A. Incorrect. The mammogram would be abnormal because silicone outside the fibrous capsule (that which is created by the body in reaction to the implant) can be seen mammographically as streaky densities, dense masses, and bright foci within lymph nodes. Mammography is sensitive enough to diagnose silicone implant rupture when the silicone is outside the fibrous capsule.
B. Correct. Mammography is not sensitive enough to detect intracapsular silicone implant rupture in most cases. Breast MRI without gadolinium-enhancement is a more sensitive examination. Specific findings described for the MRI findings of intracapsular rupture include the linguine sign created by the collapsed silicone envelope floating within the silicone held in place by the fibrous capsule.
C. Incorrect. When a saline implant ruptures, the saline is resorbed leaving the collapsed silicone envelope behind. This collapsed envelope has an easily recognized abnormal mammographic appearance.
D. Incorrect. The striking density of the silicone within lymphatics or ducts, the silicone-related
granulomatous reaction within the breasts, and fat necrosis associated with injections of paraffin or other oils that may be injected with the silicone create a very abnormal mammogram.