More than 300,000 women and teenagers underwent breast implant augmentation surgeries in 2017 (ASPS 2018). In addition, approximately 106,000 women underwent breast implant surgery for reconstruction after mastectomy. A concern of some women who have had breast implants and women interested in breast augmentation is the possible rupture of the implant. I advise my patients that rupture is an important consideration and a serious but not a common complication of breast implants. The longer you have a breast implant, the greater the chance of implant rupture.
WHAT IS A BREAST IMPLANT RUPTURE & BREAST IMPLANT RELATED ILLNESS?
What is a rupture? A breast implant rupture is a tear or hole in the outer shell of the breast implant. If you have saline implants you won’t have to wait long to get your answer. Usually the change in size as the saltwater bag deflates is rather quick. It may take a few days and in some cases the valve is the culprit and sometimes only a partial deflation is noted. Usually it will feel looser and often you will get a crinkly sensation. There is no need for alarm as it is just saltwater that your body will be shedding.
More stressful and more recently confusing are the individuals that believe they have a ruptured silicone implant. Silicone gel is thicker than saline, so when a silicone gel-filled implant ruptures, the gel may remain in the shell or in the scar tissue that forms around the implant (intracapsular rupture).
The concern is fueled by the 1992 implant scare where the FDA called for a stop on the use of silicone gel until safety concerns could be evaluated. It turns out that the silicone implant manufacturers failed to produce evidence of their safety when there were approved in the1960’s.
There was great concern that these were causing problems anywhere from autoimmune diseases such as Lupus, rheumatoid arthritis, and fibromyalgia, as well as the possibility of them causing many other symptoms such as loss of libido, loss of hair, GI disturbances and even the possibility of cancer.
From 1992, to 1997 a large number of retrospective and prospective studies were made involving huge numbers of women that have received implants. Statistically, NO correlations were made between the implants and these diseases and symptoms. However, it should be noted that on an individual basis, a foreign body of any type is possible to affect a person’s well-being. If you believe this to be the case, whether or not you believe them to be ruptured, I advise you to consult your physician and surgeon.
WHAT TO DO ABOUT A RUPTURED IMPLANT
My recommendation in these cases is to call your plastic surgeon and get an evaluation as soon as possible. While there is no health issue you do not want to let the capsule shrink up too much because it will make the replacement a little bit harder. This is simply because the capsule or the room in which the implant has lived will need to be re-enlarge so that the implant was replaced can be filled to full capacity. This is often a good time to change sizes or even consider silicone implant.
Now back to what to do with the possible ruptured implant…Sometimes a ruptured silicone implant will cause the body to create a capsular contracture. This simply means that the capsule, the space where the implant resides is now contracting and tightening making the breast firm. A long-term capsular contracture can also contribute to increase incidence of implant rupture as the continuous pressure on the implant can affect the shell or the bag of the implant. Diagnosis can be done with an MRI of the breast and most recently with 3-D ultrasound. They both have false positives and false negatives, but they have given us a tool to peek inside the breast and get an idea of the implant status.
Okay let say that we find a ruptured implant with free silicone inside the pocket! what is the implication? First of all, there is no capsular contracture, then the simple removal of the implant and the material and replacement is indicated. When the implant rupture is caused by significant trauma the capsule can be torn and the free silicone can leave the confines space. It is usually walled off by the body and can mimic a breast mass that will require biopsy and pathological examination. In these cases, removal of all the material including the capsule will be necessary.
Sometimes the silicone will be felt and a lymph node in the armpit. The lymphatic system which makes up the series of lymph nodes is simply cleaning up the silicone. Silicone in the lymph node by itself does not appear to be a problem. After the removal of the ruptured implant and material. A decision should be made on whether a replacement implant is desired or whether options such as breast lifts, fat grafts, or simply leaving the breast alone should be all entertained.
When I was training in 1988, we believed the implant manufacturers reports that these implants should last forever. Not so. I tell my patients to expect between 15 and 20 years of implant life. This does not mean that all implants rupture. Rupture after this point make it 15 or 20 years. I am simply giving patients the average time period based on my experience. Probably around 10 years after implantation one should consider a 3-D ultrasound or an MRI to ascertain that the implants are intact.
Usually the implant manufacturers have a warranty on the implants for 10 years. They will actually replace it now for the life of the patient, but they will help pay for the operation just for the first 10 years. A few are switching from saline to silicone, the manufacturers will pay the cost of the saline implants and pay you the difference. Still not a bad deal since they will often do it for the opposite side that is not ruptured as well.
I hope this has shed some light on your questions. If you have any concerns that were not addressed, please call my office for consultation.