Magnetic resonance imaging to diagnose breast implant rupture

Abstract.

The purpose of this study was to prospectively evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) as a method to discover an implant rupture in patients with breast augmentation or reconstruction. From January 1997 to February 1998, 20 breast implants in 12 patients (mean age 52.5 years) were removed surgically. Indications included local pain after reconstructive breast surgery (n=5 patients), local deformities after breast augmentation (n=3) or with (n=3) pain, and secondary intervention after sex change (n=1). In all patients, MRI (T2-weighted as well as dynamic contrast-enhanced T1-weighted sequences) was performed prior to surgery. On MRI, hypointense curvilinear lines ("linguine sign") on T2-weighted images, interruption of the fibrous capsule, or the presence of siliconomas were judged indicative of implant rupture. The MRI findings were compared with the surgical findings in all cases. MRI suggested that 14 implants were ruptured, but intraoperative rupture was confirmed in 9 implants. MRI gave a false-negative result in one implant, but false-positive in 5 cases. Sensitivity of MRI for detection of implant rupture was 100%, specificity 88%. Early and focal contrast enhancement indicative of malignancy was not seen. Siliconomas were found as lumps in two cases without a precise conclusion preoperatively. MRI combined with the clinical symptoms is the most efficient method for the evaluation of breast implant conditions. It can facilitate the decision to perform surgical revision.