Clinical History
A 45 year-old female, with history of left breast carcinoma, previously submitted to left mastectomy with retro-pectoral reconstruction with silicone implant, refers sudden pain and increased volume in the left breast, after exertion.
Imaging Findings
Breast MRI was performed to evaluate the integrity of the retro-pectoral implant on the left breast (Fig. 1). An anterior hyperintense peri-prosthetic collection is depicted on T1WI (Fig. 1a) and T1FS (Fig. 1b), with a very heterogeneous signal on T2WI (Fig. 1c).
STIR with inversion time for silicone (Fig. 1d) reveals an intact implant, without signs of intra or extra-capsular rupture. This STIR sequence enhances the silicone signal and is important to exclude migration of silicone out of the capsule.
Signal characteristics allow us to affirm that it is a blood collection. With fat suppression, the fat signal is cancelled and the blood (methaemoglobin) stands out (Fig. 1b).
Discussion
Magnetic resonance imaging (MRI) is the goldstandard technique for the evaluation of breast implants. MRI with specific protocols for breast implants evaluation allows to suppress or emphasize the signal of water, fat and silicone. Axial T1, Axial T2, STIR with suppression of the water and fat signal (silicone-only) must be obtained. In cases of suspected capsulitis and in oncological follow up a dynamic study with contrast should be performed.
There are several possible complications, of which the most common is rupture. Other less frequent complications are capsular contracture, infection, hematoma, and herniation of the prosthesis.
Haematomas are commonly seen in the peri-operative period.[1] They can be large, painful, and require drainage. Delayed haematomas are rare, caused by trauma, coagulopathy, capsular tear, recurrent cancer, or infection.[1, 2]
On MRI, haematomas appear as complex fluid collections. The signal depends on the time of evolution of the blood collections, since it is influenced by the paramagnetic properties of the compounds derived from the degradation of haemoglobin: Oxy-Hb (immediate - intermediate signal on T1 and T2); DeOxy-Hb (intermediate signal on T1 and hypointense on T2); MetHb (hyperintensity on T1 and T2); Hemosiderin (chronic - hypointensity on T1 and T2).[3]
Take Home Message, Teaching Points:
- MRI is the gold standard method for postoperative oncological follow-up of reconstructive prostheses and for the detection of silicone implants ruptures and other complications.
- MRI detects the presence of blood collections due to the paramagnetic properties of the compounds derived from the degradation of haemoglobin.
Written informed patient consent for publication has been obtained.
Differential Diagnosis List
Breast implant haematoma
Intra-capsular rupture
Extra-capsular rupture
Breast implant infection
