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Going Bust – What to do if your breast prosthesis is leaking.

01:21 18 August in Uncategorized
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If you have had a breast augmentation and experience any one of the symptoms listed below, you may have a ruptured and/or leaking prosthesis.

  – change in shape (slow and progressive or sudden deflation)

  • Sudden painful breast/s
  • A red, painful breast/s
  • Painful armpit glands with no history of viral illness or infected wound
  • Sudden awareness of size of the glands in the armpit even without pain

These are indications that your implants should be checked for possible rupture.  A mammogram will not show a ruptured implant.  You will need an ultrasound, or an MRI scan to carefully look at the shell of the implant.

Rupture of breast implants is a fairly common occurrence, especially in the older generation (OG) implants.  These OG implants had a thin shell and watery, flowing silicone oil within.   Silicone oil would leak out of the implant, infiltrate tissues and make its way to the armpit glands and cause inflammation, swelling and pain.  Patients also reported “Chronic fatigue” like symptoms, although there is a lot of debate in the literature about this, I’ve seen enough evidence to validate it.

Rupture of implants can take two forms.  It can be an intracapsular rupture meaning that the silicone has not leaked out beyond the confines of the pocket in which it has been placed – it has been contained.  Extra capsular rupture – the contents of the implant have spread beyond the capsule*and the pocket around the implant.  

Any and all types of implants have the possibility of rupturing, some are more likely to rupture than others.

Saline implants

To the best of my knowledge no-one is using saline implants anymore.  There are few saline implants still out there as most of them have deflated and/or have been replaced at some point or another.    Remember saline is just saltwater and if this old type of implant ruptures, the body just absorbs the water and the beast falls flat.  All the volume of your augment is lost and you have an empty silicone shell, lying in the pocket where your full implant used to be.  The tissue capsule will shrink down over time but probably will need to be removed along with the implant shell. The most dramatic indication of the implant rupture i.e the breast suddenly flattens is probably the least “dangerous”.

Silicone implants

Implants made 20+ years ago are more likely to rupture than the newer generation cohesive gel silicone implants which are more rupture resistant.  In my practice I take it one step further and I mostly use polyurethane foam coated cohesive gel silicone implants, and their rupture rate is very low.  This is mostly due to the fact that the implant has bonded to the tissues and is less prone to flipping, turning and moving around in the capsule – all of which can damage the shell of the implant and result in a rupture at some point.  

With new generation implants, even if they do rupture, the contents are less likely to leak out.  The reason for this is that it is so cohesive that it sticks to itself and won’t flow and is less able to move away in small particles.

 

If your implant is ruptured, what should you do? And do you need a period of “rest” between removing the ruptured implant and replacing it with a new one?

All ruptured implants should be removed and/or replaced.  If there is no infection present, the ruptured implants can be removed and replaced with new implants during the same procedure.

A patient may choose not to replace the implants, but the breasts will obviously be deflated.  Unless the breasts have enlarged during pregnancy or menopause and the patient feels happy with their size after the implant has been removed.  A mastopexy could be considered – surgically lifting the breasts without tissue removal.  This is a good way to get projection and shape without an implant.  The option would be:  Ex-plantation, capsulectomy**and possibly mastopexy.

Sometimes a  hard contracted capsule forms around the implant This another indication for removal of the implant and the surrounding tissue capsule – even if the implant is not ruptured.

If the capsule that forms around all implants is soft, the damaged implant can be removed and replaced with a new implant.  I usually advise doing both sides even if the other side isn’t ruptured so that the lifespan of the implants is the same.  This will also prevent asymmetry in the breasts

Sometimes a patient requests that the breasts are augmented and lifted with a mastopexy to have the breasts higher and better positioned on their chest.

Even after the leaking/ruptured prosthesis has been removed, sore, swollen lymph glands, may take a few months to resolve. It is therefore advisable to have a ruptured and leaking prosthesis removed as soon as possible.

Steps to follow:

  1. Contact your Plastic surgeon for an appointment and request a referral to radiology on suspicion of leaking implant.  
  2. Have ultrasound/MRI
  3. Attend Plastic surgery appointment with radiology report
  4. Follow surgeons recommendations for removal of implant or further investigation if your symptoms are not related to a ruptured implant

*Once a breast implant is in place, fibrous scar tissue forms around it, creating a tissue capsule. The body forms a protective capsule like this around any object it recognizes as foreign. The tissue capsule is usually soft or slightly firm, not noticeable, and helps to keep the implant in place.

** Capsulectomy is a technique performed during breast implant removal or breast revision surgery to remove the fibrous scar tissue that forms around the implants

 

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