MR Imaging of Extracapsular Silicone from Breast Implants
Diagnostic Pitfalls
Wendie A. Berg1,2,
Thuy Khanh Nguyen1,
Michael S. Middleton3,
Mary Scott Soo4,
Gene Pennello5 and
S. Lori Brown6
1
Department of Radiology, University of Maryland, University Imaging Center,
419 W. Redwood St., Ste. 110, Baltimore, MD 21201.
2
Greenebaum Cancer Center, University of Maryland, University Imaging Center,
Baltimore, MD 21201.
3
Department of Radiology, University of California San Diego, MRI Institute,
410 W. Dickinson St., San Diego, CA 92103.
4
Department of Radiology, Duke University Medical Center, Box 3808 Hospital
South, Durham, NC 27710.
5
Division of Biostatistics, HFZ-542, Center for Devices and Radiological
Health, Food and Drug Administration, 1350 Piccard Dr., Rockville, MD
20850.
6
Office of Surveillance and Biometrics, Center for Devices and Radiological
Health, Food and Drug Administration, Rockville, MD 20850.
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Fig. 1A. —45-year-old woman with extracapsular rupture of 15-year-old
subpectoral single-lumen silicone gel implant. Axial fast spin-echo
T2-weighted MR image with water suppression shows several small foci of
silicone gel (curved arrows) anterior to implant. Note collapsed
shell (open arrows) indicating rupture.
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Fig. 1B. —45-year-old woman with extracapsular rupture of 15-year-old
subpectoral single-lumen silicone gel implant. Axial inversion-recovery
T2-weighted MR image with water suppression shows silicone gel
(arrows) in breast. Note extensive silicone granulomata adjacent to
implant anteriorly and laterally. Extent of soft-tissue silicone is best seen
here.
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Fig. 2A. —46-year-old woman with ruptured 18-year-old subpectoral
single-lumen silicone gel implant and isolated mass of extracapsular silicone
gel. Axial inversion-recovery T2-weighted MR image with water suppression
shows silicone gel (arrow) posterolateral to implant.
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Fig. 2B. —46-year-old woman with ruptured 18-year-old subpectoral
single-lumen silicone gel implant and isolated mass of extracapsular silicone
gel. Axial fast spin-echo T2-weighted MR image with silicone suppression shows
discrete mass of silicone gel (arrow) in breast adjacent to
implant.
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Fig. 2C. —46-year-old woman with ruptured 18-year-old subpectoral
single-lumen silicone gel implant and isolated mass of extracapsular silicone
gel. Sagittal fast spin-echo T2-weighted MR image shows posterolateral
silicone gel (arrow) in breast, isointense to silicone in
implant.
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Fig. 3A. —58-year-old woman with ruptured subglandular 19-year-old
single-lumen silicone gel implant and contour deformity equivocal for breach
of capsule. Sagittal fast spin-echo T2-weighted MR image with water
suppression shows inferior contour deformity (arrow).
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Fig. 3B. —58-year-old woman with ruptured subglandular 19-year-old
single-lumen silicone gel implant and contour deformity equivocal for breach
of capsule. Axial fast spin-echo T2-weighted MR image with water suppression
shows medial contour deformity (arrow).
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Fig. 4. —48-year-old woman with ruptured subglandular 19-year-old
single-lumen silicone gel implant. Superomedial contour deformity
(arrow) on this sagittal fast spin-echo T2-weighted MR image with
water suppression is surrounded by hypointense scar. This implant was
prospectively called negative for extracapsular rupture by two-thirds
consensus. Retrospectively, reviewers could not agree whether image represents
extracapsular spread of gel, focally weakened fibrous capsule, or just contour
deformity.
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Fig. 5A. —65-year-old woman with rupture of subglandular single-lumen
silicone gel implant placed 17 years previously. Serial sagittal fast
spin-echo T2-weighted MR image with water suppression shows break of
hypointense fibrous capsule superiorly with extracapsular extrusion of gel
(arrows). Reviewers agreed retrospectively that this is true break in
capsule and not just weakening or simple contour defect of fibrous
capsule.
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Fig. 5B. —65-year-old woman with rupture of subglandular single-lumen
silicone gel implant placed 17 years previously. Serial sagittal fast
spin-echo T2-weighted MR image with water suppression shows break of
hypointense fibrous capsule superiorly with extracapsular extrusion of gel
(arrows). Reviewers agreed retrospectively that this is true break in
capsule and not just weakening or simple contour defect of fibrous
capsule.
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Fig. 6A. —75-year-old woman with ruptured 26-year-old subpectoral
single-lumen silicone gel implant. Presence of extracapsular silicone
posteriorly and laterally is seen only on inversion-recovery sequence and was
missed by two observers. Axial fast spin-echo T2-weighted MR image with water
suppression shows silicone gel (arrowheads) outside implant shell,
indicating rupture. Hypointense Dacron (DuPont, Wilmington, DE) fixation
patches (open arrows) are evident along posterior implant wall,
consistent with 530 FP series Cronin implant (Dow Corning Wright, Arlington,
TN). Patches are meant to stabilize implant position by facilitating ingrowth
of tissue. Silicone granuloma (arrow) posterolateral to implant is
not well seen.
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Fig. 6B. —75-year-old woman with ruptured 26-year-old subpectoral
single-lumen silicone gel implant. Presence of extracapsular silicone
posteriorly and laterally is seen only on inversion-recovery sequence and was
missed by two observers. Axial inversion-recovery T2-weighted MR image with
water suppression shows silicone granuloma (arrow) in breast tissue
posterolaterally with associated decrease in signal relative to gel in
capsule.
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Fig. 7A. —46-year-old woman with current intact subpectoral
double-lumen implant placed 7 years previously, who had history of prior
silicone gel implants and residual extracapsular silicone. Axial fast
spin-echo T2-weighted MR image with water suppression shows intact
double-lumen implant with outer lumen saline hypointense and inner lumen
silicone hyperintense. Two reviewers missed residual siliconoma
(arrow) from prior (presumed) rupture because siliconoma is
isointense to fat on this sequence.
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Fig. 7B. —46-year-old woman with current intact subpectoral
double-lumen implant placed 7 years previously, who had history of prior
silicone gel implants and residual extracapsular silicone. Axial
inversion-recovery T2-weighted MR image with water suppression clearly shows
hyperintense siliconoma (arrows) posteromedially. Sequences in which
silicone is hyperintense to fat are needed when extracapsular silicone is
suspected.
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Fig. 8A. —Siliconoma removed from 47-year-old woman with ruptured
12-year-old silicone implants. Dense scar formed around extracapsular
silicone. (Reprinted with permission from
[21]) Photograph of gross
specimen of resected siliconoma shows dense fibrous halves of mass connected
by strand of silicone gel (arrow).
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Fig. 8B. —Siliconoma removed from 47-year-old woman with ruptured
12-year-old silicone implants. Dense scar formed around extracapsular
silicone. (Reprinted with permission from
[21]) Photomicrograph of
histopathologic specimen shows dense fibrosis. Silicone gel is lost in
processing leaving empty spaces (arrowheads) in specimen. (H and E,
x40)
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Copyright © 2002 by the American Roentgen Ray Society.
