One of my earliest (and favorite) patients called me three weeks ago. She had undergone her yearly screening mammogram in May, which was very painful, and she noted a subsequent decrease in the size of her left breast. I asked her to come in to see me, and indeed, her left breast was significantly smaller than her right. I had performed her breast augmentation in 2002 with saline breast implants, when silicone implants were not yet back on the market. She had had absolutely no problems until now. Now what?
Any breast implant can rupture; this is a man-made medical device which does wear out with time. Typically, the shell of an implant begins to lose its integrity after 10 years. In many cases, the implant will remain intact. However, if there is a sudden trauma to an aged breast implant, as during a mammogram or a car accident, this can provoke an implant rupture. When a saline implant ruptures, the patient will typically notice a decrease in the size of the breast. The saline fluid leaks out and is absorbed by the body. However, a silicone rupture is a little trickier to detect. Because the fluid is much thicker and more cohesive, it stays within the pocket created for the implant. In some cases, the patient may not notice the rupture at all. In other cases, she may have pain, redness of the breast, or notice a subtle change in the shape of her breast. For this reason, the Food and Drug Administration (FDA) recommends regular screening MRI’s for patients with silicone breast implants.
For my patient, the diagnosis was straight-forward; she had saline implants which were 10 years old, she had sustained trauma to the breast, and she had a subsequent change in her size. If her story had been less clear-cut, or her examination less remarkable, I would have sent her for an ultrasound, which is a cheap and fast way of examining the integrity of a breast implant. It does not give all of the information that an MRI can provide, but it is an excellent first step. If an ultrasound is equivocal, an MRI is the next test that I order. Unfortunately, not all insurance companies will cover the high cost of an MRI following breast augmentation, so I generally order them only if absolutely necessary.
Once we’ve determined that an implant is ruptured, do we have to perform surgery? I always recommend to patients that they remove a ruptured implant, for several reasons. First, this is a defective medical device, and if it is not performing its function, it should be removed. Second, the inflammation associated with rupture of the implant can cause symptoms, such as pain, redness, and changes secondary to scar tissue. Scar tissue in the breast, also known as capsular contracture, is the plastic surgeon’s ultimate enemy; it can get worse with time if not treated, it can be associated with pain, and it can cause irreversible deformities of the breast. For these reasons, I advise patients to have the defective device removed. New implants can be replaced at the same time, or the patient can opt to live without her implants.
The good news is that the current generation of silicone implants is extremely durable. (My three-year old son likes to jump up and down on my implant samples in the office, and he has yet to rupture one. This has to be the best evidence available of implant strength. And no, I don’t know what prompts him to do this.) In addition, the three major implant manufacturers in the United States provide lifetime warranties on their implants. If your silicone implant ruptures, at any time, they will replace them for free, and provide funding to help with the associated surgical fees.
My patient underwent surgery last Friday with me, for removal of her old saline implants and replacement with new, slightly larger, silicone implants. She looks great, feels much better, and is able to get back to the really important thing in her life, her wonderful family.