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Breast Board > Breast Implants > Flashcards

Breast Implants Flashcards

1
Q

What percentage of implants are for cosmetic augmentation?

A

60-80%

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2
Q

What is the most common “medical” reason for implants?

A

post-mastectomy reconstruction

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3
Q

What are sites for implant placement?

A
  • subglandular (submammary; prepectoral)
  • submuscular (subpectoral; retropectoral)
  • subcutanseous
  • intramammary
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4
Q

For cosmetic augmentation mammoplasty, implants are typically placed where?

A

Beneath the glandular tissue in front of the pectoralis major muscle

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5
Q

A submuscular location is typical for what?

A

post-mastectomy reconstruction

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6
Q

Implant placement under the pectoralis muscle in patients with augmentation mammoplasty allows what?

A

easier evaluation of the breast tissue during mammo and lowers the incidence of capsular contracture

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7
Q

A subpectoral location can be subject to what?

A

Implant migration

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8
Q

Alternative site for post-mastectomy reconstruction and for tissue expanders?

A

Subcutaneous, prepectoral

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9
Q

Intramammary implants are used for what?

A

Inlays for tissue defects

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10
Q

Scanning the upper outer segment of the implant near the axilla will allow correct identification of the implant as being what?

A

submuscular in location

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11
Q

How many different types and variations of breast implants are there?

A

200

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12
Q

Common types of implants?

A
  • Saline-filled; single lumen
  • Silicone
  • Saline inflatable tissue expanders (following mastectomy)
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13
Q

Silicone types?

A
  • Single lumen gel filled
  • Double lumen
    • outer saline; inner silicone
    • outer silicone; inner saline
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14
Q

What does autologous mean?

A

donor tissue

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15
Q

Types of autologous reconstruction?

A
  • Transverse rectus abdominis muscle (TRAM) flap

- Latissimus dorsi flap

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16
Q

What is the most common double lumen implant?

A

inner silicone chamber surrounded by an outer saline chamber

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17
Q

What is the shell of an implant?

A

Elastomer or polyurethane and can be smooth or textured

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18
Q

What does a textured implant shell help reduce?

A

fibrous scarring around the implant

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19
Q

What year did the FDA restrict the use of silicone gel implants for cosmetic augmentation because of health concerns related to leakage?

A

1992

20
Q

What year did the FDA re-approve silicone gel implants after extensive clinical studies?

A

2006

21
Q

What causes severe complications and granuloma formation?

A

Direct injection of silicone, paraffin, or fat

22
Q

The placement of what has been discontinued?

A

polyvinyl sponges

23
Q

A section of periumbilical abdominal wall and subcutaneous fat, along with the associated muscular and vascular pedicles is transferred to the breast.

A

Transverse rectus abdominis muscle (TRAM) procedure

24
Q

What procedure involves transfer of tissue (muscle, fat, skin) from the upper back to the breast region?

A

Latissimus dorsi

25
Q

Short term breast implant complications?

A
  • pain and tenderness
  • bleeding/ hematoma
  • infection/ abscess
  • seroma
  • loss of nipple sensation
26
Q

Long term breast implant complications?

A
  • capsular fibrosis/ calcification
  • capsular contracture
  • herniation
  • migration
  • chronic infection
  • rupture
  • silicone granuloma
27
Q

A thin rim of scar tissue commonly forms around a breast implant adjacent to the outer shell. Most common implant complication?

A

Fibrous encapsulation; scarring begins within weeks of implantation

28
Q

Since the 1980’s, what has been added to the elastomer shell to reduce permeability?

A

fluorsilicone

29
Q

Hardening and distortion of an implant occurs when there is tightening and constriction of the surrounding fibrous capsule and causes the implant to become more rounded and ballon-shaped?

A

Capsular contracture

30
Q

Methods to reduce risk of implant capsular contracture?

A
  • Subpectoral implant placement
  • Use of saline implants
  • Textured implant shell
  • Adding fluorsilicone to elastomer shell
  • Adding polyurethane to textured shell
31
Q

Textured polyurethane-coated implants may demonstrate what between the outer implant shell and the fibrous capsule?

A

small amount of serous fluid, provides a thin space for the implant to move and maintain its flexibilty

32
Q

What modality may have difficulty differentiation herniation from extracapsular rupture?

A

mammo

33
Q

What is the second most common complication?

A

Rupture

34
Q

Besides trauma, what is the key risk factor for rupture?

A

implant age

35
Q

Most silicone implants show some degree of implant rupture after how many years?

A

11-15 years

36
Q

What is commonly seen along the anterior surface of a saline implant or tissue expander and may become palpable when there is little overlying tissue?

A

diaphragm-type fill port or expander valve

37
Q

What type of implants are more prone to wrinkling and folding?

A

saline

38
Q

What artifact is commonly seen as repeating bands of echoes along the anterior margin of the implant?

A

reverberation artifact; more pronounced with silicone implants

39
Q

What helps to reduce reverberation artifact?

A

light scanning pressure, tissue harmonics, or compound imaging

40
Q

The speed of sound through silicone is ______ than through soft tissue and saline.

A

slower (1000 m/s)

41
Q

The majority of silicone implant ruptures are where?

A

intracapsular; silicone leaks outside of the implant but is still contained by the fibrous capsule

42
Q

Main sonographic sign of intracapsular silicone implant rupture?

A

stepladder or parallel-line sign

43
Q

Leakage of silicone gel through a breach in the implant shell and the fibrous capsule.

A

extracapsular rupture

44
Q

Characteristic sonographic appearance of microglobules of silicone within soft tissue or lymph nodes?

A

echogenic noise or snowstorm sign

45
Q

What special mammo views allow exclusion of the implant on the mammo for better evaluation of the breast tissue?

A

“pushback” or Eklund views

Breast Board (9 decks)

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