Case 44 continued

This patient had saline implants which have collapsed, leaving the empty envelopes in front of the pectoralis. When this happens, the saline is absorbed by the body, and the patient will notice that the breast has shrunk rapidly. When it happens unilaterally, there can be quite a bothersome asymmetry.

There is no concept if intra- vs. extra-capsular rupture with saline implants, so there is no need to perform MRI for evaluation of saline implants. MRI is reserved for evaluation of silicone implant rupture (see Case 43).

This patient has normal saline implants:

Notice how well you can see through saline. One can see the folds of the envelope and the valves. Silicone would be a total white-out.

What is the standard evaluation of implant patients?

• Screening mammogram including MLO, CC and Implant displaced views (ID) in MLO and CC.
• Diagnostic mammogram including MLO, CC and Implant displaced views (ID) in MLO and CC.
• Screening mammogram including MLO and CC views.  If you need to do ID views, then it is a diagnostic mammogram.
• Diagnostic mammogram including MLO, CC and Implant displaced views (ID) in MLO and CC, and the ultrasound should be performed due to decreased sensitivity of mammography with implants.