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Implant With Multiple Lumina
Laurie Margolies, MD; Maria L. Anello, DO
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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

                                        1. Expert Panel on Breast Imaging et al: ACR Appropriateness Criteria Breast Implant Evaluation. J Am Coll Radiol. 15(5S):S13-S25, 2018
                                        2. 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
                                        3. 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
                                        4. 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
                                        5. Nichter LS et al: Two-year outcomes with a novel, double-lumen, saline-filled breast implant. Aesthet Surg J. 32(7):861-7, 2012
                                        6. Chien CH et al: Spontaneous autoinflation and deflation of double-lumen breast implants. Aesthetic Plast Surg. 30(1):113-7, 2006
                                        7. 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
                                        8. Miglioretti DL et al: Effect of breast augmentation on the accuracy of mammography and cancer characteristics. JAMA. 291(4):442-50, 2004
                                        9. Middleton, MS et al. Breast Implant Imaging. Lippincott, Williams and Wilkins. 192-206, 2003
                                        10. Sanger JR et al: False-positive radiographic diagnosis of breast implant rupture because of breast abscess. Ann Plast Surg. 42(5):564-7, 1999
                                        11. 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
                                        12. 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
                                        13. 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
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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

                                                  • 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

                                                                              1. Expert Panel on Breast Imaging et al: ACR Appropriateness Criteria Breast Implant Evaluation. J Am Coll Radiol. 15(5S):S13-S25, 2018
                                                                              2. 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
                                                                              3. 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
                                                                              4. 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
                                                                              5. Nichter LS et al: Two-year outcomes with a novel, double-lumen, saline-filled breast implant. Aesthet Surg J. 32(7):861-7, 2012
                                                                              6. Chien CH et al: Spontaneous autoinflation and deflation of double-lumen breast implants. Aesthetic Plast Surg. 30(1):113-7, 2006
                                                                              7. 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
                                                                              8. Miglioretti DL et al: Effect of breast augmentation on the accuracy of mammography and cancer characteristics. JAMA. 291(4):442-50, 2004
                                                                              9. Middleton, MS et al. Breast Implant Imaging. Lippincott, Williams and Wilkins. 192-206, 2003
                                                                              10. Sanger JR et al: False-positive radiographic diagnosis of breast implant rupture because of breast abscess. Ann Plast Surg. 42(5):564-7, 1999
                                                                              11. 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
                                                                              12. 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
                                                                              13. 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