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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

A 54-year-old woman with history of left breast cancer treated with mastectomy and TRAM reconstruction 10 years prior. a T2W, b unenhanced T1W fat saturated. c Enhanced T1W fat-saturated sequences demonstrate post-treatment changes within the left TRAM demonstrating minimal peripheral enhancement, which follows the fat signal on all sequences (arrows), consistent with fat necrosis. d Another patient, 53 years old, with DIEP reconstruction on the right presented with palpable lumps on the right, 2 years post-reconstruction surgery. Unenhanced T2W and enhanced T1W fat-saturated images demonstrate multiple masses (arrows) in the left breast showing a fat signal within the masses and minimal peripheral enhancement, consistent with fat necrosis
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Fig9: A 54-year-old woman with history of left breast cancer treated with mastectomy and TRAM reconstruction 10 years prior. a T2W, b unenhanced T1W fat saturated. c Enhanced T1W fat-saturated sequences demonstrate post-treatment changes within the left TRAM demonstrating minimal peripheral enhancement, which follows the fat signal on all sequences (arrows), consistent with fat necrosis. d Another patient, 53 years old, with DIEP reconstruction on the right presented with palpable lumps on the right, 2 years post-reconstruction surgery. Unenhanced T2W and enhanced T1W fat-saturated images demonstrate multiple masses (arrows) in the left breast showing a fat signal within the masses and minimal peripheral enhancement, consistent with fat necrosis

Mentions: At MR imaging, fresh fat necrosis is characterized by a round or irregular mass with central high-signal intensity on nonfat-suppressed unenhanced T1W images and high signal on T2W images, and exhibits variable enhancement following administration of gadolinium contrast material. It could show fast initial enhancement and washout on the delayed enhancement images. Chronic fat necrosis or an oil cyst appears as a round mass with smooth margins, with central high signal intensity on nonfat-suppressed unenhanced T1W images and high signal on T2W images, and exhibits no enhancement on early or delayed images. It will follow the fat signal on all sequences [15]. The presence of central fat signal intensity is the key to differentiating fat necrosis from tumor recurrence, as breast cancers do not contain central fat (Fig. 9).Fig. 9


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

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

A 54-year-old woman with history of left breast cancer treated with mastectomy and TRAM reconstruction 10 years prior. a T2W, b unenhanced T1W fat saturated. c Enhanced T1W fat-saturated sequences demonstrate post-treatment changes within the left TRAM demonstrating minimal peripheral enhancement, which follows the fat signal on all sequences (arrows), consistent with fat necrosis. d Another patient, 53 years old, with DIEP reconstruction on the right presented with palpable lumps on the right, 2 years post-reconstruction surgery. Unenhanced T2W and enhanced T1W fat-saturated images demonstrate multiple masses (arrows) in the left breast showing a fat signal within the masses and minimal peripheral enhancement, consistent with fat necrosis
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3369124&req=5

Fig9: A 54-year-old woman with history of left breast cancer treated with mastectomy and TRAM reconstruction 10 years prior. a T2W, b unenhanced T1W fat saturated. c Enhanced T1W fat-saturated sequences demonstrate post-treatment changes within the left TRAM demonstrating minimal peripheral enhancement, which follows the fat signal on all sequences (arrows), consistent with fat necrosis. d Another patient, 53 years old, with DIEP reconstruction on the right presented with palpable lumps on the right, 2 years post-reconstruction surgery. Unenhanced T2W and enhanced T1W fat-saturated images demonstrate multiple masses (arrows) in the left breast showing a fat signal within the masses and minimal peripheral enhancement, consistent with fat necrosis
Mentions: At MR imaging, fresh fat necrosis is characterized by a round or irregular mass with central high-signal intensity on nonfat-suppressed unenhanced T1W images and high signal on T2W images, and exhibits variable enhancement following administration of gadolinium contrast material. It could show fast initial enhancement and washout on the delayed enhancement images. Chronic fat necrosis or an oil cyst appears as a round mass with smooth margins, with central high signal intensity on nonfat-suppressed unenhanced T1W images and high signal on T2W images, and exhibits no enhancement on early or delayed images. It will follow the fat signal on all sequences [15]. The presence of central fat signal intensity is the key to differentiating fat necrosis from tumor recurrence, as breast cancers do not contain central fat (Fig. 9).Fig. 9

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