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E1514. A Multimodality Review of Breast Implants and Implant-Related Complications.
Authors
  1. Elizabeth West; New York Presbyterian Hospital/Columbia
  2. Christopher Doyle; Columbia University Irving Medical Center
  3. Allison Borowski; Columbia University Irving Medical Center
  4. Elise Desperito; Columbia University Irving Medical Center
  5. Richard Ha; Columbia University Irving Medical Center
Background
Breast augmentation mammoplasty with prosthetic breast implantation is a commonly performed procedure for cosmesis, often for reconstruction after mastectomy. Radiologists must be familiar with the normal appearance of breast implants as they are frequently encountered during both screening and diagnostic work-up. Several imaging modalities are routinely used for evaluating implants and assessing for implant-related complications. Each modality has its unique advantages and limitations.

Educational Goals / Teaching Points
• Review normal appearance of saline and silicone implants on mammography, ultrasound and MRI. • Present a spectrum of implant-related complications across multiple modalities. • Understand advantages and disadvantages of each modality for assessing implant-related complications.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Breast implants are classified by type and location. These features are easily identified across all modalities. Normal breast implants have a capsule-shell complex, which can be seen as a trilaminar margin on US. On MR imaging, radial folds are a normal feature of implants. Familiarity with the normal appearance of breast implants is important for recognizing potential implant-related complications. Benign implant-related complications can be divided into early and late processes. Peri-implant fluid collections or hematomas are common early complications, which are often asymptomatic and may often resolve spontaneously. Chronic hematomas may require surgical evacuation. Peri-implant infection is an uncommon early complication, but it is one that is important to recognize. Reported rates of implant-related infection range from 0.6% to 2.5%. [1,2] Infectious processes are usually clinically apparent, which can aid in diagnosis. Common late complications include capsular calcification and contracture and implant rupture. Capsular calcification is best detected on mammography. Extensive calcification can lead to capsular contraction. Implant ruptures can be classified as intracapsular or extracapsular. Although ultrasound is less sensitive for the detection of implant rupture, it is often used as a first line modality given cost effectiveness and availability. [3] In comparison, a recent meta-analysis reported a 78% sensitivity and 91% specificity of MR imaging detection of implant rupture. [4] Silicone sensitive sequences are often necessary to identify extracapsular silicone rupture. Gel bleed is an uncommon complication. Malignant implant-related complications are rare and include breast implant-related anaplastic large cell lymphoma (BIA-ALCL) and sarcomas. BIA-ALCL typically presents with a late unilateral breast effusion, often in the setting of textured implants. Pathology is typically necessary to confirm these malignant diagnoses.

Conclusion
Radiologists must be familiar with normal appearance of breast implants as well as be able to recognize both benign and malignant implant-related complications. Understanding of the advantages and disadvantages of each modality in assessing such complications is important for prompt and accurate diagnostic work-up.