Ultrasonography of the Postsurgical Breast Including Implants Gul Esen, MD , Deniz Cebi Olgun, MD The breast is one of the most common sites of sur- gical procedures performed for diagnostic and therapeutic or reconstructive purposes. Surgical interventions lead to many alterations in the breast tissue causing difficulty in the interpretation of clin- ical and radiologic findings. These changes re- solve almost completely within the first year after benign biopsy, with minor architectural distortion and scarring remaining. They can be accentuated and prolonged considerably after cancer surgery, however, mostly as a result of the effects of radia- tion therapy. 1,2 Although postsurgical changes can resemble malignant lesions in some patients, they also can mask signs of malignancy in others. It is important for radiologists to detect and appropriately recog- nize these alterations to diagnose recurrent tumor as early as possible, while there still is a chance for curative surgery. It also is important to avoid over- diagnosis in these patients so as not to lead to un- necessary biopsies of irradiated tissues where healing processes might be disturbed. Ultrasonography (US) is a useful adjunct to mammography for the evaluation of operated breasts. It not only gives valuable information in the evaluation of palpable masses and suspicious mammographic opacities but also can increase di- agnostic accuracy in the follow-up of these pa- tients. Because it is a cross-sectional modality, it is less affected by the architectural distortion and edema caused by surgery and therapy. Aug- mented breasts also are easier to evaluate by US compared with mammography. Evaluation of the treated breast is one of the most challenging aspects of breast imaging. This article reviews the sonographic findings in oper- ated breasts with the main focus on the conserva- tively treated breast. Also reviewed are the findings associated with excisional biopsies, breast implants, augmentation, and reduction mammoplasties. CONSERVATION THERAPY FOR BREAST CANCER Prospective randomized trials have established that there is no significant difference in the survival outcome of patients treated with mastectomy ver- sus breast conservation therapy. 3–8 The success of conservative treatment depends, however, on the appropriate selection and follow-up of eligible patients. It also depends on the trusted coopera- tion of a team of physicians; experienced radiolo- gists are important members of this team. During the preoperative period, the main re- sponsibility of a breast radiologist is to determine the disease extent as accurately as possible. Tu- mor size is an important determinant in the choice between breast-conserving surgery and mastec- tomy. Although there is no absolute size measure- ment that makes breast conservation impossible, in patients who have tumors larger than 5 cm, mastectomy usually is preferred. The more impor- tant factors for determination of the type of surgery are the ratio of the size of the tumor to the size of the breast and presence of multicentric dis- ease. 1,9,10 Studies have shown that US is more Istanbul University, Cerrahpasa Medical School, Department of Radiology, 34300 Istanbul, Turkey E-mail address: gulesen@istanbul.edu.tr (G. Esen). KEYWORDS  Breast  Breast neoplasms  US  Implants  TRAM flap  Reduction mammoplasty  Breast conserving surgery Ultrasound Clin 3 (2008) 295–329 doi:10.1016/j.cult.2008.10.002 1556-858X/08/$ – see front matter ª 2008 Elsevier Inc. All rights reserved. ultrasound.theclinics.com