Atlas of Breast Implant Ultrasound Jae Hong Kim 123 Atlas of Breast Implant Ultrasound Jae Hong Kim Atlas of Breast Implant Ultrasound Jae Hong Kim Breast Center The W Clinic Seoul, Korea (Republic of) ISBN 978-981-16-8281-0 ISBN 978-981-16-8282-7 (eBook) https://doi.org/10.1007/978-981-16-8282-7 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. 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The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore Preface Currently, an implant-based augmentation mammaplasty is the most popular plastic surgery in women worldwide. Moreover, breast cancer is the most common malignancy in women. Therefore, there has been an increase in the number of women who undergo breast reconstruction after mastectomy. According to the 2018 statistics in Korea, breast cancer occurred in approxi- mately 26,000 women. It is also estimated that approximately 20,000 women receive an implant-based augmentation mammaplasty every year. In particu- lar, women receiving total mastectomy have been covered by the national health insurance since 2015. This is closely associated with a continual increase in the number of women receiving an implant-based augmentation mammaplasty for reconstructive purposes. Breast is a symbol of feminity; women desire to have a beautiful breast, where breast health is an essential factor that cannot be overlooked. Women receiving an implant-based aug- mentation mammaplasty are vulnerable to diverse types of complications as there has been a dramatic increase in the use of a breast implant, for which an early detection of post-implantation complications is mandatory for assur- ance of patient health and safety. Recently, breast implant-associated anaplastic large cell lymphoma (BIA- ALCL) has been reported worldwide; three cases of BIA-ALCL have also been described in three Korean women receiving a textured implant. This warns healthcare professionals of the importance of an early diagnosis and treatment of complications that may affect women receiving a breast implant. I have performed a meticulous observation of women receiving a breast implant with the use of a high-resolution ultrasound over the decade. I am now writing this book to share my knowledge and experience with other healthcare professionals. With images and video presentations in association with surgical procedures, readers of this book will comprehend overall aspects of an evidence-based approach to an early detection of post- implantation complications. In my experience, breast ultrasound is not only an evidence-based imaging modality in making a diagnosis of complications in women receiving a breast implant at the earliest opportunities possible but also a useful tool for identi- fying a specific type of an implant like shell type, shape type, and the corre- sponding manufacturer. This book will provide a guidance to practitioners who are involved in an implant-based augmentation mammaplasty. Seoul, Korea (Republic of) Jae Hong Kim v Acknowledgment I dedicate this book to my family, especially wife, Ji Ha Kim, and my daugh- ter, Min Seo Kim, with love and gratitude. I am greatly thankful to Drs. Nam Sun Paik, Woo Chul Noh, Eun Kyu Kim, Hyun Ah Kim, Min Ki Sung, Hai Lin Park, Heung Kyu Park, and Young Bum Yoo for their helpful advice. I also express gratitude to my colleagues, Drs. Min Soo Kim, Angela Soen Lee, and Hye Jin Kim, and the members of the Korean Society of Breast Implant Research for their critical reading of this book. Finally, I send my gratitude to all the staffs of my clinic: Mrs. Go Eun Bi Seo, Yeo Jin, Lee, and Hui Xu for their great help. vii Contents 1 Current Status and Future Implications of Ultrasound in the Context of Implant-Based Breast Aesthetic and Reconstructive Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.2 Diagnostic Imaging Studies in Patients Receiving a Breast Implant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1.3 The Emerging Value of Ultrasound as a Novel Diagnostic Modality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1.4 Comparison of HRUS and MRI . . . . . . . . . . . . . . . . . . . . . . . . 2 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 2 An Evidence-Based Approach to an Implant-Based Mammaplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 2.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 2.2 Treatment Protocol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 2.2.1 Preoperative Simulation of Postoperative Outcomes . . 5 2.2.2 Surgical Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 2.2.3 An Evidence-Based Radiologic Protocol for the Early Detection of Complications of an Implant-Based Breast Surgery . . . . . . . . . . . . . . 7 2.3 Clinical Cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 2.3.1 Case 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 2.3.2 Case 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 2.3.3 Case 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 2.3.4 Case 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 2.3.5 Case 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 2.3.6 Case 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 2.3.7 Case 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 2.3.8 Case 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 2.3.9 Case 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 2.3.10 Case 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 2.3.11 Case 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 2.3.12 Case 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 2.3.13 Case 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 2.3.14 Case 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 2.3.15 Case 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 2.3.16 Case 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 ix x Contents 2.3.17 Case 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 2.3.18 Case 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 2.3.19 Case 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 3 Role of Ultrasound in the Implant-B ased Aesthetic and Reconstructive Mammaplasty . . . . . . . . . . . . . . . . . . . . . . . . 47 3.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 3.2 Role of Ultrasound in the Context of an Implant- Based Aesthetic and Reconstructive Mammaplasty . . . . . . . . . . . . . . 47 3.2.1 Characteristics of a Breast Implant . . . . . . . . . . . . . . . 47 3.2.2 Ultrasound-Guided Assessment of a Breast Implant . . 47 3.2.3 Ultrasound-Guided Diagnosis of Postoperative Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 3.2.4 Ultrasound as a Screening Tool for Patients Who Are Suspected of Having Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) . . . . . 