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Women's Health > Implants > Flashcards

Implants Flashcards

1
Q

What are some indications to get implants?

A
  • cosmetic augmentation
  • post-mastectomy reconstruction
  • congenital amastia
  • severe hypoplasia/asymmetry
  • inlays for tissue defects
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2
Q

Why would a patient have a tissue defect?

A

lumpectomy can leave uneven areas etc

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3
Q

What locations can implants be placed in?

A
  • subglandular (cosmetic)
  • submuscular (reconstruction)
  • subcutaneous
  • intramammary
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4
Q

What is a TRAM flap?

A
  • transverse rectus abdominis muscle
  • part of abdominal wall, fat, muscle and vasculature is transplanted to the breast
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5
Q

What is a latissimus dorsi flap?

A

tissue from the upper back is transplanted to the breast, implant goes under muscle

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6
Q

What are the two common types of implants?

A

silicone and saline

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7
Q

What is the most common implant used?

A

single lumen saline

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8
Q

What are the two types of silicone implants?

A
  • single lumen (gummy bear)
  • double lumen: outer saline, inner silicone or outer silicone, inner saline
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9
Q

What is a dangerous and illegal method of breast augmentation?

A

silicone injections

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10
Q

What is the sonographic appearance of implants?

A
  • defined shell/tissue surface
  • smooth elliptical shape
  • anechoic lumen (silicone has echoes at higher gain)
  • anterior reverb
  • possible folds
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11
Q

What is the difference between saline and silicone implants and the size they appear on US?

A

saline appears on US as its actual size
silicone appears larger in AP

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12
Q

What do the shell walls look like on US?

A

two thin echogenic parallel lines, a third line can be seen above and is the fibrous capsule

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13
Q

What does an expander valve look like on US?

A
  • usually on anterior surface
  • usually subareolar
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14
Q

Why can wrinkling of the skin occur with implants?

A
  • can be secondary to implant contracture
  • placement within a small pocket or underfilled implant
  • due to lobulation of implant shell
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15
Q

What kind of implants are more prone to wrinkling?

A

saline

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16
Q

What is a peripheral fold?

A

AKA radial fold
- normal
- extends from inner wall for variable distance
- internal, long, wavy complex folds

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17
Q

What can a peripheral fold appear as?

A

implant rupture

18
Q

What is reverberation artifact? What does it cause difficulties with?

A
  • repeating bands of echoes along anterior surface
  • can make it harder to detect intracapsular rupture
19
Q

What kind of implants are more likely to cause reverberation artifact?

A

silicone

20
Q

What kind of implants cause propagation speed artifact and why?

A

silicone, speed of sound is slower than in soft tissue and causes posterior structures to appear deeper

21
Q

What are short term complications of implants?

A
  • pain, tenderness
  • hematoma
  • infection and abscess
  • seroma
  • loss of nipple sensation
22
Q

What are long term implant complications?

A
  • capsular fibrosis and calcification
  • capsular contracture
  • herniation
  • migration
  • chronic infection
  • rupture
  • silicone granuloma
  • autoimmune response
23
Q

What is capsular fibrosis?

A
  • thin rim of scar tissue around implant’s outer shell
  • begins within weeks of implantation
  • response to a foreign object in body
24
Q

What is the MC implant complication?

A

fibrous encapsulation

25
Q

What is capsular contracture?

A
  • hardening & distortion of implant
  • tightening & constriction of the fibrous capsule
26
Q

What measurement of the fibrous capsule indicates capsular contracture?

A

Over 1.5 mm thick

27
Q

What does capsular contracture do to implants?

A

causes them to become more rounded or balloon shaped, causes asymmetry/distortion

28
Q

What kind of implants more commonly cause capsular contracture?

A
  • subglandular silicone
  • thin, smooth implant shells
29
Q

What are some things that can help prevent capsular contracture?

A

texturing, coating, subpectoral location

30
Q

How can capsular calcification affect US?

A

Can cause attenuation that limits evaluation

31
Q

What is herniation of an implant?

A
  • break in fibrous capsule that allows portion of intact implant to bulge through
  • can be palpable
32
Q

Why are US and MRI better at detecting herniation than mammogram?

A

Mammo cannot differentiate between herniation & extracapsular rupture

33
Q

What is the second MC implant complication?

A

rupture

34
Q

What are the two types of rupture?

A

intracapsular and extracapsular

35
Q

What are risk factors for rupture?

A

trauma and implant age

36
Q

What is the difference between a saline and silicone rupture?

A
  • silicone can cause inflammatory response and form granulomas
  • saline is absorbed by the tissues
37
Q

What is intracapsular silicone implant rupture?

A
  • silicone leaks outside of implant through shell defect
  • still inside fibrous capsule
38
Q

What does intracapsular implant rupture look like on US?

A

significant collapse and folding of implant (stepladder sign)

39
Q

What is the stepladder sign?

A
  • parallel line sign
  • most reliable
  • parallel echogenic bands reflecting from folded layers of collapsed implant shell
40
Q

What is an extracapsular silicone implant rupture?

A
  • silicone gel leaks through a defect in shell and fibrous capsule
  • silicone migrates into breast tissue, chest wall and distant locations
41
Q

What is the snowstorm sign?

A
  • most reliable finding for extracapsular rupture
  • affected tissues are highly echogenic with dirty shadowing
  • irregular pattern due to difference in acoustic properties of tissue and silicone
42
Q

What is another finding that may be present with an extracapsular rupture?

A
  • fluid collection
  • hypo/anechoic, outside fibrous capsule
  • less reliable

Women's Health (10 decks)

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