The life span of silicone gel breast implants and a comparison of mammography, ultrasonography, and magnetic resonance imaging in detecting implant rupture: A meta-analysis

Because of the growing concern surrounding the integrity and life span of s ilicone gel breast implants and the reported variations in the diagnostic a ccuracy of various imaging techniques in identifying ruptured implants, the authors undertook a meta-analysis of articles in the scientific literature to examine these concerns. They were able to include reports from the lite rature that detailed the condition and removal of 1,099 breast implants dur ing the past 7 years. The median life span of a silicone gel implant was es timated to be 16.4 years. Of the implants, 79.1% were intact at 10 years, f alling to 48.7% by 15 years. The sensitivities and specificities of three i maging modalities used in the diagnosis of implant rupture (mammography, ul trasonography, and magnetic resonance imaging [MRI]) were also evaluated an d compared statistically in an effort to discover which of the three techni ques might serve as the most reliable screening tool in the diagnosis of ge l implant rupture. The sensitivity of mammography for finding a ruptured im plant is 28.4% with a specificity of 92.9%. Ultrasonography has a sensitivi ty and specificity of 59.0% and 76.8% respectively compared with MRI, which was 78.1% and 80.0% respectively. For implants in place for 10 years, one would need to image 3.3 implants by ultrasound to identify a single possibl e rupture. However, because of the 76.8% specificity, 8.1 implants would ne ed to be imaged to find a confirmed intraoperative rupture. This was simila r to MRI, in which 3.1 implants would need to be imaged to detect one suspe cted rupture, and 6.1 implants would need to be imaged to find one intraope ratively confirmed rupture. The authors do not recommend either ultrasound or MRI as a screening tool based on their meta-analysis.