| January 2006 Case of the Month |
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Compiled By: David L. Wells, MD
History:
47 year old status post bilateral breast implants with recent surgical removal of scar from the right breast with swelling and tenderness.
Findings:
Right Breast:
The right breast implant demonstrates an abnormal collection surrounding the implant, which is of increased signal abnormality on the T1-weighted sequence. This is associated with heterogeneous decrease signal abnormality of the upper outer quadrant. The findings are suggestive of a proteinaceous collection surrounding the implant. The differential diagnosis would include a complex inflamed seroma, lymphocele, hemorrhagic collection and infected collection.
No evidence of a rupture involving the implant. Synechia adjacent to the right breast implant is noted. This is consistent with the clinical history of scar tissue involving the right breast.
Left Breast:
The left breast implant demonstrate no acute complications.
Diagnosis:
Differential diagnosis includes complex inflamed seroma, lymphocele, hemorrhagic collection or infected collection.
Discussion:
The incidence of infectious complications in breast implants world wide is 2 –2.5%, however, in the United States it is less than 1%. Smoking increases the risk of infections, deep venous thrombosis and slows healing. Cancer patients have a ten times increased risk of infections with breast implants.
Multiple micro organism can cause breast patients with implants to have infectious complications. Capsular contracture is the leading long-term complication of breast implants. This is believed to be secondary to sub-clinical infection of Staph Epidermidis in the nipple ducts. Mycobacteria may present atypically and may take up to a year before presentation. Also, Mycobacterium Fortuitum may give rise to inflammation around the implant with no symptoms elsewhere and patients usually do not have raised temperatures. Pseudomonas present with few clinical signs.
The diagnosis of an infected breast with an implant is usually made clinically, however, MRI of the breast is playing an increasing role in the diagnosis of not only infectious complications in breast with implants but also in the general evaluation of the breast as well. Specifically, MRI of the breast allows for the evaluation of the breast implant without compression and without risk of rupture to the implant. Hence, MRI of the breast may be become the procedure of choice for the evaluation of the augmented breast.
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References:
- Infection in breast implant, The Lancet Feb 1, 2005.
Region Esthetics, Information about Cosmetic and Plastic Surgery by Dr. Patrick Hudson. | |
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