Normal and Pathological Incidental Breast Implant Findings on Chest Computed Tomography: What the Radiologist Needs...

Breast augmentation and reconstruction using implants are increasingly common, resulting in a growing number of patients with breast implants undergoing chest CT for unrelated clinical indications. Although CT is not considered a primary imaging modality for breast implant evaluation, breast implants and their associated findings are frequently encountered incidentally. These findings may range from normal postoperative appearances and expected findings to degenerative changes and clinically significant complications, many of which may be asymptomatic. This review highlights the spectrum of normal and pathological breast implant findings as visualized on chest CT. Normal appearances include implant position, contour, shell characteristics, and expected postoperative changes such as minimal peri-implant fluid or radial folds. Other implant-related findings, including capsular calcification and internal debris, may mimic or obscure true complications. Pathological conditions discussed include seroma, hematoma, infection, capsular contracture, intracapsular and extracapsular rupture, silicone migration, and retained silicone following explantation. Given the limitations of CT in soft-tissue characterization and the use of ionizing radiation, CT should not be used as a replacement for dedicated breast imaging techniques. However, recognition of abnormal CT features is essential, as these incidental findings may prompt appropriate recommendations for targeted breast imaging with ultrasound or magnetic resonance imaging and guide clinical decision-making. Familiarity with these entities enables radiologists to avoid diagnostic pitfalls, provide accurate interpretations, and contribute meaningfully to patient management when breast implant findings are incidentally detected on CT.