Breast Implant Rupture: Common Questions Answered
Millions of women are currently enjoying the benefits of breast augmentation worldwide. Over 300,000 breast augmentation procedures were performed in the United States in 2013 alone (1). Still, any respectable plastic surgeon will tell you that all surgical procedures have risks and expected benefits, which must be weighed before moving forward. One such risk of breast augmentation is the risk of the implant shell weakening and developing a tear, or rupture, over time. What do you need to know about implant rupture? I have written this brief overview is an educational guide. The topic is complex and further details should be discussed in consultation with your plastic surgeon.
What are the chances of implant rupture occurring?
Most silicone implant ruptures are silent, meaning that the patient is not aware of the incident. This is in contrast to saline implant rupture, after which there will be noticeable deflation of the breast. Newer implants are designed with improved shells that perform better and are more rupture-resistant than early-generation implants. Physical examination by even the most experienced plastic surgeons is not very good at determining if a patient has a rupture. There are different types of implants available including saline, traditional silicone, and cohesive gel ‘gummy bear’ silicone. Furthermore, the risk of implant rupture increases with time. For these reasons it is difficult to determine the true prevalence of implant rupture. Recent studies have estimated the rupture rate for traditional silicone implants to be around 2% at 5 years from surgery, to between 7% and 15% at 10 years from surgery (2,3).
What happens to the ‘filling’ of the implant if the shell ruptures?
The answer depends on the implant type. I have previously written about the currently available implants (see post here):
- If a traditional silicone implant ruptures, the free silicone is usually contained within the capsule (intracapsular). Uncommonly, the silicone can leave the capsule and migrate locally (extracapsular).
- If a cohesive gel ‘gummy bear’ implant ruptures, the thicker silicone filling will be expected to stay right in the implant and not migrate anywhere.
- If a saline implant ruptures, the free saline solution will simply be absorbed by the patient’s tissues.
What should I do if I think my implant is ruptured?
You should visit with your plastic surgeon if you feel that you have a rupture. The gold standard for diagnosing an implant rupture is an MRI scan. The Food and Drug Administration recommends that traditional silicone implants be evaluated by MRI the third year after surgery, and every two years subsequently. It has been my experience that most patients who have no symptoms choose not to obtain these serial MRIs. There is some recent evidence that suggests that a high-resolution ultrasound can be a useful study to obtain first if there is a concern for rupture. It is significantly less expensive than MRI, and can give some useful information to help the decision-making process (4).
Deciding to undergo surgery to replace a ruptured implant
The current consensus is that silicone outside the implant shell does not increase the risk of breast cancer or immunologic disorders. Undergoing revision surgery is not risk-free, so a patient who suspects rupture but has no symptoms will have to weigh the risks and benefits of undergoing surgery with the guidance of her plastic surgeon. Implants placed in the United States are under manufacturer warranty coverage for a number of years after implant placement, which can help the patient manage the costs of replacement.
1. American Society for Aesthetic Plastic Surgery 2013 Statistics. https://www.surgery.org/media/statistics Accessed August 10, 2014.Hölmich LR, Kjøller K, Vejborg I, et al.
2. Prevalence of silicone breast implant rupture among Danish women. Plast Reconstr Surg. 2001;108:848–858; discussion 859.
3. Spear SL, Murphy DK. Natrelle round silicone breast implants: core study results at 10 years. Plast Reconstr Surg. 2014;133:1354-61.
4. Rietjens M et al. Appropriate use of magnetic resonance imaging and ultrasound to detect early silicone gel breast implant rupture in postmastectomy reconstruction