case studies

Breast Silicone Leak

Introduction
MRI is now proven to be the most accurate imaging modality to evaluate silicone implant rupture. Silicone implants are composed of an outer silicone membrane and inner silicone gel. A fibrous capsule always forms around the implant.

Intra-capsular rupture: involves the implant membrane allowing release of silicone gel, which does not extend beyond the fibrous capsule.

Extra-capsular rupture: rupture of both implants membranes and fibrous capsules allowing silicone to leak into surrounding tissues.

Patient History
A 50 year old female with bilateral silicone implants, presented with extreme pain and loss of shape in the left breast. Her consultant sent her for MRI breast imaging to assess the possibility of a leak.

Methodology
MRI Breast for implant leak
T2 axial water suppressed
T2 axial High resolution 512
T2 COR STIR
3D vol T2W gradient echo
Scanner Used: Siemens Magnetom Symphony 1.5T
Coil Used: CP array dedicated breast coil

Report
Bilateral sub-glandular breast implants are noted.

There is contracture of both sides (fig 1). There is an extra-capsular rupture of the left implant with silicone noted in the left axilla and axillary lymph nodes (figs 2 and 3).

There is silicone noted in the glandular tissue of the left breast (fig 4). There is generalised swelling of the left breast also. No definite rupture is seen on the right.

Conclusion
MRI provides the clinician with effective imaging of the implanted breast, whether for implant rupture or for breast pathology. The implanted breast is almost impossible to image using any other technique, with the added bonuses of MRI’s speed, multiplanar capability and high tissue contrast, all without the use of ionising radiation.

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