Ultrasound imaging for breast surgery


Today I would like to share about the Ultrasonography after the breast augmentatioin surgery.

Although there aren’t any problems after the breast augmentation, one might be curious about if the implant is at the appropriate position and think about if there is no problem inside the breast where one cannot see.

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Or, the breasts might seem thicker or there might be pain or even difference in the shape. All these changes might lead to concerns.

Ultrasonography would be very useful for such cases. There is no penetration with this test. One just uses the probe to rub on the skin and see the inside of the body and check the inside.

We refer to penetration as poking with the needle or opening up the skin but this is not something that one can do at any time. Ultrasound test is one that the patient would not feel any pain and is also a cost saving measure.

Below is a brief summary of different tests that you can do on the breasts.

 

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The cancer test of Mammogram, is one of the most common one that the patients take. A machine would press on the breast and takes a X-ray. Mammogram is one of the cheapest basic tests that you can take and is also one of the most effective means of detecting cancer. If there is a problem found from the mammogram, one could take the higher level test such as the MRI.


MRI is the most sensitive and accurate test that one can take. You can find the symptoms of the breast cancer at an early state and one can also differentiate the worst case from others as well. It also provides the most accurate results related to the damaging of the implants. US FDA recommends taking the MRI every 2 ~ 3 years as it gives certification of the implants.

However, this test is very expensive so there aren’t many patients who take MRI after the breast augmentation.
 

Ultrasonography is taken a lot for the breast cancer as well.
It has high sensitivity and high accurateness in finding something without any pain.
It is also cheaper than MRI. Ultrasonography also helps check problems of the patients with silicone implants / saline implants.

I usually recommend ultrasound to the patients who want re-surgeries.
Re-surgeries are usually done without knowing how the breast shape has changes after the first surgery or not know how the process has been changed. If a doctor wants to explain the current status and talk about the future plan, he/she needs to know the current status accurately. This could be done with the help of the ultrasound test.

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Above is an image of a patient with a revision surgery. If you look at the right breast, you might be able to know that there is something wrong with the implant. The same result came up through the Ultrasonography.






When I first saw the image above, I through that the implant was damaged. The white color shows the surface of the implant and this white line is broken in the middle. We conducted the re-surgery to find that the implant was not damaged but flipped upside-down.

This is the bottom of the implant (what we refer to as a belly button) where the brand name was printed on.

The patient thought that the skin became really dense and though that there was a capsular contracture so she massaged the breast often.

The implant was small compared to the large pocket it was in, therefore the massaging has led to the flopping of the implant.




The above image is from the ultrasound test of a patient with a damaged implant. Usually the gel inside the implant would look black but there is a lot of density with tattered surface so I suspected damage on the implant.

I found out that there was a lot of blood around the implant from the re-surgery. The patient had an auto accident after the initial surgery and it seemed that the blood from the accident stayed around the implant.

 



The above image is the result of a seroma. Seroma can be caused by different problems including the water formed from the breaking of the tissue, or bleeding, etc. The water left over that has not been absorbed causes the seroma along with other trauma, infection, etc.

Water can exist at the earlier stages after the breast augmentation but if there is liquid after 6 months, we call this a ‘Late seroma’ or ‘Late fluid collection’. We solve this problem according to the different cause of the problem.

We do not treat the problem because there is a seroma. If there is an additional problem such as an infection from the seroma, we would do the treatment to remove any problems.

But if there is a lot of blood, then we would need to find out where the blood came out from at an earlier stage.

These kind of problems can be helped out through the ultrasound test.

If there is a capsular contracture, the membrane surrounding the implant becomes very white and thick. This can be seen through the ultrasound test as well.
However, capsular contracture can be recognized by touching the breast therefore, ultrasound is not used as to tell if there is a capsular contracture or not.
The ultrasound test is used to find out additional information on how to solve the capsular contracture.




The above image is to check whether the implant is in the right position or flipped upside-down. There is a white spot in the image and this is connected from the midpoint of the implant up until the 6 o’clock location. One can find out whether the midline of the implant is through this image. Finding out this kind of a problem is one of the biggest advantages of the ultrasound test.

Today, we looked at the various results that ultrasound tests can show before and after the breast augmentation. Has this helped?

Have a great day.