Case 47 Answer

An ultrasound focused in the location of the mass will likely allow core biopsy. If not visible with ultrasound, possible because of the overlying blobs of silicone, then an MRI-guided biopsy should be performed. If you are doing breast MRI in your institution, it is important to have MR biopsy capability, or you and your clinicians will be very frustrated by the lesions visible on MRI only.

At our institution, we perform MR-guided biopsy and leave a marker clip in place, so that wire localization of the clip can be performed under mammographic guidance if the lesion is malignant or high-risk.