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Implant, Saline
Laurie Margolies, MD; Maria L. Anello, DO
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Saline implants are silicone elastomer bags (shell) filled with saline
              • Most have valves/ports to inject saline when implants are placed
                • Optimize cosmetic appearance
              • Some saline implants are prefilled
            • Expanders have port at skin, can be gradually inflated or deflated
              • Most often used for reconstruction post mastectomy
              • 50-100 cc instilled each week until desired size
              • Tubing to port may be palpable, visible on imaging
              • Not MR compatible
            • Capsule = fibrous tissue body forms around implant
            • Contracture = hardening of capsule around implant
            • Implant-displaced (ID) views = Eklund maneuver = pushback views: Implant displaced posteriorly while obtaining mammogram of parenchyma
              • Improves compression and image quality
              • Do not fully include most posterior tissues; standard CC and MLO views also required

          IMAGING

          • General Features

            • Mammographic Findings

              • Ultrasonographic Findings

                • MR Findings

                  • Image-Guided Biopsy

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            CLINICAL ISSUES

                            • Presentation

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Consider

                                    • Image Interpretation Pearls

                                      • Reporting Tips

                                        Selected References

                                        1. de Boer M et al: Breast implants and the risk of anaplastic large-cell lymphoma in the breast. JAMA Oncol. ePub, 2018
                                        2. Expert Panel on Breast Imaging:. et al: ACR Appropriateness Criteria Breast Implant Evaluation. J Am Coll Radiol. 15(5S):S13-S25, 2018
                                        3. Sosin M et al: Breast cancer following augmentation mammaplasty: A case-control study. Plast Reconstr Surg. 141(4):833-840, 2018
                                        4. Dikmans RE et al: Two-stage implant-based breast reconstruction compared with immediate one-stage implant-based breast reconstruction augmented with an acellular dermal matrix: an open-label, phase 4, multicentre, randomised, controlled trial. Lancet Oncol. 18(2):251-258, 2017
                                        5. Kaartinen I et al: Breast implant-associated anaplastic large cell lymphoma - From diagnosis to treatment. Eur J Surg Oncol. 43(8):1385-1392, 2017
                                        6. Filiciani S et al: Cohort Study to Assess the Impact of Breast Implants on Breastfeeding. Plast Reconstr Surg. 138(6):1152-1159, 2016
                                        7. Headon H et al: Capsular contracture after breast augmentation: An update for clinical practice. Arch Plast Surg. 42(5):532-43, 2015
                                        8. Rupani A et al: Lymphomas Associated with Breast Implants: A Review of the Literature. Aesthet Surg J. 35(5):533-44, 2015
                                        9. Shah M et al: Magnetic resonance imaging of breast implants. Top Magn Reson Imaging. 23(6):345-53, 2014
                                        10. Lavigne E et al: Can breast implants hinder breast cancer survival? Womens Health (Lond). 9(5):419-20, 2013
                                        11. Lavigne E et al: Breast cancer detection and survival among women with cosmetic breast implants: systematic review and meta-analysis of observational studies. BMJ. 346:f2399, 2013
                                        12. Swanson E: Prospective outcome study of 225 cases of breast augmentation. Plast Reconstr Surg. 131(5):1158-66, 2013
                                        13. Lavigne E et al: Do breast implants adversely affect prognosis among those subsequently diagnosed with breast cancer? Findings from an extended follow-up of a Canadian cohort. Cancer Epidemiol Biomarkers Prev. 21(10):1868-76, 2012
                                        14. Handel N et al: A long-term study of outcomes, complications, and patient satisfaction with breast implants. Plast Reconstr Surg. 117(3):757-67; discussion 768-72, 2006
                                        15. Brown SL et al: Breast implant adverse events during mammography: reports to the Food and Drug Administration. J Womens Health (Larchmt). 13(4):371-8; discussion 379-80, 2004
                                        16. Miglioretti DL et al: Effect of breast augmentation on the accuracy of mammography and cancer characteristics. JAMA. 291(4):442-50, 2004
                                        17. Cunningham BL et al: Saline-filled breast implant safety and efficacy: a multicenter retrospective review. Plast Reconstr Surg. 105(6):2143-9; discussion 2150-1, 2000
                                        18. Rohrich RJ: The FDA approves saline-filled breast implants: what does this mean for our patients? Plast Reconstr Surg. 106(4):903-5, 2000
                                        19. Gutowski KA et al: Saline-filled breast implants: a Plastic Surgery Educational Foundation multicenter outcomes study. Plast Reconstr Surg. 100(4):1019-27, 1997
                                        20. Strom SS et al: Cosmetic saline breast implants: a survey of satisfaction, breast-feeding experience, cancer screening, and health. Plast Reconstr Surg. 100(6):1553-7, 1997
                                        21. Ahn CY et al: Clinical significance of intracapsular fluid in patients' breast implants. Ann Plast Surg. 35(5):455-7, 1995
                                        22. Handel N et al: Factors affecting mammographic visualization of the breast after augmentation mammaplasty. JAMA. 268(14):1913-7, 1992
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Clinical Issues

