Do Women with Silicone Breast Implants Need Follow-Up MRI Scans?
Evidence on MRI to Detect Ruptured Implants Is Flawed, Says New Review
ARLINGTON HEIGHTS, Ill. - The U.S. Food and Drug Administration currently recommends regular follow-up magnetic resonance imaging (MRI) scans for women with silicone breast implants. But a new review shows significant flaws in the evidence supporting this recommendation, reports the March issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).
Because of these scientific limitations, the available data may overestimate the ability of MRI to detect ruptured breast implants-particularly when scans are performed for screening purposes in symptom-free women. The study was led by Jae W. Song, MD, at the University of Michigan, Ann Arbor.
Review Questions Diagnostic Value of Screening MRI Scans
The researchers reviewed 21 studies evaluating MRI and/or ultrasound to detect rupture of silicone breast implants. Although the FDA recommends MRI, some physicians prefer ultrasound for screening purposes.
The combined data suggested that MRI was fairly accurate in detecting implant-related problems. However, it was much more likely to detect problems in women with implant-related symptoms: 14 times more likely than in women without symptoms. Even in a mixed "screening sample" - consisting of some women with and some without symptoms - the detection rate was twice as high as in asymptomatic women.
Because most of the women in the studies had symptoms, the true accuracy of MRI for detecting implant-related problems in asymptomatic women was likely much lower. For ultrasound, reported accuracy rates varied widely.
There is a long history of controversy over possible adverse health effects of silicone breast implants. Based on reports linking ruptured implants to autoimmune diseases, the FDA banned silicone implants in 1992. The ban was lifted in 2006, when repeated studies failed to confirm the association with autoimmune diseases.
However, the FDA recommended that women undergo regular MRI scans in the years after surgery to screen for implant rupture. Given that more than 1.25 million American women have received silicone implants, it's important to evaluate the evidence that MRI is an effective screening test.
The study raises important questions about the accuracy of MRI scanning, especially in women without symptoms. Beyond the issue of accuracy, the authors note that screening tests are generally performed to detect diseases with serious consequences-whereas the health risks associated with ruptured silicone implants, if any, are still unknown.
The researchers also note that in reported cases of implant rupture, the average age of the implants is over 10 years. Dr. Song and coauthors write, "The benefits of screening within the first 10 years are unclear, and the effectiveness of such a screening program warrants further investigation." Further studies are also needed to evaluate the long-term health effects of ruptured silicone breast implants, the effectiveness of MRI or other screening tests, and the costs of and patient preferences for screening.
Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.
About Plastic and Reconstructive Surgery
For more than 70 years, Plastic and Reconstructive Surgery® has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons, Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair and cosmetic surgery, as well as news on medico-legal issues.
The American Society of Plastic Surgeons (ASPS) is the largest organization of board-certified plastic surgeons in the world. Representing more than 7,000 physician members, the society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 93 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.
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