0:00

History, she's a 58-year-old who had

0:03

remote implants placed for cosmesis.

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So these are remote cosmetic

0:09

implants and she had newly diagnosed.

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Yes, but we're going to pause on the, and

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we're mainly just going to look at our

0:18

implants because it's really nice example.

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So our teaching points here for

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this case is 1st of all, you have

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to have the right sequences, right?

0:24

You need to have, you need to have

0:27

implant silicone-specific sequences.

0:30

Um, where you actually, um, and just make sure

0:35

that each of your sites do just that.

0:38

You also have to suppress. You want to

0:40

suppress everything except silicone,

0:43

which means you also want to suppress

0:45

these two weights are weighted are great.

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But they don't also suppress, um, fluid.

0:50

So normal water.

0:51

And so you want a specific where you also

0:54

suppress second, but these are, um, very

0:59

evident, um, implant, um, uh, integrity

1:03

issues bilaterally in the right breast.

1:06

Um, in addition, I'm going to show you better

1:08

on the sagittal images, but in addition to some

1:10

wavy lines that are in there that are longer,

1:13

some of which will have keyhole or new skin.

1:18

Morphology on zoom type

1:20

images and on sagittal images.

1:23

In addition to that,

1:25

our right implant also so that

1:27

would be intracapsular rupture.

1:28

These Linguine signs, but our right

1:31

implant also has extracapsular rupture.

1:33

Let me show you the more.

1:36

Uh, the better slash more

1:39

appropriate because our T2.

1:42

Uh, it's not a trim or T2 weighted it,

1:45

um, the water has also been suppressed.

1:48

So this is a nice example of our right implant.

1:51

Nice example of wavy, um, of wavy.

1:55

Linguine sign, got a couple of

1:58

pictures here if I keep scrolling.

2:00

You're going to actually be able to see

2:01

in the contralateral resonates new sign,

2:04

but you can see quite readily the extra.

2:07

Extracapsular rupture as well remember

2:09

the capsule is not the implant shell.

2:12

So the word capsule refers to the endogenous

2:15

capsule that the patient herself has developed.

2:19

I know we talked about that in week 3

2:21

and when we're talking about about the.

2:24

The integrity of the, of the implant cover

2:29

that's called the shell just FYI, just

2:31

in terms of getting the words correct.

2:33

All right.

2:33

So that's a so this is a nice example

2:35

of intracapsular and extracapsular.

2:37

I remember the...

2:39

You hardly ever have extracapsular

2:41

rupture without intracapsular rupture.

2:43

So I think it's a fair assessment to

2:46

assume intracapsular rupture when the

2:49

predominant findings extracapsular.

2:51

We had a couple of had a couple of you comment.

2:55

Quite appropriately on the extra-

2:57

capsular rupture of this implant,

3:01

but not the intracapsular.

3:03

So I just wanted to make you aware of that.

3:05

And then the contralateral

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breast is a nice example.

3:09

That's a good, that's a good new sign.

3:11

So that can't be even a long radial.

3:14

Even a long radial fold, that's

3:16

a, that's a bit of a new sign.

3:18

There we go.

3:18

There it is coming into play.

3:21

And then just, and then really nice

3:23

Linguine and some subcapsular lines.

3:25

So, bilateral implant rupture, um, arguably,

3:28

um, I'm looking, I looked at this case a

3:30

little while ago and I was like, wait a minute.

3:32

I wonder why we didn't call

3:32

extracapsular rupture on this.

3:35

Um, I think we probably should have in

3:37

retrospect, although truthfully, most

3:39

of you just called this intracapsular

3:40

rupture and, uh, called the contralateral

3:43

intracapsular and extracapsular.

3:45

So, uh, you, you agreed

3:46

with us, or I'm not sure.

3:48

I agree with us at this point,

3:50

but it's kind of a moot point.

3:52

I think I also made the point that now

3:55

we do very few for implant integrity,

3:59

but I wanted to wrap that up just in

4:01

terms of assuring that you did know this.

4:04

This was not for implant integrity.

4:06

This was for her and it was just garden variety.

4:10

The patient did very well.

4:11

Um, and.

4:13

But we included it because of the bilateral

4:17

implant issues and hers had merely quote failed.

4:20

Remember, it's called implant failure.

4:22

Now, a lot of plastic surgeons

4:23

don't even call it rupture.

4:24

They just call it failure or they, they say

4:27

they talk about implant integrity rather than

4:29

implant rupture or the lack of implant integrity

4:33

just because there is an expectation that the

4:36

implants are going to, are going to fail, going

4:39

to rupture, sorry, and patients are, fail.

4:42

Uh, at least, at least most of the places that

4:45

I'm now covering, which I'm traipsing across

4:47

America right now in my new roles, um, but are,

4:50

um, are doing far fewer implant integrity MRs.