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Implant, Silicone
Laurie Margolies, MD; Wendie A. Berg, MD, PhD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Definitions

              • Silicone implant: Silicone elastomer envelope (shell) containing silicone gel
                • "Gummy bear" implant: Form-stable type of silicone implant
              • Capsule: Fibrous tissue (scar) body forms around implant
                • Capsulotomy: Procedure to disrupt fibrous capsule
                  • Closed: Physician twists breast while applying pressure; vs. open (surgical)
                  • High risk of causing implant rupture
              • Contracture: Hardening of capsule as scar contracts → rounding of implant
                • Baker grade I: Breast is soft, appears natural
                • Baker grade II: Breast is a little firm, appears normal
                • Baker grade III: Breast is firm and deformed
                • Baker grade IV: Breast is hard, painful, and deformed
              • Siliconoma = silicone granuloma: Mass due to silicone gel in tissue beyond implant capsule, incites foreign body reaction
              • Gel bleed: Microscopic diffusion of silicone through shell
              • Rupture: Silicone gel macroscopically outside of shell
                • Intracapsular rupture: Contained by fibrous capsule
                  • Spectrum: Uncollapsed to fully collapsed rupture depending on appearance of implant shell with respect to gel
                • Extracapsular rupture: Silicone gel spreads beyond capsule into breast ± axilla
                  • Rarely neck, chest and abdominal wall, arms
                  • May lead to change in breast contour or palpable mass
              • Breast reconstruction: Surgical creation of new breast mound from autologous tissue/implant/combination, typically post mastectomy for cancer
              • Breast augmentation: Cosmetic procedure to increase breast size or improve breast contour
              • Patch: Textured area(s) on back surface of implant, originally designed to help keep implant in place

            IMAGING

            • General Features

              • Mammographic Findings

                • Ultrasonographic Findings

                  • MR Findings

                    • CT Findings

                      • Image-Guided Biopsy

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          • Reporting Tips

                                            Selected References

                                            1. Bachour Y et al: Risk factors for developing capsular contracture in women after breast implant surgery: A systematic review of the literature. J Plast Reconstr Aesthet Surg. 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. Ryu AJ et al: Spectrum of chronic complications related to silicone leakage and migration. Am J Med. ePub, 2018
                                            4. Samreen N et al: Imaging findings of mammary and systemic silicone deposition secondary to breast implants. Br J Radiol. 20180098, 2018
                                            5. Hillard C et al: Silicone breast implant rupture: a review. Gland Surg. 6(2):163-168, 2017
                                            6. Seiler SJ et al: Multimodality imaging-based evaluation of single-lumen silicone breast implants for rupture. Radiographics. 37(2):366-382, 2017
                                            7. 2017 Plastic Surgery Statistics Report
                                            8. U.S. Food and Drug Administration: Silicone Gel-Filled Breast Implants
                                            9. Wan D et al: Revisiting the Management of Capsular Contracture in Breast Augmentation: A Systematic Review. Plast Reconstr Surg. 137(3):826-41, 2016
                                            10. Shah M et al: Magnetic resonance imaging of breast implants. Top Magn Reson Imaging. 23(6):345-53, 2014
                                            11. Johnson M: Breast implants: history, safety, and imaging. Radiol Technol. 84(5):439M-515M; quiz 516M-520M, 2013
                                            12. 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
                                            13. Swanson E: Prospective outcome study of 225 cases of breast augmentation. Plast Reconstr Surg. 131(5):1158-66, 2013
                                            14. Chung KC et al: Economic analysis of screening strategies for rupture of silicone gel breast implants. Plast Reconstr Surg. 130(1):225-37, 2012
                                            15. U.S. Food and Drug Administration. FDA update on the safety of silicone gel-filled breast implants. www.fda.gov/downloads/MedicalDevices/Products/BreastImplants/UCM260090.pdf.Published June 2011. Accessed October 23, 2012
                                            16. Venkataraman S et al: Challenges in mammography: part 2, multimodality review of breast augmentation--imaging findings and complications. AJR Am J Roentgenol. 197(6):W1031-45, 2011
                                            17. Yang N et al: The augmented breast: a pictorial review of the abnormal and unusual. AJR Am J Roentgenol. 196(4):W451-60, 2011
                                            18. Gorczyca DP et al: The diagnosis of silicone breast implant rupture. Plast Reconstr Surg. 120(7 Suppl 1):49S-61S, 2007
                                            19. 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
                                            20. Lipworth L et al: Silicone breast implants and connective tissue disease: an updated review of the epidemiologic evidence. Ann Plast Surg. 52(6):598-601, 2004
                                            21. Miglioretti DL et al: Effect of breast augmentation on the accuracy of mammography and cancer characteristics. JAMA. 291(4):442-50, 2004
                                            22. Scaranelo AM et al: Evaluation of the rupture of silicone breast implants by mammography, ultrasonography and magnetic resonance imaging in asymptomatic patients: correlation with surgical findings. Sao Paulo Med J. 122(2):41-7, 2004
                                            23. Middleton MS et al: Breast Implant Imaging. Philadelphia: Lippincott, Williams & Wilkins, 2002
                                            24. Brown SL et al: Silicone gel breast implant rupture, extracapsular silicone, and health status in a population of women. J Rheumatol. 28(5):996-1003, 2001
                                            25. Brown SL et al: Prevalence of rupture of silicone gel breast implants revealed on MR imaging in a population of women in Birmingham, Alabama. AJR Am J Roentgenol. 175(4):1057-64, 2000
                                            26. Soo MS et al: Intracapsular implant rupture: MR findings of incomplete shell collapse. J Magn Reson Imaging. 7(4):724-30, 1997
                                            27. Berg WA et al: Single- and double- lumen silicone breast implant integrity: prospective evaluation of MR and US criteria. Radiology. 197(1):45-52, 1995
                                            28. DeBruhl ND et al: Silicone breast implants: US evaluation. Radiology. 189(1):95-8, 1993
                                            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

