Magnetic resonance imaging of breast augmentation: a pictorial review

Ting Wong, Lai Wan Lo, Po Yan Eliza Fung, Hiu Yan Miranda Lai, Hoi Lam Helen She, Wing Kei Carol Ng, King Ming Kimmy Kwok, Chiu Man Lee, Ting Wong, Lai Wan Lo, Po Yan Eliza Fung, Hiu Yan Miranda Lai, Hoi Lam Helen She, Wing Kei Carol Ng, King Ming Kimmy Kwok, Chiu Man Lee

Abstract

The increasing prevalence of breast augmentation presents new challenges in breast imaging interpretation. Magnetic resonance imaging (MRI) is recognized as the gold standard for the evaluation of augmented breasts. This article reviews the MRI features of different breast augmentation techniques, their associated complications, and the role of MRI in the assessment of concurrent breast abnormalities.

Teaching points: • MRI has the highest sensitivity and specificity for implant rupture detection. • MRI is able to discriminate the nature of implanted prosthesis or injected materials. • Sensitivity of cancer detection by MRI is not reduced through implants.

Keywords: Augmentation; Breast; Implant; MRI; Malignancy.

Figures

Fig. 1
Fig. 1
Retroglandular position of implants. T1-weighted axial MR image shows the retroglandular position of bilateral silicone gel-filled implants, which are entirely anterior to the pectoral muscles (arrows)
Fig. 2
Fig. 2
Retropectoral position of implants. T2-weighted MR image on axial plane demonstrates the retropectoral position of the right silicone gel-filled implant. Note the right pectoral muscle (arrow) is split by the implant
Fig. 3
Fig. 3
Silicone gel-filled implants. T2-weighted (a), silicone-only (b), and silicone-saturated (c) axial MR images show the specific signal intensities of silicone, thus rendering the differentiation between silicone gel-filled and saline-filled implants possible
Fig. 4
Fig. 4
Saline-filled implants. High signal intensity identical to water is seen in saline-filled implants on T2-weighted sequence. Note the valves (arrows) at the anterior aspect of the shells, which are characteristic of saline-filled implants, but not silicone gel-filled implants
Fig. 5
Fig. 5
Periprosthetic fluid. T2-weighted fat-saturated axial MR image shows trace amount of periprosthetic fluid bilaterally (arrows), which is a common normal finding
Fig. 6
Fig. 6
Radial folds. T2-weighted fat-saturated coronal (a) and silicone-only axial (b) MR images of the same patient with silicone gel-filled implants show a hypointense line running from the periphery, which is perpendicular to the normal intact left silicone gel-filled implant shell, suggestive of a radial fold (arrow)
Fig. 7
Fig. 7
Capsular contracture. Axial MR images of T1-weighted (a), T2-weighted (b), and silicone-only (c) sequences show thick low signal fibrous capsules surrounding both implant shells (arrows). Note that the implant material signal is low on silicone-only sequence (c), which suggests that these are saline-filled implants. T1-weighted post contrast images with subtraction on axial (d) and coronal (e) plane show enhancement of the pseudocapsules
Fig. 8
Fig. 8
Rat tail sign. T2-weighted, fat-saturated axial MR image shows protrusion of the implant shell through a focally weakened part of the fibrous capsule at medial aspect of right breast, simulating a rat tail (arrow)
Fig. 9
Fig. 9
Subcapsular line sign. Silicone-only axial MR image shows a hypointense line (arrow) running almost parallel to and just beneath the fibrous capsule in right breast, due to a thin layer of silicone between the shell and the fibrous capsule
Fig. 10
Fig. 10
Keyhole sign (left breast) and teardrop sign (right breast). Silicone-only axial MR image shows keyhole sign (small arrow) at left breast. The invaginations of implant shell do not touch each other. Tear-drop sign is seen at right breast (large arrow), with the invaginated membranes contacting one another
Fig. 11
Fig. 11
Linguine sign. Silicone-only axial MR image shows curvilinear hypointense lines (arrows) in the left breast implant, compatible with the collapsed shell floating in the high-signal silicone gel. This is called the linguine sign
Fig. 12
Fig. 12
Extracapsular rupture. T2-weighted axial MR images (a, b) show bilateral extracapsular ruptures. Defects are seen at bilateral fibrous capsules (white arrow on the right and black arrow on the left). Both collapsed implants demonstrate the linguine sign. On the T1-weighted post-contrast image with subtraction (c) there is a thin reactive rim of enhancement surrounding the collapsed implants
Fig. 13
Fig. 13
Extracapsular rupture of the right silicone gel-filled implant. Silicone-only axial MR image shows extracapsular rupture of the right silicone gel-filled implant (arrow)
Fig. 14
Fig. 14
