Breast implant rupture
Updates to Article Attributes
Breast implant ruptures are a recognised complication of a breast implant. It can be intra- or extracapsular.
Pathology
After implantation of a silicone or saline breast implant, a fibrous capsule (scar) forms around the implant shell.
Among implant ruptures, 77-89% are intracapsular and 11-23% are extracapsular 4.
An intracapsular rupture occurs when the shell of the implant ruptures but the fibrous capsule formed by the breast remains intact. Silicone does not freely extravasate. This makes it difficult to detect on clinical exam or mammography. Intracapsular rupture is best seen on MRI.
An extracapsular rupture can lead to a change in the implant contour and may be detected on clinical examination or mammography. An extracapsular rupture implies intracapsular rupture as well 3.
Radiographic features
General
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. This has been termed the "linguine sign" and has been most commonly described with MR imaging 1. The "keyhole sign", "noose sign" or "teardrop sign" is the appearance of silicone on both sides of a radial fold and also suggests an implant rupture 2.
Mammography
Detection of implant ruptures (particularly silicone implant ruptures) are difficult on mammography and detection of intra-capsular silicone ruptures are almost impossible on mammography.
Breast ultrasound
Ultrasound may demonstrate a snowstorm appearance of an extra-capsular rupture, or the stepladder sign of an intra-capsular rupture (a normal implant should usually be anechoic). At the time of writing (2010), the overall sensitivity and specificity rates on ultrasound are thought to range between ~59-85% and ~55-79% respectively 7.
Breast MRI
Considered most sensitive for detection of implant rupture. Often does not require contrast if the indication is solely for this purpose.
Non-contrast MRI may also be able to distinguish between silicone and/or saline implants by using silicone or water only sequences. With the use of multi-planar imaging, MR may also be able to distinguish between radial folds or true ruptures. A "linguine sign" may be seen which is specific for an intra-capsular rupture is due to the free floating shell within the implant. A gross extra-capsular rupture is evident as free silicone, separate from the implant, which has extended beyond the implant capsule into the breast or axilla. Free silicone has an increased signal in T2-stir weighted sequenceSTIR sequence without any enhancement in T1 weighted fat-suppressed sequence.
The "salad oil sign" has also been described in a double lumen implant rupture, where there is mixing of the saline and silicone, although this on its own is non-specific.
See also
- gel bleed: the normal transudation of microscopic amounts of silicone gel through an intact shell
-<p><strong>Breast implant ruptures</strong> are a recognised complication of a <a href="/articles/breast-implants">breast implant</a>. It can be intra- or extracapsular.</p><h4>Pathology</h4><p>After implantation of a silicone or saline breast implant, a fibrous capsule (scar) forms around the implant shell.</p><p>Among implant ruptures, 77-89% are intracapsular and 11-23% are extracapsular <sup>4</sup>.</p><p>An <a href="/articles/intracapsular-rupture">intracapsular rupture</a> occurs when the shell of the implant ruptures but the fibrous capsule formed by the breast remains intact. Silicone does not freely extravasate. This makes it difficult to detect on clinical exam or mammography. Intracapsular rupture is best seen on MRI.</p><p>An <a href="/articles/extracapsular-rupture">extracapsular rupture</a> can lead to a change in the implant contour and may be detected on clinical examination or mammography. An extracapsular rupture implies intracapsular rupture as well <sup>3</sup>.</p><h4>Radiographic features</h4><h5>General</h5><p>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. This has been termed the "<a href="/articles/linguine-sign">linguine sign</a>" and has been most commonly described with MR imaging <sup>1</sup>. The "<a href="/articles/keyhole-sign-in-breast-implant-rupture">keyhole sign</a>", "<a href="/articles/noose-sign">noose sign</a>" or "<a href="/articles/teardrop-sign-in-breast-implant-rupture">teardrop sign</a>" is the appearance of silicone on both sides of a radial fold and also suggests an implant rupture <sup>2</sup>.</p><h5>Mammography</h5><p>Detection of implant ruptures (particularly silicone implant ruptures) are difficult on mammography and detection of intra-capsular silicone ruptures are almost impossible on mammography.