                                                    • Diagnostic Checklist

                                                      TERMINOLOGY

                                                      • Definitions

                                                        • Silicone implant: Silicone elastomer envelope (shell) containing silicone gel
                                                          • "Gummy bear" implant: Form-stable type of silicone implant
                                                        • Capsule: Fibrous tissue (scar) body forms around implant
                                                          • Capsulotomy: Procedure to disrupt fibrous capsule
                                                            • Closed: Physician twists breast while applying pressure; vs. open (surgical)
                                                            • High risk of causing implant rupture
                                                        • Contracture: Hardening of capsule as scar contracts → rounding of implant
                                                          • Baker grade I: Breast is soft, appears natural
                                                          • Baker grade II: Breast is a little firm, appears normal
                                                          • Baker grade III: Breast is firm and deformed
                                                          • Baker grade IV: Breast is hard, painful, and deformed
                                                        • Siliconoma = silicone granuloma: Mass due to silicone gel in tissue beyond implant capsule, incites foreign body reaction
                                                        • Gel bleed: Microscopic diffusion of silicone through shell
                                                        • Rupture: Silicone gel macroscopically outside of shell
                                                          • Intracapsular rupture: Contained by fibrous capsule
                                                            • Spectrum: Uncollapsed to fully collapsed rupture depending on appearance of implant shell with respect to gel
                                                          • Extracapsular rupture: Silicone gel spreads beyond capsule into breast ± axilla
                                                            • Rarely neck, chest and abdominal wall, arms
                                                            • May lead to change in breast contour or palpable mass
                                                        • Breast reconstruction: Surgical creation of new breast mound from autologous tissue/implant/combination, typically post mastectomy for cancer
                                                        • Breast augmentation: Cosmetic procedure to increase breast size or improve breast contour
                                                        • Patch: Textured area(s) on back surface of implant, originally designed to help keep implant in place

