I understand that they need to be checked, but is there a less expensive way to check for leaks or rupture. I also am aware that I may need additional surgeries in the future. I am a mom of 3, 130lbs, 5'5" and have a small frame and bone structure. Thanks.
I Really Want Memory Gel Implants, but Don't Want the Cost of the MRI's, Options?
Doctor Answers (10)
I Really Want Memory Gel Implants, but Don't Want the Cost of the MRI's, Options? Answer:
It does seem like the FDA is going to relax on its standards for MRI. And my patients have kind of fallen into 3 categories themselves, regardless of the recommendation. I had one group that will do whatever the FDA recommends (they can usually afford it!), and another group that will do it every 8-10 years and a last group that says, “if I feel fine, and not having a problem, I don’t need an expensive test to tell me I love my breasts!!” So I think you can enjoy silicone with full confidence!
MRI is not necessary for patients who choose silicone implants!
The present generation of silicone gel implants (by both manufacturers) is cohesive, and cannot leak. If the implant shell, which is an extremely tough cross-linked silicone elastomer, is cut or damaged in any way, or if there were some manufacturer-related shell defect, the cohesive gel inside is entirely unlike the liquid, oily, sticky or more fluid silicone polymers used in previous generations of implants. The present cohesive silicone gel basically "sticks together" much more readily than in older implants, and is easily removed if implant rupture is ever an issue. This occurs extremely infrequently, though I have seen it in a total of 3 implants over the past decade. I do several hundred breast surgeries per year, as does my partner, so true implant rupture really has a low incidence rate.
FDA recommendations for MRI every 2-3 years to look for "silent rupture" are now being revisited, and this nonsensical recommendation has caused over 20% of MRI patients with normal intact implants to have an unnecessary operation because of "false positive" studies. In other words, MRI studies reported "ruptured" implant(s) when at surgery these implants were found to be normal. For something that occurs in significantly less than 1% to be "evaluated" incorrectly over 20% of the time means that test and recommendation should be abandoned.
Besides that, I have always bristled at the implication that I should operate on a "test" rather than a patient. If one of my silicone breast implant patients has ANY problem or issue, then I can make a surgical recommendation based on improving or correcting a specific problem. If a patient has NO problem but a scan that says there is an implant rupture (when I know the true statistics of implant rupture), I am naturally reluctant to perform an operation that may be unnecessary in many cases, since the study is wrong so much of the time.
Unless you are already obtaining MRI scans now (to look for non-implant-related possible health problems!) every 2-3 years, does this "recommendation" to go looking for implant problems that rarely occur and are misdiagnosed over 20% of the time (FDA's own data) make any sense? Now you know why all of these answers read as they do, and why the FDA is primed to drop this "recommendation."
Have the surgery and the implants you wish, and follow your doctor's recommendations and you own good common sense! Best wishes!
Memory gel and mri
A number of individuals have written re the need and timing of MRI after the newer cohesive gel implants. I do not have anything substantial to add on that front. I practice in Chicago and if I send patients to the University Hospital where I work the costs for an MRI are to say the least high. There are two private MRI companies nearby that will perform the tests for under $500. Depending on your location I would suggest you see what the options are for pricing for an MRI of the breast for a non-insurance patient who is paying for the test in full before the procedure.
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Memory Gel implants and need for routine MRI scheduling
The FDA recent eliminated their recommendation for routine MRI screening for all patients with silicone implants.
Monthly self exam and yearly breast exam by a physician in addition to routine mammograms is sufficient unless you have a very strong family history of breast cancer.
Gel implants and MRI monitoring recommendations are changing!
Mentor Memory Gel and Allergan Natrelle Cohesive Gel Implants are currently the breast implants that are most popular. When these devices were re-introduced to the US market it was recommended that every patient have screening MRI exams every 2-3 years to try and identify a sub-clinical or so-called "silent rupture" of these implants as soon as possible. In Canada, we have had these implants and other more highly cohesive silicone gel implants available for a longer interval of time and this FDA guideline to have regular MRI screening performed was considered, but not recommended. Essentially, the benefit of picking up a silent implant rupture (which has no known health implications) with an MRI was not felt to be out-weigh the risk of a falsely positive MRI exam or the financial cost to patients to have these exams done.
This issue has recently been reviewed in the US and the scheduled MRI exam recommendation is no longer going to be made. This is a real breakthrough and for once common sense appears to have prevailed. Women with implants of any kind should do regular self breast examinations, have an annual physical with their PCP or Plastic Surgeon and follow established cancer screening guidelines. By staying in touch with your Plastic Surgeon you can be made aware of any changes to the guidelines for women with breast implants.
MRI after silicone gel breast augmentation
The FDA only "recommends" that an MRI be performed every 2-3 years - it's not mandatory. This is the only way to know if the silicone gel implant has a rupture. Unfortunately, a rupture or leak cannot be determined by physical examination. Some patients choose not to get the MRI unless they see or feel something "different".
If you really want Silicone Gel Breast Implants, I would suggest meeting with a board certified plastic surgeon and get information regarding your surgery and all of the pro's and con's associated with breast augmentation surgery. I think you will feel more comfortable after speaking with an experienced surgeon.
Do you need MRI's after cohesive gel implants?
When the FDA allowed silicone gel implants for cosmetic breast augmentation in 2006, the FDA recommended that women with silicone gel implants get periodic ( 2-3 years ) MRI's to look for "silent" ruptures. A "silent " rupture is an implant rupture that cannot be diagnosed by the appearance or feel of the breast.
The older silicone implants which are not used today were much more fluid and liquid- like. When they ruptured they could flow beyond the implant shell and scar capsule. There was often a change in shape or feel of the breast. Today's cohesive or Memory gel implants are more like a piece of firm Jello. They do no not flow like a liquid and maintain their shape. When they rupture, physical examination will not detect the rupture.
About 1% of the newer silicone implants fail each year. The result is a lot of negative MRI's or false positive MRI's.
The bottom line is the FDA will not "repossess" your implants or compel you to have the study. These guidelines will probably be modified as more data is collected on the aging of cohesive gel implants.
Richard L. Dolsky MD
Cosmetic Surgery of Philadelphia
MRI's after siliconre gel implants
The FDA reccomends MRI's in women who get silicone implants. They indicate that the MRI studies are more likely to show a rupture in women who are having problems, and less likely to show a rupture in women who are asymtomatic. The MRI's are only a recommendation and not a requirement. As one of the other doctors responded, there are incidences of both false negative and false positive reports, reducing the efficacy of the study.Mammograms are less sensitive than MRI's but can be suggestive of rupture. Mammograms are routinely performed on women after the age of 40.
I want gel implants, but...
MRI's and gel implants
The old style gel implants which could leak into your body could often be seen to have ruptured on a mammogram or an ultrasound. The new memory gel implants won't be detected this way anymore so MRI's are recommended as the gold standard foe rupture detection. While the FDA has recommended that you get these checked every 2-3 years, nobody is going to force you to do that. In my understanding, it will remain your choice to do these or not.