Implants Flashcards
What are some indications to get implants?
- cosmetic augmentation
- post-mastectomy reconstruction
- congenital amastia
- severe hypoplasia/asymmetry
- inlays for tissue defects
Why would a patient have a tissue defect?
lumpectomy can leave uneven areas etc
What locations can implants be placed in?
- subglandular (cosmetic)
- submuscular (reconstruction)
- subcutaneous
- intramammary
What is a TRAM flap?
- transverse rectus abdominis muscle
- part of abdominal wall, fat, muscle and vasculature is transplanted to the breast
What is a latissimus dorsi flap?
tissue from the upper back is transplanted to the breast, implant goes under muscle
What are the two common types of implants?
silicone and saline
What is the most common implant used?
single lumen saline
What are the two types of silicone implants?
- single lumen (gummy bear)
- double lumen: outer saline, inner silicone or outer silicone, inner saline
What is a dangerous and illegal method of breast augmentation?
silicone injections
What is the sonographic appearance of implants?
- defined shell/tissue surface
- smooth elliptical shape
- anechoic lumen (silicone has echoes at higher gain)
- anterior reverb
- possible folds
What is the difference between saline and silicone implants and the size they appear on US?
saline appears on US as its actual size
silicone appears larger in AP
What do the shell walls look like on US?
two thin echogenic parallel lines, a third line can be seen above and is the fibrous capsule
What does an expander valve look like on US?
- usually on anterior surface
- usually subareolar
Why can wrinkling of the skin occur with implants?
- can be secondary to implant contracture
- placement within a small pocket or underfilled implant
- due to lobulation of implant shell
What kind of implants are more prone to wrinkling?
saline
What is a peripheral fold?
AKA radial fold
- normal
- extends from inner wall for variable distance
- internal, long, wavy complex folds
What can a peripheral fold appear as?
implant rupture
What is reverberation artifact? What does it cause difficulties with?
- repeating bands of echoes along anterior surface
- can make it harder to detect intracapsular rupture
What kind of implants are more likely to cause reverberation artifact?
silicone
What kind of implants cause propagation speed artifact and why?
silicone, speed of sound is slower than in soft tissue and causes posterior structures to appear deeper
What are short term complications of implants?
- pain, tenderness
- hematoma
- infection and abscess
- seroma
- loss of nipple sensation
What are long term implant complications?
- capsular fibrosis and calcification
- capsular contracture
- herniation
- migration
- chronic infection
- rupture
- silicone granuloma
- autoimmune response
What is capsular fibrosis?
- thin rim of scar tissue around implant’s outer shell
- begins within weeks of implantation
- response to a foreign object in body
What is the MC implant complication?
fibrous encapsulation
