ACR Appropriateness Criteria® Breast Implant Evaluation: Update 2025

Abstract

For asymptomatic patients with saline implants, no imaging is recommended. If there is suspected saline implant rupture, ultrasound is usually appropriate, though saline implant rupture is often clinically evident. For asymptomatic patients with silicone implants, the FDA recommends that patients have an initial ultrasound or MRI examination without contrast 5 to 6 years after initial silicone implant surgery and then every 2 to 3 years thereafter. In a patient with silicone implants and suspected implant complication, MRI without contrast is usually appropriate and ultrasound and/or mammography may be appropriate, depending on age. In a patient with unexplained axillary adenopathy with current or prior silicone breast implants, ultrasound and/or mammography are usually appropriate, depending on age. In the setting of a patient with breast implants of any type and suspected implant-associated malignancy, ultrasound or MRI without and with contrast is usually appropriate as initial imaging test. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

Keywords: AUC; Appropriate Use Criteria; Appropriateness Criteria; axillary adenopathy; breast implant; breast implant-associated anaplastic lymphoma (BIA-ALCL); breast implant-associated malignancy; breast implant-associated squamous cell carcinoma (BIASCC); implant rupture; saline implant; silicone implant.