ACR Appropriateness Criteria® Breast Implant Evaluation: Update 2025

Area of Science:

• Radiology
• Medical Imaging
• Breast Health

Background:

• Current guidelines address imaging for breast implants, but specific recommendations vary.
• Asymptomatic patients with saline implants typically do not require routine imaging.
• The FDA recommends specific screening protocols for asymptomatic patients with silicone implants.

Purpose of the Study:

• To outline evidence-based imaging guidelines for patients with breast implants.
• To define appropriate imaging modalities for various implant-related complications and conditions.
• To provide a framework for the American College of Radiology Appropriateness Criteria.

Main Methods:

• Systematic analysis of peer-reviewed medical literature.
• Adaptation of established evidence-grading methodologies (e.g., GRADE).
• Utilization of the RAND/UCLA Appropriateness Method for expert consensus.

Main Results:

• No imaging is recommended for asymptomatic patients with saline implants.
• Ultrasound is appropriate for suspected saline implant rupture.
• For asymptomatic silicone implants, initial MRI or ultrasound is recommended 5-6 years post-surgery, followed by screenings every 2-3 years.
• MRI without contrast is preferred for suspected silicone implant complications.
• Ultrasound and/or mammography may be used for silicone implant complications and axillary adenopathy, depending on patient age.
• Ultrasound or MRI (with or without contrast) is appropriate for suspected implant-associated malignancy.

Conclusions:

• Imaging recommendations for breast implants depend on implant type, patient symptoms, and clinical suspicion.
• A multidisciplinary approach and evidence-based criteria guide imaging decisions.
• Guidelines are reviewed annually to incorporate new evidence and expert consensus.