                                                TERMINOLOGY

                                                • Definitions

                                                  • Saline implants are silicone elastomer bags (shell) filled with saline
                                                    • Most have valves/ports to inject saline when implants are placed
                                                      • Optimize cosmetic appearance
                                                    • Some saline implants are prefilled
                                                  • Expanders have port at skin, can be gradually inflated or deflated
                                                    • Most often used for reconstruction post mastectomy
                                                    • 50-100 cc instilled each week until desired size
                                                    • Tubing to port may be palpable, visible on imaging
                                                    • Not MR compatible
                                                  • Capsule = fibrous tissue body forms around implant
                                                  • Contracture = hardening of capsule around implant
                                                  • Implant-displaced (ID) views = Eklund maneuver = pushback views: Implant displaced posteriorly while obtaining mammogram of parenchyma
                                                    • Improves compression and image quality
                                                    • Do not fully include most posterior tissues; standard CC and MLO views also required

                                                IMAGING

                                                • General Features

                                                  • Mammographic Findings

                                                    • Ultrasonographic Findings

                                                      • MR Findings

                                                        • Image-Guided Biopsy

                                                          • Imaging Recommendations

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                • Gross Pathologic & Surgical Features

                                                                  CLINICAL ISSUES

                                                                  • Presentation

                                                                    • Natural History & Prognosis

                                                                      • Treatment

                                                                        DIAGNOSTIC CHECKLIST

                                                                        • Consider

                                                                          • Image Interpretation Pearls

                                                                            • Reporting Tips

                                                                              Selected References

                                                                              1. de Boer M et al: Breast implants and the risk of anaplastic large-cell lymphoma in the breast. JAMA Oncol. ePub, 2018
                                                                              2. Expert Panel on Breast Imaging:. et al: ACR Appropriateness Criteria Breast Implant Evaluation. J Am Coll Radiol. 15(5S):S13-S25, 2018
                                                                              3. Sosin M et al: Breast cancer following augmentation mammaplasty: A case-control study. Plast Reconstr Surg. 141(4):833-840, 2018
                                                                              4. Dikmans RE et al: Two-stage implant-based breast reconstruction compared with immediate one-stage implant-based breast reconstruction augmented with an acellular dermal matrix: an open-label, phase 4, multicentre, randomised, controlled trial. Lancet Oncol. 18(2):251-258, 2017
                                                                              5. Kaartinen I et al: Breast implant-associated anaplastic large cell lymphoma - From diagnosis to treatment. Eur J Surg Oncol. 43(8):1385-1392, 2017
                                                                              6. Filiciani S et al: Cohort Study to Assess the Impact of Breast Implants on Breastfeeding. Plast Reconstr Surg. 138(6):1152-1159, 2016
                                                                              7. Headon H et al: Capsular contracture after breast augmentation: An update for clinical practice. Arch Plast Surg. 42(5):532-43, 2015
                                                                              8. Rupani A et al: Lymphomas Associated with Breast Implants: A Review of the Literature. Aesthet Surg J. 35(5):533-44, 2015
                                                                              9. Shah M et al: Magnetic resonance imaging of breast implants. Top Magn Reson Imaging. 23(6):345-53, 2014
                                                                              10. Lavigne E et al: Can breast implants hinder breast cancer survival? Womens Health (Lond). 9(5):419-20, 2013
                                                                              11. Lavigne E et al: Breast cancer detection and survival among women with cosmetic breast implants: systematic review and meta-analysis of observational studies. BMJ. 346:f2399, 2013
                                                                              12. Swanson E: Prospective outcome study of 225 cases of breast augmentation. Plast Reconstr Surg. 131(5):1158-66, 2013
                                                                              13. Lavigne E et al: Do breast implants adversely affect prognosis among those subsequently diagnosed with breast cancer? Findings from an extended follow-up of a Canadian cohort. Cancer Epidemiol Biomarkers Prev. 21(10):1868-76, 2012
                                                                              14. Handel N et al: A long-term study of outcomes, complications, and patient satisfaction with breast implants. Plast Reconstr Surg. 117(3):757-67; discussion 768-72, 2006
                                                                              15. Brown SL et al: Breast implant adverse events during mammography: reports to the Food and Drug Administration. J Womens Health (Larchmt). 13(4):371-8; discussion 379-80, 2004
                                                                              16. Miglioretti DL et al: Effect of breast augmentation on the accuracy of mammography and cancer characteristics. JAMA. 291(4):442-50, 2004
                                                                              17. Cunningham BL et al: Saline-filled breast implant safety and efficacy: a multicenter retrospective review. Plast Reconstr Surg. 105(6):2143-9; discussion 2150-1, 2000
                                                                              18. Rohrich RJ: The FDA approves saline-filled breast implants: what does this mean for our patients? Plast Reconstr Surg. 106(4):903-5, 2000
                                                                              19. Gutowski KA et al: Saline-filled breast implants: a Plastic Surgery Educational Foundation multicenter outcomes study. Plast Reconstr Surg. 100(4):1019-27, 1997
                                                                              20. Strom SS et al: Cosmetic saline breast implants: a survey of satisfaction, breast-feeding experience, cancer screening, and health. Plast Reconstr Surg. 100(6):1553-7, 1997
                                                                              21. Ahn CY et al: Clinical significance of intracapsular fluid in patients' breast implants. Ann Plast Surg. 35(5):455-7, 1995
                                                                              22. Handel N et al: Factors affecting mammographic visualization of the breast after augmentation mammaplasty. JAMA. 268(14):1913-7, 1992