What are the risks of leaving a ruptured silicone breast implant in place?

Risks of Leaving a Ruptured Silicone Breast Implant in Place

Ruptured silicone breast implants should be removed due to risk of silicone migration, siliconoma formation, and potential progression of the rupture over time, even though most ruptures are clinically silent and may not pose immediate health risks. 1, 2

Types of Implant Rupture

• Intracapsular rupture: Silicone remains contained within the fibrous capsule that forms around the implant

  • Presents with "linguini" or "wavy-line" sign on MRI for complete rupture 3
  • Incomplete rupture shows "inverted-loop," "keyhole," "teardrop," or "hang noose" signs on MRI 3
  • Often asymptomatic and clinically undetectable 3, 1

• Extracapsular rupture: Silicone leaks beyond the capsule into surrounding breast tissue

  • Can be detected on mammography or digital breast tomosynthesis as high-density material outside the implant shell 4
  • More likely to cause symptoms including palpable findings 4

Risks and Complications

• Silicone migration: Silicone can spread to distant tissues over time 2

  • In 11% of untreated rupture cases, progression of silicone seepage was observed over a 2-year follow-up period 2
  • Can convert from intracapsular to extracapsular rupture if left untreated 2

• Siliconoma formation: Development of inflammatory granulomas in response to silicone

  • Immunohistochemical staining has revealed siliconoma with lymphoid hyperplasia and calcification in cases of long-standing rupture 5

• Breast changes and symptoms:

  • Women with untreated implant ruptures reported a significant increase in nonspecific breast changes (odds ratio, 2.1) compared to women without ruptures 2
  • May present with capsular contracture, breast lumps, or changes in breast shape 1

• Diagnostic challenges:

  • Leaving a ruptured implant in place may complicate future breast imaging and cancer detection 6
  • Clinical examination alone is unreliable for detecting implant rupture 7, 4

Long-term Outcomes

• The consensus of literature states there are no proven systemic health risks associated with implant rupture 1

  • However, only 1 of 7 patients with severe systemic symptoms became asymptomatic after explantation in one study 6

• Rupture rates increase significantly after 6-8 years of implantation 1

  • Saline implants rupture earlier (mean 5.6 years) than silicone implants (mean 12 years) 8

Management Considerations

• For symptomatic patients with ruptured implants, options include:

  • Observation with regular imaging follow-up 1, 2
  • Explantation and capsulectomy with or without replacement 1

• MRI without contrast is the gold standard for confirming intracapsular implant rupture (sensitivity 87%, specificity 89.9%) 3

• If ultrasound shows more than 2 signs of rupture, findings can be acted upon; if only 1 sign is present, MRI confirmation is recommended 3

Common Pitfalls

• Assuming all ruptures are symptomatic - most silicone implant ruptures are clinically undetectable 1

• Relying solely on clinical examination - this is unreliable for detecting implant rupture 4, 7

• Failing to differentiate between residual silicone from previous implants versus new rupture - comparison with prior imaging is critical 4, 7

• Delaying evaluation - early detection facilitates more effective management before complications develop 5