Patients present to my office weekly from around the globe with ruptured implants. They are baffled as to when they should have the implant removed and replaced. In my practice, I believe it is prudent that the patients have the implant removed as soon as possible in order to reduce scar tissue contracture and complete collapse of the pocket. With saline implants, the implant normally deflate within three to four week, leaving an empty shell with a small amount of residual fluid within the implant and fluid around the periprosthetic device. Scar tissue contracture can occur quite quickly with the upper pole muscles start scarring down to the chest wall. As a result, I recommend patients who present with ruptured saline implants have the implants removed, open capsulectomy performed and replacement within 7 to 10 days.
For patients who present with ruptured silicone implants as diagnosed by an MRI, I recommend the implants be removed with a calcified granulomata scar tissue and silicone material removed as soon as possible as well as reconstruction performed at the same setting after irrigation of the pocket. Silicone rupture that has been maintained for a long period of time, especially with the older Dow Corning implants, may lead to extracapsular migration of the silicone material throughout the lymphatics, including the axillary lymph nodes and all other lymphatic organs. Patients should have silicone and salineruptured implants replaced as soon as possible, I believe, within 10 days.
Surgery associated with a ruptured saline implant or silicone gel implant is associated not only with removing the implant itself, but also the scar tissue contracture that forms around the bag as well as the reconstruction with saline or silicone implants.