Intra vs Extra


Patients who have had ruptured silicone and saline implants can present with either intra or extracapsular rupture. The difference between the two depends upon whether the fluid or silicone gel has migrated through the capsule into the breast tissue and into lymphatics throughout the axilla and the rest of the body. All implants initially rupture as intracapsular. An intracapsular rupture is associated with both silicone and saline either fluid or gel viscous material within the capsule that surrounds the implant.

Capsules are formed from three specific components: 1) collagen; 2) fibroblast; and 3) blood vessels. A ruptured saline implant will reserve the fluid within the lymphatics in an extracapsular fashion. Silicone gel implants will rupture intracapsular, and over time if left undetected or untreated, will transcend the capsule and become extracapsular with continued spread through the lymphatics to the axillary lymph nodes, spreading to all lymphatic structures in the body. Intracapsular ruptures can be determined by MRI with silicone implants as can extracapsular. In fact, the MRI is the diagnostic test of choice for detection of silicone gel ruptured implants. Close examination will determine whether there has been spread through the capsule around the implant itself.

A saline capsular deflation normally is associated with simple resorption of the fluid to the lymphatics through the capsule, and may not lead to as much scar tissue contracture around the implant. Patients with long-term chronic silicone mastitis with untreated silicone rupture, especially with Dow Corning or PIP gel implants of the past will be associated with calcified granulomas, scar tissue contractures and silicone mastitis with silicone migration through the entire breast into the axillary lymph nodes. Patients who have extracapsular silicone migration usually present with Baker IV capsular contractures, often with hardened breasts that are painful with abnormal deformity to the shape of the breast.

The length of time determined for a silicone gel rupture to become extracapsular versus intracapsular is case-dependent. Although in most cases several years have evolved three, four, five, etc., before the silicone will transcend completely through the capsule and spread elsewhere. Patients presenting with extracapsular ruptures should have MRI’s to evaluate the axillary lymph nodes looking for significant lymphadenopathy or lymphangitis. MRI’s presenting every two to three years after the initial surgery will help to prevent extracapsular rupture by detecting ruptured silicone implants, which can then be removed prior to transcending through the capsular shell.