Automated breast volume scanner (ABVS) experience of silicone implant rupture: three cases report Tony W Chi, MD MBA Nagashima Breast Imaging Center, NBIC Clinic, Taiwan Summary: With the increasing prevalence of breast augmentation and frequency of ABVS for breast cancer screening in Taiwan Society, radiologists should be familiar with the probably ABVS signs of implant rupture to prevent misinterpretation.

3. ⦿ 3 cases of silicone implant rupture
› 1st case: pain & breast enlargement
› 2nd case: axillary mass
› 3rd case: no symptom
⦿ Implant Intact:
› homogenous anechoic interior
⦿ Implant rupture:
› multiple parallel echogenic lines in the implant interior
› echodense aggregates in the implant lumen
› mixture of hyperechoic and hypoechoic masses
› hyperechoic posterior shadowing within lymph nodes
› invagination of shell without touch of the two
membranes

4. ⦿ Cosmetic breast augmentation
› increasingly procedure performed in Taiwan
⦿ Prosthesis implantation
› the most common technique
⦿ The exact incidence of rupture is unknown
⦿ The risk of rupture
› directly related to the age of the implant
› inversely related to the thickness of the elastomer shell
⦿ (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. AJR 2000; 175:1057-1064)

5. ⦿ Most of the women do not have a right concept about
› the routine breast prosthesis examination
› the rupture risk of the breast prosthesis
⦿ Some of them
› afraid of the compression technique of mammogram
› or not affordable the Breast MRI yearly
⦿ Automated breast volume scanner
(ABVS, Siemens) may be better used to replace
breast MRI as a yearly screening tool
› not only early detection of breast cancer
› but also the possibility of implant rupture

6. ⦿ We would like to present three cases of silicone
implant rupture, all of whom underwent ABVS
› two extracapsular type
› one intracapsular type
⦿ ABVS findings (no. of cases)
› multiple parallel echogenic lines in the implant interior
“stepladder sign” (2)
› echodense aggregates in the implant lumen (2)
› mixture of hyperechoic and hypoechoic masses (2)
› hyperechoic posterior shadowing within lymph nodes
“snowstorm sign” (1)
› invagination of shell without touch of the two membranes
“keyhole sign” (1)

7. 50 year-old female
cc: significant enlargement of the breast in past few months
Implants: 19 years/subglandular
Rupture: extracapsular

9. Inside the implants
Right Left

10. 32 year-old female
cc: became hardening of the implants & axillary mass
Implants: 2 years/subglandular
Rupture: extracapsular

12. Subcapsular space

13. Surrounding breast tissue

14. Siliconoma
at right axillary lymph node

15. 27 year-old female
cc: became softening of the left implant
Implants: 1 year/subpectoral
Rupture: intracapsular

18. At low level

19. ⦿ Implant rupture as a late complication of breast
implant surgery
› often a silent phenomenon
› difficult to diagnose
⦿ Ultrasound detects silicone implant rupture
› sensitivity of 50-77
› specificity of 55-84%
⦿ (Venta LA, Salomon CG, Flisak ME, Venta ER, Izquierdo R, Angelats J. Sonographic
signs of breast implant rupture. AJR 1996; 166:1413-1419)

20. ⦿ The sign of intracapsular rupture
› the visualization of “stepladder sign”
› low level echoes within the implant
› echogenic focus of silicone between the implant
shell and fibrous capsule
⦿ (Caskey CI, Berg WA, Anderson ND, et al. Breast implant rupture:
diagnosis with US. Radiology 1994;190:819-823)

21. ⦿ The sign of extracapsular rupture
› the present of free echogenic nodule with well-
defined anterior margin and dirty incoherent
posterior shadowing within either the breast
stroma or lymph nodes, so called “snowstorm
sign”
⦿ (Harris KM, Ganott MA, Shestak KC, Losken HW, Tobon H. Silicone
implant rupture: detection with US. Radiology 1993; 187:761-768)

22. ⦿ In addition to the traditional ultrasound sign of
implant rupture, ABVS can also present the
similar MRI sign of minimally collapsed
intracapsular rupture in our case such as
› “keyhole sign
⦿ Soo MS Kornguth PJ, Walsh R, et al. INtracapsular implant rupture: MR
findings of incomplete shell collapse. J Magn Reson Imaging 1997; 7:724-730

23. ⦿ With the increasing prevalence of breast
augmentation and frequency of ABVS for
breast cancer screening in Taiwan Society,
radiologists should be familiar with the
probably ABVS signs of implant rupture to
prevent misinterpretation.

31. Q & A

32. Nagashima Breast Imaging
Center
www.nbic.com.tw
02-27182618
@breastdr