BR WI

1. BR WI Others

3. Breast Augmentation Definition :
Plastic surgery terms for the breast-implant and the
fat-graft mammoplasty approaches used to increase
the size, change the shape, and alter the texture of
the breasts of a woman.
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4. Breast Augmentation Indication :
• Primary reconstruction : augmentation
mammoplasty is applied to effect a post–mastectomy
breast reconstruction, the repair of the chest wound
consequent to the removal of a cancerous breast; to
correct congenital defects of the breast(s); and to
correct congenital defects of the chest wall.
• Elective (cosmetic surgery).
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5. Breast Augmentation Type :
• Implant
- Saline Implant
- Silicone Implant
• Non Implant
- Fat grafting
- Paraffin injection (illegal)
- Liquid silicone injection (illegal)
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Saline Implant
Silicone Implant

6. Breast Implants
1.Saline Implant
Filled with saline solution (salt water 0.90% w/v
of NaCl, ca. 300 mOsm/L.)
2. Silicone Implant
Consist of an inorganic silicon-oxygen
backbone chain (⋯-Si-O-Si-O-Si-O-⋯) with
organic side groups attached to the silicon
atoms.
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7. Breast Implants Positioned
Most commonly positioned : Retropectoral
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8. Breast Implants Positioned
Most commonly positioned : Retroglandular
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9. Breast Implant Complications
Late postoperative complications
Capsular
contracture
Silicone
granuloma
formation
Implant rupture
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Early postoperative complications
Hematoma Infection

10. Breast silicon rupture, Siliconoma

11. Implant Rupture
Classified as :
1. Intracapsular
2. Extracapsular
Most implant ruptures (77–89%) are
intracapsular
A gel bleed is defined as the normal
transudation of microscopic amounts of
silicone gel through an intact shell.
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12. Implant Rupture
Schematic of implant complications. Left: fibrous capsule normally surrounds the intact
implant. Middle:Intracapsular rupture. The implant shell is ruptured, but the silicone is
contained in the fibrous capsule. Right:Extracapsular rupture. The implant capsule and
the fibrous capsule are damaged, and silicone is outside the fibrous capsule.

13. Intracapsular Rupture
• This is the most common type of rupture (80-90%).
• The integrity of the implant is breached but the
fibrous capsule is intact, so the silicone leakage
does not extend beyond the capsule and is
confined within the periprosthetic space.

14. Intracapsular Rupture
Ultrasound:
• The "stepladder" sign:
Multiple linear or curvilinear
lines in the interior of the
implant at various levels that
correlates with the linguine
sign.
• Low-level echoes within the
implant or isoechoic
silicone between the
fibrous capsule and the
implant surface, as a sign of
minimally collapsed implant
rupture.
MRI
• Linguine sign : the most
reliable criterion is the 
collapsed intracapsular
rupture.
• Subcapsular line" sign:
a thin layer of silicone placed
between the shell and the
fibrous capsule.
• "Pull away" sign:
a localized separation of the
inner membrane of an implant
with gel on both sides.
• "Keyhole", "noose" or
"inverted-loop" sign
• "Teardrop" sign , "droplet"
sign,rat tail sign

15. Ultrasound Appearances
34 yo woman, Ultrasound shows
series of thin, double echogenic
lines that course parallel to probe
surface representing collapsed
implant shell flating within silicone
gel; most reliable sign of
intracapsular rupture 
“stepladder sign.”
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16. Ultrasound Appearances
39 yo woman, Ultrasound
image shows diffuse low-level
internal echoes within
implant. This sign may be
observed in patients with
intracapsular rupture
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17. Intracapsular Rupture
Sagittal FSE T2-weighted image. Intracapsular
rupture of a single lumen silicone-filled
implant with intracapsular rupture.
"Linguine" sign (arrow) and "keyhole"sign
(circle).
Sagittal FSE T2-weighted sequence.
Intracapsular rupture in a reverse doble-
lumen implant. "Teardrop" sign (arrow).

18. 18
Teardrop Sign Keyhole sign
Subcapsular line

19. Extracapsuler Rupture
• There is a rupture of both the implant shell and the
fibrous capsule, with silicone leakage that extends
into the surrounding tissues.

20. Extracapsular implant rupture. Breast ultrasound showing an echogenic
mass with dirty posterior shadowing, termed the "snowstorm" sign.

21. Oil Cyst

27. • Asherman syndrome, also known as uterine
synechiae, is a condition characterized by the
formation of intrauterine adhesions, which are
usually sequela from injury to the endometrium,
and is often associated with infertility.
• Clinical presentation
• Patients may present with infertility, pregnancy
loss, menstrual abnormalities (e.g. 2ry amenorrhea,
hypomenorrhea, dysmenorrhea) or abdominal
pain 1.

29. Adenomyosis

30. Adenomyosis
• Adenomyosis (or uterine
adenomyosis) is a
common uterine
condition of ectopic
endometrial tissue in the
myometrium, sometimes
considered a spectrum
of endometriosis.
• Although most commonly
asymptomatic, it may
present with
menorrhagia and
dysmenorrhea.
• Type
• Focal
• Diffuse
• Deep Infiltrate
Radiopedia
• cystic
adenomyosis and adenom
yotic cyst: rare

31. • The most frequent finding for the diagnosis of
adenomyosis is thickening of the junctional zone,
with a thickness exceeding 12 mm being highly
predictive of the diagnosis

35. USG :
lacunar placenta
Meningkatnya vaskularitas
plasenta-myometrium
Hilangnya zona ekholusen di
retroplasenta
MRI :
Intraplacental dark band
Abnorminal hipertropied
vessel
Loss of interface between
myometrium dan plasenta
24%pd pasen dengan
previa+sc 1x
67%pd pasen dengan previa
+3/lbh
Pembahasan

36. Mondor Disease