Consequences of breast implants. Archive for the ‘implant rupture’ Category. Publications in the topic

Plastic surgery - SURGERY.SU - 2009

The shell of silicone and saline implants consists of a silicone elastomer. This is a soft and elastic material, but it can sweat. If this silicone shell changes, it may break or leak the contents of the implant. When the silicone shell of the saline solution implant is passed through, it is said that the implant is leaking. The solution flowing through the shell is absorbed by the surrounding tissues, and the implant itself becomes wrinkled. When the silicone gel flows, the shell is said to break. The output of silicone gel can be to varying degrees, but the breast itself usually remains the same size. Typically, a rupture of a silicone implant can only be detected by the appearance of capsular contracture.

Risk of rupture or leakage

The risk of a saline implant leaking is approximately 1% per year. The risk of rupture of a silicone implant is about 4% per year for the first four years.

Filling volume

The risk of a saline implant leaking can be reduced by overfilling it, however strange it may seem. The fact is that with incomplete filling of the implant, small folds form on its shell. With the frequent formation of such folds, the shell becomes thinner and weaker. Therefore, there is no point in filling the implant with a minimum volume.

Silicone implants do not need to be overfilled, as they are always optimally filled with gel by the manufacturer.

Saline implant leak

Usually, saline implant leakage is immediately noticeable. Within a few hours, the breast loses its shape. There was even a case where a woman went into the shower with one breast shape and came out with another, as a result of the implant leaking (in this case, the shower was not the cause of the leak!). In some cases, implant leakage may occur gradually over several weeks or even months. Such breasts are usually slightly asymmetrical. Such changes are still much less common and are more often associated with a change in the position of the implant or its weight.

Rupture of silicone implants

If a silicone implant ruptures, the silicone gel may come out of the shell and lead to the development of capsular contracture. This is the first and only sign of a silicone implant rupture. However, this complication does not always develop when a silicone implant breaks. That is why it is recommended that women with silicone implants undergo an MRI (magnetic resonance imaging) every two years. But it should be remembered that MRI also gives accuracy only in 90% of cases, so a negative MRI result does not always indicate the absence of implant rupture. Also, a positive MRI does not always mean the presence of such a gap. Therefore, many women only get an MRI when they have some kind of problem.

What to do if an implant ruptures or leaks

When a saline implant leaks, it is usually replaced with a new implant. When a silicone implant ruptures, implant replacement with capsulotomy is usually performed (since capsular contracture usually forms when a silicone implant ruptures).

Breast augmentation surgeries are among the most sought after. After all, such an intervention solves not only aesthetic, but also psychological problems, often relieving complexes. But mammoplasty can also cause complications. Problems are of different nature, and there are many reasons for their appearance.

Read in this article

Possible problems

Mammoplasty is a major surgical intervention performed under general anesthesia. During the operation, living tissues are damaged, which then must heal. All this does not exclude the appearance of problems inherent in any surgical manipulation. Their occurrence is not at all necessary, but possible. Complications can be divided into general and specific.

Surgical

Common complications include the following:

• Development of the infectious process. The problem is detected in a few days, less often - weeks after the operation. The pain characteristic of this period does not subside, as it should, but intensifies. Swelling and redness of the skin also increase, and purulent fluid is released from the sutures. If you catch a complication at the initial stage, you can eliminate it by taking antibiotics. In other cases, it is necessary to remove the implant, carry out treatment, and only then do mammoplasty again.

Leaving a problem unattended is dangerous. The infection can develop to toxic shock, manifested by a sudden rise in temperature, vomiting, diarrhea, skin rashes, loss of consciousness. This is a deadly condition.

• Hematoma and seroma. They are collections of blood and serous fluid. A hematoma can form as a result of leakage from a vessel damaged during the intervention. Sometimes its walls are injured in the postoperative period. Seroma occurs in a similar pattern, but contains serous fluid. Small formations disappear without intervention.

But if the fluid continues to flow into them, increasing the problem to a significant size, it is necessary to drain the formation and suture the vessel. Otherwise, you can bring the complication to infection and more complex conditions.

