ACR Appropriateness Criteria® Breast Implant Evaluation: 2023 Update

Area of Science:

• Radiology
• Medical Imaging
• Breast Health

Background:

• Breast implants are common, necessitating clear guidelines for imaging surveillance and diagnostics.
• Appropriate imaging is crucial for detecting complications and associated conditions in patients with breast implants.

Purpose of the Study:

• To outline the appropriate initial imaging strategies for patients with breast implants, encompassing both asymptomatic and symptomatic individuals.
• To provide evidence-based recommendations for imaging in specific clinical scenarios involving breast implants, such as rupture, adenopathy, and lymphoma.

Main Methods:

• The document synthesizes recommendations based on the American College of Radiology Appropriateness Criteria.
• Methodology involves systematic analysis of peer-reviewed literature and expert consensus, utilizing frameworks like GRADE and the RAND/UCLA Appropriateness Method.
• Guidelines are reviewed annually by a multidisciplinary expert panel.

Main Results:

• Asymptomatic patients with saline implants require no routine imaging; ultrasound is indicated for suspected rupture.
• For silicone implants, the FDA recommends initial ultrasound or MRI 5-6 years post-surgery, followed by examinations every 2-3 years.
• Imaging modalities like ultrasound and mammography are appropriate for axillary adenopathy, while ultrasound or MRI (without contrast) is recommended for suspected silicone rupture. Ultrasound is the initial imaging of choice for suspected implant-associated anaplastic large cell lymphoma.

Conclusions:

• Initial imaging recommendations for breast implants differ based on implant type (saline vs. silicone), patient symptomatology, and clinical concerns.
• Adherence to established guidelines ensures appropriate and timely diagnostic imaging, improving patient outcomes and facilitating early detection of potential complications.