Teaching Files
Archived Case 44
Contributed by: Katherine E. Dee, MD -
What is your assessment?
Intracapsular rupturePrevious history of silicone implants
S/P removal of saline implants
Saline implant rupture
leaving the empty envelopes in front of the pectoralis. When this happens, the saline is absorbed by the body, and the patient will notice that the breast has shrunk rapidly. When it happens unilaterally, there can be quite a bothersome asymmetry.
There is no concept if intra- vs. extra-capsular rupture with saline implants, so there is no need to perform MRI for evaluation of saline implants. MRI is reserved for evaluation of silicone implant rupture
This patient has normal saline implants
Notice how well you can see through saline. One can see the folds of the envelope and the valves. Silicone would be a total white-out.
What is the standard evaluation of implant patients?
Screening mammogram including MLO CC and Implant displaced views (ID) in MLO and CCDiagnostic mammogram including MLO CC and Implant displaced views (ID) in MLO and CC
Screening mammogram including MLO and CC views. If you need to do ID views then it is a diagnostic mammogram
Diagnostic mammogram including MLO CC and Implant displaced views (ID) in MLO and CC and the ultrasound should be performed due to decreased sensitivity of mammography with implants.
(thus 4 views of each breast instead of 2). This can be performed as either a screening or diagnostic exam. It obviously takes longer and costs more to perform and read, but as of this writing (7/2002) mammography of patients with implants is not reimbursed any more than a patient with no implants.
At this time, screening ultrasound is not recommended for asymptomatic patients with implants.
What about these implants?
Subpectoral silicone implantsPrepectoral silicone implants
Subpectoral saline implants
Subpectoral dual lumen implants
Dual Lumen subpectoral implants
What about this patient?
Extracapsular silicone implant rupture
S/P removal of rupture silicone implants
Silicone injections
Diffuse fat necrosis
History of trauma from explosion with embedded debris in breasts
This is illegal in the United States, but is still performed in some parts of the world. As you can imagine, the sensitivity of mammography in these patients is greatly reduced.