Journal of Radiology
Open Access

Breast implant complications, ranging from structural issues to implant-related illnesses, necessitate precise and reliable diagnostic tools. Conventional imaging methods often fall short in providing a comprehensive assessment. It is estimated that augmentation mammoplasty accounts for roughly 15% of all plastic surgery procedures worldwide.

Two complementary causation concepts exist regarding the T cell malignant transformation seen in BIA-ALCL: (a) chronic antigenic stimulation caused by textured silicone devices and their bacterial biofilms and (b) biochemical disruptions caused by degradation molecules of silicone gel [1]. Likewise, two causation concepts exist for breast implant illness (BII); some investigators have resurrected faulty autoimmune theories in the form of autoinflammatory syndrome induced by adjuvants (ASIA), while others have emphasized widespread biochemical disruptions caused by silicone gel degradation products.

Plastic surgeons routinely use silicone gel-filled breast implants for aesthetic and repair purposes, and they repeatedly emphasize recipients’ physical and emotional satisfaction as justification for their use. In the latter half of the 1980s and the early 1990s, escalating reports of device rupture and allegations of device-related systemic ailments began to surface in hundreds of thousands of recipients [2]. Researchers proposed controversial autoimmune causation theories, prompting proponents and naysayers to seek the judgment of scientific panels.

Methods

A thorough literature review was conducted to compile data on advanced imaging techniques utilized in the evaluation of breast implant complications. Modalities such as magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography (PET), and advanced ultrasound technologies were analyzed for their diagnostic capabilities and practical considerations [3].

Silicone Gel-Filled Implants

Plastic surgeons routinely use silicone gel-filled breast implants for aesthetic and repair purposes, and they repeatedly emphasize recipients’ physical and emotional satisfaction as justification for their use. In the latter half of the 1980s and the early 1990s, escalating reports of device rupture and allegations of device-related systemic ailments began to surface in hundreds of thousands of recipients [4]. Researchers proposed controversial autoimmune causation theories, prompting proponents and naysayers to seek the judgment of scientific panels. In the latter half of the 1990s, three independent panels refuted the autoimmune theories, leading to the erroneous perception that silicone-induced systemic disease had been permanently laid to rest.

Reaction to Silicone

A fibrous capsule is formed around the device following a breast implant procedure. The fibrous capsule consists of dense fibrosis, also having an inner line of pseudosynovia with histiocytes. As a result of the protective function, the blood supply to the intracapsular environment is restricted. In addition to histiocytes, there are lymphocytes, mast cells, and fibroblasts.

Over time, when there is silicone surface degradation or when there is silicone leakage from the intact implant shell, silicone corpuscles encounters the fibrous capsule [5]. At this point, the macrophage phagocytes the silicone resulting in a foamy histiocyte. However, this phagocytosis of the foreign body is frustrated, and the material is eliminated after cell apoptosis, making the process vicious. There is then the activation of the type II inflammatory process with a predominance of recruitment of T lymphocytes, especially those in the CD4 lineage. The inflammatory process is self-regulated and divided into phases: the inflammatory phase, the peak, and regression. When triggered, its intensity can be intervened with, preventing the peak from reaching the inflammatory phase, which is always associated with exudate. When the process is cooled down, a cicatricial granuloma may be observed [6].

Silicone Granuloma Diagnosis

Despite reports in the literature demonstrating the presence of silicone granuloma in surgical capsules and target organs since the 1970s, there was no diagnostic method or criteria for performing the diagnosis.

In 2016, we started a research protocol at the IBCC oncology. The protocol objective was to observe changes in silicone implants in patients referred for a breast MRI scan [7]. The protocol prospectively evaluated approximately 1,000 patients with silicone breast implants. All patients with silicone implants who showed changes in the MRI exam were referred for additional studies with ultrasound, biopsy, and surgery, as clinically recommended. We also correlated the imaging results with the pathology and clinical symptoms reported by the patients [8].

