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 granuloma aka Silicone adenopathy aka Siliconeoma aka

  • 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

Silicone Granuloma aka Silicone adenopathy aka Siliconeoma

• See dense nodes on mammogram in pt with silicone implant

  • May have remote history of implant rupture and replacement/prior removal

• On US basically looks like snowstorm appearance, dense blob

  • Hyperechoic nodules with posterior acoustic enhancement = silicone granuloma

• 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

Silicone Injections

• Looks like numerous, diffuse bilateral masses (almost like numerous oil cysts)

• Will have snowstorm appearance too

• Breast become hard and very dense

  • MR is really the only useful imaging modality in these women

Breast Reduction Surgery

• Will see reorganization of breast tissue near the incision sites, bilaterally

  • Will present as thickened linear breast tissue near incision sites

• Benign calcifications typically seen about 2 years after surgery

  • New calcs earlier than this should be investigated for malignancy

• Typical incision locations

  • Inferior breast

  • Peri-areolar

  • Inframammary folds