Analysis of 30 Breast Implant Rupture Cases

Abstract

The detection and evaluation of implant ruptures have been an issue for many years. If a ruptured implant is not removed, noncohesive silicone gel may spread to surrounding tissue, causing granuloma, redness of the affected skin, firmness of the breast tissue and skin, or distant migration [2]. When a ruptured or leaking saline type prosthesis is not removed or replaced with a new one, severe deformity of the breast may result. Once this occurs, I have found that many cases present difficulty in the reconstruction of the deformity to breasts with a symmetric appearance. The authors state that when they encountered rupture of a hydrogel breast implant, the gel had adhered to surrounding tissue, accompanied by inflammation and granuloma formation. Also, they state that the surgical procedure required removal of the granuloma and extensive debridement of the affected skin. Diagnostic methods used to detect implant rupture include a squeeze test, mammography, sonography, computed tomographic scan, and magnetic resonance imaging (MRI). Among these, MRI is reported to be the most reliable method for detecting rupture of the implant [1], which the authors article supports. Sonography is a valuable adjunct in the evaluation of only anterior breast parenchymal pathology. Furthermore, the sensitivity and specificity of sonography may vary depending on the experience of the attending radiologist. Mammography itself may cause implant rupture [3]. Also, patients with severe capsular contracture are unable to receive mammography. Recently, a patient in Japan noticed her breast implant rupture during the course of mammography. She subsequently sued the doctor, which raised the issue of how breast cancer should be checked among those with implants. In my opinion, mammography should not be used for patients with breast implants unless either a rupture or breast cancer are strongly suspected, as evidenced by other types of evaluations. At this point, however, MRI seems to be the most reliable imaging method for evaluating patients with breast implants. No diagnostic technique offers 100% accuracy in finding an early rupture or leak of saline, noncohesive silicone, or hydrogel breast implants. Probably the best way to check these conditions is to use a battery of techniques, which means checking local symptoms such as pain, mass, swelling, redness, and firmness; noting a change in the shape and size of the breasts; and administering the squeeze test, sonography, and MRI. Among these diagnostic procedures, the authors demonstrated that the linguine sign of the MRI is the most reliable for detecting signs of rupture or leaking of the implant. Because hydrogel implants are not so popular throughout the world, it is important to know what happens if ruptured implants are not removed after many years. The authors reviewed only one case of this type in their report. Further study is required to detect early signs of rupture or leaking hydrogel implants. With regard to the silicone type prosthesis, cohesive silicone implants currently are available in many countries. These cohesive silicone implants may rupture or leak. Furthermore, the degree of silicone cohesivity varies depending on product types or companies. More studies are required to determine whether the ruptured or leaking cohesive silicone breast implantmust be removed or replacedwith a new one. If this type of condition requires treatment, the question arises as to the best way of finding the leak or rupture of the cohesive silicone prosthesis. Because cohesive silicone implants are relatively new products becoming popular in the world, it is necessary to learn more information about this type of implant. As professional doctors, once we use breast implants for our patients, we are obligated to ensure that they are always happy with their breasts. Correspondence to: Email: info@mega-clinic.com Aesth. Plast. Surg. 29:470 471, 2005 DOI: 10.1007/s00266-005-0061-9