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The history here is 80-year-old woman

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status post bilateral mastectomy

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presented for implant assessment.

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So this is one case, uh,

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covers, uh, many illustrations.

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So this, we're starting at the top.

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These are the, of course, non-fat sat.

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You see all of her fat.

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And as we're coming down, all of a

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sudden we realize, wait a minute, not

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only do I not see one normal breast,

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uh, I don't even see two normal breasts

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because it is obvious that the right

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breast doesn't have the usual parenchyma.

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There's an odd, um, there's skin thickening,

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and then there's an odd band of hypointensity.

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And then the pack is more pointed than usual.

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There's also this oddity

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of these swirls of vessels.

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And, of course, here's some

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overt post-surgical change.

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And so, of course, by now, and

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then, as we scroll down, you can

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see by now, you're reconciling the

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status post bilateral mastectomies.

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Quote implant, um, uh, integrity indications

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of this MR with the fact that, hey, wait a

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minute, one breast doesn't have an implant.

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That is an autologous, um, reconstruction.

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So that's a, that's a flap and

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the other and the left breast does

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in fact have a silicone implant.

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So, um, anyway, so these are the

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hallmarks actually of a TRAM.

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Um, and, um, just wanted to go through

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that very quickly, and then we'll, we'll

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do a bit more on the silicone as well.

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But this is the, so what happens is the normal

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breast has been removed with the exception.

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And this is important to know, in terms

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of where you might look for recurrence.

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This is actually endogenous

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um, tissue that remains,

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uh, underneath the skin.

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Um, this line is the pulled-through flap, in

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this case, a TRAM flap coming from the abdomen.

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So all of this fat is abdominal fat, whereas

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this fat is the, is the, um, just barely

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beneath the skin, but could theoretically

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still contain some, um, some breast,

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um, breast, breast, epithelial rest.

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So just a little hint there, um, and,

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um, and then this, these structures

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here reflect the actual vascular

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pedicle of the pulled-through flap.

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And then this is, um, this is, um, the,

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atrophied rectus abdominal muscle that.

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That's come to come up with a

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pull through and all of that.

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So that's just a very, very typical anatomy.

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I'm not going to belabor that

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on this one because actually

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the next case is a TRAM as well.

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Just FYI.

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Okay, so we have that information and

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so again, the value, the value, at least

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to me of anatomic assessment, we already

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know that there is no intrinsic amount of.

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Fibroglandular tissue, so

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you get to say not applicable.

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You also know that there's not going

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to be a background enhancement.

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So you get to say not applicable.

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And so also that sequence kind of helps

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you with kinds of kind of helps you with

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that determination and then we're going

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to move on from here to, um, one of the

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things that can be the silicone implant.

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Admittedly, this is a T2, but you can use a

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T2 sequence to at least look at the overall

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anatomy and appearance of the implant.

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So here's that we're starting up

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high coming down low the left.

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breast has been, um, uh, removed as

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well, but it has been reconstructed.

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They were not done at the same time, obviously

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they were done in tandem and the left breast

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was reconstructed with a silicone implant.

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We know it's a silicone implant.

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We wouldn't know so much from this T2 because

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of course T2, uh, salines are bright, but there

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is no valve as you scroll through all of it.

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There's no valve.

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And, um, you can.

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Absolutely.

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Thereby exclude from being a silicone

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saline implant, because there's no,

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there's no apparatus to reinflate it.

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And then remember on the silicone

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implants, we want to always do something.

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That is a silicone only sequence.

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That is silicone hyperintense

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and water hypointense.

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So that, like, teach regular to is not

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going to be that because a regular to is.

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Of course, water bright, it doesn't

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help so much silicone versus saline or

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silicone versus any fluid structure.

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But this is a very nice example of a completely

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intact, smoothly contoured silicone implant.

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And these are the radial

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folds that occur at the perimeter.

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Uh, there's no silicone in the middle of them.

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These are not anything with the keyhole or the

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or the teardrop or the new

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signs and so that's it.

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So the only 2 points that I was going

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to make with this case to reiterate them

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again is what a silicone implant looks

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like when it has not failed and what the

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autologous flaps, notably a TRAM flap, which

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at least in the States is far more common.