The number of women carrying breast prosthetic implants is progressively increasing, this happens both for corrective reasons after surgery and for aesthetic reasons. The rupture of the prostheses is the main cause of their removal, it occurs in most cases without a known trauma and the risk increases progressively with the age of the prostheses, usually after 10-15 years from implantation.
Magnetic Resonance Imaging (MRI) is the most useful imaging modality for the characterization of breast implants for its high spatial resolution and contrast between the prosthesis and adjacent soft tissues, it also does not use ionizing radiation. MRI has the highest sensitivity and specificity in the evaluation of prosthetic ruptures (both intracapsular and extracapsular) thanks to the use of specific sequences that selectively suppress or emphasize the silicone signal. MRI is also more accurate than mammography and ultrasound to highlight the leakage of silicone into the soft tissues of the breast and to highlight the formation of granulomas.
The Food and Drug Administration (FDA) in 2020 established some recommendations for monitoring prostheses:
- in asymptomatic patients the first MRI or ultrasound aimed at the study of prosthetic integrity should be performed 5-6 years after surgery and every 2-3 years thereafter
- in symptomatic patients or with a doubtful picture due to rupture on ultrasound at any time after surgery, MRI is always recommended
These recommendations do not replace the imaging modalities provided by the guidelines regarding the specific clinical history of the patient (e.g., mammography for breast cancer screening, etc.).
For patients undergoing oncological surgery with prosthetic breast reconstruction and who want to include in a single investigation the study of the prosthesis and the follow-up / screening, the MRI should be performed with administration of contrast medium to also study the glandular parenchyma to exclude relapses or new neoplasms.
– Imaging of breast implants—a pictorial review. Juanpere S et al. Insights Imaging 2011