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MR imaging of the reconstructed breast: What the radiologist needs to know.

Dialani V, Lai KC, Slanetz PJ - Insights Imaging (2012)

Bottom Line: Surgical management of breast cancer often entails lumpectomy or mastectomy.In this article, we will review the more commonly encountered types of breast reconstruction, which include implants, tranversus rectus abdomnis flap, latissimus dorsi flap, deep inferior epigastric perforator flap, and gluteal flaps.Radiologists will better understand the different types of breast reconstruction after mastectomy and their normal imaging appearance on MRI.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Beth Israel Deaconess Medical Center, C/o Dr. Vandana Dialani, 330 Brookline Avenue, Boston, MA, 02215, USA, vdialani@bidmc.harvard.edu.

ABSTRACT

Objective: The objective is to review the different types of breast reconstruction following cancer surgery and describe expected imaging appearances and complications seen in the reconstructed breast.

Methods: Surgical management of breast cancer often entails lumpectomy or mastectomy. When mastectomy is performed, patients often opt for breast reconstruction. Most facilities do not routinely image the reconstructed breast with mammography.

Results: However, many of these women are imaged with screening breast MRI for evaluation of the contralateral breast, or they may develop a clinical problem that warrants a diagnostic evaluation with MRI. In this article, we will review the more commonly encountered types of breast reconstruction, which include implants, tranversus rectus abdomnis flap, latissimus dorsi flap, deep inferior epigastric perforator flap, and gluteal flaps. Each of these types of reconstruction has different appearances on MR. We will also discuss potential complications that can be seen in the reconstructed breasts, including fat necrosis and recurrence.

Conclusion: Radiologists will better understand the different types of breast reconstruction after mastectomy and their normal imaging appearance on MRI. Radiologists will be more aware of how to recognize complications related to surgery as well as how to determine whether recurrence is present.

Main messages: • The different surgical techniques used in breast reconstruction are discussed. • Describes the normal magnetic resonance imaging appearance of the breast after reconstruction. • Identify MR imaging features of benign sequelae and recurrence following breast reconstruction.

No MeSH data available.


Related in: MedlinePlus

Image of a 58-year-old woman with DIEP reconstruction of the left breast showing a spiculated area (arrow) in the posterior breast. The mass demonstrates a low signal intensity on the T2W image, b intermediate signal intensity on the T1W fat-saturated unenhanced image, and c no enhancement on the gadolinium-enhanced T1W image, indicative of fibrosis
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Fig8: Image of a 58-year-old woman with DIEP reconstruction of the left breast showing a spiculated area (arrow) in the posterior breast. The mass demonstrates a low signal intensity on the T2W image, b intermediate signal intensity on the T1W fat-saturated unenhanced image, and c no enhancement on the gadolinium-enhanced T1W image, indicative of fibrosis

Mentions: Fibrosis is a common sequel of radiation therapy in the breast. Atrophy and fibrosis of the transplanted muscle are also seen as a sequel to reconstructed breast. One of the challenges in evaluating the postoperative breast is to differentiate between postoperative or post–radiation therapy scarring and tumor recurrence. Here MR imaging may often prove helpful, as post-radiation therapy fibrosis often displays low signal intensity on T2-weighted images, whereas tumor recurrence is generally isointense to slightly hyperintense to the surrounding breast parenchyma. However, an overlap exists between the two. In general, fibrosis can be differentiated from tumor by the degree and kinetics of contrast enhancement. Fibrosis is characterized by no enhancement or low-level enhancement that gradually increases with time (Fig. 8). Tumors exhibit more rapid and pronounced tissue enhancement, often with washout kinetics at delayed imaging [13]. However, false-positive results in the early postoperative period and up to several months following radiation treatment are common due to the presence of enhancing granulation tissue [14].Fig. 8


MR imaging of the reconstructed breast: What the radiologist needs to know.

Dialani V, Lai KC, Slanetz PJ - Insights Imaging (2012)

Image of a 58-year-old woman with DIEP reconstruction of the left breast showing a spiculated area (arrow) in the posterior breast. The mass demonstrates a low signal intensity on the T2W image, b intermediate signal intensity on the T1W fat-saturated unenhanced image, and c no enhancement on the gadolinium-enhanced T1W image, indicative of fibrosis
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3369124&req=5

Fig8: Image of a 58-year-old woman with DIEP reconstruction of the left breast showing a spiculated area (arrow) in the posterior breast. The mass demonstrates a low signal intensity on the T2W image, b intermediate signal intensity on the T1W fat-saturated unenhanced image, and c no enhancement on the gadolinium-enhanced T1W image, indicative of fibrosis
Mentions: Fibrosis is a common sequel of radiation therapy in the breast. Atrophy and fibrosis of the transplanted muscle are also seen as a sequel to reconstructed breast. One of the challenges in evaluating the postoperative breast is to differentiate between postoperative or post–radiation therapy scarring and tumor recurrence. Here MR imaging may often prove helpful, as post-radiation therapy fibrosis often displays low signal intensity on T2-weighted images, whereas tumor recurrence is generally isointense to slightly hyperintense to the surrounding breast parenchyma. However, an overlap exists between the two. In general, fibrosis can be differentiated from tumor by the degree and kinetics of contrast enhancement. Fibrosis is characterized by no enhancement or low-level enhancement that gradually increases with time (Fig. 8). Tumors exhibit more rapid and pronounced tissue enhancement, often with washout kinetics at delayed imaging [13]. However, false-positive results in the early postoperative period and up to several months following radiation treatment are common due to the presence of enhancing granulation tissue [14].Fig. 8

Bottom Line: Surgical management of breast cancer often entails lumpectomy or mastectomy.In this article, we will review the more commonly encountered types of breast reconstruction, which include implants, tranversus rectus abdomnis flap, latissimus dorsi flap, deep inferior epigastric perforator flap, and gluteal flaps.Radiologists will better understand the different types of breast reconstruction after mastectomy and their normal imaging appearance on MRI.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Beth Israel Deaconess Medical Center, C/o Dr. Vandana Dialani, 330 Brookline Avenue, Boston, MA, 02215, USA, vdialani@bidmc.harvard.edu.

ABSTRACT

Objective: The objective is to review the different types of breast reconstruction following cancer surgery and describe expected imaging appearances and complications seen in the reconstructed breast.

Methods: Surgical management of breast cancer often entails lumpectomy or mastectomy. When mastectomy is performed, patients often opt for breast reconstruction. Most facilities do not routinely image the reconstructed breast with mammography.

Results: However, many of these women are imaged with screening breast MRI for evaluation of the contralateral breast, or they may develop a clinical problem that warrants a diagnostic evaluation with MRI. In this article, we will review the more commonly encountered types of breast reconstruction, which include implants, tranversus rectus abdomnis flap, latissimus dorsi flap, deep inferior epigastric perforator flap, and gluteal flaps. Each of these types of reconstruction has different appearances on MR. We will also discuss potential complications that can be seen in the reconstructed breasts, including fat necrosis and recurrence.

Conclusion: Radiologists will better understand the different types of breast reconstruction after mastectomy and their normal imaging appearance on MRI. Radiologists will be more aware of how to recognize complications related to surgery as well as how to determine whether recurrence is present.

Main messages: • The different surgical techniques used in breast reconstruction are discussed. • Describes the normal magnetic resonance imaging appearance of the breast after reconstruction. • Identify MR imaging features of benign sequelae and recurrence following breast reconstruction.

No MeSH data available.


Related in: MedlinePlus