Case 47 continued

This patient had received direct silicone injections for breast enlargement. This is illegal in the USA, but is still performed in some nations. The sensitivity of mammography is obviously much lower in these patients.

This is a different patient who was told that she should have a bilateral mastectomy because her silicone injections made mammography "useless." She referred herself for a screening MRI.

Observe that multiple silicone masses are suppressed, and the single enhancing mass is easily visible on MR images.

What is your recommendation?

• Ultrasound focused in the location of the mass, followed by ultrasound-guided biopsy
• MRI-guided core biopsy
• MRI-guided wire localization and surgical excision