Poly Implant Prothèse (PIP) incidence of rupture: a retrospective MR analysis in 64 patients
Mariella Scotto di Santolo1, Bianca Cusati1, Alfonso Ragozzino1
11 Department of Radiology, University "Federico II", Napoli, Italy ; 2 Department of Radiology, Ospedale S.M.delle Grazie, Pozzuoli, Napoli, Italy ; 3 Department of General, Geriatric, Oncologic Surgery and Advanced Technologies, Napoli, Italy.
Aim Of The Study:
The purpose of this retrospective study was to describe the magnetic resonance imaging (MRI) features of Poly Implant Prothèse (PIP) hydrogel implants in a group of 64 patients and to assess the incidence of rupture, compared to other clinical trials.
Material And Methods:
In this double-center study, we retrospectively reviewed the data sets of 64 consecutive patients (mean age, 43±9 years, age range, 27-65 years), who underwent breast MRI examinations, between January 2008 and October 2013, with suspected implant rupture on the basis of clinical assessment or after conventional imaging examination (either mammography or ultrasound). All patients had undergone breast operation with bilateral textured cohesive gel PIP implant insertion for aesthetic reasons. The mean time after operation was 8 years (range, 6-14 years). No patients reported history of direct trauma to their implants.
Results:
At the time of clinical examination, 41 patients were asymptomatic, 16 complained of breast tenderness and 7 had clinical evidence of rupture. Normal findings were observed in 15 patients. In 26 patients there were signs of mild collapse, with associated not significant peri-capsular fluid collections and no evidence of implant rupture; in 23 patients there was suggestion of implant rupture, according to breast MRI leading to an indication for surgery. In particular, 14 patients showed intra-capsular rupture, with associated evidence of the linguine sign in all cases; the keyhole sign and the droplet signs were observed in 6 cases. In 9 patients there was evidence of extra-capsular rupture, with presence of axillary collections (siliconomas) in 7 cases and peri-prosthetic and mediastinal cavity siliconomas, in 5 cases.
Conclusions:
The results of this double center retrospective study, confirm the higher incidence (36%) of prosthesis rupture observed with the PIP implants, compared to other breast implants.
Insights
Poly Implant Prothèse (PIP) implants show a high rupture incidence (36%) compared to other breast implants. Magnetic resonance imaging (MRI) revealed specific signs like the linguine sign in intra-capsular ruptures.
Area of Science:
- Radiology
- Biomaterials Science
- Plastic Surgery
Background:
- Poly Implant Prothèse (PIP) manufactured hydrogel breast implants for aesthetic augmentation.
- Concerns regarding PIP implant integrity and rupture rates have been raised in clinical practice.
- Magnetic resonance imaging (MRI) is a key modality for evaluating breast implant integrity.
Purpose of the Study:
- To characterize the MRI features of PIP hydrogel breast implants.
- To determine the incidence of PIP implant rupture.
- To compare PIP implant rupture rates with other breast implant types.
Main Methods:
- Retrospective review of breast MRI examinations for 64 patients with PIP implants.
- Inclusion criteria: suspected implant rupture based on clinical or conventional imaging assessment.
- Data collected on implant integrity, rupture type (intra- vs. extra-capsular), and associated signs.
Main Results:
- 36% incidence of prosthesis rupture observed in the study group.
- Intra-capsular rupture (14 patients) showed the linguine sign in all cases.
- Extra-capsular rupture (9 patients) was associated with siliconoma formation in axillary and peri-prosthetic regions.
Conclusions:
- PIP implants exhibit a significantly higher rupture incidence compared to other breast implants.
- Specific MRI signs (e.g., linguine sign) are indicative of intra-capsular rupture in PIP implants.
- MRI is crucial for diagnosing PIP implant rupture and guiding surgical management.
