title: Ruptured gel-filled silicone breast implants: sonographic findings in 19 cases.
abstract: OBJECTIVE
  The purpose of this study was to describe and illustrate the sonographic appearances of 19 ruptured silicone gel breast implants.
  
  
  METHODS
  We retrospectively reviewed the sonograms of 16 patients with 19 ruptured silicone gel implants from two institutions. The ruptured implant was confirmed at surgery in 17 cases and by mammographic and clinical findings of a ruptured implant combined with biopsy findings of a silicone granuloma in two cases. Breast sonograms were available for review in all patients. The clinical presentation of each patient was recorded. The sonograms and mammograms were reviewed, and the findings were correlated with the surgical findings. In 16 of the 19 ruptured implants, mammographic findings suggested rupture, including lobulation of the contour of the implant and/or silicone extrusion into the breast parenchyma or axilla. In two ruptured implants, mammographic findings were normal, and in one case, no mammogram was available. In those three patients, palpable masses and clinical findings were suggestive of rupture.
  
  
  RESULTS
  Sonography showed a unique echogenic appearance called echo-dense noise, in 17 of the 19 ruptured implants; in 10 of the 17, sonograms showed hypoechoic masses of extruded silicone also. In two ruptured implants, sonograms showed only the hypoechoic masses of extruded silicone gel.
  
  
  CONCLUSIONS
  Our experience suggests that echogenic noise is a unique sonographic sign of ruptured silicone gel breast implants and may be caused by phase aberration related to the speed of sound being slower in silicone than in soft tissue.
authors.affiliation: Department of Radiology, University of Michigan Hospitals, Ann Arbor 48109-0326.
authors.forename: K A
authors.initials: KA
authors.lastname: Rosculet
authors.forename: D M
authors.initials: DM
authors.lastname: Ikeda
authors.forename: M E
authors.initials: ME
authors.lastname: Forrest
authors.forename: R M
authors.initials: RM
authors.lastname: Oneal
authors.forename: J M
authors.initials: JM
authors.lastname: Rubin
authors.forename: D O
authors.initials: DO
authors.lastname: Jeffries
authors.forename: M A
authors.initials: MA
authors.lastname: Helvie
mesh_terms: D004868:Equipment Failure; D005260:Female; D005782:Gels; D006801:Humans; D016462:Mammaplasty; D008875:Middle Aged; D019736:Prostheses and Implants; D012189:Retrospective Studies; D012828:Silicones; D013997:Time Factors; D016217:Ultrasonography, Mammary
chemical_list: D005782:Gels; D012828:Silicones