Medical Imaging of Inflammations and Infections of Breast Implants

Abstract

Breast implants are widely used for reconstructive and/or cosmetic purposes. Inflammations and infections of breast implants represent important complications in clinical practice. The proper management of complications is necessary: diagnostic imaging plays a key role in detecting sites of inflammation and/or infection. The present review aims to illustrate the radiological findings of these conditions with different imaging techniques, such as mammography (MX), ultrasound (US), magnetic resonance imaging (MRI), and nuclear medicine imaging. A knowledge of these findings is essential for radiologists and nuclear medicine physicians to provide helpful information for the clinical management of these complications.

Keywords: breast implant infections; magnetic resonance imaging; mammography; positron emission tomography; scintigraphy; ultrasound imaging.

Figure 1

MRI image of a 47-year-old woman with bilateral reconstructive implants after surgery for breast cancer. Linguine sign: proof of intracapsular rupture. The curvilinear lines (arrow) are formed by the ruptured envelope and look like Linguine pasta.

Figure 2

MRI image of a 49-year-old woman with a history of bilateral reconstructive implants after breast surgery for breast cancer. Axial T2-images show a voluminous seroma, adjacent to the right prosthesis (green arrow).

Figure 3

Inflammatory reaction from a partial prosthetic mobilization. A 47-year-old woman in for a follow-up for breast cancer with a history of reconstructive bilateral implants after a bilateral mastectomy and a recent diagnosis of partial right prosthetic mobilization. The FDG PET/CT image on the left, a re-staging PET study after neoadjuvant therapy and surgery performed a few months before the diagnosis of prosthetic mobilization, shows the symmetrical distribution of the tracer in the periprosthetic tissues bilaterally. The FDG PET/CT image on the right, performed 5 months after the previous scan, reveals the appearance of diffuse and moderate FDG uptake in the medial and inferior sides of the right breast prosthesis, a site of partial prosthetic mobilization, suggesting an inflammatory reaction of the periprosthetic tissues.

Figure 4

Breast implant infection. A FDG-PET/CT for a 51-year-old woman with a breast implant infection. Axial (A) and sagittal (B) images show an area of severe increased uptake of the radiopharmaceutical (yellow arrows, SUV max 6.7) adjacent to the lower region of the right breast implant, site of the infection process.

Figure 5

Iatrogenic intrathoracic encapsulated siliconomas from a ruptured breast implant. A 45-year-old woman with a history of right silicone-based reconstructive implant after breast surgery for breast cancer. Several years later the patient began to experience progressive fatigue. Restaging with FDG PET/CT revealed the presence of FDG-active supraclavicular and internal mammary lymphadenopathies, as clearly depicted in maximum intensity projection image (A) and in axial CT and PET/CT images (B). She underwent a biopsy that confirmed the presence of silicone granulomas. The red line corresponds to the transaxial plane.