30. TO SCREEN OR NOT TO SCREEN: EVALUATION OF MAGNETIC RESONANCE IMAGING SURVEILLANCE TO ASSESS SILICONE BREAST IMPLANT INTEGRITY

Abstract

PURPOSE: Current guidelines recommend routine magnetic resonance imaging (MRI) for detection of silicone breast implant rupture at 5-6 years post-implantation and every 2-3 years thereafter. We review the results of serial silicone implant MRI screening according to current guidelines to determine the validity of asymptomatic screening. METHODS: Institutional Review Board approval was obtained, and a retrospective review was performed. All patients who underwent silicone implant placement from 1999-2019 by a single surgeon were identified. Within this cohort, all patients who underwent one or more screening breast MRI’s with the purpose of evaluating silicone implant integrity were further identified and included in the analysis. RESULTS: In total, 4777 screening MRIs were performed in 1187 patients (827 bilateral, 360 unilateral) with 2050 silicone implants. Mean follow-up was 85.9 months. Within this cohort, 90 implants in 81 patients were detected as ruptured on screening MRI, with an overall rupture rate of 6.8%. The estimated cumulative rupture rate is 0.2% at 3 years, 1.7% at 5 years, 3.7% at 7 years and 11.2% at 10 years. The positive predictive value for MRI imaging was 87.8%, and false-positive rate was 12.2%. Incidental findings were reported in 268 patients (22.6%, excluding ruptures) and 101 of these underwent further tests and procedures. CONCLUSION: The results of this study provide real world evidence of the rate of silicone implant rupture detected on routine, periodic screening MRI. Evidence to support the routine screening of asymptomatic patients with MRI prior to 10 years after implantation may be lacking.