• Rough scar formation. Normally, healed sutures should be inconspicuous. But if the body has a tendency to hypertrophic fusion of tissues or the appearance of keloid scars, a problem will arise. When mammoplasty is the first surgical intervention, such a feature cannot be predicted. But if it is known before the operation, it is better not to do the operation, but to correct the breast in other ways.

However, a hypertrophic suture can form due to severe healing caused by improper care, suppuration. In any case, to get rid of the problem, you will need additional treatment.

• Change in the sensitivity of the nipples and areolas, mammary glands in general. The complication has a dual manifestation - pain or numbness in this area.

The first is justified by tissue damage. But if the nerves are injured or pinched, there is no freedom of muscle contractions, pain will be present even after a considerable time after the operation. It already needs to be treated. Damaged nerves can lead to loss of sensation, which also needs to be addressed.

• Increased body temperature. If it is slightly more than normal, the sign is considered as a natural reaction to surgery. But the cause of the rise in temperature is also the developed inflammation. Here you will need to take antibiotics, while in the first case, a simple observation is enough.

Specific

Complications after mammoplasty are also of a special nature, directly related to damage to the tissues of the mammary glands and the introduction of implants into this area:

• Capsular contracture. The endoprosthesis should be overgrown in the process of engraftment with a shell of fibrous tissue. But if it is too thick and dense, it causes discomfort. The chest becomes hard, painful, fullness is felt in it. And the implant is squeezed, which can cause damage, displacement, protrusion through the skin. This requires an intervention with the extraction of the endoprosthesis, removal of the contracture, and then the installation of a new one. But no one can guarantee that the complication will not happen again.

• Rupture of the implant shell. If it is salty, the chest will immediately change its shape, becoming wrinkled. When a silicone endoprosthesis ruptures, the problem is not always obvious. It is found during hardware research. But this complication in any case will require replacement of the implant.

• Asymmetry of the mammary glands. Often occurs against the background of implant displacement. The problem is also caused by defects in engraftment and with its correct position. Own tissues can behave unpredictably due to individual characteristics. The complication can be eliminated by a second operation.

• Breast deformity. An external defect in the zone of the mammary glands can be expressed not only by their asymmetry. For example, there is such a disadvantage as . These are additional hemispheres just below the mammary glands. There is a problem when the implants slip shortly after the operation or after a year and a half.

Another defect is simmastia, in which the mammary glands look fused. Both problems are treated surgically, that is, by repeated mammoplasty.

• Allergy to the implant. This is a rare complication that is characteristic of those who, in principle, have intolerance to many substances and materials. It is manifested by swelling of the chest, rashes on the skin, redness. If conservative treatment does not help, the implant will have to be removed.

• Calcification. Under the influence of the presence of a foreign object, islands of seals can form in the thickness of living tissues. This is the deposition of calcium salts, which, although rare, causes problems. If the complication is extensive, it is necessary to remove the implants.

• Necrosis of breast tissue. Areas located around the implant are subject to dying off. The scar tissue formed here is deprived of normal blood supply due to the pressure of the endoprostheses. The skin suffers more often due to the peculiarities of their installation.

• Atrophy of breast tissue. It manifests itself over time after a long stay in the mammary glands of implants or their removal without replacement with new ones. The tissues become thinner, the breast acquires an unaesthetic appearance, unevenness, flabbiness.

• Inability to lactate after the birth of a child. Surgeons argue that a well-performed intervention does not affect the ability to breastfeed. But according to statistics, 67% of women with implants do not have lactation, despite the safety of the milk ducts. Among mothers who have not had mammoplasty, this number is 7%.

Other

Mammoplasty also gives complications after surgery, as if not directly related to the presence of implants:

• Connective tissue pathology. Statistically, the effect of endoprostheses on the occurrence of autoimmune diseases has not been proven. But it cannot be denied that the operation and the adaptation of tissues to the presence of a foreign body force the immune system to work in an enhanced mode. This weakens it, which can give a chance to a systemic disease.

• Malignant tumors of the mammary glands. It is known that the presence of an implant does not affect their appearance. But after installation, mammographic examination of the breast, which is the most informative in the diagnosis of cancer, is difficult. And a benign tumor unnoticed in time has time to be reborn.

