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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Who is NOT a DIEP flap candidate?

With more women becoming aware of DIEP flap breast reconstruction as an option, the question of who is and who isn't a good DIEP flap candidate is coming up more often.

As a general rule, women that have had extensive abdominal surgery like a previous TRAM flap, tummy tuck or a complex hernia repair cannot have a DIEP or SIEA flap breast reconstruction. This is because the lower tummy tissue that is needed has usually been removed or moved around, and the necessary blood supply has been disrupted.

Having said that, most of the time previous abdominal surgery isn't an issue in experienced hands.

Many women these days have had at least one previous c-section or another gynecologic procedure like a hysterectomy. It is possible for these procedures to cause damage to the blood vessels needed for DIEP flap surgery but fortunately this is unusual. A previous c-section, hysterectomy, or tubal ligation is not a contra-indication to having a DIEP or SIEA flap. Previous liposuction is not usually a problem either unless this was extensive.

If your surgeon is worried about potential damage from previous surgery then certain tests can be performed to evaluate your anatomy more closely. This can include a simple doppler ultrasound exam in the office or a more involved test like a CT angiogram. Unfortunately, the CT scan does involve radiation.

While previous abdominal surgeries may not prevent you having DIEP flap reconstruction, women that have had multiple previous abdominal procedures are at increased risk of abdominal complications like bulging and hernia after DIEP flap surgery when compared to women that have never had prior abdominal surgery, even though the abdominal muscles are preserved. This is because the fascia (the strong layer of tissue over the muscles) has already been weakened by the previous surgeries.

Some medical issues can make any form of microsurgical breast reconstruction (like the DIEP flap) more difficult and they can also increase the risk of complications like flap loss. These include disorders that make the blood clot more easily (eg Factor V Leiden).

I hope this info helps.

Dr C

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Dr Chrysopoulo is a board certified plastic surgeon in San Antonio, Texas specializing in state-of-the-art reconstructive breast surgery. He and his partners at PRMA are In-Network for most major 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 other breast cancer patients on Facebook.

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