Breast implants have evolved and grown in popularity since the first silicone implant was developed by Houston Plastic Surgeons, Thomas Cronin and Frank Gerow. To this day, breast augmentation remains the most common procedure performed worldwide.
While implants are proven to be safe, occult or silent ruptures are not uncommon. In fact, clinical data from a recent study by Dr. Marc Salzman showed that out of 584 women with silicon gel implants in place for 3 to 20 years, 10.6% had an implant rupture they were not aware of.
At his practice in Kentucky, Dr. Salzman uses his Clarius HD3 scanner to assess implant integrity and diagnose pathology associated with augmentation surgery. We recently invited Dr. Salzman to share his ultrasound techniques for plastic surgery during a one-hour free webinar. Watch the webinar or read on for some highlights.
High-resolution ultrasound (HRUS) of breast implants can provide an abundance of information and can be easily performed in an office setting as a screening tool for asymptomatic women. Broken saline implants are self-evident, while broken silicone gel implants can have various presentations.
Notable takeaways from this is that in-office ultrasound can certainly be learned by MDs and ancillary providers,” says Dr. Salzman. “Ultrasound may be the first choice for implant surveillance because of the ease of use, it’s in the office; its lower cost, and it’s immediately available in an office setting.”
In this cohort of asymptomatic women with silicone breast implants, the incidence of silent rupture may be as high as 10.6%, so we may start seeing more demand from patients for implant screening with ultrasound.
Screening for Silicone Implant Rupture
Mammography is the least sensitive imaging modality, with 11-69% sensitivity for rupture.
Silicone is very radio-opaque, which makes it difficult to see an intra-capsular rupture.
MRI is considered to be the gold standard for intra-capsular rupture, but it may be cost-prohibitive to many patients, and access may be limited depending on location.
With operator experience, high-resolution Ultrasound sensitivity and specificity are approaching MRI. The difference – wireless ultrasound is inexpensive and available for use in an office setting. In the U.S. the FDA now recognizes screening for silent ruptures with HRUS as an alternative to MRI.
Ultrasound Appearance of Normal Intact Gel Implant vs Saline Implant
Watch this video to see how Dr. Salzman performs a thorough HRUS examination of breast implants.
There are several ultrasound characteristics of broken implants, including:
- Free gel-snowstrom pattern
- Stepladder sign
- Shell fragments
- Discontinuous shell
- Keyhole deformity
- Combinations of each
Watch the full webinar, «Ultrasound Essentials for Breast Plastic Surgery: Visualizing Silent Ruptures, Seromas, and PECS Blocks», for details
In this video, Dr. Salzman identifies an implant rupture and an upside-down implant in his asymptomatic patient.
High-resolution ultrasound for evaluation of the Swollen Breast
- Post-surgery
- Seroma versus hematoma
- Location of fluid
- Peri prosthetic versus subcutaneous
- Resolution of hematoma
- Timing of aspiration
LAP Block (lateral approach pectoralis block) for better results and post-op pain control
Dr. Salzman has customized the traditional ultrasound-guided PECS block using a lateral, in-plane approach. Using video footage from another client, Dr. Salzman demonstrates how to effectively perform a pre-operative pectoralis nerve block with techniques that will drastically reduce post-operative pain and speed post-surgical recovery. You’ll see your clients going out for dinner after their breast surgeries!
See how it’s done in this short video.
Free Upcoming Webinar on Ultrasound Guidance for BBLs
Dr. Pazmiño is presenting a webinar with Clarius on July 14, 2022, to provide free education for plastic surgeons looking to use ultrasound for safer, more accurate BBL procedures. Physicians are invited to register on the Clarius website for the live webinar “Ultrasound Guidance for Safe Brazilian Butt Lifts: Precision BBL Techniques from the Expert.”
Clarius Wireless Ultrasound for Plastic Surgery
Dr. Salzman uses the Clarius L7 HD3 in his plastic surgery practice. Clarius offers three ultrasound scanners that are suitable for plastic surgery procedures. Available for a fraction of the cost of a traditional ultrasound system, and wireless for exceptional portability, they deliver clear high-resolution imaging for breast, safer Brazilian Butt Life Procedures, regional blocks to prevent pain and more.
Contact us to learn more about Clarius wireless ultrasound for Plastic Surgery or schedule a virtual private demo today to learn which Clarius scanner is right for your practice.
