0:00

This is the baseline in this patient.

0:02

This patient's history is...

0:12

She is a 59-year-old

0:15

who currently is eight years status post bilateral silicon implants.

0:19

But at the time of this study,

0:22

she was only a year or two into her implants.

0:26

And at that time, she was having some symptoms and they were concerned, in both

0:32

breasts, they were concerned about ruptures.

0:34

I'm just going to show you this one as her baseline.

0:38

We're not going to ask questions about

0:40

this one, but just to give you something to look at and we'll come back to it.

0:44

So, right one.

0:46

And so, that's her...

0:47

Yes, that's her right breast.

0:50

And here is her left breast.

0:52

These are both silicon bright sequences.

0:56

They really give you all the information you need in this case.

0:59

And now we're going to jump forward, seven years.

1:04

And she is, again, having some symptoms.

1:06

She feels that they've changed size and she's having some discomfort.

1:10

So we've changed our protocol in the intervening seven years.

1:14

Now, we're doing bilateral study and what I

1:16

have on the left side here is the silicon bright axial sequence.

1:22

And then I have the silicon dark sequence on the right side.

1:27

And I'm just going to go through these and then we'll look at the sagittal images.

1:45

I'm going to bring up the silicon bright, which I think are by far the most helpful.

1:52

This is the right sided one.

1:56

This is left sided one.

2:01

So that's the left one,

2:06

and the right one.

2:07

Do you want to put that poll up, please?

2:08

So this is for case 6.

2:19

Alright.

2:20

We look at that one.

2:21

Good.

2:22

So most of you got the correct answer here, which was intracapsular rupture.

2:27

Then we'll talk about the differences

2:30

between intra and extracapsular rupture in a minute.

2:33

But let me just close that.

2:34

I just want to go back to the first study, her baseline study, and just show you how.

2:41

These are normal radial folds.

2:44

You allowed some little...

2:47

Let's show a better example of it.

2:49

I think this one had...

2:50

The right one had better...

2:51

There we go.

2:53

So this is a normal radial fold.

2:56

It starts at the edge of the capsule

3:01

and it stays and within the shell of the implant,

3:04

and it's just a little fold, and it ends blindly.

3:08

You know,

3:08

it's just as you can imagine a fold is going to look, we do in his...

3:12

On the left side,

3:14

there are several of those.

3:15

So that was normal and called negative correctly at the time.

3:19

But now, we're seeing something rather different.

3:22

So now, we can see this pretty well, just on the axial sequence.

3:28

We are seeing something very different here.

3:32

These folds look different.

3:33

Let me zoom up on one of these to try and show it to you a bit better.

3:40

I think this right breast pretty much shows it all.

3:43

Although, they're both very similar.

3:45

So what we're seeing here is what's called

3:47

the keyhole sign, where we've got bright silicon inside

3:52

the implant, but we've got bright silicon inside that fold, as well.

3:57

You can see as we get further down

4:00

in the implant,

4:04

down here, we're now down more inferiorly.

4:08

We're now seeing much more silicon outside of the capsule,

4:15

outside of the capsule or shell,

4:17

I'm sorry, the shell of the implant, but inside the capsule.

4:21

This is the outer capsule,

4:24

the fibrous capsule that the body forms around the implant.

4:27

And at no point are we seeing anything bright outside of that.

4:31

Now, it's always good to look at the dark silicon,

4:34

and that was just confirmed on the sagittal slices.

4:37

It's good to look at the dark silicon and link these together,

4:41

because what you want to see,

4:43

you just want to confirm that those areas which are bright

4:47

on the bright silicon, do suppress and are dark on the dark silicon.

4:53

We've not done a great job of suppression here.

4:56

You can see that although they're supposed to be fat and silicon suppressed,

5:00

but they've kind of messed up the fat suppression here.

5:04

If that remain bright, then it would be likely fluid

5:09

outside of the implant shell and under the capsule, not silicon.