What is Breast Implant Rupture?
Breast augmentation is a surgical procedure that enhances the size and shape of the breasts by using fat transfers or breast implants made of saline or silicone. Implants are usually placed behind the breast tissue or beneath the chest muscle. People opt for breast augmentation for various reasons such as personal aesthetic goals, to correct birth defects, or rebuild the breast after a mastectomy. With approximately 3.5 million individuals in the United States having breast implants, it stands as one of the most popular cosmetic surgeries. However, one potential risk of this procedure is implant rupture, which can happen in several ways.
Breast implants come in a range of types and all potentially have the risk of rupturing. When investigating a suspected rupture, it’s important to understand the implant’s type (saline or silicone) and how long it has been in the body.
When an implant is installed, the body naturally forms a protective scar barrier around it. A rupture that happens within this scar tissue is called an intracapsular rupture. However, if the implant material leaks outside of this scar tissue, it is known as an extracapsular rupture. A saline implant rupture is generally harmless as the body can safely absorb the saline solution over time. On the other hand, silicone implant ruptures can lead to more complications with silicone leaking into nearby tissues and causing local reactions and scar formations. However, studies have not found any health risks associated with silicone implant rupture. Also, it’s important to note that an extracapsular rupture means that an intracapsular rupture has happened first.
It’s worth mentioning that there’s a difference between older silicone implants and the newer, cohesive ones. While the cohesive silicone in newer implants doesn’t typically migrate to surrounding tissues, older silicone implants could, in rare cases, spread even as far as the groin area.
What Causes Breast Implant Rupture?
Implant rupture, or when an implant breaks or tears, commonly happens due to normal aging. Each implant has a suggested lifespan, and once the implant gets older than this, it’s more likely to rupture. Doctors can provide an estimate of this timeframe, which can typically be anywhere between 12 to 35 years based on medical literature and personal experiences. Any ruptures that happen within the first 20 years are considered early for modern implants.
These early ruptures can happen due to a number of reasons, including faulty valves, defects made during manufacturing, or not filling the implant properly which can cause folds in the implant’s protective layer and lead to weaknesses in the wall. Sometimes, physical injuries can also cause the implant to rupture. Most of the time, blunt injuries don’t cause the implant to rupture unless the injury is high-impact and direct, such as a hard hit on the steering wheel during a car accident.
Non-penetrating injuries were once a common cause of rupture in older silicone implants, but this happens less frequently now as many older implants have been replaced. Plus, newer implant designs have taken this into account to help prevent such incidents.
Risk Factors and Frequency for Breast Implant Rupture
The chances of an implant breaking rises as the implant gets older. The thickness of the implant’s wall is not a significant factor in breakage. This is because implant makers provide implants with different thicknesses, but the rate of breakage is quite similar among them. Although overfilling is not often the reason for breakage, it’s still important to follow the filling guidelines for each type of implant.
Signs and Symptoms of Breast Implant Rupture
Saline and silicone breast implants can sometimes rupture, but the signs can be different for each type. With saline implants, a decrease in size is usually the most common symptom, and this can be quick, or more gradual. Also, it’s important to know that ruptures rarely cause pain, except in some rare cases caused by trauma. On the flip side, if a silicone implant is damaged, you might feel some degree of pain in your chest due to an inflammatory reaction.
A deflated saline implant is easy to spot because the breast noticeably decreases in size, usually over a few days. If an implant loses volume just a few days after surgery, it may indicate that there was some damage during the procedure, or the valve might have been improperly closed. However, implant failure can also occur years later due to defects or simply because its lifespan is over.
When it comes to silicone implants, ruptures are harder to detect and usually require imaging tests. Sometimes, they can cause a noticeable lump or unevenness in the breast due to the inflammation and granulomatous tissue formed, or they may cause vague pain or tenderness. It’s also possible for them to cause no symptoms at all. It’s important to remember that in rare cases, breast implants have been associated with lymphoma, a type of cancer. This is why it’s crucial to reveal any new lumps you can feel nearby, or any systemic symptoms you’re experiencing.
