role of Portable high-resolution ultrasound in detecting breast implant rupture :Literature Review

Proposed title
Surgeon-Performed Ultrasound for Detection of Breast Implant Rupture: A Structured Literature Review

Background and rationale

Silicone breast implant rupture is frequently asymptomatic, and traditional recommendations emphasise MRI as the reference standard for assessment and surveillance. However, MRI is costly, resource-intensive, and not universally available. High-resolution breast ultrasound (US) has emerged as a practical alternative, and recent work suggests that, when performed by trained plastic surgeons in the clinic, surgeon-performed US may achieve diagnostic performance comparable to radiology-performed US and, in selected contexts, MRI.

Despite growing interest, evidence regarding surgeon-performed US for implant integrity is dispersed across small diagnostic-accuracy studies, observational cohorts, and educational reports. Key questions remain about its true sensitivity and specificity for rupture detection, its learning curve, feasibility in routine practice, and its impact on the need for MRI and on clinical decision-making. A structured literature review is required to synthesise current evidence, identify gaps, and guide future research and implementation.

Research question

What is the diagnostic performance, feasibility, and clinical impact of surgeon-performed ultrasound in the detection and surveillance of breast implant rupture compared with standard radiological imaging (radiologist-performed ultrasound and/or MRI) and surgical findings?


Objectives

1. To summarise the diagnostic accuracy (sensitivity, specificity, predictive values) of surgeon-performed ultrasound for detecting silicone breast implant rupture, using MRI and/or intra-operative findings as reference standards.
2. To describe training requirements and learning curves reported for plastic surgeons adopting in-office ultrasound for implant assessment.
3. To evaluate reported impacts on clinical pathways, including subsequent use of MRI, decision to operate, and patient counselling/management.
4. To identify knowledge gaps and limitations in the existing literature, and propose priorities for future prospective research.

Methods

This will be a structured literature review with a focus on surgeon-performed or plastic-surgeon–led ultrasound for assessment of breast implants.

Databases: MEDLINE (PubMed), Embase, Scopus, and Cochrane Library will be searched from inception to the present.

Search strategy: Combined keywords and MeSH terms will include concepts such as breast implants, silicone implants, implant rupture, ultrasound, high-resolution ultrasound, point-of-care ultrasound, plastic surgeon, and surgeon-performed*. Reference lists of included articles and key review papers will be screened for additional studies.

Eligibility criteria:

Population: Women with breast implants (aesthetic surgery only ) .
Intervention/index test:** Ultrasound performed by a plastic surgeon or breast surgeon (including HRUS and office-based or point-of-care US).
Comparator/reference standard:** Radiologist-performed US, MRI, and/or intra-operative findings regarding implant integrity.
Outcomes: At least one of: diagnostic accuracy metrics for rupture; description of training/learning curve; impact on imaging utilisation or clinical decision-making.

Study design: Diagnostic-accuracy studies, prospective or retrospective cohorts, case series ≥10 patients, and relevant methodological/educational reports. Opinion pieces without data will be excluded but may be used for contextual discussion.
Language: English (and others if translation is feasible).

Study selection and data extraction: Two reviewers (or one reviewer with verification) will screen titles/abstracts and then full texts against eligibility criteria. A standardised extraction form will capture study design, setting, surgeon training, ultrasound technique, reference standard, sample size, rupture prevalence, diagnostic performance, and reported clinical impact.

Quality assessment Where applicable, diagnostic-accuracy studies will be appraised using the QUADAS-2 framework. Observational studies will be assessed for risk of bias in sampling, measurement, and confounding.

Synthesis: A narrative synthesis will be performed, structured around:

* diagnostic performance of surgeon-performed US;
* learning curve and training requirements;
* impact on MRI utilisation and surgical decision-making;
* practical considerations for implementation in plastic surgery practice.
Where data are sufficiently homogeneous, simple pooled estimates of sensitivity and specificity may be explored descriptively, but formal meta-analysis is not the primary aim.



Expected significance

This literature review will provide a concise, evidence-based overview of the role of surgeon-performed ultrasound in detecting breast implant rupture. It will clarify whether in-house ultrasound can reliably triage patients, reduce reliance on MRI, and support same-day counselling in breast implant clinics. The findings will inform clinical practice guidelines, training curricula for plastic surgeons, and the design of future prospective diagnostic-accuracy and implementation studies.