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Correlation of high-resolution ultrasonographic findings with the clinical symptoms and electrodiagnostic data in carpal tunnel syndrome.

To the Editor: Becker implants contain an inner saline-containing compartment and an outer silicone gel–containing compartment. As in other implants, a silicone elastomer membrane surrounds each compartment. Although the incidence of the complications after tissue expander/ implant breast reconstruction has been reported to be as high as 52% in recent series, it is used widely and routinely in many centers today. Complication of the breast implants can be classified as acute and long-term complications. Acute complications include bleeding, seroma, infection, asymmetry, pain, and loss of sensations. We present a case with unreported acute complication of breast reconstruction with implant: inversion of the injection dome of the implant and detection with ultrasonography. A 41-year-old woman underwent breast reconstruction with a Becker implant (Becker 25 Expander/Mammary Prosthesis, 200 mL; Mentorcorp). A small separate pocket was created for the injection dome, but the dome was not sutured to the base. The postoperative period was uneventful until the third filling of the implant. Injection and withdrawing of the solution could not be performed with forced maneuvers. Ultrasonography was done for detection of the problem (Figure 1) and inversion of the injection dome was determined. The patient was operated under local anesthesia, and the dome was placed in proper position with sutures. Filling of the prosthesis was completed in the postoperative period, without complication. Previous reports of implant-based breast reconstruction have had variable numbers of complications and outcomes. The most common complication after implant-based reconstruction was infection. Although many perioperative and early complications were reported in the literature, to the best of my knowledge, inversion injection dome of the implant was not reported before. Becker expanders can be placed while deflated and subsequently expanded, usually by several small injections over time to stretch tissues gradually. I believe that these repeated injections to the unsutured injection dome caused this complication. This complication can be avoided with suturing of the implant to the base, creating a small pocket, and careful injection. Otherwise, the injection dome can be exteriorized through a long subcutaneous tunnel. Jackson et al described the exteriorization of the expander injection domes for 10 to 76 days, without any infection. There are various types and locations for fill ports. Two main classes of fill valves can be identified sonographically: diaphragm fill valves, which are by far the most frequently seen; and leaflet fill valves, which are less common. According to the study by Stavros et al, ultrasonography can detect the position of the dome easily because of the composition and solid pattern of the injection dome.