Figure 8.

A 65-year-old female with 2-week history of painful new lump in the medial right breast. She had bilateral subglandular silicone implants placed over 40 years ago with history of left implant rupture 4 years after placement, which was replaced with a subpectoral silicone implant. (a) Right mammogram shows high density material adjacent to the calcified fibrous capsule of the right subglandular implant (arrow) suspicious for extracapsular silicone. This corresponded to the palpable mass. Left mammogram also demonstrated extracapsular high density material (arrow), suspicious for implant rupture. (b) Ultrasound in the area of palpable right breast mass demonstrates dense shadowing with a snowstorm appearance of silicone. (c) Ultrasound of left lateral breast shows snowstorm appearance with focal cyst corresponding to extracapsular silicone noted on mammogram. (d) Old CT scan from 20 years ago shows intact right calcified fibrous capsule but the implant envelope is displaced from the capsule medially consistent with intracapsular rupture (arrow). (e). Monoenergetic DECT shows heavily calcified right fibrous capsule with collapsed and calcified implant envelope (arrowhead). Indeterminant new soft tissue density tissue medial to the implant corresponding to the palpable mass (arrows).  (f) DECT silicone color mapping images. In the right breast, palpable mass corresponds to extra-capsular silicone (arrows). There is addditional silicone anteriorly in the right breast (arrowhead). In the left breast, there is an intact left subpectoral implant. Extra-capsular silicone laterally in the left breast (arrow) is from prior implant rupture. This was biopsied and showed fat necrosis and multiple cysts filled with foreign material which would be consistent with silicone, associated inflammation and foreign body macrophages.    DECT, dual energy CT.