Economic Analysis of Screening Strategies for Rupture of Silicone Gel Breast Implants

Section of Plastic Surgery, The University of Michigan Medical School, Ann Arbor, Mich 48109-0340, USA.
Plastic and Reconstructive Surgery (Impact Factor: 3.33). 07/2012; 130(1):225-37. DOI: 10.1097/PRS.0b013e318254b43b
Source: PubMed

ABSTRACT In 2006, the U.S. Food and Drug Administration recommended screening of all women with silicone gel breast implants with magnetic resonance imaging 3 years after implantation and every 2 years thereafter to assess their integrity. The cost for these serial examinations over the lifetime of the breast implants is an added burden to insurance payers and to women. The authors performed an economic analysis to determine optimal screening strategies by considering the diagnostic accuracy of the screening tests, costs of the tests, and subsequent implant removal.
The authors determined aggregate/pooled values for sensitivity and specificity of the screening tests of ultrasound and magnetic resonance imaging in detecting silicone breast implant ruptures from the data obtained from published literature. They compiled costs, based on Medicare reimbursements for 2011, for the following elements: imaging modalities, anesthesia, and three surgical treatment options for detected ruptures. A decision tree was used to compare three alternate screening strategies of ultrasound only, magnetic resonance imaging only, and ultrasound followed by magnetic resonance in asymptomatic and symptomatic women.
The cost per rupture of screening and management of rupture with ultrasound in asymptomatic women was $1090; in symptomatic women, it was $1622. A similar cost for magnetic resonance imaging in asymptomatic women was $2067; in symptomatic women it was $2143. A similar cost for ultrasound followed by imaging in asymptomatic women was $637; in symptomatic women, it was $2908.
Screening with ultrasound followed by magnetic resonance imaging was optimal for asymptomatic women, and screening with ultrasound was optimal for symptomatic women.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Oncologic, reconstructive, and cosmetic breast surgery has evolved in the last 20 years. Familiarity with cutting-edge surgical techniques and their imaging characteristics is essential for radiologic interpretation and may help avert false-positive imaging findings. Novel surgical techniques include skin- and nipple-sparing mastectomies, autologous free flaps, autologous fat grafting, and nipple-areola-complex breast reconstruction. These techniques are illustrated and compared with conventional surgical techniques, including modified radical mastectomy and autologous pedicled flaps. The role of magnetic resonance (MR) imaging in surgical planning, evaluation for complications, and postsurgical cancer detection is described. Breast reconstruction and augmentation using silicone gel-filled implants is discussed in light of the Food and Drug Administration's recommendation for MR imaging screening for "silent" implant rupture 3 years after implantation and every 2 years thereafter. Recent developments in skin incision techniques for reduction mammoplasty are presented. The effects of postsurgical changes on the detection of breast cancer are discussed by type of surgery. ©RSNA, 2014.
    Radiographics 05/2014; 34(3):642-60. DOI:10.1148/rg.343135059 · 2.73 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Implant rupture is a common late complication of breast implant procedures. Ruptures are often silent and difficult to diagnose clinically. This review demonstrates normal appearances and sonographic signs of implant rupture. Breast sonologists should be aware of these signs and pitfalls in interpretation when imaging breast implants.
    Clinical Radiology 04/2013; 68(8). DOI:10.1016/j.crad.2013.03.014 · 1.66 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: One of the recognized complications of augmentation mammoplasty is the rupture of the breast implant, a term used to refer to any breach in the cover of the implant, which can range from a small hole to its destruction. So far the gold standard for the diagnosis of implant rupture is just removal, and there is no consensus on the ideal type of image study to use in the search for ruptured implants. Studies on this topic are mostly retrospective cases of symptomatic patients in which the rupture of the implant was confirmed by surgical removal, so there is some bias in the results. The objective of this paper is to show the strengths and weaknesses of each diagnostic category and to propose an algorithm to guide the plastic surgeon with respect to the indication of the appropriate image method to use depending on the conditions of each patient.