The rupture of silicone implants can cause the patient some concern regarding diagnosis and management.
The rupture of silicone implants can cause both the patient and plastic surgeon some concern regarding diagnosis and management. This article will glance over:
- rates of implant rupture,
- types of implant rupture,
- diagnosis and
- treatment options.
The incidence of rupture of silicone implants varies greatly according to the type of implant used, the age of the implant, degree of capsular contracture and a history of trauma (including mammography).
The diagnosis can be made by physical examination, mammography, ultrasound, or magnetic resonance imaging. More commonly, however, implant rupture is unnoticed by the patient because the free silicone is kept in place by the fibrous capsule, and often neither form nor feeling of the breast changes.
How often do implants rupture?
In a study published this year examining the incidence of breast implant rupture for newer generation cohesive implants, MRI scans cited a rupture rate of 12-17% after 10 years.
Based on MRI data in a study by Mentor, the estimated rupture rate for their Contour Profile Gel breast implant was low, with the rupture rate at 6 years of:
- 2.1% for primary augmentation,
- 2.9% for revision- augmentation,
- 1.5% for breast reconstruction,
So what do you do as a patient?
Ask your plastic surgeon, what implants he/she uses and ask for the most relevant and recent data available on the implants.
So what are the different ways implants can rupture?
The escape of silicone gel from the implant shell can be divided into 2 categories:
- Intracapsular rupture: This is the more common form of rupture accounting for 80-90% of ruptured implants. The leakage of the silicone doesn't extend beyond the fibrous capsule and most often is unrecognised because of a lack of symptoms or physical changes in breast configuration.
- Extracapsular rupture: Less common accounting for 10-20% of ruptured implants. There is leakage of gel outside the fibrous capsule into the surrounding breast tissue, with some reports in the literature of migration of the silicone particles to distant sites such as the arm pit.
How do I diagnose a ruptured implant?
In most cases ruptured implants are unnoticed as they are small intracapsular leaks with no external changes to the breast's dimensions. Should you suspect an implant rupture or you require reassurance of the integrity of your implants, then there are a number of imaging modalities available to you; namely MRI, mammogram or ultrasound. Each modality has its strengths and weaknesses, however MRI is the imaging modality of choice as it can more readily emphasise or suppress the signal from water, fat or silicone, therefore delineating silicone from surrounding breast tissue including the capsule.
The diagram below shows an intracapsular rupture and the arrows on the MRI show the appearance of a collapsed implant shell.
In the diagram and MRI below you can see an extracapsular rupture, with the straight arrow showing silicone outside the breast capsule.
Is a ruptured implant dangerous and what should I do?
Implant failures can be treated by simple implant exchange and washout of the implant pocket.
Should you decide not to undergo an operation to replace your implants, it is reassuring to know that on the basis of the currently available scientific evidence, untreated silicone breast implant rupture is a relatively harmless condition, which rarely gives rise to notable symptoms.
Because implant ruptures often occur asymptomatically, any woman with silicone implants, regardless of rupture status, should be evaluated at regular intervals by their plastic surgeon.