Yonsei Med J.  2008 Feb;49(1):111-118.

Imaging Findings of Implanted Absorbable Mesh in Patients with Breast Partial Resection

• Kwag HJ

Abstract

PURPOSE
The author presents imaging findings of patients that underwent partial resection of the breast followed by absorbable mesh implantation. MATERIALS AND METHODS: Ultrasonographic (n=18) and mammographic (n=11) images of patients that had undergone absorbable mesh implantation after breast partial resection were reviewed retrospectively. Sequential changes of the lesions were analyzed in follow-up ultrasonographic examinations, focusing on the change of the size and pattern of the lesion. The presence of a mass, asymmetry, focal asymmetry, architectural distortion, and calcification were evaluated by mammography. Pathologic findings of the implanted mesh in available cases were analyzed. RESULTS: Ultrasonograms revealed a well-encapsulated anechoic lesion with (pattern 1, n=11) or without (pattern 2, n=5) internal isoechoic nodular portion, and a hyperechoic mass-like lesion without anechoic portion (pattern 3, n=2). The mean length of the longest diameter decreased gradually as determined in follow-up examinations (3 months, 6.12 +/- 2.599cm; 6 months, 5.08 +/- 2.105cm; 12 months, 3.26 +/- 2.206cm). In mammograms, a mass (n=4) was noted at the surgical site and focal asymmetry, overlapping with the postoperative change, was seen in the remaining seven cases. Pathologic findings of two cases revealed foreign body reaction. CONCLUSION: Ultrasonography of the patients that underwent breast partial resection followed by absorbable mesh implantation showed a well-encapsulated cyst at the surgical site that gradually decreased in follow-up examinations. Adjunctive ultrasonography combined with mammography would be recommended in postoperative follow-up examinations.

Keyword

Absorbable implants; surgical mesh; breast; ultrasonography; mammography

MeSH Terms

Absorption
Adult
Biocompatible Materials/*metabolism
Breast/*cytology/metabolism/*surgery
*Breast Implants
Female
Humans
Magnetic Resonance Imaging
Mammography
Middle Aged
Retrospective Studies
*Surgical Mesh
Ultrasonography, Mammary

Figure

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  Fig. 1 A sheet of absorbable mesh folded in a fan shape and wrapped with oxidized regenerated cellulose.

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  Fig. 2 Initial ultrasonography (A) performed about 3 months after surgery of the patient that had undergone wide local excision due to an intraductal papilloma and polyglycolic acid mesh implantation revealed a well-encapsulated anechoic lesion with internal isoechoic nodular portion (pattern 1). The size of the lesion decreased gradually as seen in follow-up examinations about 6 (B) and 12 months after surgery (C).

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  Fig. 3 Postoperative mammogram of the patient, who underwent endoscopic quadrantectomy due to invasive ductal carcinoma, 3 months after surgery revealed a 4 cm sized mass (arrows) at the surgical site. The mass correlated with a well-encapsulated anechoic lesion with internal isoechoic nodular portion (pattern 1) in ultrasonogram (B) performed at the same day.

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  Fig. 4 A case of total mastectomy 16 months after wide local excision and absorbable mesh implantation due to a recurrent malignant phyllodes tumor showed a radiologic-pathologic correlation. Ultrasonogram (A) and magnetic resonance images (B-D), taken a day before the total mastectomy, showed the recurred tumor mass (arrows) and the well-encapsulated isoechoic lesion made by the implanted absorbable mesh (arrowheads). The implanted mesh showed high signal intensity in T1- (B) and T2- (C) weighted images compared with that of the breast parenchyma and subtle rim enhancement in a subtracted dynamic enhanced T1-weighted image (D). The gross specimen of the resected breast (E) was correlated with the radiologic findings. Microscopic examinations (H & E staining, × 1(F), × 40 (G)) revealed an evacuated cystic lesion (★) encapsulated by fibrous tissue (F) and the internal content containing giant cells and foamy macrophages (G).

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