Efficacy of ultrasound, mammography and magnetic resonance imaging in detecting breast implant rupture: A retrospective study of 175 reconstructive and aesthetic sub-pectoral breast augmentation cases

Abstract

To date, the effectiveness of radiological imaging in detecting silicone breast implant rupture is uncertain. The purpose of this study is to retrospectively evaluate the effectiveness of radiological imaging when diagnosing a rupture. In this study, 175 patients with 242 breast implants were included, of which 168 and 74 implants were used for breast reconstruction and aesthetic augmentation, respectively. All patients who underwent revision surgery, between January 2015 and June 2016, following breast augmentation or reconstruction were included, regardless of any pre-operative diagnosis of rupture that had been made. The diagnosis of intracapsular rupture was verified intraoperatively and compared to the pre-operative findings. With regard to pre-operative diagnostic imaging methods, we compared magnetic resonance imaging (MRI), mammography, and ultrasonography (US) findings. Among the 242 implants that were explanted, 35 clinical ruptures were confirmed and compared with the related radiological findings. We reported 22 false positives and 15 false negatives. US was the least specific and least accurate method because of its lowest positive predictive value (PPV) and negative predictive value (NPV). Mammography was the most specific and most accurate method, with the highest PPV (96%). Surprisingly, MRI was the most sensitive; however, it was neither the most specific nor the most accurate method despite having the highest NPV (98%). After comparing these three radiological techniques, we conclude that US along with MRI can be useful for young patients. Mammography, which was characterised by high specificity and accuracy, could be useful along with MRI in investigating patients over the age of 40.