So, if your doctor suspects a rupture, the following would be key questions and examinations:
- When was the implant placed?
- If known, what type of implant was placed?
- Presence and duration of any symptoms
- Experiencing any fevers/chills, or B-Symptoms
- The shape and symmetry of the breasts
- Any new breast masses
- Presence of enlarged lymph nodes in the armpit or elsewhere
- Comparing the feel of the possible ruptured implant vs the other one
- Checking for any skin differences in the affected breast vs the other one
- Any noticeable discharge from the nipple
Testing for Breast Implant Rupture
When a saline breast implant gets damaged, diagnosis is often straightforward and can be done through a simple physical examination, as the implant generally loses volume. However, if doctor decides to use imaging scans, a mammogram could show the implant with a wrinkled appearance. Ultrasound and MRI imaging may also show folds or wrinkles inside the implant.
On the other hand, a rupture in a silicone implant is more difficult to detect. Mammograms are often not very reliable for this, although bulging of the implant may suggest damage. Ultrasound isn’t much help either, as the silicone doesn’t show up well. However, a specific sign known as the stepladder sign, in which the ultrasound shows multiple, linear echoes in the implant, may be a clue. MRI scans are best for identifying a rupture in a silicone implant. Specifically, images showing silicone on both sides of a radial fold, known as a keyhole, noose, or teardrop sign can indicate a rupture. Additionally, images showing multiple layers of the implant shell, known as the linguine sign, also suggest a rupture. This shouldn’t be confused with normal straight, thick, short creases that reach the edge of the implant shell, which are normal. CT scans could also show the linguine sign, but due to its low sensitivity and high radiation levels, it isn’t typically used to evaluate ruptures.
If silicone from the implant leaks into surrounding tissues, this is called an extracapsular rupture. This can often be identified through a mammogram and ultrasound, which may show the leaked silicone in nearby tissues or even lymph nodes in the armpit. A particular sign on an ultrasound known as the snowstorm sign, which shows silicone gel droplets mixed with breast tissue creating a diverse or mixed appearance, can also suggest leakage. However, MRI scans are still the preferred method to identify the extent of the leak. Silicone leaks will have a low signal on T1 and a high signal on T2 fat-suppressed images. CT scans are generally not used to assess extracapsular ruptures, as the silicone shows a similar radiodensity to the surrounding soft tissues.
Treatment Options for Breast Implant Rupture
If a saline breast implant breaks, the emptied shell should be taken out. Similarly, a ruptured silicone implant also needs to be removed to avoid interaction with the surrounding tissues and potential spreading to nearby lymph nodes. The surgeon can then offer a modern replacement implant, either silicone or saline.
Some patients who don’t have any symptoms might be hesitant to have this operation. However, the long-term safety benefits and the risk of cancer should be discussed to help them make an informed decision.
In cases where the implant rupture is contained within the fibrous sack or ‘capsule’ that naturally forms around the implant, the surgeon can remove this capsule if they choose to. But if they manage to clean up all the silicone (in instances like a very recent rupture) they may decide not to remove the fibrous capsule. However, if any doubt remains about persistent silicone, an effort should be made to remove the entire fibrous capsule. When the capsule hardens, a procedure to remove the entire capsule, known as capsulectomy, is needed.
If the silicone implant rupture extends beyond the capsule, then the patient may need multiple surgeries to remove all the escaped silicone gel. After these procedures, a new implant could be added to return the breast to its normal shape.
What else can Breast Implant Rupture be?
There are several reasons why an implanted device might get damaged. Here are a few examples:
- It could be damaged accidentally during surgery by a surgical tool.
- Sometimes, a needle might damage it while doctors are performing a biopsy, which is a test that involves removing a small piece of tissue for examination.
- Normal aging of the implanted device might also cause it to deteriorate.
- Lastly, if a person with an implant is in a car accident, the trauma resulting from that could also potentially damage the implant.
It’s important for these reasons to be considered when dealing with damaged implants in order to figure out the best way to handle the situation.
