Silicone Breast Implant Rupture - Ultrasound or MRI?

Breast implant rupture is a risk associated with both saline and silicone implants, whether they are placed for cosmetic augmentation or breast reconstruction.

In the case of a saline implant, a rupture is very easy to detect. Saline implants deflate after rupturing as the saline (salt water) leaves the implant and is reabsorbed by the body. Beyond a clinical evaluation, no tests are required to confirm the rupture.

Silicone breast implant ruptures are usually much harder to detect. Early ruptures often go unnoticed by the patient since the silicone remains contained within the capsule of scar tissue formed by the body around the implant. These are known as "intracapsular" ruptures and are the most common. Intracapsular ruptures can progress to "extracapsular" ruptures over time.

Extracapsular ruptures involve a break in the scar capsule around the implant which allows silicone to leak out into the surrounding tissues. Associated changes in the breast can include capsular contracture, distortion, firmness, asymmetry and pain. Extracapsular silicone can also find its way into the lymphatics and lymph nodes.

If your silicone breast implant has ruptured the implant should be removed or replaced, if possible before the rupture becomes extracapsular.

The first step is to confirm the rupture with either an ultrasound or MRI. Most plastic surgeons, myself included, strongly prefer MRI when the patient has symptoms or a rupture is suspected since MRI is more accurate than ultrasound (94 vs 72%) and is less likely to miss a rupture.

Silicone Breast Implant MRI.
White arrow = "linguine sign" of intracapsular rupture
Black arrow = damaged implant capsule

Routine Screening to Check Silicone Implant Integrity

The FDA recommends that patients with silicone gel breast implants (cosmetic and reconstructive) undergo MRI screening to check for silent (intracapsular) rupture 3 years after implants are placed and every 2 years after that. Most plastic surgeons feel these recommendations are excessive since the risk of implant rupture within the first 5 years is very low and MRIs are very expensive. Many surgeons don't feel any routine screening is necessary at all. For those who do advocate for routine implant screening in women without any symptoms or changes on exam, ultrasound is a more cost effective alternative followed by MRI if the ultrasound is positive.

I hope this info helps!

Dr C

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Dr Chrysopoulo is a board certified plastic surgeon in San Antonio, TX, specializing in breast reconstruction and cosmetic breast surgery. Patients are welcomed from across and outside the US. To schedule a consultation, please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com. Connect with Dr C on Twitter and Facebook.

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Breast Reconstruction Surgery - Part II - Muscle Flap Reconstruction

Women interested in breast reconstruction after mastectomy have several reconstruction options to choose from. In Part I of this series we discussed tissue expanders, breast implants and Alloderm.

Though implant reconstruction remains the most common method of breast reconstruction in the US, many women are now steering away from this option, opting instead to use their own tissue for more “natural” results. Muscle flaps have, until fairly recently, been the only choice available for these tissue reconstructions. The most commonly offered muscle flaps are the latissimus and TRAM flap procedures.

Latissimus Dorsi Flap:

The latissimus procedure uses muscle from the back of the shoulder blade which is brought around to the breast mound to help create a new breast. During the procedure a section of skin, fat and muscle is detached from the back and brought to the breast area.

Many patients also need a tissue expander placed under the muscle flap in order to obtain a satisfactory result. The expander is replaced by a permanent implant at a second procedure down the line.

Patients will have a scar on their back shoulder region that can sometimes be seen through a tank top, swimsuit or sundress. The upper back can be numb or sore for a few following this procedure until the nerves grow back and the incisions are completely healed.

Women who are very active in sports should know that this procedure can reduce ability to participate in activities like golf, climbing, swimming, or tennis.

TRAM (Transverse Rectus Abdominis Myocutaneous) Flap:

The TRAM flap was the first procedure to describe use of one of the rectus abdominis muscles (sit-up muscles) for breast reconstruction. This procedure begins with an incision from hip to hip rather like a “tummy-tuck”.

A "flap" of skin, fat and one of the patient's abdominal muscles is typically tunneled under the skin to the chest to create a new breast. This is known as a pedicled TRAM flap. Recovery from the TRAM flap procedure can be difficult and painful and there is a risk of abdominal bulging (or “pooching”) and even hernia. Long-term, the patient has to adapt to the loss of some abdominal strength (up to 20%) which most active patients will notice.

In cases where both breasts are being reconstructed, both abdominal muscles are sacrificed and transferred to the chest (one for each breast). The loss of abdominal strength in these situations is far greater and very significant.

Over the years and with the introduction of microsurgery, the procedure has evolved several times with each modification preserving more and more abdominal muscle. This has made postoperative recovery a little easier and has decreased the potential for abdominal complications somewhat.

The latest evolution in breast reconstruction is  “perforator flap surgery”. These techniques use skin and fat from various parts of the body. Since no muscle is sacrificed recovery is much easier and muscle strength and function are preserved long-term. These techniques will be discussed in Part III of this breast reconstruction series.

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Dr Chrysopoulo is a board certified plastic surgeon specializing in breast reconstruction after mastectomy including the DIEP flap and Alloderm one-step procedures. In-network for most US insurance plans. Toll Free (800) 692-5565. Latest news in breast reconstruction surgery and research available at The Breast Cancer Reconstruction Blog.

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