Ch 13 Breast Implants Flashcards
What are the 2 m/c types of breast implants?
Saline + silicone
What imaging modality is the gold standard for assessing implant integrity?
MRI
Why is u/s used to evaluate breast implants?
-It evaluates the overlying breast tissues for pathology + changes within/around the prosthesis
-U/s has a lower cost
Is mammography used to evaluate breast implants?
No, it may be suboptimal + difficult to assess
Where are implants m/c placed?
-Posterior to glandular tissue + anterior to pectoralis muscle
-In the subglandular or prepectoral location
What is another less common location implants can be placed?
-Posterior to the pectoralis major muscle
-In the submuscular or retropectoral location
(this may reduce capsular contracture)
What location is standard for placement of tissue expanders + implants following a mastectomy?
Posterior to the pectoralis major muscle (submuscular or retropectoral location)
SF of saline implants?
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)
Are single or double lumen silicone implants m/c?
Single
SF of single lumen silicone implants?
-Generally anechoic
-They come in prefilled sizes
SF of double lumen silicone implants?
-They have separate silicone + saline chambers
-An echogenic membrane is shown to separate the chambers
-A filling port extends to the expandable saline chamber
Are fibrous capsules more pronounced with silicone or saline implants?
Silicone
Why does a fibrous capsule form around an implant?
It is the bodies response to a foreign body
SF of silicone shells?
Smooth or textured (texturing may reduce capsular contracture)
SF of normal implants?
-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)
What is the capsule-shell-echo-complex?
-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
Propagation speed artifact occurs in silicone or saline implants?
Silicone - b/c the speed of sound is much slower
List 4 common u/s findings when imaging breast implants?
-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)
Changes in implant shape, contour + size may be due to what?
-Fibrous or calcific contracture
-Herniation
-Rupture
-Deflation
List 3 main implant complications?
-Capsular contracture (m/c with silicone implants)
-Focal herniation
-Peri implant seroma abscess or hematoma
Capsular contracture is m/c with silicone or saline implants?
Silicone
What is capsular contracture?
-Thickening + hardening of the fibrous capsule
-The implant becomes round, hard + immobile
SF of capsular contracture?
-Thickened capsule-shell complex with poor compressibility when probe pressure is applied
-Capsular calcifications may be seen
What is a focal herniation caused by?
-Herniation of the implant that occurs through a crack in the fibrous capsule
-It presents as a palpable lump
