Let’s talk implants. Silicone gel breast implants were introduced in 1963, and have since been widely used for breast augmentation to improve appearance and increase self-confidence, as well as for reconstruction after surgical mastectomy (removal of breasts), or from injury such as burns.
Removal and examination of the implant is the best way to find out whether an implant has ruptured. Sometimes, the rupture can be a mere pin hole, or it can also be in the form of visible tears. Other times, the implant can rupture during scanning at the doctor’s, which can cause too much compression. Implants can rupture due to trauma as well, resulting from motor vehicle accidents, falls, gunshot wounds, etc. However, trauma-related implant ruptures are uncommon.
Implant ruptures detected by physical examination are not always accurate. Imaging methods such as mammography, ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) are commonly used to assess the integrity of silicone gel breast implants. Imaging findings are subtle when there is minimal gel leakage, as in disintegration of the shell or slight tearing.
There is no general consensus on how to treat women with ruptured breast implants. Some plastic surgeons recommend removal of implants within 8 years after implantation to risk chances of rupture as the implant ages. Suggestions have also included removal of implants from patients with symptoms of systemic disease. However, there is common agreement among plastic surgeons to remove the implant if the ruptured implant causes complications locally, such as breast deformity, pain, etc. In 1992, Food and Drugs Administration recommended removal of a breast implant if it ruptured.
Manufacturers of implants, clinicians, patients, and regulatory agencies are concerned about the consequences of ruptured silicone-gel breast implants. The frequency and severity of implant ruptures is unknown as is any possible side effects due to exposure of silicone gel to other tissues or development of systemic disease. Previously undetected implant ruptures are now being detected with advanced MRI techniques. Intracapsular and extracapsular ruptures are detectable on imaging. These are brand-new advancements in technology, and they will give us a better chance at recognizing if something’s wrong from a much earlier stage.
Ruptures Increase with Age
It is clear that the incidence and prevalence of breast implant ruptures are higher than previously suspected, and the risks of rupture increases with the age of the implant. It is also known that the implant rupture may progress from a tiny rupture to a tear and visible leakage of silicone gel that could possibly cause severe disruption. In rare cases, the silicone gel can be expressed through the nipples. Implant rupture and ‘bleeding’ of the silicone gel can cause contamination of lymph nodes in the armpit. This is one thing we know for certain about the effects of silicone on the body.
Silicone gel migration has been previously reported to the chest wall, lung membrane, ribs, upper arm, biceps, etc. Sometimes, distant migration of the gel can occur to areas like the abdominal wall, liver, and groin area. This is, as you can imagine, unsafe and unwanted.
Women opting for silicone-gel breast implants must consider risks and benefits of the procedure and discuss with their physician all available options for breast augmentation.