IMAGING OF COMPLICATIONS OF AUGMENTATION MAMMAPLASTY

The recent Food and Drug Administration hearings have brought new attention to breast implants and the importance of mammography in these patients to detect unsuspected breast pathology and complications of this surgical procedure. More patients are now being seen with implant failures in mammography departments. Very little attention has been paid to the mammographic findings and their significance until recently in the plastic surgery literature. A retrospective review was undertaken of all patients who had undergone prior augmentation mammaplasty and were imaged between 1989 and 1992. Patients with complications such as capsular contracture and implant rupture constitute the basis of our study. Mammography can be used to detect complications of augmentation mammaplasty such as calcific or fibrous capsular contracture. In calcific contracture, fine microcalcifications along the edge of the implant can be seen by mammography. Fibrous contracture is identified in mammography by a thick band of tissue surrounding the implant. Contour changes and slippage of the prosthesis also can be easily imaged mammographically. After implant rupture, free globules of silicone within the breast or silicone accumulated within axillary lymph nodes can be imaged by mammography. However, irregularities in the implant contour or encapsulated implant rupture may be occult in mammography and detected only by sonography or magnetic resonance imaging (MRI). Mammography is an excellent method for evaluating the integrity of a breast implant. However, because mammography cannot image the posterior portion of the implant, other modalities may be used in the evaluation of suspected complications of augmentation mammaplasty. Sonography is helpful in cases in which mammography fails to define a palpable mass suspected to represent a contour abnormality. It is also useful to determine whether a localized bulge in the implant demonstrated by mammography represents an encapsulated rupture. The role of MRT in the evaluation of breast implant integrity is currently being investigated. Rare false-positive or false-negative imaging studies can be expected.