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BREAST IMPLANT RUPTURE

BREAST IMPLANT RUPTURE. A POWER POINT PRESENTATION. INTRODUCTION. Breast implant rupture is a well known complication of breast implant It is one of the main causes of implant removal Rupture may be classified as ‘intra-capsular’ or ‘extra-capsular’

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BREAST IMPLANT RUPTURE

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  1. BREAST IMPLANT RUPTURE A POWER POINT PRESENTATION

  2. INTRODUCTION • Breast implant rupture is a well known complication of breast implant • It is one of the main causes of implant removal • Rupture may be classified as ‘intra-capsular’ or ‘extra-capsular’ • Intracapsular rupture (77-99%); Extracapsular rupture (11-23%) (Supsakova, 2010) It is one of the main causes of implant removal • Single chamber prostheses full of silicone are the most commonly used type of breast implants (Cabrera et al. 2013)

  3. NORMAL SONOGRAPHIC APPEARANCE OF BREAST IMPLANTS • Well defined margins of silicone cover • Homogenous silicone lumen • Anechoic interior • Anterior appearance shows smooth bands of echoes (reverberation) • Presence of radial creases is normal • Implants can show presence of valves – these are normal findings

  4. ULTRASOUND IMAGES OF INTACT IMPLANTS IMAGE ON THE LEFT - Ultrasound pictures (a) and (b) show an intact breast implant. Black asterisk shows breast gland, Black arrow shows pectoralis major muscle. White arrow shows thin, continuous echogenic line representing parenchymal tissue-implant interface and silicone implant (white asterisk) Ultrasonography of a woman with intact implants, Perez 2011, Figure 18 IMAGE ON THE RIGHT – The intact breast implant shows a well defined anterior margin with an anechoic and homogenous internal appearance. Normal reverberation artefact is seen in the anterior aspect of the implant and should not be confused with abnormalities Normal Mammary Prosthesis, Ortega et al,2013, Figure 3

  5. ULTRASOUND IMAGES OF INTACT IMPLANTS IMAGE ON THE LEFT - The normal appearance of a radial folds in an implant with normal physiological amount of capsular free fluid. Normal Mammary Prosthesis, Ortega et al,2013, Figure 3 IMAGE ON THE RIGHT – All inflatable implants have valves. An example of such a valve is shown on the right Ultrasoundpaedia, Ultrasound of the Breast – Normal, 2014, http://www.ultrasoundpaedia.com/normal-breast/

  6. INTRACAPSULAR RUPTURE • Defined as rupture that only involves the silicone shell, with free silicone gel still contained by the surrounding fibrous capsule (Bondurant et al. 1999) ‘Intracapsular Rupture’, Breast Health Ultrasound, OBGYN.net Staff. 2014

  7. SONOGRAPHIC FINDINGS OF INTRACAPSULAR RUPTURE • ‘Step ladder sign’ – several horizontal and parallel echogenic lines observed inside of the lumen of the implant • This occurs due to extraversion of silicone gel surrounded collapsed shell of the implant • Echogenic implant lumen • Ill defined implant margin • Silicone globules between implant surface and fibrous capsule

  8. ULTRASOUND IMAGES SHOWING INTRACAPSULAR RUPTURE Intracapsular Rupture, Ortega et al,2013, Figure 3 Ruptured Breast Implant, ulrasoundcases.info Case 315.7, 2014 Image above shows ‘step ladder sign’ with multiple echogenic lines seen within the implant lumen Another image showing intracapsular rupture. Note the presence of echogenic material within the implant lumen

  9. EXTRACAPSULAR RUPTURE • Silicone access to breast tissue caused by the disruption of BOTH implant shell and fibrous capsule. • Characterised by the presence of macroscopic amounts of silicone outside breast implant AND fibrous capsule ‘Intracapsular Rupture’, Breast Health Ultrasound, OBGYN.net Staff. 2014

