What is the best imaging modality for assessing implant rupture?

• A. Mammography
• B. Ultrasound
• C. MRI
• D. CT

Answer: (C)

Magnetic resonance imaging is the imaging method of choice for evaluating suspected breast implant rupture because it provides the most accurate assessment of implant integrity and silicone leakage. MRI uses silicone-specific sequences that clearly visualize the implant shell and any silicone that has escaped the capsule, allowing precise distinction between intracapsular rupture (the shell is folded or ruptured but remains within the fibrous capsule) and extracapsular rupture (silicone outside the capsule). A classic MRI sign of intracapsular rupture is the linguine sign, where folded shell strands appear like noodles within the implant. This level of detail and accuracy is why MRI has the highest sensitivity and specificity for rupture. Ultrasound can detect rupture signs such as a collapsed shell within the capsule (sometimes described as a step-ladder appearance), but it is more operator-dependent and less reliable for intracapsular rupture. Mammography and CT provide limited information about rupture and are not as effective for this purpose due to artifacts and soft-tissue visualization limits.