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Novel decision algorithm for the diagnosis of silicone gel breast implant ruptures

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European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

The main complications of breast implantation are caused by capsular contracture and implant rupture. Although the evaluation of implant rupture is primarily driven by patient symptoms, including change in breast shape, size, or firmness, most patients with breast implant rupture do not clinically manifest significant symptoms, thereby developing a so-called silent rupture. For all these reasons, its diagnosis generally relies on imaging techniques such as mammography, ultrasound, and magnetic resonance imaging.

Methods

We conducted a retrospective non-randomized study, carried out between March 2013 and August 2017. In this study, we evaluated 30 symptomatic patients who underwent mono or bilateral prosthetic breast reconstruction, a total of 51 implants after skin-sparing mastectomy or nipple-sparing mastectomy for breast cancer and following breast implant removal or replacement due to suspicious rupture or capsule contraction.

Results

Ultrasound suspected ruptures in 32/51 (62.7%) implants, while 19/51 implants resulted intact upon ultrasound examination. The sensitivity and specificity of ultrasound were 90 and 80% respectively. Magnetic resonance imaging suspected ruptures in 30/51 (58.8%) implants, while 21/51 (41.1%) implants resulted intact. The magnetic resonance imaging sensitivity and specificity were 87 and 85%, respectively.

Conclusions

Ultrasound evaluation may be the first level exam in case of suspicious symptomatic breast implant rupture. Importantly, our results demonstrate that magnetic resonance imaging could be avoided in all those cases where an extracapsular rupture has been diagnosed using ultrasound.

Level of Evidence: Level IV, diagnostic study.

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Authors and Affiliations

  1. Plastic Surgery Unit, AOU Città della Salute e della Scienza di Torino, University of Torino, Turin, Italy

    Paolo Bogetti, Marco Fraccalvieri, AntonGiulio Mangia, Anna Gianfala, Erind Ruka & Stefano Bruschi

  2. Department of Diagnostic Imaging and Radiotherapy, Radiology Institute, University of Torino, A. O. U. Città della Salute e della Scienza di Torino – Presidio Ospedaliero Molinette, Via Genova 3, 10126, Turin, Italy

    Giovanni Cappello, Giovanna Mariscotti & Manuela Durando

  3. Plastic Surgery Unit, Ospedale Mauriziano, Turin, Italy

    Paolo Balocco

Authors
  1. Paolo Bogetti
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  2. Marco Fraccalvieri
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  3. Giovanni Cappello
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  4. Paolo Balocco
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  5. Giovanna Mariscotti
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  6. Manuela Durando
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  7. AntonGiulio Mangia
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  8. Anna Gianfala
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  9. Erind Ruka
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  10. Stefano Bruschi
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Corresponding author

Correspondence to Marco Fraccalvieri.

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Conflict of interest

Paolo Bogetti, Marco Fraccalvieri, Giovanni Cappello, Paolo Balocco, Giovanna Mariscotti, Manuela Durando, AntonGiulio Mangia, Anna Gianfala, Erind Ruka, and Stefano Bruschi declare that they have no conflict of interest.

Ethical approval

All procedures were in accordance with the ethical standards of the institutional research committee and with 1964 Helsinski declaration and its later amendments.

Informed consent

Patients provided consent before their inclusion in this study.

Disclosure

All authors disclose all relationships or interests that could influence or bias the work.

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Bogetti, P., Fraccalvieri, M., Cappello, G. et al. Novel decision algorithm for the diagnosis of silicone gel breast implant ruptures. Eur J Plast Surg 41, 677–684 (2018). https://doi.org/10.1007/s00238-018-1434-z

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  • DOI: https://doi.org/10.1007/s00238-018-1434-z

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