This 67-year-old woman had breast implants placed 31 years ago. Her right breast has gotten bigger since her last examination. Please note that image 5 is from an exam two years prior.
A. What is a very important question you should ask to interpret these images properly?
B. How would you characterize these implants?
C. If the pink arrow on image 1 points to silicone, what type of image is this?
D. If the green arrow on image 2 is pointing to saline, what type of image is this?
E. If image 3 is a modestly fat-suppressed and water-suppressed image, what is the differential diagnosis of the tissues labeled with the yellow arrows in the left breast (image 3) and the right breast (image 4)?
F. If one were to tell you the collections labeled with the yellow arrows on image 3 and 4 were not present on multiple prior MR mammograms, what would be your answer for the tissue marked by the yellow arrow, blue arrow and orange arrow?
A. Perhaps there are two correct answers. 1. Does the patient have a prior MRI, and can we see it? 2. What type of implant has been placed?
B. Double lumen silicone and saline.
C. Fat-suppressed proton-density image, heavily water-weighted.
D. Water-suppressed image. In addition, some modest fat-suppression is also present.
E. An outer saline lumen or a seroma.
F. The yellow arrow indicates seroma, the blue arrow indicates the saline component of a dual lumen implant, and the orange arrrow indicates a nonsuppressed silicone component of dual lumen implant.
When you look at the patient’s prior MRI, you will see at the very end of this teaching case that the fluid collection around the right implant was not there and represents one of two enlarging seromas. The left seroma grew prior to this scan (yellow arrow, image 5).
MRI is a “thumbs up” as the first, best, and often the only, test for breast implant failure.
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