PURPOSE: To determine the value of breast ultrasonography (US) in the
assessment of silicone breast implants for rupture. MATERIALS AND METH
ODS: Seventy-four women with local or systemic symptoms related to sil
icone implants underwent breast US. Of these, 28 underwent surgical re
moval of the implants. RESULTS: Of 57 implants removed, 37 were intact
. The most reliable sign of an intact implant was an anechoic interior
, although reverberation artifact and radial folds could be seen. Of 2
0 ruptured implants, 16 were intracapsular and four were extracapsular
ruptures. The most reliable US sign of rupture was echogenic, horizon
tal (''stepladder'') lines (14 of 20 ruptures). Two of the four extrac
apsular ruptures were accurately identified as echogenic nodules outsi
de the implant; two were false-negative findings. Three intracapsular
ruptures identified at US were false-positive; six were false-negative
. Overall sensitivity for rupture was 70%, specificity was 92%, positi
ve predictive value was 82%, and negative predictive value was 85%. CO
NCLUSION: Breast US is capable of depicting intracapsular and extra-ca
psular rupture of breast implants.