Breast Implants Flashcards
What percentage of implants are for cosmetic augmentation?
60-80%
What is the most common “medical” reason for implants?
post-mastectomy reconstruction
What are sites for implant placement?
- subglandular (submammary; prepectoral)
- submuscular (subpectoral; retropectoral)
- subcutanseous
- intramammary
For cosmetic augmentation mammoplasty, implants are typically placed where?
Beneath the glandular tissue in front of the pectoralis major muscle
A submuscular location is typical for what?
post-mastectomy reconstruction
Implant placement under the pectoralis muscle in patients with augmentation mammoplasty allows what?
easier evaluation of the breast tissue during mammo and lowers the incidence of capsular contracture
A subpectoral location can be subject to what?
Implant migration
Alternative site for post-mastectomy reconstruction and for tissue expanders?
Subcutaneous, prepectoral
Intramammary implants are used for what?
Inlays for tissue defects
Scanning the upper outer segment of the implant near the axilla will allow correct identification of the implant as being what?
submuscular in location
How many different types and variations of breast implants are there?
200
Common types of implants?
- Saline-filled; single lumen
- Silicone
- Saline inflatable tissue expanders (following mastectomy)
Silicone types?
- Single lumen gel filled
- Double lumen
- outer saline; inner silicone
- outer silicone; inner saline
What does autologous mean?
donor tissue
Types of autologous reconstruction?
- Transverse rectus abdominis muscle (TRAM) flap
- Latissimus dorsi flap
What is the most common double lumen implant?
inner silicone chamber surrounded by an outer saline chamber
What is the shell of an implant?
Elastomer or polyurethane and can be smooth or textured
What does a textured implant shell help reduce?
fibrous scarring around the implant
What year did the FDA restrict the use of silicone gel implants for cosmetic augmentation because of health concerns related to leakage?
1992
What year did the FDA re-approve silicone gel implants after extensive clinical studies?
2006
What causes severe complications and granuloma formation?
Direct injection of silicone, paraffin, or fat
The placement of what has been discontinued?
polyvinyl sponges
A section of periumbilical abdominal wall and subcutaneous fat, along with the associated muscular and vascular pedicles is transferred to the breast.
Transverse rectus abdominis muscle (TRAM) procedure
What procedure involves transfer of tissue (muscle, fat, skin) from the upper back to the breast region?
Latissimus dorsi
Short term breast implant complications?
- pain and tenderness
- bleeding/ hematoma
- infection/ abscess
- seroma
- loss of nipple sensation
Long term breast implant complications?
- capsular fibrosis/ calcification
- capsular contracture
- herniation
- migration
- chronic infection
- rupture
- silicone granuloma
A thin rim of scar tissue commonly forms around a breast implant adjacent to the outer shell. Most common implant complication?
Fibrous encapsulation; scarring begins within weeks of implantation
Since the 1980’s, what has been added to the elastomer shell to reduce permeability?
fluorsilicone
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?
Capsular contracture
Methods to reduce risk of implant capsular contracture?
- Subpectoral implant placement
- Use of saline implants
- Textured implant shell
- Adding fluorsilicone to elastomer shell
- Adding polyurethane to textured shell
Textured polyurethane-coated implants may demonstrate what between the outer implant shell and the fibrous capsule?
small amount of serous fluid, provides a thin space for the implant to move and maintain its flexibilty
What modality may have difficulty differentiation herniation from extracapsular rupture?
mammo
What is the second most common complication?
Rupture
Besides trauma, what is the key risk factor for rupture?
implant age
Most silicone implants show some degree of implant rupture after how many years?
11-15 years
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?
diaphragm-type fill port or expander valve
What type of implants are more prone to wrinkling and folding?
saline
What artifact is commonly seen as repeating bands of echoes along the anterior margin of the implant?
reverberation artifact; more pronounced with silicone implants
What helps to reduce reverberation artifact?
light scanning pressure, tissue harmonics, or compound imaging
The speed of sound through silicone is ______ than through soft tissue and saline.
slower (1000 m/s)
The majority of silicone implant ruptures are where?
intracapsular; silicone leaks outside of the implant but is still contained by the fibrous capsule
Main sonographic sign of intracapsular silicone implant rupture?
stepladder or parallel-line sign
Leakage of silicone gel through a breach in the implant shell and the fibrous capsule.
extracapsular rupture
Characteristic sonographic appearance of microglobules of silicone within soft tissue or lymph nodes?
echogenic noise or snowstorm sign
What special mammo views allow exclusion of the implant on the mammo for better evaluation of the breast tissue?
“pushback” or Eklund views
