Novel decision algorithm for the diagnosis of silicone gel breast implant ruptures

Background: The main complications of breast implantation are caused by capsular contracture and implant rupture. Although the evaluation of implant rupture is primarily driven by patient symptoms, including change in breast shape, size, or firmness, most patients with breast implant rupture do not clinically manifest significant symptoms, thereby developing a so-called silent rupture. For all these reasons, its diagnosis generally relies on imaging techniques such as mammography, ultrasound, and magnetic resonance imaging. Methods: We conducted a retrospective non-randomized study, carried out between March 2013 and August 2017. In this study, we evaluated 30 symptomatic patients who underwent mono or bilateral prosthetic breast reconstruction, a total of 51 implants after skin-sparing mastectomy or nipple-sparing mastectomy for breast cancer and following breast implant removal or replacement due to suspicious rupture or capsule contraction. Results: Ultrasound suspected ruptures in 32/51 (62.7%) implants, while 19/51 implants resulted intact upon ultrasound examination. The sensitivity and specificity of ultrasound were 90 and 80% respectively. Magnetic resonance imaging suspected ruptures in 30/51 (58.8%) implants, while 21/51 (41.1%) implants resulted intact. The magnetic resonance imaging sensitivity and specificity were 87 and 85%, respectively. Conclusions: Ultrasound evaluation may be the first level exam in case of suspicious symptomatic breast implant rupture. Importantly, our results demonstrate that magnetic resonance imaging could be avoided in all those cases where an extracapsular rupture has been diagnosed using ultrasound. Level of Evidence: Level IV, diagnostic study