Effect of MRI on breast tissue expanders and recommendations for safe use

Abstract

Ferromagnetic port-containing breast tissue expanders are currently labeled MRI-unsafe because of the presumption that magnets should not enter the machine. However, designating these devices as MRI-unsafe can lead to unnecessary procedures or suboptimal imaging choices. This study provides an exvivo analysis of how breast tissue expanders behave when subjected to strong magnetic fields to determine which variables might affect clinical risk. Three different brands of tissue expanders were evaluated in three MRI environments. Translational force was determined using the deflection angle method. Torque on empty, saline-filled, and air-filled expanders was evaluated on a 0-4 scale. Magnetic field was measured using a gaussmeter. The weight required to prevent displacement of the expanders was determined for both air- and saline-filled expanders. Temperature over time was measured using an alcohol thermometer. Magnetic field strength, deflection angle, and torque were the greatest in 3T MRI environments and varied by device manufacturer (Sientra>Mentor>Allergan). Saline-filled expanders required 240mL and air-filled required 360mL volume to make the torque undetectable, and the effect of torque could be mitigated with prone positioning. A weight of 120g was required to prevent displacement of a saline-filled tissue expander and 870g for an empty expander. There were no appreciable changes in temperature. Previously described risks may be reduced by using a 1.5T MRI, device selection, filling expanders with saline, and prone positioning. MRI can be considered in patients with breast tissue expanders when appropriate peri-procedural choices have been made so that the benefits of undergoing MRI outweigh the risks.