What is the most sensitive imaging evaluation for breast implant rupture?
MRI is the reference standard. US may be used to evaluate for rupture as well, but the examination is operator dependent. Rupture may be contained within the fibrous capsule surrounding the implant shell (intracapsular) or may extend outside the fibrous capsule (extracapsular). Although mammography detects extracapsular rupture, it is limited in the evaluation of intracapsular rupture, the more common form of rupture. MRI findings of implant rupture include the “linguine” sign (the most reliable finding) where serpentine low signal intensity foci representing the deflated implant shell are seen within a background of high signal intensity silicone; and the “keyhole” or “noose” signs where a small amount of silicone is seen between a nondeflated implant shell and the fibrous capsule.