Name : Maryam
Family : Noori
Affiliation :Teb Azma Imaging Center,Ghom,Iran
Academic Degree : Radiologist
Resident : ------------------
Gender : Female
Age : 29
The young woman with right breast pain & tenderness. She had undergone bilateral breast augmentation one year prior to evaluation.
On T1w selected image, you can see bilateral sub-pectoral prosthesis. On T2 specially silicone images curvilinear low-signal-intensity lines (corresponding to the collapsed prosthesis shell) are seen within the silicone-filled fibrous capsule the next images & sagital reconstructed demonstrate bright signal lesions outside the capsule. Thicker capsular enhancement is identified in right implant. (the last image)
Intra & extra-capsular rupture of right implant.
Discussion (Related Text)
Breast prostheses can be surgically implanted ventral to the pectoralis major muscle (prepectoral position) or dorsal to it (subpectoral position) .The breast implant is typically oval in shape or very rarely round. Deformation of the surface is not a pathological finding as long as the outer shell is intact. Folds of the outer shell into the lumen of the prosthesis (radial folds) are commonly seen. They are often only 1-2 cm long and represent a normal finding as long as they demonstrate a junction with the outer shell. Intracapsular rupture means rupture of the implant shell which typically collapses and then swims within the silicone gel. Released silicone lies outside the prosthesis but inside the fibrous capsule on MRI , Multiple curvilinear low-signal-intensity lines (corresponding to the collapsed prosthesis shell) are seen within the silicone-filled fibrous capsule. This is the most reliable indication of an intracapsular rupture (Linguine sign). Salad-oil sign : Drops of saline are seen floating within the silicone gel . This is not a reliable sign of implant rupture. It can only be used as a diagnostic criterion indicating the presence of an intracapsular rupture in combination with the linguine sign. Extra-capsular rupture cause with both the implant shell and the fibrous capsule with macroscopic leakage of silicone into the surrounding tissues.(20 % of all prosthesis ruptures). An examination in at least two angulations is recommended to attain a complete depiction of all tissue closely surrounding the prosthesis.
Practical MR mammography, Uwe Fischer.