Intra-operative and three-dimensional ultrasound guided explantation of silicone breast implants

Ultrasound is useful in evaluating the integrity of silicone gel breast implants. This modality is now being applied intra-operatively to determine the location of free silicone from leaking or ruptured implants, and to provide guidance for the surgeon in its removal or biopsy. Intra-operative ultrasound was performed on 17 implants in 10 patients. In 7 patients additional three-dimensional (3D) ultrasound images were obtained. Of the 17 implants, 8 had free silicone extending beyond the fibrous capsule and 9 were ruptured with silicone contained within the capsule. In the case of extra-capsular rupture, free silicone could easily be localized in the breast and axilla. 3D imaging was helpful in determining the exact size and extent of the free silicone; In two cases scar and muscle infiltration prevented complete removal, but the ultrasound assisted in localizing involved tissue for biopsy. The intra-operative ultrasound confirmed preoperative findings and added little time to the surgical procedure. Intra-operative and 3D ultrasound can provide valuable information during surgical explantation of ruptured implants