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Appropriate Use of Magnetic Resonance Imaging and Ultrasound to Detect Early Silicone Gel Breast Implant Rupture in Postmastectomy Reconstruction

Rietjens, Mario; Villa, Gaetano; Toesca, Antonio; Rizzo, Stefania; Raimondi, Sara; Rossetto, Fabio; Sangalli, Claudia; De Lorenzi, Francesca; Manconi, Andrea; Matthes, Angelo Gustavo Zucca; Chahuan, Badir; Brenelli, Fabricio; Bellomi, Massimo; Petit, Jean Yves

Plastic & Reconstructive Surgery: July 2014 - Volume 134 - Issue 1 - p 13e–20e
doi: 10.1097/PRS.0000000000000291
Breast: Outcomes Articles
Press Release
Discussion

Background: Implant rupture is one of the most important sequelae of breast reconstruction after mastectomy. The primary aim of this study was to compare magnetic resonance imaging and ultrasound evaluation with intraoperative findings and provide a reliable description of the occurrence of each radiological sign.

Methods: The authors prospectively recruited a consecutive series of 102 postmastectomy patients requiring implant change for aesthetic purposes. Magnetic resonance imaging and ultrasound evaluation results were compared with intraoperative findings. Sensitivity, specificity, positive predictive value, negative predictive value, and the overall accuracy of magnetic resonance imaging and ultrasound in detecting ruptured implants were calculated, along with their corresponding 95 percent confidence intervals.

Results: Magnetic resonance imaging performs better than ultrasound for diagnosis of breast implant rupture, with overall accuracies of 94 and 72 percent, respectively. The negative predictive value of ultrasound was 85 percent, meaning that in the case of negative ultrasound findings, magnetic resonance imaging may be avoided. Teardrop sign and water droplets are the most common findings on magnetic resonance imaging.

Conclusions: Magnetic resonance imaging should be considered the method of choice for investigating silicone gel implant rupture in postmastectomy patients, and the standardization of magnetic resonance imaging criteria may improve magnetic resonance imaging accuracy. The authors therefore suggest a strategy of screening asymptomatic women with ultrasound every year and with magnetic resonance imaging every 5 years.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, II.

Milan, Italy; and Barretos, Brazil

From the Departments of Plastic and Reconstructive Surgery, Radiology, and Breast Surgery, and the Division of Epidemiology and Biostatistics, European Institute of Oncology; and the Department of Breast and Reconstructive Surgery, Barretos Cancer Hospital.

Received for publication September 11, 2013; accepted January 2, 2014.

Disclosure: The authors have no financial interest in any of the products or devices mentioned in this article.

Mario Rietjens, M.D., Division of Plastic Surgery, European Institute of Oncology, Via Ripamonti, 435, Milan, Italy 20141 mario.rietjens@ieo.it

©2014American Society of Plastic Surgeons