Less Conventional Breast Augmentation Techniques

There are less conventional breast augmentation techniques, specifically intramammary injections of free silicone and hyaluronic acid. These methods, although less common or even prohibited, present unique imaging challenges that necessitate expert radiological understanding to manage effectively. Historically used for cosmetic enhancement, silicone remains a permanent substance within the body, leading to long-term complications such as pain and granulomas. The imaging appearance is characterized by densely coalesced masses known as siliconomas, which significantly complicate interpretation by obscuring underlying breast tissue. This can hinder the accurate diagnosis of breast conditions and requires careful imaging techniques to differentiate between normal post-procedure appearances and potential malignancies. Hyaluronic acid injections, on the other hand, are temporary, attracting water molecules to enhance volume. This technique uses a denser form of hyaluronic acid compared to that used for facial treatments, tailored by viscosity and cross-linking properties to achieve desired outcomes. The imaging after hyaluronic acid injections shows less dense, confluent masses compared to silicone. These substances appear as variable-sized pseudo-cysts on ultrasound, lacking the "snowstorm" appearance typical of silicone, which aids in differentiating the two substances in clinical assessments. Overall, this chapter emphasizes the importance of radiologists being fully aware of these techniques to effectively interpret diagnostic images and manage potential complications.