I am trying to decide between silicone and saline. I have a good amount of breast tissue, a 32C. My PS that I am thinking about using told me, " Although the FDA recommends that you change a gel implant in the event of a tear, most plastic surgeons including myself, feel a ruptured implant does not need to be changes." Does this sound accurate?
PS for Breasts Says if Cohesive Silicone Ruptures He Does Not Believe in Switching Them Out? Is This Normal?
Doctor Answers (16)
Replace silicone implants if ruptured
This may be a bit of a long-winded explanation, but I believe it requires some explanation. Although in general, the FDA recommendations should always be followed, it becomes more difficult with diagnosed ruptured breast implants with the new cohesive gel implants.
The reason for this is that the implants today rupture at a very low rate, and the detection of a ruptured implant can be quite difficult. When a patient comes to the office with an MRI that shows a ruptured breast implant, but they are asymptomatic, it is not a clear-cut decision to undergo removal of the implants. With any test, there are a certain number of "false positive" results. What this means is that although the test states that the implant is ruptured, in reality it is not. It is simply an error with the test itself. These false positive results cannot be completely eliminated. The problem becomes, when a patient comes in with a suspected ruptured implant, they may undergo an operation that is completely unnecessary since the implant is in actuality not ruptured. With the FDA recommendation that all implants be removed if ruptured, there will be more cases of false positive results leading to removal of intact implants. These operations, of course, do not benefit anyone.
At this point I am unaware of any clear-cut consensus on how these issues should be treated. There is some debate in the plastic surgery literature about how the monitoring of breast implants and this false positive rate may in fact lead to more harm than good as it may lead to more unnecessary surgeries due to this false positive rate. Also, most surgeons are trained not to operate on test results alone. Usually surgery is only recommended when there is a clear-cut benefit from the surgery. A patient with asymptomatic breasts with a possible rupture needs to consider all options before moving toward surgery as the implants may in fact be intact.
Because of these reasons I think that it is a difficult decision based simply upon the results of a study to undergo removal and/or replacement of the implants.
If you have reason to believe that your implants are ruptured, it is important to seek consultation with a breast surgeon to find out what the best answer is in your particular situation.
The real problem is that in some patients the MRI is far too sensitive and the so called ruptures are actually just shell folding within the capsule and not really a rupture
While the FDA recommends replacement, replacing a leaking silicone gel implant is a decision that each plastic surgeon and patient should assess individually. Certainly if there is deformity or hardening, this decision easier to make. The dilemma is with "silent" rupture when detection is incidental and there are no symptoms or deformities. Often there is no immediate danger to the patient and these conditions can remain stable and asymptomatic for a long time. It is hard to recommend that all ruptured implants be replaced at great overall cost and possible complication with finite risk when no demonstrable benefit will occur, yet you cannot claim that everything is normal and no danger exists in an individual patient.
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Implant failure and replacement
While I have not formally surveyed my colleagues, most, if not all, that I know would recommend replacing a failed implant. It will be more difficult to detect failure in the new form stable implants with MRI, but not impossible. We used a MRI which accurately diagnosed failure of one of these implants in a patient that I saw and treated. It is irresponsible to not replace a failed implant, especially given the controversy that silicone implants have had in the past. I believe that they are safe when the patient and surgeon are diligent about followup and treat any problem pro-actively.
Cohesive Gel implants ??
Could it be that you misunderstood your Plastic Surgeon ?
The FDA states that you have to replace a ruptured implant . The FDA has on their website several pages dealing specifically about breast implants and you can read about their recommendations.
Having said that nowadays with the high cohesive and form stable implants it is sometimes very difficult to figure out(even with an extensive examination and MRI) if an implant is broken. The gel stays contained in the shell and the scar around the implant. There are many women with broken/defective implants and the patient and their Surgeons are unaware of it. I do not know of any scientific research that would place such a patient in physical danger. Your surgeon may meant to tell you that you do not have to undergo replacement of a Gel implant just on a "hunch".
If you have already plenty of breast tissue ("C" cup) you maybe happy with a Saline implant. When a Saline implant is defective you will know sooner than later. I think you should be able to clear your concerns very easily with the Surgeon of your choice. Ask him all the questions and voice your concerns!
Ruptured Implants Should Be Replaced?
Conventional wisdom is to replace implants in the event of rupture. Determining whether or not the form stable implants are ruptured may be difficult. Partial tears will be extremely difficult to detect. Many of these new form stable implants may well stay in for much longer periods of time for the reasons stated above.
To replace or not
The question you bring up raises a good point. If you opt for saline implants, then you don't need to decide whether or not to replace a broken implant. As far as a broken gel implant is concerned, I would definitely replace one that is broken. And remember, the manufacturer will provide a replacement for life free of charge.
Cohesive gel implant issues?
In my opinioin if an implants ruptures it should be exchanged out even if it is a cohesive gel implant that will probably maintain its shape.
No rush to replace ruptured cohesive implant
As you can see from the previous replies, part of the problem is that when a silicone gel implant develops an opening in the shell (rupture isn't really the right word), there is no change in the appearance of the breast so no real way to even know. One study screened a large population of women with implants with MRI's, and identified a number of cases of "rupture." About half of the women opted to have them replaced, and the other half were brought back about 2 years later and there were no significant changes (as I recall.) So while it is a good idea to replace them if you become aware of a rupture, there is no urgency.
Treatment of Ruptured Breast Implant
There are two things to consider regarding your question about whether to replace a "ruptured" cohesive silicone breast implant. First is how do you know that it is ruptured. It used to be that an MRI could detect a rupture as the gel would seep out of the shell and the shell could be seen on an MRI within the gel. With the newer cohesive gel implants there is a real question as to how to tell if they are ruptured since the gel stays cohesive and the shell should not migrate. There are, therefore, probably many people with "ruptured" implants that do not know it. This is probably also true for the older implants if there have been no problems and, thus, no MRI has been done. The second thing to consider is that the "recommendation" is just that. It is based on no good scientific data comparing how those that had the implant replaced and those who did not have it replaced fared. From the data available and my own experience of following many patients with ruptured breast implants there appears to generally be no reason to replace a known ruptured breast implant unless there are symptomatic problems such as abnormal contour, inability to determine if there is a breast lump, pain, etc. I would, therefore agree with your surgeon.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.
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