Evaluation

Diagnosis

In order to appropriately diagnose ruptured implants, we must determine the type of implant used.  Saline versus silicone implant ruptures are very different in diagnosis.  Ruptured saline implants are normally associated with a clinical finding of complete deflation of the bag over time that becomes gradually worsened.  There is significant asymmetry of the breast and often visibility of the implant edge can become prominent in very thin ectomorphic patients.  The critical signs of a ruptured saline implant for diagnostic purposes are obvious.  One breast will be completely reduced in size.

The patient will notice a decrease in volume and the bra fit will be quite noticeably different.  Diagnosing a ruptured silicone implant, on the other hand, usually requires MRI diagnosis in order to determine the integrity of the shell of the implant.  A ruptured silicone implant on MRI shows a linguini sign in which there is a loss of integrity of the shell of the bag.  Ruptures of silicone implants are often referred to as “silent ruptures”, in which the implant symmetry is still maintained although the implant may be ruptured on one or both sides.  Therefore, as of November 2006, the FDA desires that women have MRI’s every two to three years for diagnosing ruptured silicone implants.

What are the symptoms?

The symptoms of ruptured silicone and saline implants can include pain in the breast, as well as tenderness on palpation of the breast. Associated swelling of the breast, redness or irritation of the skin can occur with significant rupture, especially associated with increased inflammatory process in thinned out patient’s breasts. Deflation of the breast may occur where there is loss of upper pole fullness to the tissue.  Malposition or change in shape of the breast is often seen, as well as lumpiness or swelling in the area around the breast. Patients may experience persistent pain, especially with saline implants in which the edges of the implant can create a contour deformity causing out-pocketing of the implant and subdermal irritation in thinned-out patients.  A delayed rupture of saline implants may lead to severe encapsulation with complete collapse of the pocket and scar tissue impingement.  This can also lead to pain from the capsulitis itself, especially with Baker IV capsular contractures.

Causes of ruptured implants.

The causes of ruptured implants can be multifactorial.

1) Simple wear and tear of the implants over time can lead to rupturing of the implant.  Saline implants can be differentiated from smooth versus textured coating.  Textured coated implants have a higher rate of rupture than saline. Crease crack formation can lead to shell disruption leading to ruptured silicone material.  Smooth wall saline implants have less evidence of rupture along the peripheral shell and more obvious rupture associated with a fill-tube valve area.  Fill valve is a unidirectional valve and over time this can become bidirectional, leading to fluid leakage from the valve itself, similar to that of the valve in a tire. All silicone and saline implants are not lifetime devices and will fail over time. Silicone implant rupture can be smooth or textured as well. These do not have valves, and therefore these ruptures occur from creased cracks within the shell of the bags, once again, greater with textured silicone than with smooth gel implants.

2) Blunt trauma.  Blunt trauma can lead to rupture of silicone and/or saline implants.  Incidents such as seatbelt whiplash, falling on the chest from an accident such as skiing or snowboarding accidents, may lead to blunt traumatic rupture of the saline or silicone implant. Massage therapy when lying directly in the prone position on the chest could lead to rupture of a silicone or saline implant. Screening and diagnostic mammograms without the Eklund technique in which there is no cone compression, but rather direct compressive force to the breast without repositioning the implant during a mammography may lead to severe blunt rupture of the saline or silicone implant.

3) Assault to the chest can also lead to ruptured implant integrity. Any forceful activity causing specific pressure may lead to rupture of the implant, especially implants placed subglandular versus submuscular.  Obviously the greater coverage of an implant, dual plane or subpectoral, will have greater coverage or have less risk of blunt traumatic rupture of the bag.

4) Penetrating trauma, including projectile velocity bullets, can certainly lead to a rupture of either silicone or saline implant.  Needle injections to the chest wall can also lead to rupture of an implant.