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Free Silicone With Giant Cell Reaction Can Enhance on Breast MRI

Background Breast augmentation with silicone implants is commonplace, and such implants have a risk of rupture which increases over time. Most implant ruptures are asymptomatic, and magnetic resonance imaging (MRI) is a recommended imaging modality for surveillance to detect these events. If a silic...

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Autores principales: Miles, Brittany L, Nguyen, Quan D
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9584033/
https://www.ncbi.nlm.nih.gov/pubmed/36284818
http://dx.doi.org/10.7759/cureus.29365
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author Miles, Brittany L
Nguyen, Quan D
author_facet Miles, Brittany L
Nguyen, Quan D
author_sort Miles, Brittany L
collection PubMed
description Background Breast augmentation with silicone implants is commonplace, and such implants have a risk of rupture which increases over time. Most implant ruptures are asymptomatic, and magnetic resonance imaging (MRI) is a recommended imaging modality for surveillance to detect these events. If a silicone leak enhances on MRI, it is currently categorized according to the Breast Imaging Reporting and Data System (BI-RADS) as category 4, which results in a recommendation for biopsy even when free silicone leakage is the most likely diagnosis. In this article, we present a case series that illustrates this issue with the BI-RADS system and propose an algorithmic approach that may allow some patients to be placed into BI-RADS category 3 and avoid biopsy. Methodology Eight cases of silicone breast implant rupture were identified at the University of Texas Medical Branch at Galveston over a five-year period. Two cases were excluded because MRI was not performed. The remaining six cases were evaluated for history and physical findings as well as mammogram, ultrasound, and MRI. All identified cases had been categorized as BI-RADS 4 and underwent biopsy. Results The six cases in this series exhibited pre-biopsy radiographic findings that were most consistent with silicone implant rupture. The ruptures were proven by biopsy, and no evidence of malignancy was identified in any of the patients. Conclusions Free silicone from breast implant rupture can present with enhancement on MRI. The two main categories of breast MRI enhancement, namely, mass and non-mass, include malignancies in their differential diagnoses and result in a BI-RADS category 4 designation. By correlating the findings with other imaging modalities, some of these patients can be classified as BI-RADS category 3 and biopsy can safely be avoided.
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spelling pubmed-95840332022-10-24 Free Silicone With Giant Cell Reaction Can Enhance on Breast MRI Miles, Brittany L Nguyen, Quan D Cureus Plastic Surgery Background Breast augmentation with silicone implants is commonplace, and such implants have a risk of rupture which increases over time. Most implant ruptures are asymptomatic, and magnetic resonance imaging (MRI) is a recommended imaging modality for surveillance to detect these events. If a silicone leak enhances on MRI, it is currently categorized according to the Breast Imaging Reporting and Data System (BI-RADS) as category 4, which results in a recommendation for biopsy even when free silicone leakage is the most likely diagnosis. In this article, we present a case series that illustrates this issue with the BI-RADS system and propose an algorithmic approach that may allow some patients to be placed into BI-RADS category 3 and avoid biopsy. Methodology Eight cases of silicone breast implant rupture were identified at the University of Texas Medical Branch at Galveston over a five-year period. Two cases were excluded because MRI was not performed. The remaining six cases were evaluated for history and physical findings as well as mammogram, ultrasound, and MRI. All identified cases had been categorized as BI-RADS 4 and underwent biopsy. Results The six cases in this series exhibited pre-biopsy radiographic findings that were most consistent with silicone implant rupture. The ruptures were proven by biopsy, and no evidence of malignancy was identified in any of the patients. Conclusions Free silicone from breast implant rupture can present with enhancement on MRI. The two main categories of breast MRI enhancement, namely, mass and non-mass, include malignancies in their differential diagnoses and result in a BI-RADS category 4 designation. By correlating the findings with other imaging modalities, some of these patients can be classified as BI-RADS category 3 and biopsy can safely be avoided. Cureus 2022-09-20 /pmc/articles/PMC9584033/ /pubmed/36284818 http://dx.doi.org/10.7759/cureus.29365 Text en Copyright © 2022, Miles et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Plastic Surgery
Miles, Brittany L
Nguyen, Quan D
Free Silicone With Giant Cell Reaction Can Enhance on Breast MRI
title Free Silicone With Giant Cell Reaction Can Enhance on Breast MRI
title_full Free Silicone With Giant Cell Reaction Can Enhance on Breast MRI
title_fullStr Free Silicone With Giant Cell Reaction Can Enhance on Breast MRI
title_full_unstemmed Free Silicone With Giant Cell Reaction Can Enhance on Breast MRI
title_short Free Silicone With Giant Cell Reaction Can Enhance on Breast MRI
title_sort free silicone with giant cell reaction can enhance on breast mri
topic Plastic Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9584033/
https://www.ncbi.nlm.nih.gov/pubmed/36284818
http://dx.doi.org/10.7759/cureus.29365
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