[Radiological control following breast reconstructive surgery]

Radiological control of the breast that has been operated because of cancer and reconstructed has a double aim: to provide early detection of any recurrence and data on the state of the reconstructive mechanisms employed.

We must know the clinical-surgical antecedents of the patient, especially the surgical technique, the implant model used, its localisation and the existence of any symptomatology. The radiological techniques employed are the mammography, ultrasound and magnetic resonance. The first is useful in detecting extracapsular breast implant rupture but inefficient in intracapsular rupture. Ultrasound is superior in the visualisation of signs of intracapsular rupture and the detection of infiltrating carcinoma, although it does not manage to visualise calcifications with reliability. Magnetic resonance is the most sensitive and efficient technique for detecting infiltrating relapses and also for intra and extracapsular ruptures. If the exact nature of a lesion cannot be reliably determined with image techniques, the next step is a percutaneous biopsy, extracting samples that are suitable for cytohistological analysis. The guide systems for percutaneous puncture include: palpation, mammography-stereotaxy, ultrasound and magnetic resonance.

Abnormal findings in the reconstructed breast are classified in three groups, according to origin and localisation: 1. Dependent on the implants; 2. Extraprosthetic benign pathology; and 3. Malign pathology. The different pathological situations that might appear are reviewed.

Yearly radiological control of the patient with reconstruction following breast cancer is important because of the high risk of relapse and new tumours. Radiological and clinical control are complementary and include local and regional control. Mammography, ultrasound and magnetic resonance are the most suitable techniques for radiological control. Suspicion of relapse should be confirmed by percutaneous puncture. The correct use of these techniques requires experience and a preferential dedication to breast radiology.