Silicone breast implants, used for augmentation or reconstruction, consist of a silicone shell filled with silicone gel. Though durable, these implants are not lifetime devices and can rupture. Understanding ruptured implant implications is important. This article explores how ruptures are identified, their effects on health and aesthetics, and typical approaches to address them.
Types of Silicone Implant Ruptures
Silicone implant ruptures fall into two main types based on gel containment. The most common type is an intracapsular rupture, where the silicone shell breaks, but the gel remains contained within the fibrous capsule. This capsule, a naturally formed layer of scar tissue, surrounds the implant. Often called “silent ruptures,” they may not present with noticeable symptoms.
In contrast, an extracapsular rupture occurs when both the implant shell and the surrounding fibrous capsule are compromised. This allows the silicone gel to escape beyond the confines of the capsule. The escaped silicone can then migrate into the surrounding breast tissue or to regional lymph nodes, particularly those in the armpit. Extracapsular ruptures are considered more severe due to the potential for silicone dispersion.
Identifying a Ruptured Implant
Detecting a ruptured silicone implant can be challenging, as many ruptures, particularly intracapsular ones, lack immediate or obvious signs. Some individuals experience changes in breast shape or size, new lumps, or tenderness. Other symptoms include breast pain, a burning sensation, or hardening of breast tissue, indicating capsular contracture. However, these symptoms are not exclusive to ruptures and can be associated with other breast conditions.
Medical imaging plays a central role in accurately diagnosing a ruptured implant, particularly for silent ruptures. Magnetic Resonance Imaging (MRI) is the most accurate method for detecting silicone implant ruptures. MRI scans provide detailed images of the implant and surrounding tissues, identifying subtle signs of a rupture.
Ultrasound can also be used as a preliminary screening tool for implant integrity. While ultrasound can detect some ruptures, it is less definitive than MRI and may miss some types. Mammography, primarily used for breast cancer screening, is less effective for directly detecting implant ruptures but may show changes in implant shape or density that warrant further investigation.
Health and Aesthetic Consequences
A ruptured silicone implant can lead to various local effects within the breast. The immune system may react to escaped silicone, causing inflammation and granulomas. These small, localized lumps feel like inflammation within the breast tissue. If it exacerbates or causes capsular contracture, the fibrous capsule around the implant can tighten and harden, leading to breast distortion, pain, and discomfort.
In cases of extracapsular rupture, silicone gel can migrate beyond the immediate implant pocket. It commonly travels to the axillary lymph nodes in the armpit, where it can cause swelling or lumps. While less common, silicone has been reported to migrate to more distant sites in very rare instances, though this is not a typical outcome.
Beyond physical symptoms, a ruptured implant can significantly impact the aesthetic appearance of the breast. Changes in breast shape, size, and symmetry are common, leading to cosmetic dissatisfaction. The breast might appear deflated, lumpy, or distorted. While some individuals report broader systemic symptoms like fatigue or joint pain, attributing these directly to silicone exposure from ruptured implants remains an area of ongoing scientific research and debate.
Addressing a Ruptured Implant
Once a silicone implant rupture is confirmed, consulting with a board-certified plastic surgeon is the recommended next step. The primary approach to addressing a ruptured implant involves surgical intervention. The standard recommendation is removal of the ruptured implant itself.
In many cases, a capsulectomy is also performed, involving removal of the fibrous capsule around the implant. This procedure is important if the capsule is significantly hardened due to capsular contracture or if it contains escaped silicone. Surgeons may perform a total capsulectomy, removing the entire capsule, or a partial capsulectomy, depending on the extent of the rupture and the condition of the capsule.
If silicone gel has spread into the surrounding breast tissue or lymph nodes during an extracapsular rupture, the surgeon attempts to remove as much visible silicone as possible. However, complete removal of all dispersed silicone may not always be feasible. After the ruptured implant and any affected capsule or silicone are removed, individuals have several options: replacing the implant with a new silicone or saline implant, choosing not to replace the implant, or exploring alternative reconstructive options like fat grafting.