Dirty shadow adjacent to old implants

[Stephen Bird]

When you see dirty shadowing and ill-defined capsular margins on old implants, is this an indication of silicone leaking? or does it just demonstrate an old implant?

[Stephen Bird]

This can be tricky,
Old implants often have internal echoes and when you see some hazy change around the periphery of the implant I feel this is more likely due to some capsule contraction (which is very common). These old implants often have intracapsular ruptures which means the silicone gel is in contact with the fibrous capsule and hence some contracture is common. I would only go for extravasated extracapsular rupture when I see a proper snow storm appearance in the native breast tissue or extravasated hypoechoic silicone.

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