Ruptured Implant and Silicone in Lymph Node

Mommy,
This is a very complex situation that you present, requiring an extensive discussion with a board certified plastic surgeon and possibly a breast surgeon. There is no great urgency, but it sounds like your implants can and should be replaced. It is possible that if your implants are older model technology, they may not be ruptured, but instead may be "bleeding" silicone (a microscopic leaking through an intact shell). This bleeding silicone may be taken up by the lymph nodes. The removal of the nodes would have to be discussed with your treating surgeons, as everything we do in surgery and life, has consequences and you need to know what those are. Good luck!

         Silicone breast implants are not intended to last a lifetime and occasionally these devices fatigue and rupture. When this happens, the silicone is usually contained within the fibrous capsule that surrounds the implant.

         Although removal of ruptured silicone breast implants is not an emergency, most surgeons agree that ruptured implants should be removed as soon as possible. When ruptured silicone implants are left in place for prolonged periods of time, the silicone can actually leak into the surrounding tissue and lymph nodes. This can result in an inflammatory process known as a silicone granuloma. Although this problem is not life threatening, it can make subsequent reconstruction more difficult.

         When ruptured implants are removed, it may be necessary to remove the breast capsule as well. In most cases, new breast implants can be placed during this operative procedure. 

You did not mention why you believe that your implant is leaking.  With the new form of breast implants produced after 2009 there is little chance of the implant gel material migrating since the gel is more cohesive than it was prior to this time.  Therefore it may be difficult to tell if it is ruptured since the implant tends to keep its original shape. The problem is non an emergency.  You would need some type of diagnostic study to determine if it was actually ruptured such as a  mammogram, MRI or ultrasound.  With the new form of implants there is little risk of migration of Silicone to the lymph nodes. 

Ruptured Silicone Implants should be removed and replaced. Typically removal of the surrounding capsule (Capsulectomy) is also performed to remove traces of silicone. The likelihood of this happening would be more likely prior to 2006 especially after trauma. After 2006 silicone implants were all more cohesive (more gel like).

 I would recommend removal of  silicone filled lymph nodes (grossly filled, not microscopic) if lymph nodes are enlarged or easily accessible be removed and tested. The likelihood that is involved in serious condition is very rare and in fact, I reported on one of the few ever reported which occurred in more than 25 years of practice.

Web reference: http://journals.lww.com/plasreconsurg/Fulltext/2012/03000/First_Report_of_Nodal_Marginal_Zone_B_Cell.72.aspx

Ruptured implants should be removed. The silicone can cause granuloma formation which in and of itself is not dangerous but makes it more difficult to remove later. I'm not sure what you mean by "rupture silicone in the lymph nodes" since the silicone should not be in the lymph nodes.

A ruptured implant should be replaced at a convenient time for the patient. It is not an emergency and will cause no long term health problems. The silicone will be contained by the capsule that forms around all breast implants.

It is unnecessay to remove lymph nodes if silicone is suspected. Probably everyone in this country has molecular silicone in a lymph node somewhere. Injection needles are lubricated with silicone so anytime you get a medical injection or IV, some silicone is shed into the blood and ultimately filtered through the lymphatics.

The treatment depends on which silicone implant was utlized.

The more cohesive gel impants are quite firm and do not easily spread when ruptured. However, the less cohesive gell implants can diffuse throughout the breasts. This can be quite a mess to clean up. Therefore it is best for you to find and treat these as soon as possible.

Breast implants, like most medical devices, are not meant to last a lifetime. I advise our prospective patients that replacement will likely occur sometime over their life time. In 1999, the Institute of Medicine concluded that silicone implants do not cause any major health problems. Research and reports from the last decade have shown that silicone gel-filled implants do not pose additional risk to women’s short-term or long-term health. Most plastic surgeons would recommend removing the implant and/or implanting material. You are correct in that this is not an medical emergency.

The breast lump should be thoroughly examined. The best imaging for looking at the ruptured implant and silicone material is the MRI. I would strongly advise you to see a board certified plastic surgeon that is experienced in breast surgery in order to have the old implant and implant silicone material removed. A thorough medical history and physical examination will be performed and a surgical plan formulated specifically for you. Obviously, you will need to decide if you wish to have replacement with new implants.

I agree- if the implants are known to be ruptured, nothing good is going to come from leaving them in place. I wouldn't want you to think that dealing with the issue is an emergency, but the longer the silicone material is allowed to stay in place, the greater the chances of further silicone migration to lymph nodes or other locations.

This further migration will only make further diagnostic maneuvers necessary in order to rule out more serious problems like breast cancer- maneuvers you might avoid if further migration can be prevented by removing your implants sooner rather than later.

Fundamentally, a silicone implant is a foreign body- if you know it's broken, it's best to have it removed.

Current recommendations are to replace or remove ruptured implants. While studies have shown that there is likely no significant _systemic_ harm from leaking silicone the silicone itself can cause local inflammation which can lead to scar tissue and other local problems over time.

And as Dr. Freund and Dr. Karamanoukian have pointed out - it is important that any new lump in your breast or armpit be evaluated to rule-out breast cancer. Don't assume it is from the silicone.

I hope this helps.