Free silicone at chest wall. Reconstructed T2 coronal MR image with MIP (a) reveals extensive silicone leakage (black arrows) from bilateral silicone gel-filled implants. The free silicone has identical signal with the silicone gel inside the implants. On T2-weighted, fat-saturated axial image (b) discrete free silicone foci are seen over the chest wall (white arrows)
Fig. 15
Fig. 15
Collapsed right saline-filled implant. T2-weighted axial MR image shows collapsed right implant shell (arrow). The leaked hydrosaline solution has been resorbed
Fig. 16
Fig. 16
Desirable retroglandular position of PAAG. T2-weighted axial MR image demonstrates uncomplicated PAAG injection, with a collection of homogeneous T2 hyperintense material (arrows) at the retroglandular region of each breast, located anterior to the pectoral muscles
Fig. 17
Fig. 17
Asymmetric breasts after PAAG injection. T2-weighted (a) and T1-weighted (b) axial MR images show the undesirable outcome of breast asymmetry after augmentation by PAAG injection
Fig. 18
Fig. 18
Intrapectoral migration of PAAG. T2-weighted, fat-saturated sagittal MR image reveals PAAG tracking along fascial planes of the pectoral muscle (arrow)
Fig. 19
Fig. 19
Chest wall extension of PAAG in a patient with history of left breast augmentation by PAAG injection and silicone gel-filled implant. Extension of PAAG to chest wall is clearly shown on this T2-weighted, fat-saturated MR axial image. Silicone is of low signal while PAAG is of high signal on this sequence. Medial extension of PAAG to pre-sternal region is noted (arrow)
Fig. 20
Fig. 20
PAAG at anterior abdominal wall. Axial T2-weighted fat-suppressed image show there is minimal PAAG in bilateral retroglandular spaces (black arrows) (a). Instead, the main collections are found over anterior abdominal wall (white arrows) (b)
Fig. 21
Fig. 21
PAAG injection complicated with recurrent right breast abscess. Axial MR images of T1-weighted (a) and T2-weighted, fat-saturated (b) sequences depict a T1 hypointense and T2 hyperintense collection (black arrows) at the right breast. It shows rim enhancement after contrast injection (c). A sinus tract (arrowhead) is demonstrated at the lower outer aspect of the collection on the T1-weighted post-contrast coronal image with subtraction (d). Note the T1 low signal (a), T2 high signal (b) PAAG collection without any enhancement at the left retroglandular region (white arrows) (c)
Fig. 22
Fig. 22
Free silicone injection. High signal collections (black arrows) are noted at the retroglandular regions of both breasts on these axial MR images of silicone-only sequence (a–c), compatible with free silicone. Collections are also seen in premammary fat (white arrowheads), retropectoral region (white arrows), and pre-sternal region (black arrowheads). They are suppressed on silicone-saturated sequence (d, e). No enhancement is noted over the pre-sternal collection (black arrowheads) on T1-weighted post-contrast image with subtraction (f)
Fig. 23
Fig. 23
Unilateral right breast paraffin injection. T1-weighted (a), T2-weighted (b), T2-weighted, fat-saturated (c), and T1-weighted, fat-saturated, post-contrast (d) axial MR images show a right breast mass (black arrows) with T1 and T2 low to intermediate signals and minimal contrast enhancement. Nipple retraction (white arrow) is observed (a)
Fig. 24
Fig. 24
Myocutaneous flaps. These are MR images of a patient with history of bilateral mastectomy and breast reconstruction with TRAM flap at right breast and latissimus dorsi flap plus saline-filled implant at left breast, in order to maintain breasts symmetry. T2-weighted (a) and T2-weighted fat-saturated (b) axial MR images reveal the complete fatty composition of both breasts without normal glandular tissue, except over the region of saline-filled implant. The denuded dermal layer of the abdominal tissue (arrow) is seen parallel to the skin of right breast
Fig. 25
Fig. 25
Fat necrosis after autologous fat implant. T1-weighted (a), T2-weighted, fat-saturated (b), and T1-weighted, fat-saturated (c) axial MR images show a multilobulated lesion (arrows) with signal identical to fat in the left breast. Mild perifocal edema is noted (b). T1-weighted, post-contrast axial MR image with subtraction (d) shows the non-enhancing nature of the fatty masses. A thin rim of enhancement surrounding them is likely due to post-operative changes
Fig. 26
Fig. 26
Concurrent breast tumour anterior to right breast implant. T1-weighted (a), T2-weighted (b), and T1-weighted, post-contrast with subtraction (c) axial MR images show a T1 and T2 hypointense lesion with contrast enhancement (arrow) anterior to right breast implant. It was pathologically proven to be invasive ductal carcinoma

