Breast implants: The value of ultrasound in detecting a rupture of implant

Abstract

Background / Objective Breast implant surgery for cosmetic purpose is the most popular plastic surgery and it has been performed for over 100 years. The amount of these procedures has risen significantly in the past decade according to American Society of Plastic Surgeons. It is important to determine changes in implant integrity because most of implant ruptures do not cause any clinical symptoms. The aim of our study was to evaluate the diagnostic value of ultrasound (US) in the detection of intact and ruptured breast implants. Methods In this retrospective study the medical documentation of women who underwent breast implant surgery and US check-ups at Tautrimas Aštrauskas Clinic in Kaunas, Lithuania in 2015-2023 were analyzed. The study included 92 patients with breast implants who underwent breast ultrasound and suspected rupture of one or both implants. An intact breast implant was characterized by even and continuous implant shell and homogeneous intracapsular echo-texture. The signs of a ruptured breast implant were uneven implant shell and inhomogeneous intracapsular echo-texture. The implants were divided into two groups: intact breast implants and ruptured breast implants. Surgery followed every evaluation of implant rupture by US. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were evaluated. Results In this study 184 implants were evaluated. Ultrasound diagnosis of an intact implant was made in 40,8% cases, a certain or suspected implant rupture - in 59,2% of cases. The accuracy of US in diagnosis of implant rupture was 97,3%, sensitivity – 99,1%, specificity – 94,9%, PPV – 96,3%, NPV - 98.7% and of all cases only 0.5% of cases were false negative. Conclusions US is reliable in evaluating breast implant integrity. The reported sensitivity of US for predicting implant rupture varies widely in the literature, from 50 to 94%. In the current study, the sensitivity was very high (99,1%, 96,7% CI, 86% to 101,4%). It can be influenced by the radiologist’s work experience. The new updated FDA 2023 guidelines state that magnetic resonance imaging (MRI) is the most effective method for detecting silent rupture of silicone gel-filled breast implants, but ultrasound is an acceptable alternative test for rupture in asymptomatic patients. The ultrasound is cheaper, faster, more affordable, and also very sensitive for assessing implant integrity. With reference to our study US examination after breast augmentation surgery with silicone gel implants is recommended annually.