                                                      IMAGING

                                                      • General Features

                                                        • Mammographic Findings

                                                          • Ultrasonographic Findings

                                                            • MR Findings

                                                              • CT Findings

                                                                • Image-Guided Biopsy

                                                                  • Imaging Recommendations

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • General Features

                                                                        CLINICAL ISSUES

                                                                        • Presentation

                                                                          • Demographics

                                                                            • Natural History & Prognosis

                                                                              • Treatment

                                                                                DIAGNOSTIC CHECKLIST

                                                                                • Consider

                                                                                  • Image Interpretation Pearls

                                                                                    • Reporting Tips

                                                                                      Selected References

                                                                                      1. Bachour Y et al: Risk factors for developing capsular contracture in women after breast implant surgery: A systematic review of the literature. J Plast Reconstr Aesthet Surg. 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. Ryu AJ et al: Spectrum of chronic complications related to silicone leakage and migration. Am J Med. ePub, 2018
                                                                                      4. Samreen N et al: Imaging findings of mammary and systemic silicone deposition secondary to breast implants. Br J Radiol. 20180098, 2018
                                                                                      5. Hillard C et al: Silicone breast implant rupture: a review. Gland Surg. 6(2):163-168, 2017
                                                                                      6. Seiler SJ et al: Multimodality imaging-based evaluation of single-lumen silicone breast implants for rupture. Radiographics. 37(2):366-382, 2017
                                                                                      7. 2017 Plastic Surgery Statistics Report
                                                                                      8. U.S. Food and Drug Administration: Silicone Gel-Filled Breast Implants
                                                                                      9. Wan D et al: Revisiting the Management of Capsular Contracture in Breast Augmentation: A Systematic Review. Plast Reconstr Surg. 137(3):826-41, 2016
                                                                                      10. Shah M et al: Magnetic resonance imaging of breast implants. Top Magn Reson Imaging. 23(6):345-53, 2014
                                                                                      11. Johnson M: Breast implants: history, safety, and imaging. Radiol Technol. 84(5):439M-515M; quiz 516M-520M, 2013
                                                                                      12. 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
                                                                                      13. Swanson E: Prospective outcome study of 225 cases of breast augmentation. Plast Reconstr Surg. 131(5):1158-66, 2013
                                                                                      14. Chung KC et al: Economic analysis of screening strategies for rupture of silicone gel breast implants. Plast Reconstr Surg. 130(1):225-37, 2012
                                                                                      15. U.S. Food and Drug Administration. FDA update on the safety of silicone gel-filled breast implants. www.fda.gov/downloads/MedicalDevices/Products/BreastImplants/UCM260090.pdf.Published June 2011. Accessed October 23, 2012
                                                                                      16. Venkataraman S et al: Challenges in mammography: part 2, multimodality review of breast augmentation--imaging findings and complications. AJR Am J Roentgenol. 197(6):W1031-45, 2011
                                                                                      17. Yang N et al: The augmented breast: a pictorial review of the abnormal and unusual. AJR Am J Roentgenol. 196(4):W451-60, 2011
                                                                                      18. Gorczyca DP et al: The diagnosis of silicone breast implant rupture. Plast Reconstr Surg. 120(7 Suppl 1):49S-61S, 2007
                                                                                      19. 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
                                                                                      20. Lipworth L et al: Silicone breast implants and connective tissue disease: an updated review of the epidemiologic evidence. Ann Plast Surg. 52(6):598-601, 2004
                                                                                      21. Miglioretti DL et al: Effect of breast augmentation on the accuracy of mammography and cancer characteristics. JAMA. 291(4):442-50, 2004
                                                                                      22. Scaranelo AM et al: Evaluation of the rupture of silicone breast implants by mammography, ultrasonography and magnetic resonance imaging in asymptomatic patients: correlation with surgical findings. Sao Paulo Med J. 122(2):41-7, 2004
                                                                                      23. Middleton MS et al: Breast Implant Imaging. Philadelphia: Lippincott, Williams & Wilkins, 2002
                                                                                      24. Brown SL et al: Silicone gel breast implant rupture, extracapsular silicone, and health status in a population of women. J Rheumatol. 28(5):996-1003, 2001
                                                                                      25. Brown SL et al: Prevalence of rupture of silicone gel breast implants revealed on MR imaging in a population of women in Birmingham, Alabama. AJR Am J Roentgenol. 175(4):1057-64, 2000
                                                                                      26. Soo MS et al: Intracapsular implant rupture: MR findings of incomplete shell collapse. J Magn Reson Imaging. 7(4):724-30, 1997
                                                                                      27. Berg WA et al: Single- and double- lumen silicone breast implant integrity: prospective evaluation of MR and US criteria. Radiology. 197(1):45-52, 1995
                                                                                      28. DeBruhl ND et al: Silicone breast implants: US evaluation. Radiology. 189(1):95-8, 1993