References

    1. Herborn CU, Marincek B, Erfmann D, Meuli-Simmen C, Wedler V, Bode-Lesniewska B, et al. Breast augmentation and reconstructive surgery: MR imaging of implant rupture and malignancy. Eur Radiol. 2002;12(9):2198–2206. doi: 10.1007/s00330-002-1362-x.
    1. Colombo G, Ruvolo V, Stifanese R, Perillo M, Garlaschi A. Prosthetic breast implant rupture: imaging--pictorial essay. Aesthet Plast Surg. 2011;35(5):891–900. doi: 10.1007/s00266-011-9694-z.
    1. Juanpere S, Perez E, Huc O, Motos N, Pont J, Pedraza S. Imaging of breast implants—a pictorial review. Insights Imaging. 2011;2(6):653–670. doi: 10.1007/s13244-011-0122-3.
    1. Amano Y, Aoki R, Kumita S, Kumazaki T. Silicone-selective multishot echo-planar imaging for rapid MRI survey of breast implants. Eur Radiol. 2007;17(7):1875–1878. doi: 10.1007/s00330-006-0533-6.
    1. Middleton MS, McNamara MP., Jr Breast implant classification with MR imaging correlation. Radiographics. 2000;20(3) doi: 10.1148/radiographics.20.3.g00mae11.
    1. Yang N, Muradali D. The augmented breast: a pictorial review of the abnormal and unusual. Am J Roentgenol. 2011;196(4):W451–W460. doi: 10.2214/AJR.10.4864.
    1. Glynn C, Litherland J. Imaging breast augmentation and reconstruction. Br J Radiol. 2008;81(967):587–595. doi: 10.1259/bjr/61567884.
    1. Brown SL, Middleton MS, Berg WA, Soo MS, Pennello G. Prevalence of rupture of silicone gel breast implants revealed on MR imaging in a population of women in Birmingham, Alabama. Am J Roentgenol. 2000;175(4):1057–1064. doi: 10.2214/ajr.175.4.1751057.
    1. Lui CY, Ho CM, Iu PP, Cheung WY, Lam HS, Cheng MS, et al. Evaluation of MRI findings after polyacrylamide gel injection for breast augmentation. Am J Roentgenol. 2008;191(3):677–688. doi: 10.2214/AJR.07.2733.
    1. Luo SK, Chen GP, Sun ZS, Cheng NX. Our strategy in complication management of augmentation mammaplasty with polyacrylamide hydrogel injection in 235 patients. J Plast Reconstr Aesthet Surg. 2011;64(6):731–737. doi: 10.1016/j.bjps.2010.10.004.
    1. Cheng NX, Wang YL, Wang JH, Zhang XM, Zhong H. Complications of breast augmentation with injected hydrophilic polyacrylamide gel. Aesthet Plast Surg. 2002;26(5):375–382. doi: 10.1007/s00266-002-2052-4.
    1. Helbich TH, Wunderbaldinger P, Plenk H, Deutinger M, Breitenseher M, Mostbeck GH. The value of MRI in silicone granuloma of the breast. Eur J Radiol. 1997;24(2):155–158. doi: 10.1016/S0720-048X(96)01027-3.
    1. Khong PL, Ho LW, Chan JH, Leong LL. MR imaging of breast paraffinomas. Am J Roentgenol. 1999;173(4):929–932. doi: 10.2214/ajr.173.4.10511150.