• Deterioration of sexual life. Loss of breast sensation, which persists for a long time in some, deprives a woman of the usual sensations during lovemaking. And this area by nature should be an erogenous zone.

About what complications are most common after mammoplasty, see this video:

Factors that will affect the result

The possibility of getting a complication after mammoplasty is not at all predetermined. What determines the successful outcome of the operation and a trouble-free life with implants:

• Choosing an operating doctor and clinic. Many complications arise due to incorrect installation of the implant, violations of sterility during surgery, careless manipulation of surgical instruments. These are infections, necrosis, hematomas, seromas, damage to areas that should remain intact during the intervention.

Postoperative care provided in the hospital also affects the outcome. Equally important is the doctor's taking into account the characteristics of the patient's body at the stage of preparation for mammoplasty.

• Preparation for surgery and rehabilitation. You can not ignore the results of tests taken to identify contraindications. It is important to make an effort to prepare the body for it and facilitate recovery after. It is forbidden to drink alcohol, smoke and take blood-thinning drugs.

Mandatory wearing during compression underwear, refusal, stay in the heat. Careful care of the stitches and a timely visit to the doctor are important if something is alarming.

Mammoplasty gives a chance to correct what nature has done wrong or merciless time has done. But it requires a more attentive attitude to health, work on oneself, a lot of money, constant monitoring. If you correct the breast with implants and avoid complications, you still need to be ready to replace them in 5-15 years.

I heard that some patients of plastic surgeons face such a problem as a rupture of implants after a few years. Can you please tell me how relevant this is? Can you guarantee that the implants will not break? And which manufacturer's product do you use? Thank you.

Doctors Answers

Hello Julia. To date, all leading manufacturers of implants give a lifetime warranty on their products. So there is no need to worry about the shell rupture. They can withstand huge loads, which are not in the body at all. The only thing that is really dangerous is wounds with a sharp object (knife), which should be avoided even without implants, and the second, more realistic option is medical manipulations, punctures of the mammary gland. Therefore, before such procedures, it is MANDATORY to warn the doctor about the presence of implants. But even if the implant was accidentally damaged, there is no urgent need for surgery, because. the gel is not fluid and does not migrate anywhere from the implant bed. In this case, it is recommended to replace the implant with a new one in a planned manner.

Hello. At the moment there is no such problem. Leading manufacturers give a lifetime warranty on implants. We use Allergan, Mentor, Arion... In order to destroy the implant shell, you need to make tremendous efforts. All the rarest cases of shell damage are related to implants of very old generations.

Hello Julia! In surgery, the word guarantee is a misnomer. In general, there are no guarantees in medicine. About implants - all firms producing implants position their lifelong standing. However, with a serious injury that harms the body, the implant can also be damaged.

Hello, implant manufacturers give a lifetime warranty on their products and issue a passport for the implant that is being installed. Most often in my practice I use implants of the two most famous manufacturers Mentor or Natrele. I invite you to an internal consultation. Dr. Kirill Lelikov

Hello! Now almost more than 80% of manufacturers give a guarantee of 50 years or more. Implants withstand loads from 5 to 8 atmospheres of pressure. Yes, it’s better for me to forget about diving with an implant, but in everyday life and even with frequent flights, implants can easily withstand the load. It is possible to mechanically damage the implant shell, then the gel can leak out. But even with this, advanced firms create gel forts that do not spread very much, remaining as close as possible. And yes, in such cases it is necessary to remove it surgically. Mechanical damage is different among medical ones - this is damage (rupture) of cannulas, for example, when they want to add volume using lipofilling. Or other injuries, the impact of which exceeds the load of 5-8 atmospheres. And this is almost Summing up, I can say with confidence that modern gel-filled implants are the safest for a modern woman leading an active lifestyle. In my practice I use Natrel Silimed, Motiva Nagor, Eurosilicone and Mentor. Sincerely, Victoria S.

Greetings! I work with implants from only two companies: Mentor and Allergan. They have a lifetime warranty on their products and in my 16 years of experience I have not seen breaks. If you have any questions, please call. I will be happy to help you with the choice of implants and with the operation.

