title: Ruptured or intact: what can linear echoes within silicone breast implants tell us?
abstract: OBJECTIVE
  During sonographic evaluation of silicone breast implants for possible rupture, we have frequently encountered several patterns of linear echoes within the implants. To our knowledge, the significance of this finding has not been established in the literature. The purpose of this study was to determine whether internal echoes are significant in predicting implant rupture.
  
  
  METHODS
  Thirty-three patients with 64 silicone implants were prospectively entered into a study that included gray-scale sonography of the implants and subsequent surgical removal. Echo patterns within the implants were retrospectively evaluated on hard-copy films and compared with the integrity of the implant at surgery.
  
  
  RESULTS
  Three categories of internal echo patterns were identified: "thick linear echoes." "thin linear echoes," and "commas." One or more of these echo patterns were seen in 57 (89%) of the 64 implants. Thick linear echoes were seen in 23 (36%) of the 64 implants, thin linear echoes were seen in 33 (52%) of the 64 implants, and commas were seen in 47 (73%) of the 64 implants. All echo patterns were seen in intact and ruptured implants with nearly equal frequency. We found no statistical significance for any echo pattern in predicting whether an implant was ruptured or intact. Of the 64 implants, four were entirely free of internal echoes. All four implants were intact.
  
  
  CONCLUSIONS
  A variety of linear echoes can be seen in most silicone breast implants on gray-scale sonography. The presence or absence of linear echoes is not useful in predicting implant rupture. Complete absence of internal echoes, while highly predictive of an intact implant, is infrequently seen.
authors.affiliation: Department of Radiology, University of Minnesota Hospital and Clinic, Minneapolis, MN 55455, USA.
authors.forename: L U
authors.initials: LU
authors.lastname: Palmon
authors.forename: M C
authors.initials: MC
authors.lastname: Foshager
authors.forename: H
authors.initials: H
authors.lastname: Parantainen
authors.forename: L I
authors.initials: LI
authors.lastname: Everson
authors.forename: B
authors.initials: B
authors.lastname: Cunningham
mesh_terms: D000328:Adult; D001941:Breast Diseases / Q000000981:diagnostic imaging* / Q000209:etiology*; D018427:Breast Implants / Q000009:adverse effects*; D004868:Equipment Failure; D005260:Female; D006801:Humans; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012189:Retrospective Studies; D012828:Silicones; D013997:Time Factors; D016217:Ultrasonography, Mammary
chemical_list: D012828:Silicones