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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Tattoos to Cover Mastectomy and Breast Reconstruction Scars on the Rise

For years, tattoos have been used to apply the finishing touches to breast reconstruction. A form of medical tattooing is used to add color to the reconstructed nipple and areola as the final stage of the reconstructive process. Recently, 3D tattooing has also become available to add even more life-like results.

Some breast cancer patients are now turning to more "traditional" ink-based tattoos to cover their mastectomy or breast reconstruction scars in more elaborate ways.

If you've ever considered getting an elaborate tattoo to hide your breast cancer scars, rest assured you're not alone! I'm seeing more and more breast cancer patients doing just that. Here are some examples:

Tattoo over right mastectomy scar
Source: iconosquare.com

Tattoo over left breast reconstruction scar
Source: launchboulder.pmpblogs.com

If you're considering a tattoo yourself, here are some more examples of tattoos used to cover mastectomy and breast reconstruction scars.

From a surgical standpoint, I don't see a problem with patients choosing to go this route. It's a very personal decision. Tattooing won't "ruin" a breast reconstruction. However, tattooing of course does have its risks including skin infections (e.g. MRSA), allergic reactions to the dyes, additional scarring, ink deposition in lymph nodes and cartilage, and even blood borne diseases (e.g. tetanus, hepatitis B and C). Tattoo pigments can also occasionally interfere with MRI exams and decrease the quality of the images.

Like anything, doing your research is crucial. Please make sure you choose a reputable and experienced artist and review examples of their previous work ahead of time.

Dr C

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Dr Chrysopoulo is a board certified plastic surgeon in San Antonio, TX, specializing in the DIEP flap and other state-of-the-art breast reconstruction procedures. In-Network for most US insurance plans. Patients are welcomed from across and outside the US. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with others touched by breast cancer on Facebook.

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