Hello Julia! This problem exists. No one, I think, will give you a guarantee that the prostheses will not break. Manufacturers give a lifetime guarantee that if something happens to the prosthesis, you will be returned a similar product or its full cost. Violation of the integrity of the shell can occur from a sharp push to the chest, with a sharp operation of the seat belt in an accident. In my work, I most often use Allergan or Arion prostheses.

In practice, this cannot happen, only with serious injury or damage. These are quite rare, almost casuistic cases. You don't think about it. Implants are now modern with a good shell, but they themselves must understand that anything can happen and no one can give a 100 percent guarantee

Hello! Yes, gaps are rare, but they do happen. There is no reliable information why this is happening, but I personally saw the facts of the gap myself. That is why manufacturers recommend replacing implants every 10 years.

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"ART-Clinic" - clinic of plastic surgery and cosmetology The clinic of plastic surgery and cosmetology "ART-Clinic" operates on the basis of the Institute of Neurosurgery named after N.N. Burdenko since 2003. Its founder Alexander Ivanovich Nerobeev is an outstanding surgeon, professor, doctor of medical sciences, Honored Scientist of the Russian Federation, laureate of the State Prize of the Russian Federation, an extra-class specialist, recognized not only in our country, but also abroad, to this day personally performs the most complex operations. Through the efforts and energy of Professor Alexander Ivanovich Nerobeev, a school of unique specialists has been created who are able to successfully manage the most serious cases, including complications after plastic surgery. The priority of "ART-Clinic" is the colossal experience of its specialists in the field of cosmetology, plastic and maxillofacial surgery, as well as a first-class scientific and technical base. Over the years of successful work, ART-Clinic has earned a reputation as a company that meets international standards of quality and professionalism. Therefore, today it is here that not only the most popular and sought-after aesthetic operations are performed, but also the most complex, rare and even unique corrections. The ART-Clinic team is: Long-term experience of successful work A team of highly qualified doctors Modern minimally invasive methods of operations and reconstructions Responsibility, openness and professionalism More than 10,000 satisfied patients Beauty will save the world, and aesthetic medicine will support it in this

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Modernity sets its requirements in everything. As standards change, we need to not only look good, but also showcase our uniqueness. We turn our clothes into works of art, but what about our flaws? We do not always have perfect skin or a figure, but this is not a sentence, and aesthetic medicine will help us in the fight against our shortcomings. The Lege Artis clinic is based on the principles of aestheticism, which bring you closer to the desired ideal, transforming your body into a real masterpiece. The most difficult thing in the work of a plastic surgeon is to emphasize the individuality of a person and at the same time achieve an excellent result from the procedure. Being true virtuosos, the experienced plastic surgeons of the Lege Artis clinic cope with this task with amazing ease. It is very difficult to get the naturalness of the procedures performed, but reviews about Lega Artis say otherwise. The high competence of doctors has been repeatedly confirmed by various clinics in the USA and Israel. Frequent internships abroad allow you to adopt techniques that open up new opportunities and reduce the recovery period. The most modern equipment of the clinic helps to achieve maximum efficiency of procedures. The patient experiences stress during the operation and the best medicine after it is comfort and peace. Clinic Lege Artis and the feedback of its clients on social networks speak of the exemplary service and attentive attitude that the clinic staff surrounds their visitors. A characteristic feature of the Lege Artis clinic is to ensure the complete safety of the patient. Doctors, based on their rich experience and advanced technical equipment, make accurate planning, which leads to the expected success. At Lega Artis, reviews are used to constantly improve the quality of service and maintain it at the proper level. Management and plastic surgeons study them regularly to stay in close contact with the patient.

Breast plastic surgery - mammoplasty - is a serious surgical intervention that can lead to a number of postoperative complications. In addition to general surgical problems (infectious processes, hematomas, scars, scars), it is possible to develop specific complications that occur only after this procedure.

