Frank bulges or herniations represent areas of weakening of the fibrous capsule and potential weak points of the elastomer shell [18]. An implant that becomes more rounded in appearance may signify the presence of capsular contracture rather than implying a problem with implant integrity. Calcifications along the fibrous capsule, thought to arise as a consequence of a chronic inflammatory response, are more frequently encountered in older implants that have been in place for multiple years. Capsular calcifications correlate with implant age, but calcifications alone do not necessarily imply capsular contracture or implant rupture. Although insensitive for identifying intracapsular rupture, DBT is useful in detecting extracapsular silicone. When silicone escapes the confines of the fibrous capsule and enters the surrounding breast parenchyma, DBT can often reveal the high-density free silicone. In the absence of a prior history of implant rupture or revision, the presence of silicone outside the expected contour of the implant signifies extracapsular rupture and, by extension, intracapsular rupture [18,20]. MRI Breast Without and With IV Contrast There is no relevant literature to support the use of MRI without and with IV contrast in the evaluation of asymptomatic silicone implants less than 5 years after implant placement. MRI Breast Without IV Contrast There is no relevant literature to support the use of MRI without IV contrast in the evaluation of asymptomatic silicone implants less than 5 years after implant placement. Note that in the updated FDA recommendations for asymptomatic patients with silicone implants, the first US or MRI should be performed at 5 to 6 years postoperatively, then every 2 to 3 years thereafter [1]. US Breast There is no relevant literature to support the role of US breast in the evaluation of an asymptomatic patient with silicone implants that have been in place less than 5 years.
Breast Implant Evaluation. Frank bulges or herniations represent areas of weakening of the fibrous capsule and potential weak points of the elastomer shell [18]. An implant that becomes more rounded in appearance may signify the presence of capsular contracture rather than implying a problem with implant integrity. Calcifications along the fibrous capsule, thought to arise as a consequence of a chronic inflammatory response, are more frequently encountered in older implants that have been in place for multiple years. Capsular calcifications correlate with implant age, but calcifications alone do not necessarily imply capsular contracture or implant rupture. Although insensitive for identifying intracapsular rupture, DBT is useful in detecting extracapsular silicone. When silicone escapes the confines of the fibrous capsule and enters the surrounding breast parenchyma, DBT can often reveal the high-density free silicone. In the absence of a prior history of implant rupture or revision, the presence of silicone outside the expected contour of the implant signifies extracapsular rupture and, by extension, intracapsular rupture [18,20]. MRI Breast Without and With IV Contrast There is no relevant literature to support the use of MRI without and with IV contrast in the evaluation of asymptomatic silicone implants less than 5 years after implant placement. MRI Breast Without IV Contrast There is no relevant literature to support the use of MRI without IV contrast in the evaluation of asymptomatic silicone implants less than 5 years after implant placement. Note that in the updated FDA recommendations for asymptomatic patients with silicone implants, the first US or MRI should be performed at 5 to 6 years postoperatively, then every 2 to 3 years thereafter [1]. US Breast There is no relevant literature to support the role of US breast in the evaluation of an asymptomatic patient with silicone implants that have been in place less than 5 years.