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MIDS 227 (neck + breast) > Ch 13 Breast Implants > Flashcards

Ch 13 Breast Implants Flashcards

1
Q

What are the 2 m/c types of breast implants?

A

Saline + silicone

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2
Q

What imaging modality is the gold standard for assessing implant integrity?

A

MRI

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3
Q

Why is u/s used to evaluate breast implants?

A

-It evaluates the overlying breast tissues for pathology + changes within/around the prosthesis
-U/s has a lower cost

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4
Q

Is mammography used to evaluate breast implants?

A

No, it may be suboptimal + difficult to assess

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5
Q

Where are implants m/c placed?

A

-Posterior to glandular tissue + anterior to pectoralis muscle
-In the subglandular or prepectoral location

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6
Q

What is another less common location implants can be placed?

A

-Posterior to the pectoralis major muscle
-In the submuscular or retropectoral location

(this may reduce capsular contracture)

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7
Q

What location is standard for placement of tissue expanders + implants following a mastectomy?

A

Posterior to the pectoralis major muscle (submuscular or retropectoral location)

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8
Q

SF of saline implants?

A

Single anechoic lumen + an anterior filling port to allow fluid expansion to the desired size

(note: the fill valve may be the cause of a palpable lump near the areola)

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9
Q

Are single or double lumen silicone implants m/c?

A

Single

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10
Q

SF of single lumen silicone implants?

A

-Generally anechoic
-They come in prefilled sizes

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11
Q

SF of double lumen silicone implants?

A

-They have separate silicone + saline chambers
-An echogenic membrane is shown to separate the chambers
-A filling port extends to the expandable saline chamber

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12
Q

Are fibrous capsules more pronounced with silicone or saline implants?

A

Silicone

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13
Q

Why does a fibrous capsule form around an implant?

A

It is the bodies response to a foreign body

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14
Q

SF of silicone shells?

A

Smooth or textured (texturing may reduce capsular contracture)

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15
Q

SF of normal implants?

A

-Capsule shell echo complex (3 echogenic lines)

-Textured implants appear thick or fuzzy

-Reverb artifact (band of false echoes across anterior lumen of implant)

-Propagation speed artifact in silicone implants (posterior wall of implant + distal structures falsely appear deeper into the chest than the adjacent tissues)

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16
Q

What is the capsule-shell-echo-complex?

A

-Smooth shells consist of an inner + outer layer
-It appears as 2 smooth thin echogenic lines with an adjacent capsule
-These 3 close echogenic lines is called the capsule-shell-echo-complex

17
Q

Propagation speed artifact occurs in silicone or saline implants?

A

Silicone - b/c the speed of sound is much slower

18
Q

List 4 common u/s findings when imaging breast implants?

A

-Linear in folding of the shell
-Long/wavy folds can mimic a double lumen implant or a intracapsular rupture
-Lobulation of the contour of an intact implant or wrinkling
-Reactive fluid may be b/w the shell + fibrous capsule (aka peri-implant effusion)

19
Q

Changes in implant shape, contour + size may be due to what?

A

-Fibrous or calcific contracture
-Herniation
-Rupture
-Deflation

20
Q

List 3 main implant complications?

A

-Capsular contracture (m/c with silicone implants)
-Focal herniation
-Peri implant seroma abscess or hematoma

21
Q

Capsular contracture is m/c with silicone or saline implants?

A

Silicone

22
Q

What is capsular contracture?

A

-Thickening + hardening of the fibrous capsule
-The implant becomes round, hard + immobile

23
Q

SF of capsular contracture?

A

-Thickened capsule-shell complex with poor compressibility when probe pressure is applied
-Capsular calcifications may be seen

24
Q

What is a focal herniation caused by?

A

-Herniation of the implant that occurs through a crack in the fibrous capsule
-It presents as a palpable lump

25
Q

What is a peri-implant seroma abscess or hematoma caused by?

A

From implant surgery, infection or trauma

26
Q

Why would implants rupture spontaneously?

A

Due to trauma or degeneration over time (increased age of implant)

27
Q

What 2 imaging modalities are most sensitive when assessing silicone implants integrity?

A

MRI + u/s

(b/c silicone blocks the penetration of x-rays, saline does not)

28
Q

Do saline or silicone implants rupture more easily from trauma?

A

Saline

(saline is reabsorbed by the body after the rupture, whereas silicone is not)

29
Q

Silicone implant failure is classified as an ___ or ___?

A

Intracapsular rupture (ICR) or extracapsular rupture (ECR)

30
Q

What is the m/c type of implant rupture?

A

ICR

31
Q

What is an ICR?

A

Break in the implant shell but is still contained by the fibrous capsule

32
Q

SF of an ICR?

A

Classic appearance:
-Step ladder sign or parallel line sign
-Appears as multiple, parallel echogenic lines layered within the silicone gel contained by the fibrous capsule

33
Q

The step ladder sign is associated with ___?

A

Significant rupture

34
Q

The step ladder sign corresponds to the ___ sign seen on MRI scans?

A

The linguine sign

35
Q

What are the pitfalls when trying to diagnose ICR?

A

Confusing other linear echoes as ICR (ex. reverb, redundant radial folds or double lumen membrane interfaces)

36
Q

Which imaging modality is more reliable than u/s in diagnosing ICR?

A

Non-contrast MRI

(especially in pt’s with double lumen implants)

37
Q

What is an ECR?

A

-Defect in both the implant shell + fibrous capsule
-Silicone leaks into the breast tissue

-Free silicone can migrate along the chest wall to the axilla, lymph nodes + extramammary sites

38
Q

SF of an ECR?

A

Echogenic noise sign or snowstorm appearance

MIDS 227 (neck + breast) (14 decks)

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