Outcomes of In-Office, High Resolution, Ultrasound Silicone Breast Implant Surveillance by Plastic Surgeons.

ABSTRACT

BACKGROUND: Implant rupture is a known complication in cosmetic breast surgery but access and cost barriers hinder proper implant surveillance. OBJECTIVES: This study aims to validate High Resolution Ultrasound (HRUS) for diagnosing silicone implant rupture, and secondarily, explore the predictors of implant rupture in a single-surgeon cohort. METHODS: A retrospective chart review identified patients who underwent HRUS of silicone breast implants that were placed by the senior author (WPA). HRUS sensitivity/specificity and predictive values were calculated. Multivariable logistic regression assessed predictors of implant rupture. Kaplan-Meier methods estimated 10 and 15-year implant survival. RESULTS: Among 254 patients (508 implants) included, 52 patients (104 implants) underwent operative exploration for various reasons; 20 implants had confirmed ruptures. Examining this operative cohort, HRUS had excellent positive and negative predictive value, respectively, 100% (95% CI 83.1-100%) and 97.6% (95% CI 91.6-99.3%); the sensitivity was 90.9% (95% CI 70.8-98.9%) and specificity was 100% (95% CI 95.6%-100%). The median age of the implant at the time of ultrasound was 119 months (10 years; IQR 79-152 months). After multivariable adjustment, the only the implant age was a significant predictor of implant rupture (p=0.04). Across the entire cohort, Kaplan-Meier methods estimated a 10-year and 15-year implant survival rate of 0.98 (95% CI 0.96-0.99) and 0.80 (95% CI 0.71-0.87), respectively. Subgroup analysis showed 10 and 15-year implant survival rates of 0.99 and 0.92, respectively, for surveillance-only HRUS patients. CONCLUSIONS: Plastic surgeon delivered office-based HRUS surveillance is a highly sensitive and specific method to assess silicone breast implant integrity.