MRI Diagnosis Of Ruptured Silicone Breast Implants

Posted On: July 18, 2019 Author: The Office of Dr. Stuart Linder Posted In: Breast topics, Home, Ruptured Implant

Patients who present with silicone gel implants may present with ruptured silicone implants, although it is difficult to detect clinically.  Patients should undergo every two to three years postaugmentation or augmentation revision with silicone implants and MRI in order to determine the integrity of its shell or the bags.  Our patients are instructed that the MRIs are extremely important with silicone implants in that they allow the radiologist and the surgeon to determine a rupture intra- versus extracapsular.  The intracapsular rupture of silicone implants can be detected by what is called the Linguine sign.  The weightiness and black and white echo seen on the MRI is pathognomonic for the ruptured silicone bag.

The next four pictures represent a ruptured silicone on the right.  Notice the Linguine sign as well as the medial rupture of the implant on the right implant.  The left implant is completely intact.  There is no evidence of loss of integrity of the shell or Linguine sign.  The implants that rupture in silicone patients are referred to as “silent ruptures.”  This is different from saline implants that are referred to as “clinical ruptures” which can be diagnosed by visualization of the breast, showing an obvious asymmetry.  Remember that mammograms and ultrasounds can provide false positive or actually more often false negative results, indicating that the silicone implants are intact, but they are actually ruptured.

Patient presents recently with a 25-year-old ruptured Silimed silicone implant notable on MRI is extravasation of both intra and extracapsular rupture.  Patient presents clinically with painful breast deformity, Baker IV capsular contracture, double-bubble breast deformity with ruptured silicone mastitis.

The video shows the patient’s implant being removed with the silicone material as loose globular amounts of small droplets of silicone rather than a smooth viscous silicone liquid.  These implants are 25 years old and are no longer available in America.  The Silimed Biocel textured implants in my experience have a high rupture rate.  Notice the textured coating of the silicone shell with the calcifications and white plaque shown throughout the shell.  Notice half of the implant has lost its integrity and that the free silicone is identifiable throughout the breast.  Patients who present with ruptured Biocel silicone textured implants should have them removed.

Notice open capsulectomy silicone material exenteration is required and reconstruction with either silicone or saline implants can be performed.  These Allied Biocel Silimed textured implants are rare and I only see these a few times a year in my busy revision reconstructive practice due to its rarity.

https://www.youtube.com/watch?v=NLcnANpy1xg&feature=youtu.be