Laurie Margolies, MD; Maria L. Anello, DO

KEY FACTS

Terminology
Imaging
Top Differential Diagnoses
Clinical Issues

TERMINOLOGY

Definitions
- Multilumen implants usually double lumen
  - Majority have outer saline-filled lumen and inner silicone-filled lumen
    - Outer saline shell can be unfilled or filled to varying degree at time of placement
      - Saline usually added through valve on shell patch or outer shell; valve is usually posterior
      - Expander type may have tubing to port just deep to skin
      - When developed, thought was that outer shell could be deflated to minimize contracture symptoms
      - Outer lumen size can be changed when patient wants to change implant size
    - 2 shell-patch configurations exist
      - Shared-back-patch implants have one patch attached to both lumen shells
      - Separate-back-patch implants (bag-in-bag configuraton) have 2 patches: Silicone lumen component floats in saline-filled outer lumen
  - Reverse double lumen: Outer lumen silicone, inner saline (uncommon)
    - Inner saline lumen gradually filled over months through subcutaneous port
      - Fill tube starts in inner lumen, goes through valve on inner lumen shell, then through outer lumen and outer shell value to subcutaneous fill port
      - Tube pulled when implant fully inflated
    - Most often used for reconstruction, gradually stretching chest wall tissue
      - Outer silicone thought to give more natural feel
  - Both lumina silicone: Gel within gel; often with saline mixed with inner silicone
    - When saline mixed with silicone, termed "reverse adjustable double-lumen implants"
      - Saline placed in inner lumen with silicone; can adjust amount of saline
  - Both lumina saline: Developed to decrease wrinkling and capsular contracture
  - Triple lumen: Typically have silicone gel inner and middle lumens and saline outer lumen
    - Saline can be added through value on outer shell patch
    - Often have keyhole appearance anteriorly between silcone lumina
- Multilumen implants developed to allow outer saline lumen to be deflated to decrease contracture symptoms and to decrease gel bleed
- Capsule: Scar tissue that body forms around implant

IMAGING

General Features
Mammographic Findings
Ultrasonographic Findings
MR Findings
Imaging Recommendations
CT Findings

DIFFERENTIAL DIAGNOSIS

PATHOLOGY

General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features

CLINICAL ISSUES

Presentation
Natural History & Prognosis
Treatment

DIAGNOSTIC CHECKLIST

Consider
Image Interpretation Pearls

Selected References

Expert Panel on Breast Imaging et al: ACR Appropriateness Criteria Breast Implant Evaluation. J Am Coll Radiol. 15(5S):S13-S25, 2018
Hammond DC et al: Long-term outcomes with the McGhan Style 153 dual-lumen breast implant: Implications for future implant design. J Plast Reconstr Aesthet Surg. 69(9):1211-7, 2016
Shah AT et al: Imaging of common breast implants and implant-related complications: A pictorial essay. Indian J Radiol Imaging. 26(2):216-25, 2016
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
Nichter LS et al: Two-year outcomes with a novel, double-lumen, saline-filled breast implant. Aesthet Surg J. 32(7):861-7, 2012
Chien CH et al: Spontaneous autoinflation and deflation of double-lumen breast implants. Aesthetic Plast Surg. 30(1):113-7, 2006
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
Miglioretti DL et al: Effect of breast augmentation on the accuracy of mammography and cancer characteristics. JAMA. 291(4):442-50, 2004
Middleton, MS et al. Breast Implant Imaging. Lippincott, Williams and Wilkins. 192-206, 2003
Sanger JR et al: False-positive radiographic diagnosis of breast implant rupture because of breast abscess. Ann Plast Surg. 42(5):564-7, 1999
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
Berg WA et al: MR imaging of the breast in patients with silicone breast implants: normal postoperative variants and diagnostic pitfalls. AJR Am J Roentgenol. 163(3):575-8, 1994
Lemperle G et al: Effect of cortisone on capsular contracture in double-lumen breast implants: ten years' experience. Aesthetic Plast Surg. 17(4):317-23, 1993

