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Senologie - Zeitschrift für Mammadiagnostik und -therapie 2020; 17(04): 273-286
DOI: 10.1055/a-1099-5175
Übersicht

Implantate der weiblichen Brust – Teil 2: Implantatkomplikationen

Breast implants – Part 2: Pathologic findings of implants in MRI
Uwe Fischer
1   Diagnostisches Brustzentrum Göttingen BZG, Göttingen
,
Hafiez Said
2   Abteilung für Plastische und Rekonstruktive Chirurgie, Krankenhaus Neu Bethlehem, Göttingen
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Zusammenfassung

Bei der Diagnostik von Implantaten wird prinzipiell unterschieden zwischen frühen postoperativen und späten Komplikationen. Unmittelbar postoperative Komplikationen betreffen ganz allgemein die Nachblutung, die Wundinfektion und die Wundheilungsstörung. Diese Veränderungen sind in aller Regel klinisch und ggf. durch einen ergänzenden Ultraschall zu diagnostizieren. Bei später auftretenden Komplikationen im Zusammenhang mit dem Implantat kann unterschieden werden zwischen solchen, die eher frühzeitig nach Implantateinbringung entstehen (Rotation, Hernierung, Kapsulitis, Kapselfibrose), und solchen, die sich im Rahmen der Materialermüdung typischerweise erst 10–20 Jahre nach Einbringung des Implantats ausbilden (Gelbluten, Hüllenabhebung, intrakapsuläre und extrakapsuläre Ruptur). Unabhängig hiervon kann es natürlich jederzeit durch die Einwirkung externer Kräfte zu einer Ruptur des Implantats (Silikonaustritt, Silikonom) kommen. In der zweiten der 3-teiligen Präsentation werden die Komplikationen von Implantaten der weiblichen Brust unter besonderer Berücksichtigung der MRT präsentiert.

Abstract

In the diagnostics of implants, early postoperative changes were differentiated from complications that occur later. Direct postoperative complications apply to secondary haemorrhage, infection or delayed healing of the wound. These changes are typically diagnosed by clinical and/or ultrasound examination. Late complications can be separated in rotation, herniation, and inflammation or fibrosis of the capsula (preferred within the first years after implantation) on one side, and gel bleeding, retraction of the shell, and intra- or extracapsular rupture as a sign of fatigue of material commonly 10–20 years after implantation. Moreover, an implant can be ruptures due to external force effects followed associated with an extension of silicon (siliconoma). In this second of three parts of a publication about MRI of breast implants, the authors describe typical and untypical complications of implants in diagnostic imaging.

Schlüsselwörter

Brust - Implantat - Komplikation - Ruptur - Bildgebung - MRT

Key words

breast - implants - complication - rupture - imaging - MRI


Publication History

Article published online:
15 December 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

