High frequency ultrasound in breast surgery: A narrative review of current evidence and future directions

High-frequency ultrasound (HFUS) is a versatile but underutilised imaging modality in breast surgery. Its high resolution offers a unique imaging perspective when compared to other modalities such as magnetic resonance imaging (MRI) and conventional, lower frequency ultrasound (<10 MHz). This narrative review synthesises current literature on the applications of HFUS in breast surgery including future directions.

A comprehensive search of PubMed, Embase, Web of Science, CiNAHL, Cochrane CENTRAL and Scopus was conducted for studies published between January 2020 and September 2025. Eligible articles included clinical studies, reviews, and technical evaluations using probes >10 MHz in breast surgery applications.

HFUS demonstrates strong clinical utility in implant monitoring, lymphatic supermicrosurgery and breast reconstruction. Compared to MRI, emerging evidence indicates that HFUS can produce concordant results in 87-100% of cases, whilst displaying additional advantages such as greater accessibility and real-time imaging. The high definition offered by HFUS facilitates flap reconstruction planning, and its ability to visualise lymphatic channels and dermal thickness is also a useful tool for the planning of lymphaticovenous anastomoses for lymphoedema.

HFUS imaging appears to show great promise for breast surgery, although future research on comparative studies to develop imaging protocols is needed. More widespread adoption will also require integration into surgical training curricula.