Very dense breasts with multiple benign-appearing masses Previous history of silicone implant rupture Direct silicone injections Steatocystoma multiplex
direct silicone injections
This patient had received direct silicone injections for breast enlargement. This is illegal in the USA, but is still performed in some nations. The sensitivity of mammography is obviously much lower in these patients.
This is a different patient who was told that she should have a bilateral mastectomy because her silicone injections made mammography “useless.” She referred herself for a screening MRI.
Observe that multiple silicone masses are suppressed, and the single enhancing mass is easily visible on MR images.
What is your recommendation?
Ultrasound focused in the location of the mass followed by ultrasound-guided biopsy MRI-guided core biopsy MRI-guided wire localization and surgical excision
An ultrasound focused in the location of the mass will likely allow core biopsy. If not visible with ultrasound, possible because of the overlying blobs of silicone, then an MRI-guided biopsy should be performed
If you are doing breast MRI in your institution, it is important to have MR biopsy capability, or you and your clinicians will be very frustrated by the lesions visible on MRI only.
At our institution, we perform MR-guided biopsy and leave a marker clip in place, so that wire localization of the clip can be performed under mammographic guidance if the lesion is malignant or high-risk.