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Editor's Notes

• #4: This study included 28 implants in 16 patients, all of whom underwent ABVS in between 2010-2014. The diagnosis of implant rupture was confirmed by surgery. Implant rupture was diagnosed in 5 out of 28 implants (17.9%). In those patients with ruptured implants, 2 were belonging to deflation of saline implants and 3 were silicone implants. 3 had no symptoms, 1 presented with pain, and 1 complained of ipsilateral axillary lymph node swelling. Implants with a homogenous anechoic interior were considered to be intact. ABVS findings indicating implant rupture included multiple parallel echogenic lines in the implant interior in 2 cases and a mix of hyperechoic and hypoechoic masses in 3 cases.
• #5: Cosmetic breast augmentation is an increasingly common procedure performed in Taiwan. Breast prosthesis implantation is still the most common technique. The exact incidence of breast implant rupture is unknown, although the risk of rupture is directly related to the age of the implant and is inversely related to the thickness of the elastomer shell. *(Brown SL, Middleton MS, Berg WA, Soo MS, Pennello G. Prevalence of rupture of silicone gel breast implants revealed on MR imaging in a population of women in Birmingham, Alabama. AJR 2000; 175:1057-1064)
• #6: Most of the women with breast augmentation do not have a right concept about the routine breast examination and the rupture risk of the breast prosthesis. Some of them are afraid of the compression technique of mammography. Breast MRI, standard technique to detect implant rupture, may be too expensive for them. Automated breast volume scanner (ABVS, Siemens) may be better used to replace breast MRI as a yearly screening tool not only early detection of breast cancer but also the possibility of implant rupture.
• #7: We would like to present three cases of silicone implant rupture, all of whom underwent ABVS. The diagnosis of implant rupture was confirmed by surgery. Two cases of implant rupture were diagnosed as extracapsular type, whereas the other one was intracapsular type. ABVS findings were including multiple parallel echogenic lines in the implant interior in 2 cases, echodense aggregates in the implant lumen in 2 cases, mixture of hyperechoic and hypoechoic masses in 2 cases, hyperechoic posterior shadowing within lymph nodes in 1 case and invagination of shell without touch of the two membranes in 1 case.
• #20: Implant rupture as a late complication of breast implant surgery is often a silent phenomenon that is difficult to diagnose. Ultrasound detects silicone implant rupture with a sensitivity of 50-77% and specificity of 55-84%. (Venta LA, Salomon CG, Flisak ME, Venta ER, Izquierdo R, Angelats J. Sonographic signs of breast implant rupture. AJR 1996; 166:1413-1419)
• #21: The sign of intracapsular rupture is the visualization of “stepladder sign”, low level echoes within the implant or echogenic focus of silicone between the implant shell and fibrous capsule. (Caskey CI, Berg WA, Anderson ND, et al. Breast implant rupture: diagnosis with US. Radiology 1994;190:819-823)
• #22: The sign of extracapsular rupture is the present of free echogenic nodule with well-defined anterior margin and dirty incoherent posterior shadowing within either the breast stroma or lymph nodes, so called “snowstorm sign”. (Harris KM, Ganott MA, Shestak KC, Losken HW, Tobon H. Silicone implant rupture: detection with US. Radiology 1993; 187:761-768)
• #23: In addition to the traditional ultrasound sign of implant rupture, ABVS can also present the similar MRI sign of minimally collapsed intracapsular rupture including the “teardrop sign”, the “keyhole sign”, and the subcapsular line sign” in our cases. Soo MS Kornguth PJ, Walsh R, et al. INtracapsular implant rupture: MR findings of incomplete shell collapse. J Magn Reson Imaging 1997; 7:724-730