Breast Implants

Question 1

What percentage of implants are for cosmetic augmentation?

Answer 1

60-80%

Question 2

What is the most common “medical” reason for implants?

Answer 2

post-mastectomy reconstruction

Question 3

What are sites for implant placement?

Answer 3

• subglandular (submammary; prepectoral)
• submuscular (subpectoral; retropectoral)
• subcutanseous
• intramammary

Question 4

For cosmetic augmentation mammoplasty, implants are typically placed where?

Answer 4

Beneath the glandular tissue in front of the pectoralis major muscle

Question 5

A submuscular location is typical for what?

Answer 5

post-mastectomy reconstruction

Question 6

Implant placement under the pectoralis muscle in patients with augmentation mammoplasty allows what?

Answer 6

easier evaluation of the breast tissue during mammo and lowers the incidence of capsular contracture

Question 7

A subpectoral location can be subject to what?

Answer 7

Implant migration

Question 8

Alternative site for post-mastectomy reconstruction and for tissue expanders?

Answer 8

Subcutaneous, prepectoral

Question 9

Intramammary implants are used for what?

Answer 9

Inlays for tissue defects

Question 10

Scanning the upper outer segment of the implant near the axilla will allow correct identification of the implant as being what?

Answer 10

submuscular in location

Question 11

How many different types and variations of breast implants are there?

Answer 11

200

Question 12

Common types of implants?

Answer 12

• Saline-filled; single lumen
• Silicone
• Saline inflatable tissue expanders (following mastectomy)

Question 13

Silicone types?

Answer 13

• Single lumen gel filled
• Double lumen
  
  • outer saline; inner silicone
  • outer silicone; inner saline

Question 14

What does autologous mean?

Answer 14

donor tissue

Question 15

Types of autologous reconstruction?

Answer 15

• Transverse rectus abdominis muscle (TRAM) flap

- Latissimus dorsi flap

Question 16

What is the most common double lumen implant?

Answer 16

inner silicone chamber surrounded by an outer saline chamber

Question 17

What is the shell of an implant?

Answer 17

Elastomer or polyurethane and can be smooth or textured

Question 18

What does a textured implant shell help reduce?

Answer 18

fibrous scarring around the implant

Question 19

What year did the FDA restrict the use of silicone gel implants for cosmetic augmentation because of health concerns related to leakage?

Answer 19

1992

Question 20

What year did the FDA re-approve silicone gel implants after extensive clinical studies?

Answer 20

2006

Question 21

What causes severe complications and granuloma formation?

Answer 21

Direct injection of silicone, paraffin, or fat

Question 22

The placement of what has been discontinued?

Answer 22

polyvinyl sponges

Question 23

A section of periumbilical abdominal wall and subcutaneous fat, along with the associated muscular and vascular pedicles is transferred to the breast.

Answer 23

Transverse rectus abdominis muscle (TRAM) procedure

Question 24

What procedure involves transfer of tissue (muscle, fat, skin) from the upper back to the breast region?

Answer 24

Latissimus dorsi

Question 25

Short term breast implant complications?

Answer 25

- pain and tenderness - bleeding/ hematoma - infection/ abscess - seroma - loss of nipple sensation

Question 26

Long term breast implant complications?

Answer 26

- capsular fibrosis/ calcification - capsular contracture - herniation - migration - chronic infection - rupture - silicone granuloma

Question 27

A thin rim of scar tissue commonly forms around a breast implant adjacent to the outer shell. Most common implant complication?

Answer 27

Fibrous encapsulation; scarring begins within weeks of implantation

Question 28

Since the 1980's, what has been added to the elastomer shell to reduce permeability?

Answer 28

fluorsilicone

Question 29

Hardening and distortion of an implant occurs when there is tightening and constriction of the surrounding fibrous capsule and causes the implant to become more rounded and ballon-shaped?

Answer 29

Capsular contracture

Question 30

Methods to reduce risk of implant capsular contracture?

Answer 30

- Subpectoral implant placement - Use of saline implants - Textured implant shell - Adding fluorsilicone to elastomer shell - Adding polyurethane to textured shell

Question 31

Textured polyurethane-coated implants may demonstrate what between the outer implant shell and the fibrous capsule?

Answer 31

small amount of serous fluid, provides a thin space for the implant to move and maintain its flexibilty

Question 32

What modality may have difficulty differentiation herniation from extracapsular rupture?

Answer 32

mammo

Question 33

What is the second most common complication?

Answer 33

Rupture

Question 34

Besides trauma, what is the key risk factor for rupture?

Answer 34

implant age

Question 35

Most silicone implants show some degree of implant rupture after how many years?

Answer 35

11-15 years

Question 36

What is commonly seen along the anterior surface of a saline implant or tissue expander and may become palpable when there is little overlying tissue?

Answer 36

diaphragm-type fill port or expander valve

Question 37

What type of implants are more prone to wrinkling and folding?

Answer 37

saline

Question 38

What artifact is commonly seen as repeating bands of echoes along the anterior margin of the implant?

Answer 38

reverberation artifact; more pronounced with silicone implants

Question 39

What helps to reduce reverberation artifact?

Answer 39

light scanning pressure, tissue harmonics, or compound imaging

Question 40

The speed of sound through silicone is ______ than through soft tissue and saline.

Answer 40

slower (1000 m/s)

Question 41

The majority of silicone implant ruptures are where?

Answer 41

intracapsular; silicone leaks outside of the implant but is still contained by the fibrous capsule

Question 42

Main sonographic sign of intracapsular silicone implant rupture?

Answer 42

stepladder or parallel-line sign

Question 43

Leakage of silicone gel through a breach in the implant shell and the fibrous capsule.

Answer 43

extracapsular rupture

Question 44

Characteristic sonographic appearance of microglobules of silicone within soft tissue or lymph nodes?

Answer 44

echogenic noise or snowstorm sign

Question 45

What special mammo views allow exclusion of the implant on the mammo for better evaluation of the breast tissue?

Answer 45

"pushback" or Eklund views