From the Guidelines
Magnetic Resonance Imaging (MRI) is the best imaging modality to determine if there is damage to a breast implant, as it provides detailed images of both the implant shell and its contents, allowing for accurate detection of ruptures, including silent ruptures that may not cause symptoms. This is based on the most recent and highest quality study, which reported a sensitivity of 87% and a specificity of 89.9% for MRI in detecting breast implant ruptures 1.
Key Points
- MRI is superior to ultrasound and mammography for detecting breast implant ruptures, particularly intracapsular ruptures where the silicone remains contained within the fibrous capsule that forms around the implant.
- The FDA recommends that women with silicone gel-filled implants undergo MRI screening three years after implant placement and every two years thereafter.
- Ultrasound may be used as an initial screening tool due to lower cost and greater accessibility, but it is less sensitive than MRI, with a reported accuracy of 72%, sensitivity of 30%, and specificity of 77% in some studies 1.
- Mammography has low sensitivity for detection of implant rupture due to the silicone implant appearing extremely radiopaque, and is not recommended for implant evaluation in asymptomatic patients with silicone implants 1.
Imaging Modalities
- MRI: provides detailed images of both the implant shell and its contents, allowing for accurate detection of ruptures, including silent ruptures that may not cause symptoms.
- Ultrasound: may be used as an initial screening tool, but is less sensitive than MRI, particularly for detecting intracapsular ruptures.
- Mammography: has low sensitivity for detection of implant rupture and is not recommended for implant evaluation in asymptomatic patients with silicone implants.
Recommendations
- MRI is the recommended imaging modality for assessing breast implant integrity, particularly for detecting intracapsular ruptures.
- Ultrasound may be used as an initial screening tool, but MRI should be used to confirm the diagnosis.
- Mammography should not be used for implant evaluation in asymptomatic patients with silicone implants.
From the Research
Imaging Modalities for Assessing Breast Implant Integrity
- Magnetic Resonance Imaging (MRI) is considered the accepted standard for evaluating breast implant integrity 2, 3, 4
- MRI has high spatial resolution and contrast between implants and soft tissues, and does not use ionizing radiation 3
- MRI has the highest sensitivity and specificity for implant rupture, thanks to its sequences that can suppress or emphasize the signal from silicone 3
Comparison of Imaging Modalities
- A study found that physical examination with or without mammography is as accurate as MRI in determining implant integrity in the setting of capsular contracture 2
- Another study found that ultrasound is nearly as effective as MRI for detecting breast implant ruptures and is superior for detecting silicone depositions in axillary lymph nodes 5
- Ultrasound may be an acceptable alternative to MRI for evaluating silicone leakage from silicone breast implants 5
Limitations and Considerations
- Some women may be unable to undergo MRI due to contraindications such as cardiac pacemakers, aneurysm clips, and claustrophobia, in which case mammography, ultrasonography, and computed tomography may be used 4
- Free silicone from breast implant rupture can present with enhancement on MRI, which may lead to unnecessary biopsies 6
- The prevalence of gel bleed and its potential adverse health effects may be underestimated, and further research is needed to explore its potential association with systemic symptoms 5