The Efficacy and Associated Learning Curve of Office-Based High-Resolution Ultrasound to Detect Shell Failure in...

High-resolution ultrasound (HRUS) is widely employed in plastic surgery practices to detect implant rupture prior to revisional surgery. Published research has found a good overall accuracy of shell failure detection. The literature often references a learning curve associated with incorporating this imaging technique into a medical practice, but it has yet to be visualized or defined.

This study was undertaken to calculate current testing statistics for use of HRUS to detect shell failure and to define the learning curve associated with the predicted improvement reflected by statistics of test and surgeon proficiency.

A retrospective review of sequential in-office HRUSs on patients with breast implants was conducted across 2 plastic surgery practices. Preoperative ultrasound reports and intraoperative findings were compared. Test statistics were calculated for each group of 10 subsequent patients, and a regression analysis was performed to define the learning curve.

A total of 480 implants were examined and averages for all test statistics were calculated. All were higher than most of the previously reported literature standards. The regression analysis showed a linear improvement for both sensitivity and specificity over time, with significant improvement in sensitivity.

Results show that HRUS is highly effective in detecting shell failure in breast implants. There is also a calculable linear improvement for all test values of the HRUS over time. Surgeons were able to remain above the literature standard for sensitivity after their 60th HRUS reading. This improvement shows that continued use and practice of the imaging technique allow for more accurate findings.