No, not every ruptured silicone breast implant needs to be removed. It’s important to differentiate the type of rupture; intra- or extra-capsular. Extra-capsular silicone breast implant ruptures should be removed, while intra-capsular ruptures, even if no symptoms or discomfort exist, should be followed closely by a board certified plastic surgeon and monitored with an MRI.
When an implant is placed within a breast the body recognizes it as foreign and forms a capsule around it. The fibrous capsule develops naturally to separate the implant from the surrounding pectoralis muscle and breast tissue. When an implant ruptures it may remain within the capsule which is known as an intra-capsular rupture. If silicone gel from the ruptured implant migrates outside the capsule, it is defined as an extra-capsular rupture. A 2004 study published in the Plastic and Reconstructive Surgery Journal did not establish a significant specific risk associated with ruptured intracapsular silicone implants over a 2 year period. 75% of breast implant ruptures in the study were intracapsular. Over a 2-year period, about 10% of the implants with intracapsular rupture progressed to extracapsular rupture as detected by MRI.
Breast symptoms associated with implant rupture include; changes in breast shape, hardness, and breast pain. In some rarely reported instances extra-capsular rupture can result in free floating silicone that migrates to areas outside of the breast. Extracapsular silicone deposits can lead to inflammation resulting in hardness, painful nodules, lymph node enlargement and skin breakdown. I recommend implant removal along with all silicone material when dealing with an extracapsular breast implant rupture.
A person presenting with an intracapsular rupture should undergo a complete breast history and physical examination. A persons’ activity, healthy, and psychological distress about the potential consequences help me determine if implant removal or close follow up is recommended.
The MRI is recognized as the gold standard to detect a ruptured silicone implant. The FDA recommends an MRI be performed starting three years after silicone breast implant placement and every 2 years thereafter. The purpose of the MRI is to detect an implant rupture and determine if the rupture is intra or extra capsular. Remember, not every person with a ruptured intracapsular implant requires immediate implant removal. At a minimum, close patient follow up with a plastic surgeon is a must as intracapsular ruptures can progress therefore future MRI imaging and surgeon involvement is needed
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