Specific complications of mammoplasty

The most common complications are:

1. Capsular fibrous contracture.
2. Calcification.
3. Violation of the integrity of the endoprosthesis.
4. Specific chest deformity (double fold).
5. Displacement of the endoprosthesis.
6. Symmastia.
7. Allergic reaction.
8. Decreased information content of mammography.

According to various estimates, the risk of developing specific complications is 30-50%.

Capsular fibrous contracture

The individual reactivity of the organism in response to the implantation of a breast implant can manifest itself in the form of capsular fibrous contracture. As a result of inflammation, a dense connective tissue capsule gradually forms around the endoprosthesis.

According to the classification of Baker (1976), capsular fibrous contracture has 4 degrees of severity:

1. In appearance, the breast does not differ from healthy, soft to the touch.
2. The implant can be palpated. There is no visible deformation, in appearance the breast does not differ from a healthy one.
3. The chest becomes hard. Noticeable deformation.
4. The chest is cold, hard, significant deformation is noticeable.

In practice, treatment is required only for grades 3 and 4.

The causes of capsular fibrous contracture are not fully understood. It is known that breast implants with a smooth surface are more likely to cause this specific complication. The location of the prosthesis under the skin is often accompanied by fibrous contracture.

Treatment of capsular fibrous contracture is surgical. The breast implant is replaced during the operation, the fibrous tissue is excised.

Calcification

Calcification is also a manifestation of individual increased reactivity of the organism. In this specific complication around the implant occurs aseptic inflammation , as a result of which calcium salts are deposited in limited areas.

Foci of compaction may be visible on examination or detected on palpation. Severe calcification deforms the mammary gland and dramatically reduces the aesthetic effect of the operation.

There is no specific prevention for this complication.

In severe cases of calcification, it is necessary to replacement of the endoprosthesis and excision of foci of seals.

Violation of the integrity of the endoprosthesis

Violation of the integrity of the implant can be a consequence poor quality shell or strong mechanical impact .

Too thin shell material is found in cheap or defective implants.

Excessive mechanical impact on the implant can be caused by trauma (shock, fall, accident), during some sports training.

Violation of the integrity of the endoprosthesis wall manifests itself in different ways - depending on whether the saline or silicone implant was chosen.

Salt Implants after damage to the membrane, within a short time after the injury (up to 24 hours), they completely shrink and the breast is restored to the preoperative size. This is due to the fact that such a prosthesis is filled with liquid, which quickly leaves even through a small wall defect.

Silicone implants after damage, the walls can retain their former shape for a long time. Such prostheses are filled with gel, which slowly leaks through a small hole in the wall. Sometimes a violation of the integrity of the endorothesis is detected only a few months after the injury. Magnetic resonance imaging (MRI) may be required to clarify the condition of the implant wall.

Prevention of violation of the integrity of the implant is careful choice of the manufacturer, paying attention to those that meet all modern safety requirements.

In addition, a woman must comply all the rules of the regime after the operation , including avoiding situations that are traumatic to the mammary gland.

Treatment of this specific complication – only surgical. The damaged endoprosthesis is replaced. Inflammation, fibrosis resulting from the outflow of a solution or gel are treated with medications (anti-inflammatory therapy, antibacterial drugs) and surgically (excision of fibrosis foci).

Specific chest deformity (double fold)

A change in the correct shape of the breast after arthroplasty may be associated with the development of severe calcification, capsular fibrous contracture, and implant displacement. A specific deformity of the breast is considered double fold formation .

On examination, the mammary gland lying on the surface of the prosthesis is contoured.

The cause of the double fold may be incorrectly installed prosthesis or inaccurately selected size . Round, low-profile implants are more likely to cause this complication.

Prevention consists in the exact selection of the implant and the place of its installation.

Treatment of specific breast deformity– surgical (repeated mammoplasty).

Displacement of the endoprosthesis

Displacement of the breast endoprosthesis reduces the aesthetic appearance after surgery.

Incorrect position of the implant can be fixed in the immediate postoperative period, or occur later.

Displacement may be the result of surgeon errors: neglect of anatomical features, the choice of an oversized prosthesis. The technique of implant placement through the armpit increases the risk of this complication.

Besides, injury, capsular contracture can also lead to displacement of the breast endoprosthesis.

