Extracapsular Rupture of Breast Implants

The above images are from a woman who presented with left chest wall pain after a motor vehicle accident. CECT demonstrates bilateral prepectoral breast implants with asymmetry in size, retraction of the left implant, thickening of its capsule and surrounding hematoma. Findings are suspicious for extracapsular rupture.

While most centers use CECT for the initial evaluation of trauma patients, MRI with dedicated breast coil is the most sensitive for detecting implant rupture. Findings on various imaging modalities include:

Mammography: 

• wrinkled contour of implant
• dense, globular masses due to extracapsular silicone

Ultrasound:

• stepladder sign - linear echogenic layers of the collapsed implant shell
• "snowstorm" appearance - increased echogenicity due to extracapsular spread of silicone

MRI:

• T2WI may show extracapsular high signal
• use of water suppressed STIR images will render bright signal for silicone

REFERENCES

Brown SL, Middleton MS, Berg WA, et al. Prevalence of rupture of silicone gel breast implants revealed on MR imaging in a population of women in Birmingham, Alabama. Am J Roentgenol 2000;175:1057-64.

Scaranelo AM, Marques AF, Smialowski EB, et al. Evaluation of the rupture of silicone breast implants by mammography, ultrasonography and magnetic resonance imaging in asymptomatic patients: correlation with surgical findings. Sao Paulo Med J 2004;122(2):41-7.