Ms. Powers is a 54 year old female with complicated surgical history including recent excisional biopsy in 11/2015 for recurrent secretory carcinoma with close cranial inked surgical margin. She presents today for MRI for further evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.Bilateral retroglandular silicone implants are intact.RIGHT BREAST:In the right retroareolar region, there is irregular enhancement along with associated architectural distortion identified, measuring approximately 2.6 x 2.9 x 2.2 cm (AP x ML x SI). This measures approximately 3.2 cm in AP oblique dimension. The enhancement extends from the anterior aspect of the implant to the nipple. Based on the history of multiple excisional biopsies/lumpectomies, it is unclear whether this enhancement represents residual disease versus post-surgical changes.However, there is no additional abnormal enhancement identified elsewhere in right breast. LEFT BREAST:There is no abnormal enhancement in the left breast. AXILLAE:No abnormal axillary lymph nodes are identified in either axillary region.
(1) 3.2 cm area of irregular enhancement in the right retroareolar region, spanning from the implant to the nipple. Based on the history of multiple excisional biopsies/lumpectomies, it is unclear whether this enhancement represents residual disease versus post-surgical changes. However, this MR-detected area of enhancement does correspond in distribution and location to the mammographically detected residual calcifications on recent diagnostic workup (from 05/24/2016), favoring residual disease.(2) No MRI evidence of malignancy in the left breast. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: B - Surgical Consultation.