Related Anatomy

Related Differential Diagnoses

References

Tables

KEY FACTS

Terminology
Imaging
Top Differential Diagnoses
Clinical Issues

TERMINOLOGY

Definitions
- Multilumen implants usually double lumen
  - Majority have outer saline-filled lumen and inner silicone-filled lumen
    - Outer saline shell can be unfilled or filled to varying degree at time of placement
      - Saline usually added through valve on shell patch or outer shell; valve is usually posterior
      - Expander type may have tubing to port just deep to skin
      - When developed, thought was that outer shell could be deflated to minimize contracture symptoms
      - Outer lumen size can be changed when patient wants to change implant size
    - 2 shell-patch configurations exist
      - Shared-back-patch implants have one patch attached to both lumen shells
      - Separate-back-patch implants (bag-in-bag configuraton) have 2 patches: Silicone lumen component floats in saline-filled outer lumen
  - Reverse double lumen: Outer lumen silicone, inner saline (uncommon)
    - Inner saline lumen gradually filled over months through subcutaneous port
      - Fill tube starts in inner lumen, goes through valve on inner lumen shell, then through outer lumen and outer shell value to subcutaneous fill port
      - Tube pulled when implant fully inflated
    - Most often used for reconstruction, gradually stretching chest wall tissue
      - Outer silicone thought to give more natural feel
  - Both lumina silicone: Gel within gel; often with saline mixed with inner silicone
    - When saline mixed with silicone, termed "reverse adjustable double-lumen implants"
      - Saline placed in inner lumen with silicone; can adjust amount of saline
  - Both lumina saline: Developed to decrease wrinkling and capsular contracture
  - Triple lumen: Typically have silicone gel inner and middle lumens and saline outer lumen
    - Saline can be added through value on outer shell patch
    - Often have keyhole appearance anteriorly between silcone lumina
- Multilumen implants developed to allow outer saline lumen to be deflated to decrease contracture symptoms and to decrease gel bleed
- Capsule: Scar tissue that body forms around implant

IMAGING

General Features
Mammographic Findings
Ultrasonographic Findings
MR Findings
Imaging Recommendations
CT Findings

DIFFERENTIAL DIAGNOSIS

PATHOLOGY

General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features

CLINICAL ISSUES

Presentation
Natural History & Prognosis
Treatment

DIAGNOSTIC CHECKLIST

Consider
Image Interpretation Pearls

Selected References

Expert Panel on Breast Imaging et al: ACR Appropriateness Criteria Breast Implant Evaluation. J Am Coll Radiol. 15(5S):S13-S25, 2018
Hammond DC et al: Long-term outcomes with the McGhan Style 153 dual-lumen breast implant: Implications for future implant design. J Plast Reconstr Aesthet Surg. 69(9):1211-7, 2016
Shah AT et al: Imaging of common breast implants and implant-related complications: A pictorial essay. Indian J Radiol Imaging. 26(2):216-25, 2016
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
Nichter LS et al: Two-year outcomes with a novel, double-lumen, saline-filled breast implant. Aesthet Surg J. 32(7):861-7, 2012
Chien CH et al: Spontaneous autoinflation and deflation of double-lumen breast implants. Aesthetic Plast Surg. 30(1):113-7, 2006
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
Miglioretti DL et al: Effect of breast augmentation on the accuracy of mammography and cancer characteristics. JAMA. 291(4):442-50, 2004
Middleton, MS et al. Breast Implant Imaging. Lippincott, Williams and Wilkins. 192-206, 2003
Sanger JR et al: False-positive radiographic diagnosis of breast implant rupture because of breast abscess. Ann Plast Surg. 42(5):564-7, 1999
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
Berg WA et al: MR imaging of the breast in patients with silicone breast implants: normal postoperative variants and diagnostic pitfalls. AJR Am J Roentgenol. 163(3):575-8, 1994
Lemperle G et al: Effect of cortisone on capsular contracture in double-lumen breast implants: ten years' experience. Aesthetic Plast Surg. 17(4):317-23, 1993

KEY FACTS

Terminology

Imaging

Top Differential Diagnoses

Clinical Issues

TERMINOLOGY

Definitions

IMAGING

General Features

Mammographic Findings

Ultrasonographic Findings

MR Findings

Imaging Recommendations

CT Findings

DIFFERENTIAL DIAGNOSIS

PATHOLOGY

General Features

Staging, Grading, & Classification

Gross Pathologic & Surgical Features

CLINICAL ISSUES

Presentation

Natural History & Prognosis

Treatment

DIAGNOSTIC CHECKLIST

Consider

Image Interpretation Pearls

Selected References

Tables

KEY FACTS

Terminology

Imaging

Top Differential Diagnoses

Clinical Issues

TERMINOLOGY

Definitions

IMAGING

General Features

Mammographic Findings

Ultrasonographic Findings

MR Findings

Imaging Recommendations

CT Findings

DIFFERENTIAL DIAGNOSIS

PATHOLOGY

General Features

Staging, Grading, & Classification

Gross Pathologic & Surgical Features

CLINICAL ISSUES

Presentation

Natural History & Prognosis

Treatment

DIAGNOSTIC CHECKLIST

Consider

Image Interpretation Pearls

Selected References