Breast Implants

Breast Implants General Info

  • Implants can be placed two different ways:

    • Sub-glandular

      • feels more natural

    • Sub-pectoral

      • Easier to displace when you do a mammogram, mammograms therefore have better sensitiity than a MG in pt with sub-glandular implant

  • Two types of implants:

    • Saline

    • Silicone

  • Key points

    • Implants are not a CI to core needle biopsy

    • Implants do not increase risk of cancer

    • Screening mammogram with implants requires 4 views —> CC, MLO, displace CC, displaced MLO

      • Displaced view is basically just pushing the implant out of the way to just see breast tissue without implant in the picture

Saline Implant

  • Can see through them

  • Suspect rupture —> physical exam & mammogram

    • Will not form a capsule so no such thing as intracapsular rupture

    • Rupture doesn’t really matter from a management standpoint, cosmetic issue only

Silicone Implant

  • Cannot see through them

  • Suspect rupture —> start with US probably, will ultimately need MRI

  • Capsule

    • Body will form a capsule around the implant made of scar tissue and shit

    • Note that the actual container holding the silicone is not the capsule it is tissue itself that walls off around the implant that is the capsule

  • Intracapsular rupture (80%) - Image 1

    • Rupture of the container of the silicone implant but not the actual capsule (soft tissue capsule) itself

    • Called linguine appearance

    • Squiggle line will not have attachment to wall (radial fold will!)

  • Extracapsular rupture (20%) - Image 2

    • Implies intracapsular + extracapsular

      • Cannot have extracapsular rupture alone

    • Injury violates the soft tissue capsule and container of the silicone implant

    • Snowstorm appearance on US - looks like dense blob

  • Silicone Adenopathy

    • See dense nodes on mammogram in pt with silicone implant

    • On US basically looks like snowstorm appearance, dense blob

    • Then need to recommend MRI to evaluate for implant rupture

    • Note: Gel bleed will present similarly

      • Normal transudation of micro-amounts of silicone through the container of the implant

Radial Fold

  • Basically the normal folds in the capsule of the breast implant

  • Mimics rupture

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