Treatment of endoprosthesis displacement- surgical. Asymmetry is eliminated during the second operation.

Simmastia

Simmastia is too close location of endoprostheses. Visually, the mammary glands "grow together." This complication is formed due to the choice of oversized implants.

The anatomical features of a woman (the proximity of the mammary glands to each other before surgery) can also be considered the cause of the complication.

Prevention of symmastia is a careful selection of the volume of the endoprosthesis before surgery.

Treatment of complications– only surgical. Breast implants are replaced with smaller ones.

Allergic reaction

Allergy to implant materials is rare. The manifestations of such a reaction can be in the form dermatitis, edema, rashes and etc.

To prevent complications, it is necessary to use high-quality implants made of hypoallergenic materials. In women with a history of polyvalent allergies, the risk of developing a reaction to the implant is higher, so the feasibility of surgery should be evaluated very carefully.

Treatment for an allergic reaction is carried out therapeutically (antihistamines, hormonal drugs).

In severe persistent cases of allergy, the removal of endoprostheses or their replacement with hypoallergenic counterparts is indicated.

The owners of the patent RU 2364339:

The invention relates to medicine, namely to radiation diagnostics, and is intended for diagnosing a rupture of a breast implant. Multislice computed tomography is performed with a tomographic slice thickness of 0.5-1 mm in the position of the patient lying on her stomach on a stand without relying on the mammary glands. Build multiplanar and three-dimensional reconstructions. When determining an implant wall defect and conglomerates in breast tissues with a density of 80-120 Hounsfield units, a conclusion is made about the rupture of the implant walls with the release of silicone beyond its limits. EFFECT: method allows to increase the accuracy of early diagnosis of a breast implant rupture, to clearly localize small implant ruptures, less than 1 cm in size, to identify a breast implant rupture against the background of edema and severe cicatricial changes, to differentiate fluid from silicone deposits around the implant, to improve implant visualization and correct assessment of all structural elements of the mammary gland, to identify silicone conglomerates when the implant breaks in the retromammary region of the mammary gland.

SUBSTANCE: invention relates to medicine, in particular to radiation diagnostics, and can be used for early diagnosis of breast implant rupture.

Breast augmentation (augmentation mammoplasty) is currently one of the most frequently performed operations in plastic surgery.

Most often, this operation is resorted to by patients who experience mental discomfort due to the small size of the breast, its imperfect shape, congenital asymmetry, changes in the shape of the breast after childbirth or surgical interventions. The use of implants in breast reconstruction is the most popular method.

Currently, the most common biocompatible material used for the manufacture of breast implants and tissue expanders is silicone. Most often, single-chamber implants are used.

The most common reasons for removing a breast implant are evidence of implant rupture and leakage of its contents.

The relevance of visual assessment of the state of the implant and surrounding tissues after augmentation mammoplasty is beyond doubt.

To visualize breast implants, methods such as x-ray mammography, ultrasound (ultrasound), magnetic resonance imaging (MRI) are currently used.

X-ray mammography is not very informative for assessing ruptures of breast implants. In addition, its implementation is associated with mandatory compression of the mammary gland, which in the early postoperative period leads to traumatization of the periprosthetic fibrous capsule [Radial diagnosis of diseases of the mammary glands. Guide for doctors. // Edited by G.E. Trufanov. - St. Petersburg, 2006 - 232 p.].

Ultrasound is completely harmless to patients, atraumatic and allows for multiple dynamic studies of the tissue surrounding the implant [Zabolotskaya N.V., Zabolotsky B.C. New technologies in ultrasound mammography. // M., 2005 - 240 p.].

However, ultrasound has certain limitations due to the limits of its capabilities:

The subjectivity of the interpretation of the received image, depending on the position of the transducer;

Small image field (gives only an aiming image or lengthens the study);

Difficulties in differentiating fluid from silicone deposits around the implant when it ruptures;

It is not always possible to determine the violation of the integrity of the implant.

MRI of breast implants is performed using special surface coils. In the absence of a surface coil for the mammary glands, MRI of implants becomes impossible.

