COMPARATIVE SILICONE BREAST IMPLANT EVALUATION USING MAMMOGRAPHY, SONOGRAPHY, AND MAGNETIC-RESONANCE-IMAGING - EXPERIENCE WITH 59 IMPLANTS

With the current controversy regarding the safety of silicone implants , the detection and evaluation of implant rupture are causing concern for both plastic surgeons and patients. Our study obtained comparative value analysis of mammography, sonography, and magnetic resonance ima ging (MRI) in the detection of silicone implant rupture. Twenty-nine s ymptomatic patients (total of 59 silicone implants) were entered into the study. Intraoperative findings revealed 21 ruptured implants (36 p ercent). During physical examination, a positive ''squeeze test'' was highly suggestive of implant rupture. Mammograms were obtained of 51 i mplants (sensitivity 11 percent, specificity 89 percent). Sonography w as performed on 57 implants (sensitivity 70 percent, specificity 92 pe rcent). MRI was performed on 55 implants (sensitivity 81 percent, spec ificity 92 percent). Sonographically, implant rupture is demonstrated by the ''stepladder sign.'' Double-lumen implants may appear as false- positive results for rupture on sonography. On MRI, the ''linguine sig n'' represents disrupted fragments of a ruptured implant. The most rel iable imaging modality for implant rupture detection is MRI, followed by sonogram. Mammogram is the least reliable. Our study supports the c linical indication and diagnostic value of sonogram and MRI in the eva luation of symptomatic breast implant patients.