The use of silicone breast implants has been a controversial and hotly debated topic, with most of the controversy centering on the suggested association between silicone and connective tissue disorders. Local adverse effects of non contained silicone are well documented and include granuloma formation, fibrosis, and migration. Although the need to identify and remove a ruptured silicone implant remains somewhat controversial, the timely removal of a ruptured implant is desirable because delays may increase the degree of silicone leakage and migration, thus making complete removal difficult or impossible (Rosculet, Ikeda, Forrest, 1992).
In this article, we present our experience using ultra sonography (US), magnetic resonance (MR) imaging, and mammography to detect free (direct injection), extra capsular (implant in place), and residual (implant removed) silicone and its associated complications in women with a history of silicone breast implants. The specific topics discussed are examination technique; detection of silicone with US, MR imaging, and mammography; breast augmentation with silicone; and extra capsular spread of silicone.
Indications for the examinations included complaints of breast pain and tenderness, neck and shoulder pain, chest wall pain, fibromyalgia, and vague joint and muscle pains in patients with a history of direct silicone injection or a silicone prosthesis placed for breast augmentation or reconstruction (Rosculet, Ikeda, Forrest, 1992).
The US appearance of free silicone is variable. The classic appearance is a highly echogenic pattern of scattered and reverberating echoes with a well-defined anterior margin and loss of detail posteriorly. This pattern has been described as "echogenic noise" or "echodense noise" with an appearance similar to a "snowstorm". Occasionally, this echogenic noise is absent, replaced by acoustic shadowing with the silicone blocking the transmission of sound. Large to medium-sized conglomerates of free silicone can appear as hypoechoic masses which are almost indistinguishable from cysts and are usually surrounded by echogenic....
