Patients presenting with rupture of their saline implants can present with pain to the breast, potential permanent changes in nipple sensitivity, implantleakage leading to loss of upper pole fullness of the breast, distortion of the shape of the breast associated with visible rippling and indentation of the tissue associated with the edges of the bag, redness to the skin, tenderness and increasing pain. There may also be capsular contracture leading to capsulitis.
Patients with ruptured saline implants present to our office weekly. We recommend that these implants be removed as soon as possible with open capsulotomy and capsulectomies performed with implant exchange, in order to reduce the ensuing scar tissue contracture around the bag. Saline implants contrary to silicone implants are more user-friendly. When a saline implant ruptures, the implant loses its size and shape. The saline will then be resorbed into the body and excreted with the urine.
Some of the saline, however, will remain around the ruptured saline implant which could lead to a darker yellow color fluid. Determining the duration that occurred since rupture of the saline implant, by inspection of the operating room of the clarity of the fluid, is very useful. Light clear fluid usually represents a rupture within four weeks. As the fluid takes on a more yellow color, this can be usually extended for several months. Implants that have ruptured for well over a year may present with minimal amounts of fluid or a small amount of fluid that is dark yellow straw color in appearance associated with a very chronic rupture. The yellow fluid may be associated with increased levels of protein and fibrin within the collection of fluid.
Normally patients with acute rupture present to our office showing great asymmetry to the breast which can occur within less than seven days. The shape and size are quite significantly reduced leading to asymmetry within the bra. Pain can also be associated symptoms. Tenderness on mild to moderate palpation, as well as the infolding of the edges of the bag along the inner tissue, can also be very irritating. On a rare occasion, the patient may present with fever, as well as redness to the skin, which could be associated with an infection surrounding the implant intracapsular from the fluid internally.
Our recommendations for any ruptured saline implant is: remove the implant, explore, irrigate, and clean out the pocket, release scar tissue through an open capsulectomy or capsulotomy with implant either replaced or final explantation.
Diagnosis of a saline ruptured implant is very straightforward. In the majority of cases, the patients will present with a complete loss of fullness to the breast clinically. Usually, mammogram, ultrasound, CT or MRI’s are not required and only clinical examination will indicate a complete rupture of the saline implant. Patients who may present with an acute rupture with slight asymmetry may do well with an ultrasound in order to examine for fluid around the implant itself within the intracapsular pocket. We normally watch these patients for two to three weeks. We examine their breasts at that time. An obvious ruptured implant will continue to leak over time, and the breast will become significantly smaller. MRI’s and CT’s are not indicated for patients with ruptured saline implants. I believe clinical examination alone yields the best results and that the patients again can be followed on a biweekly basis in order to follow the shape, size, and form of the breast.
The fluid within a saline implant with both collect within the intracapsule and, over time, resorb through the capsule and be absorbed into the excretory system of the body. There should be no harm of normal sterile saline that was placed in an implant after it has ruptured, and this does not lead to harm to any patient. However, the ruptured saline implant should be removed as soon as possible with the scar tissue released to avoid further damage to the pocket. Both Mentor and Allergan or Natrelle saline implants are not lifetime devices. These implants will rupture over time. Ruptures can occur either due to crease cracks within the shell of a smooth implant or from a leakage through the valve of the implant. The valves are normally unidirectional, but over time can become bidirectional with leakage of fluid through the valve. Textured implants have been shown through the years to have a higher incidence of rupture due to crease crack formation and failure of these implants. In my practice, we do not use textured implants.
The video below shows an example of a ruptured saline implant with deflation of the saline implant due to a small peripheral tear in the silicone shell. The majority of saline ruptures that I have seen in my practice in Beverly Hills have been a valve leakage in which any directional valve becomes bi-directional with saline leaking through the valve. This patient specifically upon examination had a ruptured saline implant which was 70% ruptured with a small peripheral tear as seen on the video. Pressure of the implant shows fluid that shoots out the periphery of the implant. Again, the majority of cases of ruptured saline are associated with valvular failure and the valve then becomes bidirectional with leakage from the valve and leaflet.
Textured implants are associated with fibrous adherence to the overlying tissue with continued movement of the chest wall; pectoralis muscle or subglandular plane will lead to crease crack formation and a rupture of the bag associated with slits within the peripheral shell of the implant edge. Once again, only smooth saline and silicone implants are used in our practice, which I believe reduces incidents of rupture of both types of implants.
The rupture rate is approximately three to seven percent for the saline implants over five years. This rate can increase up towards 20% after 10 years. When a patient identifies an obvious asymmetry or visible loss of fullness, they should see their Board Certified Plastic Surgeon for examination and possibility of secondary breast reconstruction or breast revision surgery.
Ruptured Smooth Saline
Ruptured Textured Saline
Evaluation of Ruptured
Removal of a Ruptured