Background: The rates of mastectomy and breast reconstruction are increasing in both therapeutic and prophylactic settings. Autologous fat grafting, flaps, and implants have become a common component of breast reconstruction, with a wide variety of imaging appearances. Presented is a pictorial review of common imaging findings and a set of unique cases highlighting its variable appearances and complications.
Learning Objectives: • To review common methods of breast reconstruction after mastectomy including autologous reconstruction with flaps and fat grafting, implant reconstruction, and a combination of both; • to identify common imaging features and complications; • and to highlight a series of interesting cases.
Abstract Content/Results: We aim to present a succinct pictorial review of imaging findings associated with different breast reconstruction techniques including a variety of autologous methods, implants and combination of these techniques. The educational exhibit starts with reviewing different methods of reconstruction, followed by a set of unique cases with detailed imaging explanations that highlight the expected imaging spectrum and complications following reconstruction.
An representative unique case includes:
A 43-year-old female status post mastectomy for ductal carcinoma in-situ, with silicone implant reconstruction and fat-grafting, who presented with a palpable left upper outer breast lump. On physical exam, the lump was noted to be soft and semi-mobile.
There was no correlate on mammography, and ultrasound showed a 31 mm well-circumscribed, heterogeneous oval mass, suggestive of fat necrosis. With real-time scanning, the finding was noted to be superficial to the silicone implant elastomer shell and deep to the overlying external fibrous capsule (Figure 1). Follow-up MRI confirmed the mass’s location in the potential space between the underlying intact implant and overlying fibrous capsule (Figure 2). The non-enhancing mass demonstrated fat intensity and was consistent with fat necrosis within an implant radial fold, likely placed inadvertently at the time of fat-grafting.
Conclusion: At the conclusion of this presentation, the reader will be able to recognize the variable imaging appearance and complications associated with autologous flaps, fat grafting, and implants following mastectomy.
