Fundamentals of High-Resolution Ultrasound in Breast Implant Screening for Plastic Surgeons

Now is the time for the plastic surgeon community to embrace ultrasound technology, and learn how to screen for breast implant issues. The equipment is now affordable, especially compared with other imaging devices within a typical practice. It is recommended that the surgeon and one or more members of their staff receive hand-on training, which should involve patients or volunteers with implants. After that, the best approach is to routinely scan as many patients as possible to increase familiarity with different implants and different clinical situations. Questionable findings should be reviewed by others with more experience. Although the learning curve is relatively short, a surgeon new to ultrasound should get a confirmatory MRI before basing their decision about whether to take a patient to surgery solely on their reading of a ruptured implant. Surgeons are also advised to conduct an ultrasound examination of their revision patients immediately before surgery, to better visualize and compare the ultrasound findings to the clinical situation. When effectively incorporated into a surgeon's practice, HRUS quickly becomes an extension of the physical examination. It allows surgeons to visualize deeper tissue planes; determine if any fluid is present; better plan for surgery knowing if an implant is textured or smooth; and most importantly, know whether the implant shell is ruptured or intact. HRUS allows for better billing practices and time management for plastic surgeons, informing them of what to expect in revision or replacement surgery. Ultrasound is also transformational in other aspects of plastic surgery practices, including ultrasound-guided seroma management, identification of deep fill ports, and guidance of anesthetic injections and fat transfer placement.