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Breast Implant Rupture - should I be worried?

Breast Implants, just like any other device, can fail. Here we ask Dr. Dan Bunker, Specialist Plastic Surgeon from @plasticsurgerytasmania, all about it.

Q: Why do Breast Implants Rupture?

A: Breast implants, especially these days, are very well made. However, with time and the ongoing stresses of general life, or in cases of a significant impact to the implant, ruptures can occur. This is especially true of some of the older implants or ones that have been in for a long time. Rupture refers to the outside layer of the implant (the shell) breaking.

Q: Does this happen often?

A: No, ruptures are rare. In fact, new implants very rarely rupture. It is also important to remember that the quoted ruptured rates are based on retrospective studies which lag behind the technological iterations in current implant manufacturing techniques.

Q: Should I be worried if I have implants in that they will randomly 'pop'!?

A: Implants are not lifelong devices and require monitoring. I like to see my patients yearly but certainly once you hit the 10 year mark, you should have your implants checked annually. This is usually done by a combination of examination and imaging (such as ultrasound). Not all ruptures have obvious physical signs - we call these 'silent ruptures'. That is why we use imaging to look at the implant itself. Rapid changes in the shape or size of the breasts should also prompt early referral.

Q: What is the best test to see if my implant has ruptured?

A: The best test we currently have is an MRI. It can look in detail at the implant, the surrounding capsule and the breast tissue. However, MRIs can be expensive and have long wait times. As a result, ultrasounds are usually performed first. These have a high false positive rate for intracapsular rupture, however. This means that it may say there is a rupture when there isn't, usually because it interprets a fold in the implant shell as a rupture. When I see a patient with a rupture detected on ultrasound, I will often send them for an MRI before any surgery is undertaken.

Q: Did you say 'intracapsular rupture'? Aren't all ruptures the same?

A: Great question! No they aren't. When an implant is placed, our immune system senses it as a foreign body. The results is that it surrounds the implant in a layer of scar. This layer of scar is referred to as a 'capsule'. This capsule can be quite thin, or it can be thick and hard and cause distortion of the breast in some cases. When an implant ruptures, it means the implant shell has ruptured. This allows silicone to leak out of the implant. In some newer implants there is less risk of leakage after the implant breaks - we call these 'form stable' devices. Ruptures can be intracapsular or extracapsular.

Q: What is intracapsular versus extracapsular ruptures?

A: As I mentioned, breast implants are surrounded by a layer of scar we call the 'capsule'. If the implant ruptures and all the material is contained within this scar shell, we call this INTRACAPSULAR RUPTURE. If, however, the implant shell and the scar lining have both broken down, we call this EXTRACAPSULAR RUPTURE.

Breast Implant Rupture

Q: Which type of implant rupture do I need to be worried about? A: All implant ruptures require assessment by a Specialist Plastic Surgeon. However, extracapsular ruptures where the implant can leak silicone into the breast tissue is more urgent. While silicone is inert, it can cause swelling or hard lumps within the breast or armpit as the body tries to clear the silicone. These lumps are called 'silicomas' and can be very troublesome. Another issue with these lumps is that they can interfere with screening for breast cancer.

Intracapsular rupture, on the other hand, is contained. These are usually silent ruptures. Eventually, an intracapsular rupture will usually become an extracapsular rupture. There is no way to know exactly when this will occur.

Q: My implants have ruptured - Do I need surgery?

A: In the case of extracapsular rupture, I would recommend surgery sooner rather than later. The goal is to remove the broken implants, as much capsule as possible and as much leaked silicone as possible from the breasts. It is not possible to remove every molecule of silicone.

In the case of intracapsular rupture, I would still recommend surgery due to the risk of eventual extracapsular rupture and silicone extravasation into the breast, but we have time on our side. Surgery is often easier in the case of intracapsular rupture and in many cases the entire capsule can be removed, which houses the ruptured implant.

Q: My friend got a 'capsulectomy' when she had her implants taken out. What does this mean? A: The capsule is the scar lining around the implant. Sometimes this is thick and even calcified, other times it is very thin. Capsulectomy refers to excision of this scar layer. This is easier when the implants were placed in a subglandular plane. In cases of submuscular implant placement, sometimes the deepest layer of capsule can't be safely removed where it is stuck onto the ribs. Wherever possible, or if the capsule is thick, I usually try to remove it entirely.

Q: Do I have to have my implants replaced? A: You don't have to have your implants replaced, but most patients do. Just like when you decided to have the put in initially, the choice is entirely yours. At your consultation, we will discuss the options available. Some patients may not want another implant, some may want an implant of a different size, some may opt for other methods of breast augmentation such as fat grafting. In addition, as many patients had their implants placed quite a few years ago, they may request a breast lift due to sagging of the breast over time.

Q: I am having my ruptured implants removed. Will I have to pay for new implants? A: This varies from patient to patient. For some patients, particularly those who had their implants inserted for congenital abnormalities or for reconstruction after breast cancer, the cost of the implants is covered. For cosmetic augmentation, replacement implants are not covered. There are other costs associated with surgery and you will have detailed information regarding any financial obligations provided by the practice prior to any surgery.

Q: I want a Breast Augmentation, but now I am worried that my implants will rupture. Is this likely?

A: It is important to remember that breast implant rupture is rare. In addition, implants used today are very well made. A Specialist Plastic Surgeon will discuss Breast Augmentation with you in detail prior to any surgery. You should not have any surgery until your questions are answered and you feel comfortable.

Stay safe,

Daniel Bunker Specialist Plastic Surgeon

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