Breast Implants (Module 2 - Unit 5)

Question 1

What modality is the gold standard for assessing implant integrity?

Answer 1

MRI

Question 2

Where are cosmetic implants typically placed?

Answer 2

posterior to the glandular tissue, anterior to the pect muscle

Question 3

What location for implants may reduce capsular contracture and the the standard for placement of tissue expanders and implants following mastectomy?

Answer 3

Posterior to the pect major (submuscular or retropectoral location)

Question 4

What do saline implants look like in ultrasound?

Answer 4

Single anechoic lumen and anterior filling port

Question 5

What do single and double lumen silicone implants look like in ultrasound?

Answer 5

Single-lumen: come in prefilled sizes and are generally anechoic
Double-lumen: separate silicone and saline chambers, echogenic membrane separates the chambers

Question 6

What is most common: single or double lumen silicone implants?

Answer 6

Single lumen

Question 7

Fibrous capsules are more pronounced with what type of implant?

Answer 7

Silicone

Question 8

What forms around an implant and is the body’s natural response to a foreign body?

Answer 8

Fibrous capsule

Question 9

What is the capsule-shell-echo complex?

Answer 9

Inner and outer layer appear as 2 smooth thin echogenic lines with a 3rd line, which is an adjacent fibrous capsule

Question 10

What type of artifact is seen across the anterior lumen of the implant?

Answer 10

Reverb

Question 11

The speed of sound is much slower in silicone, so what type of artifact is seen when the posterior wall of the implant and distal structures falsely appear to extend deeper into the chest than adjacent tissues?

Answer 11

Propagation speed artifact in silicone

Question 12

What are some common ultrasound findings in implants?

Answer 12

• Linear in-folding of the shell
• Long or wavy folds
• Wrinkling, or lobulations
• Reactive fluid seen between the shell and fibrous capsule

Question 13

What is the reactive fluid seen between the shell and fibrous capsule called?

Answer 13

Peri-implant effusion

Question 14

What is capsular contracture?

Answer 14

Thickening and hardening of the fibrous capsule (implant becomes round, hard, and immobile)

Question 15

Capsular contracture is more common with which type of implant?

Answer 15

Silicone

Question 16

What is a focal herniation?

Answer 16

Herniation of the implant through a crack of the fibrous capsule - presents as palpable lump

Question 17

What type of implant rupture is easier to handle?

Answer 17

Saline, due to the body being able to absorb it

Question 18

What is the most common type of implant rupture?

Answer 18

Intracapsular

Question 19

What is an intracapsular rupture?

Answer 19

A break in the implant shell but is still contained by the fibrous capsule

Question 20

What sonographic sign is associated with significant rupture?

Answer 20

Stepladder sign or parallel line sign

Question 21

The step ladder sign corresponds to which sign seen on MRI scans?

Answer 21

Linguine

Question 22

What are the diagnostic pitfalls for an intracapsular rupture?

Answer 22

Confusing other linear echoes

Question 23

What is an extracapsular rupture?

Answer 23

Defect in both the implant shell and fibrous capsule?

Question 24

What is the ultrasound appearance for a extracapsular rupture?

Answer 24

• echogenic noise sign/ snowstorm appearance