Breast Implant Rupture

Breast Augmentation is a surgical procedure to enlarge small breasts, underdeveloped breasts, or breasts that have lost their fullness after pregnancy. However, the FDA does not consider breast implants, whether saline or gel, permanent devices. Breast implants may rupture or deflate immediately after surgery or may occur weeks , months, or even several years later. Others may take 10 or more years to rupture or deflate. The current rupture rate for saline implants, as determined by the FDA, is 7% at 7 years.

The mechanisms for breast implant rupture or deflation include:

  • tear, crack, or hole in the shell
  • damage to the valve or growth of tissue into valve
  • valve separates from implant shell (delamination)

The causes of breast implant rupture include:

  • normal aging of implant shell and valve
  • damage by surgical instruments
  • too much handling during surgery
  • damage during procedures to the breast, such as biopsies and fluid drainage
  • compression during a mammogram
  • stresses such as trauma or intense physical pressure (closed capsulotomy)
  • capsular contracture
  • overfilling or underfilling of saline-filled breast implants causing the shell to crack or tear

When saline filled implants rupture, the saline is absorbed by the body. One will notice the size of the breast getting smaller. This may occur over days, weeks or even months, depending on the size of the leak. The saline is not harmful to the body.

However, when silicone gel-filled implants rupture, some women may notice decreased breast size, hard knots, uneven appearance of the breasts, pain or tenderness, redness, tingling, swelling, numbness, burning, or changes in sensation. Also, one may experience hardness of the implants or capsular contracture. Other women may unknowingly experience a rupture without any symptoms (silent rupture). The silicone gel may migrate away from the breast causing lumps, called granulomas, to form in the breast, chest wall, armpit, arm, or abdomen.

Silent ruptures, usually with gel implants, may be noticed on routine mammograms or ultrasounds. Magnetic resonance imaging, MRI, is the most sensitive imaging technique for diagnosing a silicone gel implant rupture.

If a women is diagnosed with an implant rupture, it is recommended to remove and replace the ruptured implant. If the implants are more then 10 years old, most plastic surgeons would recommend replacing both implants at the same time. If the implant is not replaced, the pocket or capsule around the implant may get smaller and tighten around the deflated implant. This will make replacement at a later date more difficult, there will be an increased risk for asymmetry and may cause more discomfort.

The procedure is performed as an outpatient surgery at the ambulatory surgery center. The operation is usually performed under general anesthesia and take about 30 to 60 minutes. The implants are usually removed and replaced through the same incision as the initial breast augmentation. However, if an axillary incision was used, it may be difficult to perform this procedure through this incision, especially for ruptured silicone gel implants. Thus, the plastic surgeon may recommend an inframammary crease or areola incision.

When silicone gel implants rupture, the material may stay within the breast capsule. This is known as an ‘intracapsular rupture’. If this occurs, the implants and material can be removed usually without removing the capsule. However, if the rupture has caused a significant capsular contracture or the gel material has leaked outside of the capsule, ‘extracapsular rupture’, then it is recommended that the capsule be removed with the ruptured implants. This is called a capsulectomy.

After the operation, you will wear a soft bra for support. Swelling and discoloration may occur but will quickly disappear. Stitches are placed under the skin and are dissolvable. Thus, there are no stitches to be removed. Activities may be restricted for the first few days. One can usually return to work in a week. Strenuous activity is limited for four weeks.

Rarely, one may experience complications after surgery. The most common risk is the formation of a capsular contracture. This is scar tissue which can tighten around the implant. This can range from being imperceptible to increased firmness in the breast. This condition can be corrected by cutting the scar capsule, which will soften the breast. Other risks include bleeding, infection, changes in nipple sensation, implant rupture or malposition.

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