49 3.2.5 Ultrasound as a Component of a Multi-Disciplinary Algorithm-Based Approach to an Early Detection of Complications of an Implant-Based Augmentation Mammaplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 4 Distinguishing Various Types of Breast Implant Using High- Resolution Ultrasonography . . . . . . . . . . . . . . . . . . . 55 4.1 Location of a Breast Implant . . . . . . . . . . . . . . . . . . . . . . . . . . 55 4.2 Constituents of a Breast Implant . . . . . . . . . . . . . . . . . . . . . . . 55 4.3 Surface Topography of a Breast Implant . . . . . . . . . . . . . . . . . 56 4.4 Shape and Manufacturer of a Breast Implant . . . . . . . . . . . . . 60 5 Usefulness of High-Resolution Ultrasound in Detecting Complications of an Implant-B ased Mammaplasty . . . . . . . . . . 89 5.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 5.2 Folding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 5.3 Periprosthetic Fluid Collection . . . . . . . . . . . . . . . . . . . . . . . . 90 5.4 Rupture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 5.4.1 Saline Implant Rupture . . . . . . . . . . . . . . . . . . . . . . . . 92 5.4.2 Silicone Implant Rupture . . . . . . . . . . . . . . . . . . . . . . . 94 5.5 Thickened Capsule and Capsular Contracture . . . . . . . . . . . . . 101 5.6 Upside-Down (USD) Rotation . . . . . . . . . . . . . . . . . . . . . . . . . 110 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 6 Breast Implant-Associated Anaplastic Large Cell Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 6.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 6.2 A Vicious Circle of Crisis of a Breast Implant . . . . . . . . . . . . 123 6.3 Association Between the Onset of BIA-ALCL and a Textured Implant. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 6.4 Approaches to Risk Management for an Early Detection of BIA-ALCL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 Contents xi 6.5 Conflict of Interest (COI) in Plastic Surgery and Its Possible Involvement in Crisis of Stakeholders in an Implant-Based Augmentation Mammaplasty . . . . . . . . . . . . . . . . . . . . . . . . . . 125 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 7 Usefulness of High-Resolution Ultrasound (HRUS) in Planning Revision or Reoperation for Patients Receiving an Implant- Based Augmentation Mammaplasty. . . . . . . . . . . . . . . . 129 7.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 7.2 Preoperative Considerations Based on HRUS for Reoperation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 7.3 An Algorithm-Based Approach to HRUS-Assisted Reoperation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 7.3.1 Location of a Pocket . . . . . . . . . . . . . . . . . . . . . . . . . . 131 7.3.2 Surface Topography of the Shell of a Breast Implant . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 7.3.3 Status of a Capsule . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 7.3.4 Implant-Related Complications . . . . . . . . . . . . . . . . . . 138 7.3.5 Previous Surgical Approaches . . . . . . . . . . . . . . . . . . . 148 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148 8 Clinical Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 8.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 8.2 Illustrative Cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 8.2.1 Case 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 8.2.2 Case 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 8.2.3 Case 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 8.2.4 Case 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 8.2.5 Case 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 8.2.6 Case 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164 8.2.7 Case 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164 8.2.8 Case 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 8.2.9 Case 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 8.2.10 Case 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 8.2.11 Case 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168 8.2.12 Case 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175 8.2.13 Case 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 8.2.14 Case 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186 8.2.15 Case 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189 8.2.16 Case 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 8.2.17 Case 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 8.2.18 Case 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193 8.2.19 Case 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 8.2.20 Case 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 8.2.21 Case 21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 8.2.22 Case 22 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200 8.2.23 Case 23 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208 8.2.24 Case 24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214 8.2.25 Case 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214 xii Contents 8.2.26 Case 26 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216 8.2.27 Case 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216 8.2.28 Case 28 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224 8.2.29 Case 29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224 8.2.30 Case 30 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227 8.2.31 Case 31 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232 8.2.32 Case 32 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232 8.2.33 Case 33 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238 8.2.34 Case 34 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238 8.2.35 Case 35 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244 8.2.36 Case 36 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244 8.2.37 Case 37 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 248 8.2.38 Case 38 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 248 8.2.39 Case 39 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250 8.2.40 Case 40 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254 8.2.41 Case 41 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257 8.2.42 Case 42 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257 8.2.43 Case 43 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257 8.2.44 Case 44 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257 8.2.45 Case 45 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 266 8.2.46 Case 46 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 266 8.2.47 Case 47 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 266 8.2.48 Case 48 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275 8.2.49 Case 49 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277 8.2.50 Case 50 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277 8.2.51 Case 51 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281 8.2.52 Case 52 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 288 9 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291