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An MRI Every Five: Evaluating Breast Implant Screening Guidelines
Casey Zhang
*, Shayan M. Sarrami, Vanessa Mroueh, Andreea Gavrilescu, Carolyn De La Cruz
Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
Introduction:
In 2020, the FDA updated its surveillance recommendations for breast implant rupture to an ultrasound or MRI 5-6 years following silicone implant placement, with repeat screening every 2-3 years after. This study aims to assess the risk of implant rupture and evaluate the utility of routine surveillance MRIs in diagnosing implant rupture.
Methods:
We performed a retrospective review of patients who underwent implant-based reconstruction for breast cancer with a single surgeon between 2012-2017. Inclusion criteria included implant-based reconstruction and a minimum follow-up period of five years. Clinical notes and imaging records were reviewed. Univariate analysis was performed to elucidate implant rupture rate and bivariate analysis was performed to identify factors associated with rupture.
Results:
A total of 348 patients underwent reconstruction with implants. 11.2% of reconstructions were with saline implants and 82.8% with silicone implants. 110 (31.6%) patients underwent at least one routine screening MRI to assess implant integrity. Implant rupture occurred in 24 patients, with an overall rupture rate of 6.9%. Average time from implant placement to rupture was 5.9 ± 3.8 years. 12 (50%) ruptures presented without any clinical symptoms, and were found incidentally on routine MRI screening. 15 (62.5%) ruptures were diagnosed on MRI, and 12.5% diagnosed incidentally on chest CT. All ruptures were identified as intracapsular on imaging and intraoperatively. 19 (79.1%) patients with rupture underwent implant replacement. Average time from rupture diagnosis to implant removal or replacement was 6.1 months (range 0.3 - 36.9 months).
Conclusion:
Implant rupture occurs on average 5.9 years after placement. Many patients with implant rupture may not present with clinical symptoms, and the true rate at which patients undergo routine MRI screening is low. Routine screening every 5 years is accurate in detecting for rupture. Patients should be counseled on the risk of implant rupture and the potential for additional operations for implant replacement.
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