</p><h5>Breast ultrasound</h5><p>Ultrasound may demonstrate a snowstorm appearance of an extra-capsular rupture, or the <a href="/articles/stepladder-sign">stepladder sign </a>of an intra-capsular rupture (a normal implant should usually be anechoic). At the time of writing (2010), the overall sensitivity and specificity rates on ultrasound are thought to range between ~59-85% and ~55-79% respectively <sup>7</sup>.</p><h5>Breast MRI</h5><p>Considered most sensitive for detection of implant rupture. Often does not require contrast if the indication is solely for this purpose.</p><p>Non-contrast MRI may also be able to distinguish between silicone and/or saline implants by using silicone or water only sequences. With the use of multi-planar imaging, MR may also be able to distinguish between radial folds or true ruptures. A "linguine sign" may be seen which is specific for an intra-capsular rupture is due to the free floating shell within the implant. A gross extra-capsular rupture is evident as free silicone, separate from the implant, which has extended beyond the implant capsule into the breast or axilla. Free silicone has an increased signal in T2-stir weighted sequence without any enhancement in T1 weighted fat-suppressed sequence.</p><p>The "<a href="/articles/salad-oil-sign">salad oil sign</a>" has also been described in a double lumen implant rupture, where there is mixing of the saline and silicone, although this on its own is non-specific.</p><h4>See also</h4><ul><li>- +<p><strong>Breast implant ruptures</strong> are a recognised complication of a <a href="/articles/breast-implants">breast implant</a>. It can be intra- or extracapsular.</p><h4>Pathology</h4><p>After implantation of a silicone or saline breast implant, a fibrous capsule (scar) forms around the implant shell.</p><p>Among implant ruptures, 77-89% are intracapsular and 11-23% are extracapsular <sup>4</sup>.</p><p>An <a href="/articles/intracapsular-rupture">intracapsular rupture</a> occurs when the shell of the implant ruptures but the fibrous capsule formed by the breast remains intact. Silicone does not freely extravasate. This makes it difficult to detect on clinical exam or mammography. Intracapsular rupture is best seen on MRI.</p><p>An <a href="/articles/extracapsular-rupture">extracapsular rupture</a> can lead to a change in the implant contour and may be detected on clinical examination or mammography. An extracapsular rupture implies intracapsular rupture as well <sup>3</sup>.</p><h4>Radiographic features</h4><h5>General</h5><p>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. This has been termed the "<a href="/articles/linguine-sign">linguine sign</a>" and has been most commonly described with MR imaging <sup>1</sup>. The "<a href="/articles/keyhole-sign-in-breast-implant-rupture">keyhole sign</a>", "<a href="/articles/noose-sign">noose sign</a>" or "<a href="/articles/teardrop-sign-in-breast-implant-rupture">teardrop sign</a>" is the appearance of silicone on both sides of a radial fold and also suggests an implant rupture <sup>2</sup>.</p><h5>Mammography</h5><p>Detection of implant ruptures (particularly silicone implant ruptures) are difficult on mammography and detection of intra-capsular silicone ruptures are almost impossible on mammography.</p><h5>Breast ultrasound</h5><p>Ultrasound may demonstrate a snowstorm appearance of an extra-capsular rupture, or the <a href="/articles/stepladder-sign">stepladder sign </a>of an intra-capsular rupture (a normal implant should usually be anechoic). At the time of writing (2010), the overall sensitivity and specificity rates on ultrasound are thought to range between ~59-85% and ~55-79% respectively <sup>7</sup>.</p><h5>Breast MRI</h5><p>Considered most sensitive for detection of implant rupture. Often does not require contrast if the indication is solely for this purpose.</p><p>Non-contrast MRI may also be able to distinguish between silicone and/or saline implants by using silicone or water only sequences. With the use of multi-planar imaging, MR may also be able to distinguish between radial folds or true ruptures. A "linguine sign" may be seen which is specific for an intra-capsular rupture is due to the free floating shell within the implant. A gross extra-capsular rupture is evident as free silicone, separate from the implant, which has extended beyond the implant capsule into the breast or axilla. Free silicone has an increased signal in STIR sequence without any enhancement in T1 weighted fat-suppressed sequence.</p><p>The "<a href="/articles/salad-oil-sign">salad oil sign</a>" has also been described in a double lumen implant rupture, where there is mixing of the saline and silicone, although this on its own is non-specific.</p><h4>See also</h4><ul><li>
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