Abstract
Despite advances in breast implant design and technology, rupture continues to be a significant complication and increases with time. The exact incidence of implant rupture varies by the implant model, age, and purpose (augmentation vs. reconstruction, primary vs. secondary) and may be calculated using the Kaplan-Meier analysis. One should be cautious in making direct comparisons of the data from different manufacturers. The most common cause of implant rupture is iatrogenic damage by surgical instruments. Magnetic resonance imaging is the gold standard for diagnosing and confirming suspected ruptures. Ultrasound may be a useful adjunct under appropriate circumstances. The US Food and Drug Administration recommends MRI surveillance of implant rupture starting 3 years after implantation and recurring every 2 years afterward. Compliance with this recommendation remains poor. Saline implant rupture is easy to diagnose, as there is a noticeable decrease in volume shortly after rupture. Management includes surgical removal of the implant and capsulectomy with or without replacement. Most silicone implant ruptures are silent and intracapsular. To avoid conversion to extracapsular rupture or avoid an inflammatory stimulus that may lead to capsular contracture, elective explantation is still indicated. Extracapsular ruptures can be symptomatic and are managed by surgical removal and capsulectomy with or without replacement.
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References
American Society of Plastic Surgeons. 2017 Plastic surgery statistics report. https://www.plasticsurgery.org/documents/News/Statistics/2017/plastic-surgery-statistics-report-2017.pdf. Accessed 18 Jan 2019.
Center for Devices and Radiological Health U.S. Food and Drug Administration. FDA update on the safety of silicone gel-filled breast implants. https://www.fda.gov/downloads/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/UCM260090.pdf. Published June 20, 2011. Accessed 18 Jan 2019.
Hillard C, Fowler JD, Barta R, Cunningham B. Silicone breast implant rupture: a review. Gland Surg. 2017;6(2):163–8. https://doi.org/10.21037/gs.2016.09.12.
Handel N, Garcia ME, Wixtrom R. Breast implant rupture. Plast Reconstr Surg. 2013;132(5):1128–37. https://doi.org/10.1097/PRS.0b013e3182a4c243.
Spear SL, Murphy DK. Natrelle round silicone breast implants. Plast Reconstr Surg. 2014;133(6):1354–61. https://doi.org/10.1097/PRS.0000000000000021.
Spear SL, Murphy DK, Slicton A, Walker PS. Inamed silicone breast implant core study results at 6 years. Plast Reconstr Surg. 2007;120(Supplement 1):8S–16S. https://doi.org/10.1097/01.prs.0000286580.93214.df.
Maxwell GP, Van Natta BW, Bengtson BP, Murphy DK. Ten-year results from the Natrelle 410 anatomical form-stable silicone breast implant Core study. Aesthet Surg J. 2015;35(2):145–55. https://doi.org/10.1093/asj/sju084.
Hammond DC, Canady JW, Love TR, Wixtrom RN, Caplin DA. Mentor contour profile gel implants. Plast Reconstr Surg. 2017;140(6):1142–50. https://doi.org/10.1097/PRS.0000000000003846.
Cunningham B, McCue J. Safety and effectiveness of Mentor’s MemoryGel implants at 6 years. Aesth Plast Surg. 2009;33(3):440–4. https://doi.org/10.1007/s00266-009-9364-6.
Stevens WG, Calobrace MB, Alizadeh K, Zeidler KR, Harrington JL, d’Incelli RC. Ten-year core study data for Sientra’s Food and Drug Administration–approved round and shaped breast implants with cohesive silicone gel. Plast Reconstr Surg. 2018;141:7S–19S. https://doi.org/10.1097/PRS.0000000000004350.
Walker PS, Walls B, Murphy DK. Natrelle saline-filled breast implants: a prospective 10-year study. Aesthet Surg J. 2009;29(1):19–25. https://doi.org/10.1016/j.asj.2008.10.001.
Mentor Corporation. Saline-filled and Spectrum™ Breast Implants. https://www.fda.gov/downloads/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/UCM232436.pdf. Published March 24, 2009. Accessed 19 Jan 2019.
Nichter LS, Hardesty RA, Anigian GM. IDEAL IMPLANT structured breast implants. Plast Reconstr Surg. 2018;142(1):66–75. https://doi.org/10.1097/PRS.0000000000004460.
Health Canada. Summary Basis of Decision (SBD) Mentor MemoryGel silicone gel-filled breast implants. http://hc-sc.gc.ca/dhp-mps/prodpharma/sbd-smd/md-im/sbd_smd_2011_mentorround-69312-eng.php. Accessed 19 Jan 2019.
Health Canada. Summary Basis of Decision (SBD) NATRELLE silicone-filled breast implants – smooth shell with barrier layer and NATRELLE silicone-filled breast implants – textured shell with barrier layer. http://www.hc-sc.gc.ca/dhp-mps/prodpharma/sbd-smd/md-im/sbd_smd_2012_natrelleround_61865_60524-eng.php. Accessed 19 Jan 2019.
Collis N, Sharpe DT. Silicone gel-filled breast implant integrity: a retrospective review of 478 consecutively explanted implants. Plast Reconstr Surg. 2000;105(6):1979–85; discussion1986–9.