Contraindications to breast MRI are general contraindications to magnetic resonance imaging: artificial pacemakers, artificial heart valves, ferromagnetic vascular clips, claustrophobia, valves on double-circuit breast implants [Rink P.A. Magnetic resonance in medicine. // M., 2003 - 256 p.].

The disadvantages of MRI include the rather long time required to acquire images, which leads to artifacts from respiratory movements. Problems arise with a large volume of the mammary glands, when they do not correspond to the holes of the surface coils [Lukyanchenko A.B., Gurova N.Yu. X-ray computed and magnetic resonance imaging in the diagnosis and assessment of the prevalence of breast cancer. // In the journal: Radiology - Practice - 2001 - No. 3. - S.3-9].

One of the most serious shortcomings of MRI of breast implants should be considered the lack of precise criteria for interpreting images in case of intracapsular rupture of the implant. The main sign of intracapsular rupture, characterized by the presence of linear tortuous structures with a low-intensity MP signal, is nonspecific, as it can be detected when implant wrinkles occur and lead to diagnostic errors during MRI.

A known method for diagnosing a rupture of a breast implant by computed tomography (CT) [E.Azavedo, V.Bone. Imaging breasts with silicone implants. European Radiology - Volume 9, Number 2, 349-355 - 1999], during which the possibilities of CT in the diagnosis of breast implant rupture were revealed in comparison with mammography, ultrasound and MRI.

Studies of the mammary glands using CT in this method are carried out according to the standard method, which is as follows: the patient is placed on the table top in a horizontal position on her back, her hands are behind her head. The thickness of the tomographic layer is 5 or 10 mm.

This diagnostic method does not allow to detect ruptures of the breast implant, as it has significant drawbacks:

In the position of the patient lying on his back, the mammary glands under their own weight are displaced in the lateral direction, which makes it extremely difficult to visualize both the structure of the mammary gland itself and implant ruptures;

For the same reason, there is a decrease in the size of the retromammary space, which complicates the search and differentiation of silicone in case of an extracapsular rupture of the implant in this section of the mammary gland;

When the hands are placed behind the head in the supine position, tension and convergence of the structures of the axillary regions occur, which impairs the detection of silicone in them when the breast implant is ruptured;

When the patient is lying on his back with his hands behind his head, the large and small pectoral muscles converge and they practically do not differentiate from each other;

Conducting a CT examination of the mammary glands with a tomographic layer thickness of 5 mm or more leads to the appearance of "jaggedness" on multiplanar and three-dimensional images, which can simulate implant ruptures and does not allow visualization of ruptures smaller than 5 mm.

The objective of the invention is to improve the accuracy of diagnosis and earlier detection of rupture of the breast implant.

This problem is solved by a method consisting in the fact that multislice computed tomography is performed with a tomographic slice thickness of 0.5-1 mm, with the patient lying on her stomach on a stand without support on the mammary glands, multiplanar and three-dimensional reconstructions are built, when determining the implant wall defect and conglomerates in mammary gland tissues with a density of 80-120 Hounsfield units make a conclusion about the rupture of the walls of the implant with the release of silicone beyond its limits.

Practically, the diagnostic method is carried out as follows.

1. The study is carried out with the patient lying on her stomach on a stand consisting of two rollers.

2. The mammary glands are freely located between the rollers, without touching the table top.

4. The tomography mode is spiral. Tomogram - lateral.

5. Research phases - native. The thickness of the tomographic slice is 0.5-1 mm.

6. The study is carried out at one breath hold to exclude the movement of the chest and mammary glands in order to avoid blurring the image obtained from the level of the spinous process of the 7th cervical vertebra. The number of tomograms is selected depending on the constitutional features of the patient.

