title: Longitudinal Ultrasound Study of Breast Implant Rupture Over a Six-Year Interval.
abstract: BACKGROUND
  Silicone gel-filled implants as opposed to saline-filled breast implants are the most commonly used breast implants in Europe, and this has recently also become the case in the United States. Modern implants have a multiple layer silicone shell and high to very high levels of cohesive silicone gel inside. Although breast magnetic resonance imaging is at present considered the gold standard imaging method for breast implant rupture detection, breast ultrasound (US) imaging is still the first-step investigation in Europe. The aim of this study was to verify whether or not the stepladder sign at US is still associated to intracapsular rupture among the last generation silicone breast implant.
  
  
  METHODS
  In this study, 156 patients presenting for breast augmentation, mastopexy with implants and breast reconstruction for a total number of 303 breast implants inserted were enrolled. A preoperative breast ultrasonography was performed, and patients underwent a routine US scan every 6 months for 24 months to evaluate the implant status. A final US evaluation 6 years after implantation was also performed.
  
  
  RESULTS
  Stepladder signs were seen at 6 years in 170 implants (56%) of the examined implants at US scan, and only 2 implants showed signs of possible rupture because of severe distortion of the implant profile with or without external silicone collection. A third ruptured implant was detected at magnetic resonance imaging by the presence of breach of the shell at the posterior surface of the implant with small external silicon collection and was eventually confirmed at surgery. Therefore, the overall rupture rate found at the United States at 6 years was about 1% (3 of 303 implants). According to our findings, the stepladder sign at the United States is no longer associated to intracapsular rupture.
  
  
  CONCLUSIONS
  Plastic surgeons, patients, and financial departments of hospitals would also be delighted to know that surgeons should not take patients back to theater for implant explantation when aging signs are not associated with a visible breach of the implant shell or external silicone collections.
authors.affiliation: From the *Casa di Cura Villa Valeria; †Department of Plastic Surgery, and ‡Department of Plastic and Reconstructive Surgery, Catholic University of "Sacro Cuore", University Hospital Rome, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Rochira
authors.forename: Pietro
authors.initials: P
authors.lastname: Cavalcanti
authors.forename: Antonio
authors.initials: A
authors.lastname: Ottaviani
authors.forename: Damiano
authors.initials: D
authors.lastname: Tambasco
mesh_terms: D018427:Breast Implants / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D016462:Mammaplasty / Q000009:adverse effects* / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D011475:Prosthesis Failure / Q000009:adverse effects; D020034:Silicone Gels / Q000009:adverse effects*; D014463:Ultrasonography
chemical_list: D020034:Silicone Gels