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

Abstract

Abstract Background Implant rupture is a known complication in cosmetic breast surgery, but access and cost barriers hinder proper implant surveillance. Objectives In this study we aimed 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 W.P.A. HRUS sensitivity and specificity and predictive values were calculated. Multivariable logistic regression assessed predictors of implant rupture. Kaplan-Meier methods estimated 10-year 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; interquartile range 79-152 months). After multivariable adjustment, only the implant age was a significant predictor of implant rupture (P = .04). Across the entire cohort, Kaplan-Meier methods estimated 10-year and 15-year implant survival rates of 0.98 (95% CI 0.96-0.99) and 0.80 (95% CI 0.71-0.87), respectively. Subgroup analysis showed 10-year 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 for assessing silicone breast implant integrity. Level of Evidence: 3