What is Your Diagnosis

Breast implant: Certain types of breast implants consist of a silicone rubber envelope filled with fluid. Until a few years ago, silicone gel was used exclusively. Now combinations of silicone gel and saline are used (saline in an outer lumen, silicone in the inner lumen of a double-lumen implant). After the implantation, a fibrotic capsule forms around the rubber envelope of the implant (Fig. 12.24a, b). The capsule often retains the fluid even after the rubber envelope has ruptured and collapsed (Fig. 12.24c).

f If a breast implant is inserted in an attempt to reconstruct i the breast after breast cancer surgery, a tumor recurrence can often only be excluded by MRI (Fig. 12.25). If a breast has been enlarged for cosmetic reasons, special implant displacement views are obtained in addition to regular mammographic views. If the breast parenchyma cannot be visualized adequately, or if implant rupture is suspected, patients may need to be examined with MRI.

• Diagnosis: Hannah still has no clue what to say about Mrs. Baywatch's breasts. After contrast administration, Mrs. Baywatch's breasts show no contrast enhancement whatsoever, so an invasive carcinoma can be excluded with sufficient certainty. And the rounded signal void in the right breast is best explained by a metal artefact, which would not surprise anyone after the apparent surgery. But what is the second large structure anterior to the silicone implant? Two additional MRI sequences point Hannah in the right direction (Fig. 12.26). Apart from that she takes the time to have a long conversation with the patient, which helps a lot in sorting out image findings in patients with a complex past surgical history.

I Breast Implant

I Breast Implant

Fig. 12.24a This silicone-selective MRI sequence amplifies the silicone signal inside the implant. The fibrotic capsule around it is filled with fluid. A few drops of silicone (arrows) can be seen within the folds of the implant, indicating a leak of the implant envelope. b These folds have to be differentiated from frank ruptures of the implant envelope. c The MRI appearance of ruptured implant envelopes is characterized by a typical pattern reminiscent of a popular Italian dish: it is called the "linguini" sign. The silicone remains within the outer fibrotic capsule around the collapsed rubber envelope.

Fig. 12.24a This silicone-selective MRI sequence amplifies the silicone signal inside the implant. The fibrotic capsule around it is filled with fluid. A few drops of silicone (arrows) can be seen within the folds of the implant, indicating a leak of the implant envelope. b These folds have to be differentiated from frank ruptures of the implant envelope. c The MRI appearance of ruptured implant envelopes is characterized by a typical pattern reminiscent of a popular Italian dish: it is called the "linguini" sign. The silicone remains within the outer fibrotic capsule around the collapsed rubber envelope.

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