A 45F with a PSH of silicone breast implants in ’99 comes in to the ED after slipping on some ice and falling onto her chest.  She is concerned that an implant broke and that she’ll “get blood poisoning or cancer” if the implant isn’t taken out right away.  What is the appropriate management of this patient?

First of all, she will not get “blood poisoning”, cancer, or any other life-threatening problem from a ruptured implant that is not addressed right away.  Most implant ruptures are silent, but a patient may present with an irregularly shaped breast or experience breast/chest pain, mastitis, or inflammatory skin changes from the leaked silicone.  Removing the implant is not an emergency and can be addressed as an outpatient.  However, if we were to image the patient in the ED, *breast MRI* would be the appropriate imaging study.  While ultrasound is the appropriate modality for identifying saline implant ruptures, US has insufficient sensitivity and specificity for silicone implants.