ABSTRACT Introduction: Detection of ruptured breast implants can be challenging, even with MRI. The aim of this study was to examine different breast implants ex vivo with contrast-enhanced ultrasound (CEUS) to determine whether this technique allows screening of implant failure. Objectives: 20 breast implants were examined. Ultrasound was performed using B-mode and CEUS with a multifrequency linear probe after injecting SonoVue to a box filled with NaCl. For interpretation, a scoring system was created (CEUS 1: intact implant, CEUS 5: obvious leakage, called macro-leakage). Results: CEUS was able to detect leakages of all implants, including micro-leakages, verified via microscopy (sensitivity: 100%). Polyurethane (PU) implants with CEUS 2 had a median time of implantation of 14.1 years, silicone implants with CEUS 5 were implanted 3.1 years on average. Silicone implants displayed no significant linear correlation between foreign body capsule formation (Baker score) and CEUS score (correlation coefficient r=0.08). Most of the PU implants with lower Baker grade 3 showed a lower CEUS grade and vice versa, leading to a high correlation (r=0.77). Conclusions: CEUS can be useful to detect implant rupture as an additional method for patients with equivocal sonographic findings. This is a new technique that can help diagnose surface qualities of breast implants
