Monday, March 8, 2010

Possible Implant Rupture: Is MRI Useful? – an Article Review

Updated 3/2017 -- all links (except to my own posts) removed as many no longer active. and it was easier than checking each one.

Currently, magnetic resonance imaging (MRI)  is considered the accepted standard to evaluate silicone breast implant integrity.  This article (full reference below) reports a retrospective review study devised to “evaluate its utility in diagnosing ruptured silicone implants in the setting of capsular contracture and to correlate the preoperative assessment of implant integrity with or without magnetic resonance imaging with operative findings.”
The study involved 171 patients with capsular contractures with a total of 319 capsulectomies.  Preoperative MRIs was done on 160 implants, whereas the remaining 159 were evaluated using only physical examination and/or mammography. The authors then analyzed postoperative results  to determine the sensitivity, specificity, and accuracy of preoperative MRI in comparison with clinical and/or mammography evaluation alone.
They found that while the MRI was occasionally valuable, overall it was no more accurate than clinical evaluation in predicting implant status (intact or ruptured):   magnetic resonance imaging 124 of 160 (78 percent) and clinical 121 of 159 (76 percent; p = 0.77).
Their conclusions:
In the setting of capsular contracture, physical examination with or without mammogram is as accurate as magnetic resonance imaging in determining implant integrity. Although magnetic resonance imaging is a sensitive diagnostic tool, in symptomatic patients with capsular contracture, it cannot be viewed as infallible

It is nice to know that I am not slighting my patient by not always getting that MRI.  If she has a hard capsule, if my clinical exam suggests a rupture, then I strongly encourage her to have a capsulectomy with implant removal or exchange.  The MRI will not change that plan, so I don’t tend to order one.

Capsular Contracture and Possible Implant Rupture: Is Magnetic Resonance Imaging Useful?; Plast Reconstr Surg 125(3):830-835, March 2010; Paetau, Alyssa A.; McLaughlin, Sarah A.; McNeil, Rebecca B.; Sternberg, Erez; TerKonda, Sarvam P.; Waldorf, James C.; Perdikis, Galen [doi: 10.1097/PRS.0b013e3181cb6066]

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