From the Guidelines
If you suspect a ruptured breast implant, you should consult a plastic surgeon or healthcare provider immediately for evaluation, as prompt treatment can help minimize potential complications and improve outcomes, particularly for silicone implants where silicone can leak into surrounding tissues, potentially causing inflammation or granulomas 1.
Implications of a Ruptured Breast Implant
The implications of a ruptured breast implant can be significant, and it is essential to seek medical attention promptly. Signs of rupture include changes in breast shape, size, firmness, increased pain, swelling, or lumps.
Diagnosis and Treatment
Diagnosis typically requires imaging such as an MRI, ultrasound, or mammogram. Treatment usually involves surgical removal of the damaged implant and replacement if desired. For silicone implants, removal is more urgent as silicone can leak into surrounding tissues, potentially causing inflammation or granulomas 1. Saline implant ruptures are less medically concerning as the saltwater solution is safely absorbed by the body, though the breast will appear deflated.
Importance of Regular Check-ups
Regular check-ups with your healthcare provider are recommended for those with breast implants, with MRI screening suggested 3 years after implantation and every 2 years thereafter for silicone implants 1. This can help identify potential issues early on and prevent complications.
Key Considerations
- Extracapsular silicone implant ruptures can present with palpable findings or other symptoms, and mammography or DBT can identify extracapsular silicone 1.
- Sonographic findings of intracapsular rupture have been described, including a “stepladder” appearance of the collapsed implant shell, but US is well known to be operator dependent, and other studies have reported much lower sensitivities and accuracies for US diagnosis of intracapsular silicone implant rupture 1.
- MRI findings of both intracapsular and extracapsular rupture have been described, and pooled data from a recent meta-analysis showed sensitivity of 87% and specificity of 89.9% for MRI 1.
Recommendations
- Consult a plastic surgeon or healthcare provider immediately if you suspect a ruptured breast implant.
- Do not attempt to diagnose or treat a suspected rupture yourself, as proper medical assessment is essential to determine the extent of the rupture and appropriate treatment options.
- Regular check-ups with your healthcare provider are crucial for those with breast implants, with MRI screening suggested 3 years after implantation and every 2 years thereafter for silicone implants.
From the Research
Implications of a Ruptured Breast Implant
- A ruptured breast implant may be detected by physical exam, ultrasound, or magnetic resonance imaging (MRI) 2, 3, 4.
- The majority of silicone implant ruptures are clinically undetectable, but symptomatic patients may present with capsular contracture, breast lumps, or changes in breast shape 2.
- The most common cause of implant rupture is instrument damage during placement, and rupture may be confined to the peri-prosthetic capsule or may extravasate into the breast tissue 2, 5.
- Patients with ruptured implants have been studied closely, and the consensus of the literature states that there are no health risks associated with implant rupture 2.
- Symptomatic patients with ruptured implants should be offered the choice of observation, or explantation and capsulectomy with or without replacement 2.
Diagnosis and Management
- MRI is the most sensitive and specific study to evaluate breast implant rupture, but mammography supplemented with ultrasonography constitutes the most cost-effective initial study 3.
- Breast sonologists should be aware of the sonographic signs of implant rupture, including normal appearances and pitfalls in interpretation when imaging breast implants 4.
- Silicone granuloma formation is a potential complication of silicone implant rupture, and breast MRI is a useful diagnostic tool to assess implant integrity and complications 6.
Complications and Risks
- Iatrogenic damage is the most frequent cause of rupture, suggesting that rupture may be more often operator-related than device-dependent 5.
- The cumulative incidence of rupture has been correlated with implant generation, and extensive data on current-generation breast implants are now available from numerous sources 5.
- There is a critical need to implement uniform statistical methodology using follow-up data only through the patient's last MRI scan, as rupture rates can vary greatly depending on the statistical methodology selected 5.