MRI Report Questions

mlenz2

I recently went in for a mammogram and ultra sound because I had suspected a rupture of a silicone implant (I was having pain and swelling on the right breast for months). I am a 37 YO female, I am unsure of family history because my mother was adopted. I have been healthy other than two melanoma surgeries on my abdomen both were Stage 1A, 5 years ago. I should also add I have never had radiation so not sure why that question is asked. Going in for biopsy next week just have been uneasy about it...

The below was reported back:

FINDINGS:

There is extreme fibroglandular tissue with moderate background parenchymal enhancement.

There are bilateral retropectoral silicone implants. Linguine sign is noted in the right breast, consistent with intracapsular rupture. There is no extracapsular silicone. The left implant is intact.

There is diffuse enhancement in the right breast without focal mass identified. However, in the left upper, inner breast, there is segmental nonmass enhancement measuring up to 2.9 cm. The lateral breast remains quiet.

There is no axillary or internal mammary adenopathy bilaterally.

IMPRESSION:

1. Asymmetric enhancement of the left upper, inner breast for which MR guided biopsy is recommended. Does the patient have a history of radiation to the left lateral chest/breast which would cause this half of the breast to become hypoactive?

2. Findings consistent with intracapsular rupture of right implant.

ASSESSMENT: BIRAIDS 4 - Suspicious abnormality - MR guided biopsy recommended

I guess my question is, in most cases such as these with segmental nonmass enhancement, as reported above come back to be nothing??

Thank you for your help in advance!

djmammo

mlenz2

Its a little confusing. Let's start by recognizing the report does not describe a suspicious enhancing mass so the odds of an invasive cancer being present are very low.

They mention enhancement of the upper inner left breast with what sounds like a lack of the expected amount of enhancement on the outside (lateral aspect) of the left breast. One of the things that can cause this decrease or lack of enhancement is radiation.

My question is, does the upper inner left breast appear to have segmental enhancement when compared to the poorly enhancing lateral left breast or when compared to the right breast? Also, what does the left breast look like on mammo and US in the areas they describe as having too much and too little enhancement? Are there calcifications in the upper inner left breast? Did the US show a difference in the tissues of the left breast? Is there more fibrous than glandular tissue in the outer portion of the left breast? You have had surgery for implant placement, did that affect the blood supply to the outside of that breast? Is the glandular tissue distributed asymmetrically because of the presence of the implant?

I think its reasonable to biopsy the area they think is suspicious to exclude a problem but I would not be too anxious about the outcome between now and then. Let us know what they find.

mlenz2

I am not clear on the comparison as it relates to the right breast? The only area it states is “segmental non mass enhancement measuring up to 2.9 cm” I am not sure what that even means as my doctor didn’t seem very clear. My implants were put in 12 years ago through a small incision under my nipple, there is no scar or anything there and I have had no issues until 4-5 months ago. When I went in for US they only viewed the right breast as that’s was the only one which was inflamed and painful. It sounds like this is something which shouldn’t be a cause for concern, thanks so much for the response!