What is the recommended treatment for a right intracapsular (within the capsule) rupture of a breast implant?

Management of Right Intracapsular Breast Implant Rupture

Surgical removal of the ruptured implant is the recommended treatment for intracapsular breast implant rupture to prevent complications such as silicone migration and inflammatory reactions.

Diagnostic Confirmation

• MRI without contrast is considered the gold-standard imaging study for confirming intracapsular implant rupture, with a sensitivity of 87% and specificity of 89.9% 1
• Complete intracapsular rupture presents with the characteristic "linguini" or "wavy-line" sign on MRI, which is the most specific sign of intracapsular implant rupture 1
• Incomplete intracapsular rupture may show "inverted-loop sign," "keyhole sign," "teardrop sign," or "hang noose sign" on MRI 1
• Ultrasound may be used as an initial evaluation but has lower sensitivity (30%) and accuracy (72%) for detecting intracapsular rupture compared to MRI 1

Treatment Approach

• Surgical removal (explantation) of the ruptured implant is the definitive treatment to prevent silicone migration beyond the capsule 2, 3
• Even though most intracapsular ruptures are asymptomatic, removal is recommended because:
  • Silicone can migrate to distant sites, regional sites, and lymph nodes if left untreated 2
  • The rate of implant ruptures increases with time, with higher risk in older implants 2, 3
  • Migration of silicone can lead to siliconoma formation with lymphoid hyperplasia and calcification 3

Surgical Considerations

• Complete capsulectomy (removal of the implant and surrounding fibrous capsule) is often performed to ensure removal of all silicone material 3
• An adapted suction technique may be used to aid in the removal of leaked silicone gel, which can be difficult due to its high viscosity 4
• Options after explantation include:
  • Implant replacement with a new prosthesis
  • Autologous tissue reconstruction
  • No replacement (if desired by patient) 2, 3

Post-Treatment Monitoring

• If a new implant is placed, the FDA recommends ongoing monitoring with MRI or ultrasound to detect any future complications 1
• For patients with a history of silicone implant rupture, more vigilant follow-up is advised due to the increased risk of complications with subsequent implants 3

Important Considerations

• Intracapsular rupture is often clinically silent and may not cause obvious symptoms, making imaging crucial for diagnosis 1, 2
• Delay in treatment can lead to extracapsular rupture where silicone leaks beyond the fibrous capsule, which is more difficult to manage 2
• In cases where ultrasound shows more than 2 signs of rupture (abnormal implant shell, heterogeneous content, abnormal axillary lymph nodes), findings can be acted upon; if only 1 sign is present, MRI confirmation is recommended 1