTS The cost per rupture of screening and management of rupture with ultrasound in asymptomatic women was $1090; in symptomatic women, it was $1622. A similar cost for magnetic resonance imaging in asymptomatic women was $2067; in symptomatic women it was $2143. A similar cost for ultrasound followed by imaging in asymptomatic women was $637; in symptomatic women, it was $2908. CONCLUSION Screening with ultrasound followed by magnetic resonance imaging was optimal for asymptomatic women, and screening with ultrasound was optimal for symptomatic women.
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Berry MG, Stanek JJ. The PIP mammary prosthesis: A product recall study. J Plast Reconstr Aesthet Surg 2012; 65:697-704. [DOI: 10.1016/j.bjps.2012.02.019] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Revised: 02/14/2012] [Accepted: 02/16/2012] [Indexed: 01/13/2023]
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Alerte sanitaire et implants mammaires PIP : expérience du centre régional de lutte contre le cancer de Lille. Bull Cancer 2012; 99:147-53. [DOI: 10.1684/bdc.2011.1531] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Crouzet C, Gangloff D, Chaput B, Grolleau JL, Garrido I. Bilan à 18 mois du retrait du marché des prothèses Poly Implant Prothèse. Expérience d’un centre anticancéreux. ANN CHIR PLAST ESTH 2012; 57:9-15. [DOI: 10.1016/j.anplas.2012.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 01/09/2012] [Indexed: 11/26/2022]
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Challenges in Mammography: Part 2, Multimodality Review of Breast Augmentation—Imaging Findings and Complications. AJR Am J Roentgenol 2011; 197:W1031-45. [DOI: 10.2214/ajr.11.7216] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Colombo G, Ruvolo V, Stifanese R, Perillo M, Garlaschi A. Prosthetic breast implant rupture: imaging--pictorial essay. Aesthetic Plast Surg 2011; 35:891-900. [PMID: 21487917 DOI: 10.1007/s00266-011-9694-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 02/28/2011] [Indexed: 10/18/2022]
Abstract
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.
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