Ruptured Silicone Implant Replacement - Which Is The Best Option? (Photos)

Question

I got silicone implants 15 years ago (2010, Allergen) and they have both ruptured which I discovered with an MRI last week. I have two surgical opinions. 1. Remove the impant, clean the area out and replace with the same size. 2. Remove the implant, remove the capsule, and then replace the implant with potentially the same size or maybe slightly bigger since things are a little saggier (stage 1 he said) I am worried about removing the capsule and can that cause any issues? He said the risk was more bleeding, he said he prefers to remove it b/c it would ensure he gets all the silicone . The first doctor does not. I am unsure which is the better decision. Here is what the MRI revealed: -Both implants are retromuscular silicone implants. -Both have intracapsular rupture. -There is partial collapse of the implant shell. -There is no extracapsular silicone on either side. -There is no lymphadenopathy. -The radiologist does not describe a thickened capsule, calcified capsule, capsular contracture, or extensive surrounding fibrosis/scarring. Thoughts on which makes more sense? I am worried if the first doctor just cleans it out I can have issues with additional scarring or leftover silicone. But removing the capsule what if it causes changes to my breast tissue. etc. Please share your thoughts.

Harry T. Haramis, MD, FACS · Answer

Exchanging ruptured implants should be fairly straightforward. Usually recommend go up a little on size.

The pocket / capsule will frequently require some release and/or removal. It all depends upon how thick and tight the capsule is.

True , total capsule removal can cause tissue and skin issues, especially in thinned out areas. An intra operating decision can be made upon removal of the implants and silicone- is likely to be a combo of your different consults.

Either way, there is a slightly higher chance of capsule scar tissue formation with repeated implant surgery.

Gerald Minniti, MD, FACS · Answer

Both options are commonly performed. We know that minute amounts of silicone gel are impregnated in the capsule, but that is not harmful. If you have capsular contracture, then capsulectomy would be warranted. There is a third option, one that appears to be a good one for you. You could have the implants and any gel removed from the pockets and then have your pectoralis muscle repaired USING the capsule as a means of sewing the muscle back down to the chest wall. Once that has been done, a new, subfascial pocket can be created for a new implant. The implant of choice is the Motiva breast implant, which has the lowest rate of rupture because of its construction that centers around the gel/shell interface. It also has a unique shell surface topography that down regulates immune mediated inflammation. This surgery is easy to recover from, does not require drains, and allows your muscle to work as intended. Subfascial implant placement is not new, and there is now a lot of data showing favorable outcomes compared to subpectoral (dual plane) pockets with regards to capsular contracture and implant malposition. With the advent of Motiva implants, muscle coverage is not necessary.

David Tauber, MD · Answer

The submitted images are selected MRI views, so they support the history of implant failure but do not allow a reliable assessment of breast sagging, nipple position, or whether a lift is needed. Both ruptured silicone implants should be addressed surgically, but a complete capsulectomy is not automatically required in every rupture. The decision depends on the MRI report and operative findings: whether silicone is contained within the capsule, whether the capsule is thickened, contracted, calcified, or contaminated, and how safely it separates from the chest wall. More extensive capsule removal can increase bleeding and chest-wall injury risk. The usual goals are removal of the ruptured implants, meticulous removal of accessible silicone, and replacement if desired. I would not choose a larger implant simply to treat sagging; implant size and any need for a lift should be decided from a clinical examination and breast measurements. Ask each surgeon to review the full MRI report and explain exactly how much capsule they plan to remove and why.

Ruptured Silicone Implant Replacement - Which Is The Best Option? (Photos)

Answers (3)

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