For those with silicone breast implants, how do you know if you have a silent rupture? Sometimes it is obvious that something has happened- your implant changes shape, turns hard, looks different than it has. But there are times where the implant has leaked and still looks and feels the same.
How do you know what type of implant you have? Many patients don’t know if their implant is silicone or saline, in front of or behind the muscle.
Some doctors recommend just changing out the silicone gel breast implants every 10 years. I don’t know if that is the answer, as many implants (particularly the newer generation ones) can go years longer and still be ok.
This is from the PRS July 2023 Journal. “Use of High Resolution Ultrasound in Characterizing a Breast Implant and Detecting a Rupture of the Device.”
So what did the journal article say? They are proponents of using high definition ultrasound to understand what you have and if it ruptures. Their study shows:
- FILLER PROPERTY. High resolution ultrasound can tell you if your implant is saline or silicone gel filled. (Yes, many women do not know what type filler they have in their implant. Some very old styles of implants actual are “dual lumen” and have gel and saline.)
- POCKET. Is your implant in front of or behind the pectoral muscle? I can usually tell this on physical exam, but sometimes it is hard to tell. This can change the risk and type of future surgeries.
- SURFACE TOPOGRAPHY OF THE SHELL. Is it textured? “It is almost impossible to differentiate between a smooth surface and microtextured device. They think they can see macrotextured surfaces. Why do we care? The ALCL cancer is only associated with textured breast implants.
- SHAPE AND MANUFACTURER. They say you can tell an anatomic implant (shaped, teardrop) because of an orientation mark on the anterior or posterior shell surface. They found they could differentiate the different manufactures by looking at the shell based on shape, number, length and position of the orientation marks, including a round macrotextured breast implant which has no orientation marking.
- DIAGNOSIS OF RUPTURE. They state the ruptures may present with changes in soft feel or shape, size, pain, or palpable breast or armpit nodules. Saline implants tend to deflate, so you can see the size change. Gel bleed though is a type of rupture where the shell does not tear, but they state they can see it on ultrasound. Usually they will state “intracapsular rupture” (where the gel is contained within the capsule your body made around the implant) vs. extracapsular.
My thoughts?
Great to see this level of detail from an ultrasounds, so you don’t have to do a MRI to evaluate. I rarely see extracapsular spread of silicone with a ruptured implant, but intracapsular rupture (where all of the gel is contained within the capsule your body made around the implant years ago) is definitely seen. You should consider an ultrasound or MRI if you have a silicone implant to detect these. Recommendations are to start at 3 -5 years after implantation. I would urge those with implants over 10 years out to do imaging regularly.