7. Based on the data obtained, the construction of multiplanar and three-dimensional reconstructions is carried out.

The method we have developed for diagnosing mammary glands has the following advantages:

1. Helps to clearly localize small (less than 1 cm) implant ruptures;

2. Allows you to identify the rupture of the breast implant against the background of edema and severe cicatricial changes;

3. Differential diagnosis of fluid from silicone deposits around the implant during its rupture does not cause difficulties, since the density of silicone is 10 times higher (80-120 Hounsfield units) than the density of the liquid (0-10 Hounsfield units);

4. When the patient is lying on her stomach on a stand without relying on the mammary glands, optimal conditions are created for the uniform distribution of glandular and adipose tissues, which improves the visualization of the implant and the correct assessment of all structural elements of the mammary gland;

5. Allows you to maximize the size of the retromammary space and identify silicone conglomerates when the implant breaks in this area of ​​the mammary gland.

122 women with suspected implant rupture were examined. Depending on the complications, the examined patients were distributed as follows: extracapsular implant rupture was detected in 34 patients, which accounted for 27.9% of all patients, intracapsular rupture - in 23 (18.8%), capsular contracture - in 39 (32.0%) , seroma - in 26 (21.3%).

The studies were carried out on a Toshiba Asteion multispiral computed tomograph with a tomographic slice thickness of 0.5 mm, followed by the construction of multiplanar and three-dimensional reconstructions.

All women with complications that developed after augmentation mammoplasty underwent surgical treatment.

Computed tomography revealed implant ruptures in all 57 cases. The accumulation of silicone in the breast tissues outside the implant shell, which is a sign of an extracapsular rupture, is determined by a density of 80-120 Hounsfield units. Intracapsular implant ruptures were determined on MSCT mammograms as wall defects without silicone release into the surrounding mammary gland tissues.

Patient Zh., aged 32, was admitted to the clinic in connection with complaints of deformity of the right mammary gland. From the anamnesis: a year ago, augmentation (augmentation) mammoplasty of both mammary glands with silicone implants was performed for cosmetic purposes. The deformity arose in connection with a bruise of the mammary gland three days ago. On examination, attention is drawn to the asymmetry in the size of the glands.

Preliminary diagnosis: implant rupture.

According to the proposed method using multislice computed tomography with a tomographic slice thickness of 0.5 mm, a series of tomograms obtained after multiplanar reconstruction revealed a 9 mm implant wall defect at the border of the lower quadrants of the right mammary gland with silicone leaking into the surrounding tissues. The density of the identified silicone was 110 Hounsfield units.

The changes revealed by computed tomography were regarded as an extracapsular rupture of the implant of the right mammary gland.

The patient underwent removal of the ruptured prosthesis and simultaneous installation of a new silicone implant.

Patient N., aged 28, complained of an increase in the volume and density of the left mammary gland compared to the right gland. On examination, her skin is edematous, hyperemic, saphenous veins are dilated. There is a local increase in temperature and pain syndrome. From the anamnesis: 6 months ago, augmentation mammoplasty of both mammary glands was performed with silicone implants for cosmetic purposes. Preliminary diagnosis: suspicion of gray and implant rupture.

According to the proposed method using multislice computed tomography with a tomographic slice thickness of 1 mm, on a series of tomograms obtained after multiplanar reconstruction, an irregularly rounded implant wall defect with a diameter of 6-8 mm is determined on the medial surface of the implant of the left breast at the level of the sternum. Silicone was found outside the folds of the implant, but inside the junctional capsule (intracapsular tear). The density of the identified silicone was 95 Hounsfield units. Around the implant of the left mammary gland, a liquid of a homogeneous structure is determined, more along the back wall of the implant (in the retromammary zone). The density of the liquid was 10 Hounsfield units. Implant of the right mammary gland without signs of internal and external damage.

Conclusion: intracapsular rupture of the implant of the left breast, liquid (seroma) on the left.

After surgery, this diagnosis was confirmed.

Thus, computed tomography makes it possible to detect and differentiate a rupture of a breast implant with great diagnostic accuracy.

A method for computed tomographic diagnosis of a breast implant rupture, characterized in that multislice computed tomography is performed with a tomographic slice thickness of 0.5-1 mm in the position of the patient lying on her stomach, on a stand, without relying on the mammary glands, multiplanar and three-dimensional reconstructions are built, with determination of an implant wall defect and conglomerates in breast tissues with a density of 80-120 Hounsfield units, a conclusion is made about the rupture of the implant walls with the release of silicone beyond its limits.