From the Guidelines
To assess a leaking breast implant, an ultrasound (US) should be considered as the initial diagnostic imaging modality, given its high diagnostic accuracy of 94.7%, sensitivity of 98.3%, and specificity of 89.2%, as reported in a recent study by Rukanskiene et al 1. When evaluating a leaking breast implant, it is essential to consider the type of implant, as saline and silicone implants have different characteristics and symptoms. Saline implant leaks are typically noticeable due to deflation or asymmetry of the breast, whereas silicone implant leaks can be more challenging to detect, often presenting as a "silent rupture" with symptoms such as changes in breast shape, firmness, or size; pain, burning, or tingling; swelling; or hardening of the breast.
Diagnostic Imaging Modalities
- Ultrasound (US): useful for initial screening, with a high diagnostic accuracy of 94.7% 1, and can identify extracapsular silicone, which presents as a classic "snowstorm" pattern.
- MRI: considered the gold standard for detecting silicone implant ruptures, with a high sensitivity and specificity, and recommended every 2-3 years for surveillance.
- Mammography: may also detect ruptures but is less sensitive than US and MRI.
- CT scans: occasionally used but expose patients to radiation and are not the preferred initial diagnostic modality.
Clinical Evaluation
A thorough clinical evaluation is necessary to determine the extent of leakage and appropriate treatment options, which may include implant removal or replacement. It is crucial to consult a plastic surgeon or medical professional immediately if a leak is suspected. The FDA recommendations regarding evaluation for implant rupture do not replace additional imaging that may be warranted based upon each patient's underlying medical history or circumstances 1.
From the Research
Assessing a Leaking Breast Implant
To assess a leaking breast implant, several methods can be employed, including:
- Physical exam
- Ultrasound
- Magnetic Resonance Imaging (MRI) 2, 3, 4, 5 MRI is widely accepted as the imaging study of choice for diagnosing silicone breast implant rupture, due to its high sensitivity and specificity 3, 5.
Imaging Features of Implant Rupture
Imaging features that may indicate implant rupture include:
- Complicated internal structure
- Diffuse low-level echoes on sonograms
- Internal membranes on MR images
- Fluid droplets within the silicone on MR images
- Irregular implant contour (although this can be unreliable) 4
Evaluation of Implant Integrity
Noncontrast breast MRI is the imaging modality of choice for evaluating the integrity of breast implants and complications of breast augmentation 5. The use of MRI contrast material is indicated when infection or malignancy is suspected 5.
Detection of Implant Rupture
Implant rupture may be detected by:
- Physical exam
- Ultrasound
- MRI The majority of silicone implant ruptures are clinically undetectable, and symptomatic patients may present with capsular contracture, breast lumps, or changes in breast shape 2.