Name the implant type and position, then look for intracapsular rupture (linguine sign), extracapsular silicone, and the late seroma or mass that can mean breast implant-associated anaplastic large cell lymphoma.
Orient first
- Intracapsular rupture: the shell collapses within an intact fibrous capsule; extracapsular: silicone escapes into the breast or nodes.
- Silicone-specific MRI sequences suppress fat and water to show silicone alone.
- A late (> 1 year) peri-implant effusion or mass with a textured implant should prompt aspiration for BIA-ALCL (CD30).
Acquire the study
- Axial and sagittal silicone-only (fat- and water-suppressed) and water-only sequences; post-gadolinium T1 when a mass is suspected.
The manoeuvre
- Implant type (single lumen silicone, saline, double lumen) and position (subglandular vs subpectoral).
- Silicone-only series: linguine sign (floating shell folds) = intracapsular rupture.
- Teardrop, keyhole or noose signs: silicone within a radial fold (early rupture).
- Silicone outside the capsule in breast tissue or axillary nodes = extracapsular.
- Peri-implant fluid or a capsule mass with enhancement.
What confirms it
- Linguine sign on silicone-sensitive MRI for intracapsular rupture; silicone outside the capsule for extracapsular.
What licenses you to exclude it
- An implant without shell folds within the silicone and no silicone outside the capsule on MRI is intact.
The classic misread
- Radial folds (normal) called rupture — the fold connects to the shell and contains no silicone inside it.