Evaluation of Magnetic Resonance Imaging Surveillance to Assess Silicone Breast Implant Integrity: Revisiting Screening Frequency
Haripriya S. Ayyala, MD1; Tarek Afifi, MD1; Meghana Shamsunder, MPH1; Colleen McCarthy, MD1; Peter G. Cordeiro, MD1
1Memorial Sloan Kettering Cancer Center
Introduction: Current guidelines recommend routine magnetic resonance imaging (MRI) for detection of silicone breast implant rupture at 5-6 years post-implantation and every 2-3 years thereafter. We review the results of serial silicone implant MRI screening according to current guidelines to determine the validity of asymptomatic screening.
Methods: Institutional Review Board approval was obtained, and a retrospective review was performed. All patients who underwent silicone implant placement from 1999-2019 by a single surgeon were identified. Within this cohort, all patients who underwent one or more screening breast MRIs with the purpose of evaluating silicone implant integrity were further identified and included in the analysis.
Results: In total, 4909 screening MRIs were performed in 1211 patients (838 bilateral, 373 unilateral) with 2049 silicone implants. Mean follow-up was 7.12 years. Within this cohort, 90 implants in 81 patients were detected as ruptured on screening MRI, with an overall screening rupture rate of 4.29%. The actual number of ruptures after explantation was 58 with a true rupture rate of 2.83%. The estimated cumulative rupture rate is 0.3% at 3 years, 1.0% at 5 years, 2.5% at 7 years and 12% at 10 years (Figure 1). The positive predictive value for MRI imaging was 65.5%, and false-positive rate was 2.51%. Incidental findings were reported in 356 patients (29.39% excluding ruptures) and 169 of these underwent further tests or procedures.
Conclusion: The results of this study provide real world evidence of the rate of silicone implant rupture detected on routine, periodic screening MRI. Evidence to support the routine screening of asymptomatic patients with MRI prior to 10 years after implantation may be lacking.
Back to 2022 Posters