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Is it necessary to have a ruptured implant removed?
One of my silicone implants has ruptured. I have had no side effects or symptoms. An MRI report states that, 'No leakage of implant material into the breast or chest wall evident.' I had sent inquiries to several surgeons about having surgery again. One of them suggested that it is not necessary to replace the implant. Is this true? I am very concerned about capsular contracture, especially since I have read that it is more common in secondary surgeries. Is this also true?
A broken implant is somewhat controversial as to removal or not. The most common reason for a late capsular contracture is a broken implant. If you leave a broken implant in for a long time, we see many more silicone granulomas and calcium formations. I don't think it is emergent, but that it should be removed soon to keep from having more and bigger complications. Implant generally last about 10 years. Good luck to you.
Treatment of Ruptured Breast Implant
Conventional wisdom says to replace ruptured breast implants since they are ruptured. However, the body makes its own wall around the implants and can contain the silicone even if the shell is ruptured. Over the years I have followed many patients with known ruptured silicone breast implants and no symptoms. They have almost all done well over many years. We have changed the implants only when there were symptoms, and have never had anyone develop a problem where we wished we had done something sooner. When replacement is done properly, capsular contracture should be no different from primary surgery.
The textbook answer is to replace things that are 'broken'. But logically, you could argue that silicone gel (the filling in your implant) is not dangerous to you as best we know and since you have scar tissue around the implant and material that contains it, it should be of no consequence. Speculation would suggest if you're in accident with blunt trauma to your chest, that the capsule could break, leading to the gel getting into your breast tissues.
A.: It is generally recommended that if an implant is ruptured, it should be removed. The free silicone gel doesn’t cause any disease. The body normally forms an internal scar or capsule around any implant, which will usually contain the silicone gel. The capsule may contract causing firmness and distortion whether the implant is intact or has ruptured. The silicone gel from the disrupted implant may, however, increase the capsular contraction. The concern is that any trauma which may disrupt the scar capsule could allow the silicone gel to extend into the surrounding tissue, including the breast tissue, causing lumps called siliconomas or granulomas and make it much more difficult to remove the material in the future.
Capsular contractions can occur with any implant and I have found it to occur more frequently in patients who have had prior capsular contraction and implants placed. The majority of patients, however, having secondary surgery, do not develop capsular contractions. You should have a consultation with a plastic surgeon certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns, the options and what is realistic with that surgeon in person.
Robert Singer, MD FACS
La Jolla, California