    1. Kang BJ, Jung JI, Park C, Park WC, Jeon HM, Hahn ST, et al. Breast MRI findings after modified radical mastectomy and transverse rectus abdominis myocutaneous flap in patients with breast cancer. J Magn Reson Imaging. 2005;21(6):784–791. doi: 10.1002/jmri.20309.
    1. Devon RK, Rosen MA, Mies C, Orel SG. Breast reconstruction with a transverse rectus abdominis myocutaneous flap: spectrum of normal and abnormal MR imaging findings. Radiographics. 2004;24(5):1287–1299. doi: 10.1148/rg.245035734.
    1. Hedegard W, Niell B, Specht M, Winograd J, Rafferty E. Breast reconstruction with a deep inferior epigastric perforator flap: imaging appearances of the normal flap and common complications. Am J Roentgenol. 2013;200(1):W75–W84. doi: 10.2214/AJR.12.9270.
    1. Losken A, Pinell XA, Sikoro K, Yezhelyev MV, Anderson E, Carlson GW. Autologous fat grafting in secondary breast reconstruction. Ann Plast Surg. 2011;66(5):518–522. doi: 10.1097/SAP.0b013e3181fe9334.
    1. Missana MC, Laurent I, Barreau L, Balleyguier C. Autologous fat transfer in reconstructive breast surgery: indications, technique and results. Eur J Surg Oncol. 2007;33(6):685–690. doi: 10.1016/j.ejso.2006.12.002.
    1. Brinton LA, Lubin JH, Burich MC, Colton T, Brown SL, Hoover RN. Breast cancer following augmentation mammoplasty (United States) Cancer Causes Control. 2000;11(9):819–827. doi: 10.1023/A:1008941110816.
    1. Sardanelli F, Boetes C, Borisch B, Decker T, Federico M, Gilbert FJ, et al. Magnetic resonance imaging of the breast: recommendations from the EUSOMA working group. Eur J Cancer. 2010;46(8):1296–1316. doi: 10.1016/j.ejca.2010.02.015.
    1. Brinton LA. The relationship of silicone breast implants and cancer at other sites. Plast Reconstr Surg. 2007;120(7 Suppl 1):94S–102S. doi: 10.1097/01.prs.0000286573.72187.6e.
    1. Miglioretti DL, Rutter CM, Geller BM, Cutter G, Barlow WE, Rosenberg R, et al. Effect of breast augmentation on the accuracy of mammography and cancer characteristics. JAMA. 2004;291(4):442–450. doi: 10.1001/jama.291.4.442.
    1. Keech JA, Jr, Creech BJ. Anaplastic T-cell lymphoma in proximity to a saline-filled breast implant. Plast Reconstr Surg. 1997;100(2):554–555. doi: 10.1097/00006534-199708000-00065.
    1. Adrada BE, Miranda RN, Rauch GM, Arribas E, Kanagal-Shamanna R, Clemens MW, et al. Breast implant-associated anaplastic large cell lymphoma: sensitivity, specificity, and findings of imaging studies in 44 patients. Breast Cancer Res Treat. 2014;147(1):1–14. doi: 10.1007/s10549-014-3034-3.
    1. Gidengil CA, Predmore Z, Mattke S, van Busum K, Kim B. Breast implant-associated anaplastic large cell lymphoma: a systematic review. Plast Reconstr Surg. 2015;135(3):713–720. doi: 10.1097/PRS.0000000000001037.

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