Evaluation of the Rupture of Silicone Breast Implants by Mammography

OBJECTIVE: The purpose of this study was to compare the efficacies of mammography, sonography and MR imaging in the detection of breast implant rupture of an asymptomatic population. MATERIALS AND METHODS: We prospectively evaluated 83 breast implants in 44 asymptomatic patients who subsequently had implants removed by a surgeon to determine sensitivity and specificity of mammography, ultrasonography and magnetic resonance imaging, using predetermined diagnostic criteria of implant rupture. Eightythree implants were evaluated by both film-screen mammography and highresolution sonography and 77 implants were evaluated by MRI. All radiological signs were discussed and false positive and false negative were retrospectively evaluated to identify the pitfalls of the investigations. RESULTS: The sensitivity and specificity of mammography were 20% and 89%, respectively; of sonography , 30% and 81%, respectively; and of MRI, 64% and 77%, respectively. The difference between patients with breast implants for cosmetological and oncological reasons were discussed. CONCLUSION: Our experience suggests that MRI seems to be the best isolated imaging method for evaluation of rupture among asymptomatic patients and further recommendations were made. INTRODUCTION: It is estimated that more than one million and a half to two million women have undergone implant surgery, which are made out silicone gel in their great majority. These implants are used to reconstruct breasts after mastectomy, to correct congenital or traumatic deformities and to increase or to remodel the breast shape for cosmetological reasons. The psychological benefits of this procedure are widely acknowledged; however, silicone breast implants can lead to a range of important complications, such as hardening and rupture. The pre-operative diagnosis of rupture is very difficult to be made by a physical exam because symptoms and signs are vague most of the time. In the case of deflation of a saline implant there is a decrease in the breast volume, which can be easily noticed during an examination. On the other hand, the rupture of a silicone breast implant is less obvious and thus more difficult to notice, mainly if it is enclosed by the fibrous capsule. Different imaging methods can identify the integrity of the breast implants and also the extension of a possible silicone leakage going to the glands and adjacent tissues. Mammography (MG), Ultrasonography (US), Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI) were used to evaluate the integrity of breast implants in symptomatic patients for rupture. Each method has its own characteristics, which will determine whether or not the particular method is appropriate for the study of a patient case. Three different modalities of diagnostic imaging methods were analyzed believing that these methods could help the detection of silicone breast implant rupture. A group of clinically asymptomatic patients were taken as a group sample. These patients wanted to remove or change their breast implants based on psychological or cosmetological reasons. The following methods were analyzed: 1.Mammography: First, because this is the choice exam in the breast cancer screening program. Second, because the sample used had high chances of needing reconstruction surgery and because this service was notably known for accomplishing oncological surgery. 2.Ultrasonography: Because it is a relatively inexpensive exam and also because it does not use ionizing radiation. 3.Magnetic Resonance Imaging: Because, despite being expensive, it allows images in multiple plans with a global vision of the implant in the breast and of the breast into the