  • Literatur

  • 1 Senologie 2020; 17: 197-206 . doi:10.1055/a-1099-5024
    PubMed
  • 2 Nemecek JA, Young VL. How safe are silicone breast implants?. South Med J 1993; 86: 932-944
    CrossrefPubMedGoogle Scholar
  • 3 Poeppl N, Schreml S, Lichtenegger F. et al. Does the surface structure of implants have an impact on the formation of a capsular contracture?. Aesthetic Plast Surg 2007; 31: 133-139
    CrossrefPubMedGoogle Scholar
  • 4 Hedén P, Bronz G, Elberg JJ. et al. Long-term safety and effectiveness of style 410 highly cohesive silicone breast implants. Aesthetic Plast Surg 2009; 33: 430-436
    CrossrefPubMedGoogle Scholar
  • 5 Adams WP, Rios JL, Smith SJ. Enhancing patient outcomes in aesthetic and reconstructive breast surgery using triple antibiotic breast irrigation: six-year prospective clinical study. Plast Reconstr Surg 2006; 118: 46S-52S
    CrossrefPubMedGoogle Scholar
  • 6 Araco A, Granvante G, Araco F. et al. Capsular contracture: results of 3002 patients with aesthetic breast augmentation. Plast Reconstr Surg 2006; 118: 1499-1500
    CrossrefPubMedGoogle Scholar
  • 7 Spear SL, Parikh PM, Goldstein JA. History of breast implants and the Food and Drug Adminis- tration. Clin Plast Surg 2009; 36: 15-21
    CrossrefPubMedGoogle Scholar
  • 8 Ganott MA, Harris KM, Ilkhanipour ZS. et al. Augmentation mammoplasty: normal and abnormal findings with mammography and US. RadioGraphics 1992; 12: 281-295
    CrossrefPubMedGoogle Scholar
  • 9 Peters WJ, Smith D, Fornasier VL. et al. An outcome analysis of 100 women after explantation of silicone gel breast implants. Ann Plast Surg 1997; 39: 9-19
    CrossrefPubMedGoogle Scholar
  • 10 Gabriel SE, Woods JE, O’Fallon WM. et al. Complications leading to surgery after breast implantation. N Engl J Med 1997; 336: 677-682
    CrossrefPubMedGoogle Scholar
  • 11 Handel N, Gutierrez J. A long-term study of outcomes, complications, and patient satisfaction with breast implants. Plast Reconstr Surg 2006; 117: 757-767
    CrossrefPubMedGoogle Scholar
  • 12 Embrey M, Adams EE, Cunningham B. et al. A review of the literature on the etiology of capsular contracture and a pilot study to determine the outcome of capsular contracture interventions. Aesthetic Plast Surg 1999; 23: 197-206
    CrossrefPubMedGoogle Scholar
  • 13 Ersek RA. Rate and incidence of capsular contracture: a comparison of smooth and textured silicone double-lumen breast prostheses. Plast Reconstr Surg 1991; 87: 879-884
    CrossrefPubMedGoogle Scholar
  • 14 Pajkos A, Deva AK, Vickery K. et al. Detection of subclinical infection in significant breast implant capsules. Plast Reconstr Surg 2003; 111: 1605-1611
    CrossrefPubMedGoogle Scholar
  • 15 Virden CP, Dobke MK, Stein P. et al. Subclinical infection of the silicone breast implant surface as a possible cause of capsular contracture. Aesthetic Plast Surg 1992; 16: 173-179
    CrossrefPubMedGoogle Scholar
  • 16 Dobke MK, Svahn JK, Vastine VL. et al. Characterization of microbial presence at the surface of silicone mammary implants. Ann Plast Surg 1995; 34: 563-569
    CrossrefPubMedGoogle Scholar
  • 17 Ahn CY, Ko CY, Wagar EA. et al. Microbial evaluation: 139 implants removed from symptomatic patients. Plast Reconstr Surg 1996; 98: 1225-1229
    CrossrefPubMedGoogle Scholar
  • 18 Schreml S, Heine N, Eisenmann-Klein M. et al. Bacterial colonization is of major relevance for high-grade capsular contracture after augmentation mammaplasty. Ann Plast Surg 2007; 59: 126-130
    CrossrefPubMedGoogle Scholar
  • 19 Fodor J, Gulyás G, Polgár C. et al. Radiotherapy and breast reconstruction: The issue of compatibility. Orv Hetil 2003; 144: 549-555
    PubMedGoogle Scholar
  • 20 Spear SL, Baker JL. Classification of capsular contracture after prosthetic breast reconstruction. Plast Reconstr Surg 1995; 96: 1119-1123
    CrossrefPubMedGoogle Scholar
  • 21 Blount AL, Martin MD, Lineberry KD. et al. Capsular contracture rate in a low-risk population after primary augmentation mammaplasty. Aesthet Surg J 2013; 33: 516-521
    CrossrefPubMedGoogle Scholar
  • 22 Handel N, Jensen JA, Black Q. et al. The fate of breast implants: a critical analysis of complications and outcomes. Plast Reconstr Surg 1995; 96: 1521-1533
    CrossrefPubMedGoogle Scholar
  • 23 Wiener TC. The role of betadine irrigation in breast augmentation. Plast Reconstr Surg 2007; 119: 12-15
    CrossrefPubMedGoogle Scholar
  • 24 Wiener TC. Relationship of incision choice to capsular contracture. Aesthetic Plast Surg 2008; 32: 303-306
    CrossrefPubMedGoogle Scholar
  • 25 Huang GJ, Wichmann JL, Mills DC. Transaxillary subpectoral augmentation mammaplasty: a single surgeon's 20-year experience. Aesthet Surg J 2011; 31: 781-801
    CrossrefPubMedGoogle Scholar
  • 26 de Faria Castro Fleury E, D'Alessandro GS, Lordelo Wludarski SC. Silicone-Induced Granuloma of Breast Implant Capsule (SIGBIC): Histopathology and Radiological Correlation. J Immunol Res 2018; 20: 6784971
    PubMedGoogle Scholar
  • 27 de Faria Castro Fleury E, Morais Rêgo M, Costa Ramalho L. et al. Silicone-induced Granuloma of Breast Implant Capsule (SIGBIC): Similarities and Differences With Anaplastic Large Cell Lymphoma (ALCL) and Their Differential Diagnosis. Breast Cancer (Dove Med Press) 2017; 9: 133-140
    PubMedGoogle Scholar
  • 28 Brown SL, Middleton MS, Berg WA. et al. Prevalence of rupture of silicone gel breast implants revealed on MR imaging in a population of women in Birmingham, Alabama. Am J Roentgenol 2000; 175: 1057-1064
    CrossrefPubMedGoogle Scholar
  • 29 Soo MS, Kornguth PJ, Walsh R. et al. Intracapsular implant rupture: MR findings of incomplete shell collapse. J Magn Reson Imaging 1997; 7: 724-730
    CrossrefPubMedGoogle Scholar
  • 30 Gorczyca DP. MR imaging of breast implants. Magn Reson Imaging Clin N Am 1994; 2: 659-672
    CrossrefPubMedGoogle Scholar
  • 31 Gorczyca DP, Brenner RJ. The Augmented Breast. Radiologic & Clinical Perspectives. Stuttgart: Thieme New York; 1997
    Google Scholar