  10. SONOGRAPHIC FINDINGS IN EXTRACAPSULAR RUPTURE • ‘Snowstorm appearance’ – echogenic pattern resembling ‘bowel gal’ within an implant. • Well defined hyperechoic, homogenous node with round anterior shape causing dirty acoustic shadowing – i.e. snowstorm appearance in involved axillary lymph node

  11. ULTRASOUND IMAGES OF EXTRACAPSULAR RUPTURE Extracapsular silicone implant rupture. (a) ultrasound image showing ‘snow storm sign’ in a lymph node containing silicone, (b) corresponding mammogram showing an irregular lump from the implant (arrow head) Extracapsular Rupture Perez 2011, Figure 21

  12. ULTRASOUND IMAGES OF EXTRACAPSULAR RUPTURE Extracapsular Rupture, Ortega et al,2013, Figure 11 Extracapsular Rupture, Ortega et al,2013, Figure 10 Image on the left shows a well defined hyperechoic node which causes dirty posterior shadowing (the snowstorm sign) representative of extracapsular silicone gel that has traversed into the breast parenchyma. Image on the right shows the axillary region containing an enlarged lymph node infiltrated causing a snow storm appearance

  13. US PITFALLS IN IMPLANT IMAGING • Fibrous changes that occur in tissue adjacent to silicone gel implants can cause difficulty in imaging • The development of scar tissue along incision site can contribute to suboptimal imaging • Reverberation in anterior part of implant is normal and must not be mistaken for pathology • Sound travels faster in silicone gel, thereby causing them to appear deeper than they truly are • Ultrasound is highly operator dependent • Unable to visualise posterior surface of the implant due to beam attenuation caused by silicone

  14. ADVANTAGES OF ULTRASOUND IN BREAST IMPLANT IMAGING • Inexpensive • Uses non-ionsing radiation • Has potential to detect both intra and extra capsular rupture • An anechoic interior on ultrasound is a strong indicator of an intact implant • Can be more sensitive than mammography for evaluation of implant integrity • In addition to rupture, ultrasound can be used to evaluate other complication of breast implants such as hematomas, seromas, fat necrosis and abscesses (Rojas et al, 2005)

  15. REFERENCES • Ortega, Jamie, Fredy Cabrera, and MichealRestrepo. "DIAGNOSIS BY ULTRASOUND OF RUPTURE OF MAMMARY IMPLANTS AND OTHER ASSOCIATED COMPLICATIONS: REVISION ARTICLE." Rev Colomb Radio 24, no. 3, 3734-42. Accessed September 11, 2014. http://www.webcir.org/revistavirtual/articulos/diciembre13/colombia/col_ingles.pdf. • Geertsma, Taco. "Welcome to Ultrasoundcases.info - Ultrasound Cases ..." Accessed September 8, 2014. http://www.ultrasoundcases.info/Slide-View.aspx?cat=455&case=838. • Hallett, Richard. "Imaging in Breast Implant Rupture ." Imaging in Breast Implant Rupture. October 1, 2013. Accessed October 6, 2014. http://emedicine.medscape.com/article/345877-overview#a22. • Hickey, Janice, and Franklin Goldberg. Ultrasound Review of the Abdomen, Male Pelvis & Small Parts. Philadelphia: Lippincott, 1999. • Luijkx, Tim, and Morlie Wang. "Breast Implant Rupture." Radiopaedia Blog RSS. Accessed October 9, 2014. http://radiopaedia.org/articles/breast-implant-rupture. • Juanpere, Sergi, Elsa Perez, Oscar Huc, NaiaraMotos, Josep Pont, and Salvador Pedraza. "Imaging of Breast Implants—a Pictorial Review." Insights into Imaging 2, no. 6 (2011): 653-70. Accessed October 12, 2014. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3259319/#!po=63.8889. • "Ultrasound of the Breast - Normal." Accessed October 9, 2014. http://www.ultrasoundpaedia.com/normal-breast/. • Bondurant, Stuart. Safety of Silicone Breast Implants. Washington, D.C.: Institute of Medicine, 2000.

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