What is the management for a saline breast implant rupture?

Management of Saline Breast Implant Rupture

Saline breast implant rupture is usually clinically evident and typically requires surgical removal with potential replacement, as the saline is resorbed by the body over days, resulting in a noticeable change in breast size and shape. 1

Clinical Presentation and Diagnosis

• Clinical Recognition:

  • Rupture of saline implants is generally clinically apparent due to rapid deflation
  • Patients experience a noticeable change in breast size and shape over days as the saline is resorbed by the body 1
  • Average time to diagnosis of saline implant rupture is approximately 5.6 years after insertion 2

• Imaging Confirmation (if clinical diagnosis is equivocal):

  • Age <30 years: Ultrasound is the initial examination of choice 1
  • Age 30-39 years: Either ultrasound or diagnostic mammography/DBT 1
  • Age ≥40 years: Diagnostic mammography/DBT is first-line, with ultrasound for problem-solving 1

• Imaging Findings:

  • Ultrasound: Collapsed implant shell is visible 1
  • Mammography/DBT: Collapsed implant shell is visible and diagnostic 1
  • MRI: Not indicated for saline implant evaluation 1, 3

Management Algorithm

1. Confirm Diagnosis:

   • Clinical examination (visible asymmetry, size change)
   • Imaging if clinical findings are equivocal (based on age-appropriate modality)

2. Surgical Management:

   • Primary Treatment: Implant removal with or without replacement 2, 4
   • Options include:
     • Implant exchange with new implant 2
     • Complete removal without replacement 2
     • Fat grafting (in select cases) 2

3. Special Circumstances:

   • If Infection Present:

     • Mild infection: Oral antibiotics + surgical management 5
     • Severe infection: Intravenous antibiotics + removal without immediate replacement 5

   • If Exposure/Extrusion:

     • Without severe infection: Salvage may be attempted (90.9% success rate) 5
     • With severe infection: Removal with delayed replacement is recommended 5

Important Considerations

• Saline implant rupture is generally safer than silicone rupture as the saline is harmlessly absorbed by the body without significant sequelae 1

• Spontaneous rupture is the most common cause, but iatrogenic rupture can occur during other surgical procedures, particularly thoracic surgery 6

• False-positive diagnosis of rupture can occur with periprosthetic abscess, highlighting the importance of proper diagnostic evaluation 7

• Patients seeking implant removal due to rupture generally report satisfaction with the outcome despite potential aesthetic limitations 4

Follow-up

• No specific imaging follow-up is required for asymptomatic patients with saline implants 1
• Regular breast cancer screening should continue according to standard guidelines 1

Pitfalls to Avoid

• Do not rely on MRI for saline implant rupture diagnosis - it has no role in this setting 1, 3
• Do not delay management of infected implants, as this can lead to more severe complications 5
• Be cautious of misdiagnosis - periprosthetic abscess can mimic implant rupture on imaging 7