Early in the research, our main focus was to determine the prevalence of BIA-ALCL. We had a patient with an atypical intracapsular mass in the first cases, vascularized on ultrasound and magnetic resonance imaging. The patient underwent a percutaneous biopsy of the mass with the diagnosis of capsular contracture. The image was incompatible with a trivial capsular contracture [9]. We asked the pathologist to search for free silicone in the biopsy specimens. After the secondlook analysis, silicone granuloma was diagnosed, with giant cells and material refracting to polarized light in the microscopy analysis. We describe the findings as silicone-induced granuloma of breast implant capsules (SIGBIC).

Results

MRI stands out as a leading modality for assessing the integrity of silicone implants, offering high sensitivity and detailed anatomical information. CT scans, with their ability to capture three-dimensional structures, provide valuable insights into implant positioning and adjacent tissue conditions. PET imaging proves advantageous in detecting metabolic changes associated with implant-related illnesses, contributing to a holistic diagnostic approach.

Discussion

Despite the advancements, challenges persist, including accessibility, cost implications, and the need for standardized protocols. The integration of artificial intelligence and machine learning algorithms holds promise for streamlining image interpretation and improving diagnostic efficiency [10]. Ongoing research into contrast agents and novel imaging technologies is crucial for addressing current limitations and expanding the diagnostic arsenal.

Conclusion

In conclusion, advanced imaging strategies play a pivotal role in the comprehensive assessment of breast implant complications. The evolving landscape of imaging technologies offers exciting possibilities for refining diagnostic accuracy and patient outcomes. A collaborative effort among clinicians, radiologists, and researchers is essential for the integration of these advanced imaging modalities into routine clinical practice, ensuring timely and precise detection of device complications in breast implant patients.

1. El-Serag HB, Rudolph KL (2007) Hepatocellular carcinoma: epidemiology and molecular carcinogenesis. Gastroenterology 132: 2557-2576.

Indexed at, Google Scholar, Crossref

2. Forner A, Llovet JM, Bruix J (2012) Hepatocellular carcinoma. Lancet 379: 1245-1255.

Indexed at, Crossref

3. Marrero JA, Kulik LM, Sirlin CB, Zhu AX, Finn RS, et al (2018) Diagnosis, staging, and management of hepatocellular carcinoma: 2018 practice guidance by the American Association for the Study of Liver Diseases. Hepatology 68: 723-750.

Indexed at, Google Scholar, Crossref

4. Finn RS, Qin S, Ikeda M, Galle PR, Ducreux M, et al. (2020) Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma. N Engl J Med 382: 1894-1905.

Indexed at, Google Scholar, Crossref

5. Bruix J, Takayama T, Mazzaferro V, Chau GY, Yang J, et al. (2015) Adjuvant Sorafenib for Hepatocellular Carcinoma after Resection or Ablation (STORM): a phase 3, randomised, double-blind, placebo-controlled trial. Lancet Oncol 16: 1344-1354.

Indexed at, Google Scholar, Crossref

6. Khor B, Gardet A, Xavier RJ (2011) Genetics and pathogenesis of inflammatory bowel disease. Nature 474: 307-317.

Indexed at, Google Scholar, Crossref

7. Danese S, Fiocchi C (2011) Ulcerative colitis. N Engl J Med 365: 1713-1725.

Indexed at, Crossref

8. Loftus EV Jr. (2004) Clinical epidemiology of inflammatory bowel disease: incidence, prevalence, and environmental influences. Gastroenterology 126: 1504-1517.

Indexed at, Google Scholar, Crossref

9. Kaplan GG, Ng SC (2017) Understanding and preventing the global increase of inflammatory bowel disease. Gastroenterology 152: 313-321.

Indexed at, Google Scholar, Crossref

10. Matsuoka K, Kanai T (2015) The gut microbiota and inflammatory bowel disease. Semin Immunopathol 37: 47-55.

Indexed at, Google Scholar, Crossref