Hadad E, Klein D, Seligman Y, Wiser I, Heller L. Sub-muscular plane for augmentation mammoplasty patients increases silicone gel implant rupture rate. Br J Plast Surg. 2019:1–5. https://doi.org/10.1016/j.bjps.2018.11.009.
Brandon H. Mechanical analysis of explanted saline-filled breast implants exposed to betadine pocket irrigation. Aesthet Surg J. 2002;22(5):438–45. https://doi.org/10.1067/maj.2002.128626.
Al-Sabounchi S, De Mey AMG, Eder H. Textured saline-filled breast implants for augmentation mammaplasty: does overfilling prevent deflation? A long-term follow-up. Plast Reconstr Surg. 2006;118(1):215–22. https://doi.org/10.1097/01.prs.0000220478.38646.9f.
Mason WTM, Hobby JAE. Immediate rupture of breast implant following trauma. Plast Reconstr Surg. 2003;111(7):2432–3. https://doi.org/10.1097/01.PRS.0000061860.86524.4D.
Brown SL, Todd JF, Luu H-MD. Breast implant adverse events during mammography: reports to the Food and Drug Administration. J Womens Health (Larchmt). 2004;13(4):371–8; discussion379–80.
Hölmich LR, Fryzek JP, Kjøller K, et al. The diagnosis of silicone breast-implant rupture. Ann Plast Surg. 2005;54(6):583–9. https://doi.org/10.1097/01.sap.0000164470.76432.4f.
Rietjens M, Villa G, Toesca A, et al. Appropriate use of magnetic resonance imaging and ultrasound to detect early silicone gel breast implant rupture in postmastectomy reconstruction. Plast Reconstr Surg. 2014;134(1):13e–20e. https://doi.org/10.1097/PRS.0000000000000291.
Chung KC, Malay S, Shauver MJ, Kim HM. Economic analysis of screening strategies for rupture of silicone gel breast implants. Plast Reconstr Surg. 2012;130(1):225–37. https://doi.org/10.1097/PRS.0b013e318254b43b.
Gorczyca DP, Gorczyca SM, Gorczyca KL. The diagnosis of silicone breast implant rupture. Plast Reconstr Surg. 2007;120(Supplement 1):49S–61S. https://doi.org/10.1097/01.prs.0000286569.45745.6a.
McCarthy CM, Pusic AL, Kerrigan CL. Silicone breast implants and magnetic resonance imaging screening for rupture: do U.S. Food and Drug Administration recommendations reflect an evidence-based practice approach to patient care? Plast Reconstr Surg. 2008;121(4):1127–34. https://doi.org/10.1097/01.prs.0000302498.44244.52.
Coroneos CJ, Selber JC, Offodile AC II, Butler CE, Clemens MW. US FDA breast implant postapproval studies. Ann Surg. 2019;269(1):30–6. https://doi.org/10.1097/SLA.0000000000002990.
Medot M, Landis GH, McGregor CE, et al. Effects of capsular contracture on ultrasonic screening for silicone gel breast implant rupture. Ann Plast Surg. 1997;39(4):337–41.
Beekman WH, van Straalen WR, Hage JJ, Taets van Amerongen AH, Mulder JW. Imaging signs and radiologists’ jargon of ruptured breast implants. Plast Reconstr Surg. 1998;102(4):1281–9.
Hölmich LR, Vejborg I, Conrad C, Sletting S, McLaughlin JK. The diagnosis of breast implant rupture: MRI findings compared with findings at explantation. Eur J Radiol. 2005;53(2):213–25. https://doi.org/10.1016/j.ejrad.2004.03.012.
Moyer HR, Ghazi BH, Losken A. The effect of silicone gel bleed on capsular contracture. Plast Reconstr Surg. 2012;130(4):793–800. https://doi.org/10.1097/PRS.0b013e318262f174.
Weisman MH, Vecchione TR, Albert D, Moore LT, Mueller MR. Connective-tissue disease following breast augmentation: a preliminary test of the human adjuvant disease hypothesis. Plast Reconstr Surg. 1988;82(4):626–30.
Hölmich LR, Lipworth L, McLaughlin JK, Friis S. Breast implant rupture and connective tissue disease: a review of the literature. Plast Reconstr Surg. 2007;120(Supplement 1):62S–9S. https://doi.org/10.1097/01.prs.0000286664.50274.f2.
Deapen D. Breast implants and breast cancer: a review of incidence, detection, mortality, and survival. Plast Reconstr Surg. 2007;120(Supplement 1):70S–80S. https://doi.org/10.1097/01.prs.0000286577.70026.5d.
Brinton LA. The relationship of silicone breast implants and cancer at other sites. Plast Reconstr Surg. 2007;120(Supplement 1):94S–102S. https://doi.org/10.1097/01.prs.0000286573.72187.6e.
Acknowledgment
We would like to thank Dr. Cheryl Herman in the Department of Radiology at Washington University School of Medicine for providing radiographic examples of intracapsular and extracapsular implant ruptures.
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Ha, A.Y., Grant, D.W., Tenenbaum, M.M., Myckatyn, T.M. (2021). Implant Rupture: Pathophysiology, Diagnosis, and Management. In: Kim, J.Y. (eds) Managing Common and Uncommon Complications of Aesthetic Breast Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-57121-4_5
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