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Breast Implant Imaging.

Brown Medical School
Providence, RI 02912

By Michael S. Middleton and Michael P. McNamara Jr. Philadelphia, PA: Lippincott Williams & Wilkins, 320 pp., 2003. $129

Most books about breast imaging can dedicate only a chapter or part of a chapter to implant evaluation. Drawing on their considerable combined experience with implant imaging, patients with implants, and implant manufacturers, Drs. Middleton and McNamara have provided the first definitive reference on the subject. Included with the book, bound inside the back cover, is a supplementary CD-ROM. In addition to containing the 584 images from the book in JPG format, 340 additional images in PDF format, 11 color images, and six audio-video interleave movie files, the CD-ROM has a searchable catalogue of breast implants that the authors describe as the most complete and comprehensive catalogue of its kind that is available to the public. Although the book is certainly comprehensive enough to be used as a reference, its economy of size (320 pages), along with the authors' writing styles and the plethora of images, allows it to be easily read from start to finish.

As befits a definitive reference, the text begins at the beginning with a history of breast implants along with descriptions and figures of the molecular structure and properties of silicone. Chapter 1 also provides an overview of implant imaging including a discussion of specific implant terminology with convincing arguments as to why certain terms, such as "gel bleed" and "leakage," should be discontinued. Chapter 2 moves on to the clinical presentation of patients with implant complications. A particularly interesting feature of this chapter and one that again befits a definitive reference book on implants is the inclusion of tables presenting arguments agreeing with and opposing the theory that silicone implants cause systemic symptoms and a description of the legal actions that have resulted from those concerns.

Chapters 3-6 are the "meat" of the book in terms of imaging features of normal and ruptured implants and soft-tissue silicone. Chapter 3 details the strengths and weaknesses of MRI, sonography, mammography, and CT as methods of imaging patients with implants. The style of writing, in which the authors use the first person (plural) to describe their experiences in the use of MRI and sonography, is engaging. Chapters 4 and 5 cover the appearances of normal and abnormal implants. The images throughout the book are excellent, but the numerous examples of normal contour variations, normal folds, herniations, and examples of every kind of rupture are especially useful. Chapter 6 discusses artifacts of MRI and sonography of breast implants and soft-tissue silicone.

The large variety of implants that have been placed in women's breasts since 1963 makes the subject of classification of breast implants potentially mind-numbing. In chapter 7, the authors do an admirable job of giving an overview of the classification scheme, while making use of the CD-ROM to provide the comprehensive catalogue. Chapter 8 discusses practical considerations in the evaluation of implant integrity, including imaging algorithms and specific protocols for breast MRI. Chapters 9 and 10 describe the evaluation of soft-tissue silicone from ruptured implants and silicone fluid injections, respectively. Chapters 11 and 12 complete the text with discussions of breast cancer imaging and additional surgical considerations in the patient with implants. A nice finishing touch is the practical information in the sample breast implant intake form in appendix A and the sample report in appendix B.

In summary, Breast Implant Imaging manages to be both a definitive reference and an easy read. I recommend Breast Implant Imaging as a wonderful resource to all radiologists involved with breast implant imaging.

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Mainiero, M. B. Search for Related Content PubMed Articles by Mainiero, M. B. Social Bookmarking                      What's this?