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Is it medically necessary to remove a ruptured silicone breast implant inserted in 1980?

Q:

I just found out that a silicone breast implant that was inserted in 1980 has ruptured.  Is it medically necessary to remove the ruptured implant now?

A:

The first question is how do you know the implant is ruptured? The only sure way to know is an MRI which can see through the silicone to see the implant shell within the silicone. If you are sure, the standard answer about replacing a ruptured silicone implant is to advise that it be done. However there is no study with valid results that shows that this is the correct answer. In fact, I have data to the contrary, having followed a significant number of people with known ruptured silicone implants for many years without any untoward effects. The reason for this may be that the body creates a scar wall around the implant that contains the silicone after the implant shell ruptures. These data concern people without symptoms. Therefore, if you are having symptoms from the rupture, then the implants should be replaced or removed to correct the symptoms. With no symptoms, especially if the rupture was discovered accidentally, I generally let the patient choose what to do. One symptom, of course, is worry about what could happen.

R.T. Buchanan, MD

A:

Ruptured Breast Implants:

If an implant has ruptured and been documented by an MRI, I would highly recommend that it be removed to prevent dissemination silicone formation of granulomas in the breast area.

R.J. Rohrich, MD

A:

Yes, if you have a ruptured silicone gel breast implant documented by MRI the implant should be removed. Older silicone implants do not have cohesive gel thus there is risk of "leakage" of silicone into the tisues. In addition your risk of capsular contracture may be increased.

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