Implants

Question 1

What are PIP implants?

Answer 1

PIP implants are a type of silicone breast implant that were banned in 2010 after it came to light that they had been manufactured using industrial grade, rather than medical grade, silicone and were much more likely than others to rupture. There are no significant health risks identified.

Question 2

How can you tell an implant has ruptured?

Answer 2

• If breasts look misshapen/lumpy then USS of both breasts
• Normal implant appearance is anechoic (black) appearance of the implant contents
• Intracapsular rupture where silicone has leaked out of the implant shell but is held in place by the fibrous capsule formed by the body around the implant - there will be multiple abnormal linear areas within the implant

Question 3

What are the key features of a fibroadenoma?

Answer 3

• Most common in young women
• Mobile lump usually suggests a benign lesion
• A typical fibroadenoma on an USS will look like a solid mass with an ovoid shape and a well-defined margin
• Potentially do a biopsy if the patient is >25 (US-guided core biopsy)
• They do not routinely need excising but this may be considered if the lesion is large (>4cm), if the lesion is growing or if the patient requests excision.
• Most stay the same size and some get smaller with time and some do increase in size

Question 4

What is a fibroadenoma?

Answer 4

A benign fibroepithelial lesion of the breast which is composed of both stromal and epithelial components. Macroscopically, fibroadenomas are round or ovoid masses with a rubbery cut surface and are composed of relatively uniform pale brown tissue. They have well-circumscribed margins and are often lobulated with duct structures within the lesion seen as slit-like spaces.

Question 5

What happens with fibroadenomas in postmenopausal women?

Answer 5

Fibroadenomas are prone to involution and often develop characteristic calcification known as popcorn calcification. On mammograms it shows as multiple calcified fibroadenomas.

Question 6

What are the features of a cyst on a scan?

Answer 6

• In older women the most likely cause of a new grape-sized lump is a cyst.
• On a mammogram cysts have a black ‘halo’ which is a benign fracture
• A woman may have multiple rounded masses of varying sizes in both breasts - well defined
• On US cysts are a well-defined rounded mass with a black (anechoic) fluid centre.

Question 7

What is the management for cysts?

Answer 7

• Cysts are benign and don’t need treatment, however, if it is causing the patient symptoms such as a lump or pain then the fluid is usually aspirated
• Cysts don’t turn into cancer
• If the patient finds a new lump they should come back to get it checked out, rather than assume it is another cyst
• Normal cyst fluid can be aspirated and fluid can be a different colour. It does not need cytological or microbiological examination and can be discarded. One exception is if the fluid is blood-stained so it’s normally sent for cytology