Lesson 3B (Part 1) Flashcards
Saline breast implants (4)
- Saline solution
- Filled at the time of the surgery
- If they rupture they get absorbed
- Single lumen
What volume can breast implants be?
120-960cc
Silicone breast implants (3)
- Pre-filled with silicone gel
- a thick, sticky fluid that closely mimics the feel of human fat - They have a silicone outer shell that is filled with silicone gel
- They come in different sizes and have either smooth or textured shells
What is the most common type of breast implant?
Saline
Where are the breast implant locations? (2)
- Subglandular
2. Subpectoral
Subglandular
Between glandular tissue and pectoral muscle
- breast augmentation
Subpectoral
Between pectoralis major and minor muscles
- breast reconstruction following mastectomy
Which breast implant location is more common for cosmetic purposes?
Subglandular
What is the normal appearance of breast implants on US?
Radial fold in an implant with normal physiological amount of capsular free fluid
What is a normal finding of an implant?
Valve
- high down artifact
How do you image breast implants?
2 fold examination
What is the 2 fold examination for breast implant imaging? (2)
- Breast tissue.
- Deeper implant
- may require lower frequency or a curved probe to investigate
implant
- should be anechoic with well defined margins
- folds are commonly seen in the implant surface
- small traces of simple fluid will be seen overlying the implant but is contained by the overlying fibrous capsule that contains the implant
What does normal subpectoral prosthesis look like on US?
Only the upper part of the implant is covered by the pectoral muscle
What forms around the implant shell after implantation of a silicone or saline breast implant?
A fibrous capsule
- scar
What does a ruptured implant look like on US? (2)
- The implant is empty with multiple folds
2. No anechoic centre
When does an intracapsular rupture occur?
When the shell of the implant ruptures but the fibrous capsule formed by the breast remains intact
Stepladder sign
Indicating that an intracapsular breast implant rupture
- infolding of the wall and free silicone outside the implant
silicone particles in the axilla
Linguine sign
In an intracapsular rupture the contents of the implant are contained by the fibrous scar, while the shell appears as a group of wavy lines
What is another term for stepladder sign on MRI?
Linguine sign
What can the extracapsular rupture lead to?
A change in the implant contour and may be detected on clinical examination or mammography
What does an extracapsular rupture imply?
An intracapsular rupture as well
What does a ruptured silicone prothesis for extracapsular appear like?
A snow storm
What are implant count irregularities due to?
A retraction and encapsulation of fibrous connective tissue
What are sonographic findings postsurgical for breast implant imaging? (4)
- Skin thickening
- scarring - Architectural distortion of the parenchyma
- Development of a mass and/or calcifications
- Hypoechoic or hyperechoic structures and/or masses with acoustic shadowing
What can postsurgical breast implant images mimic?
Cancer
- thus prompting a thorough workup to determine if tissue sampling is indicated to exclude malignancy
What is the acute stage of cancer in the breast from implants?
Hematomas may be ill defined or may present as a mass containing complex echoes with distal acoustic enhancement or shadowing
What happens over time to acute stage cancer in breast implants?
The hematoma organizes and becomes more masslike, and the fluid becomes more hypoechoic and may even appear cystic
What sonographic finding is consistent with a resolving hematoma after surgery?
Complex mass with internal echoes
What sonographic finding can be seen in both cancer patients as well as postsurgical scars? (2)
- Acoustic shadowing
2. Irregular hypoechoic masses
What are the sonographic findings in the acute postoperative period?
Diffuse hemorrhage and/or edema
- increase or decrease echogenicity
- or an area of architectural distortion
