MR is the most accurate technique for evaluation of implant integrity offering sensitivity for rupture between 80%-90% and specificity of 90-97%.
This patient underwent breast augmentation with silicone implants 25 years ago. She recently noted bulging at the inferior portion of her left breast.
Intracapsular rupture is defined as rupture of the implant shell with silicone leakage which does not extend beyond the fibrous capsule.
The most reliable sign on MRI for intracapsular rupture is the presence of multiple curvilinear low-intensity lines within the high-intensity silicone gel. This is also referred to as the linguine sign and represent the collapsed implant shell floating within the silicone gel and is only seen in collapsed rupture.
In an uncollapsed rupture, free silicone is seen outside the implant shell but is still contained within the fibrous capsule.
Extracapsular silicone implant rupture is defined as rupture of both the implant shell and fibrous capsule with leakage extending beyond the fibrous capsule.
This patient exhibits both kinds of rupture seen with silicone implants.