My Breast Implants Ruptured Within a Year of Surgery. What Are my Rights?

First of all, it sounds as if you are talking to lawyers about "rights" rather than asking your doctor about your worries (or trusting his answers). If you no longer trust your plastic surgeon, seek additional opinions from other experienced board-certified plastic surgeons--you may be surprised to find that they concur with your doctor. Will you continue to mistrust anyone who does not agree with your self-diagnosis, or will you trust a scan that the FDA acknowledges is incorrect 21% of the time? Remember, you asked your surgeon to do this operation for you; now you sound as if you are upset at him because you have pain and you think your implant is ruptured, and now you have a scan that agrees with you. What if your scan is wrong?

You should know that your silicone implants (assuming you have the latest generation of silicone implants made by either manufacturer) are made up of a cohesive silicone gel that CANNOT rupture or "leak." Older silicone implants could indeed leak and/or rupture, and patients could develop lumpy irregularities or capsular contracture. The latter can in some cases be painful (as nerves are stretched or tightened by the progressively tightening scar capsule around the implants.)

Of course, pain, numbness, and tingly sensations ARE a normal part of every breast augmentation patient's recovery, some more some less, but always for all patients! And at three months post-op, any irritated or cut nerves are at maximum healing and regeneration, which can take as long as a year or more. So these sensations are truly normal, and usually are different on one side as compared to the other. But naturally, this is what concerns come patients--one side feels "fine" and the other has discomfort, so "something" must be wrong, correct? Increasing pain is potentially worrisome, but also expected to some degree as nerves do heal and send sensations more fully. Beyond a year or so, things should be pretty much stable, so persistent worsening (or sometimes persistence without improvement causing more annoyance) is an appropriate issue.

I absolutely understand your concern, but other than your pain at three months, why do you think you had an implant rupture? Was there swelling on that side you didn't have on the other? Accidental trauma, bump, bruising, or other reason to suspect implant damage? Other than pain discrepancy, do your breasts look and feel normal? Was the MRI done to look for answers to the pain or to "determine if your implant is ruptured" since that is what you have feared for 9 months now? In the absence of any other objective findings besides different pain in each breast, your doctor is wise to NOT operate on the basis of a scan; I always tell patients that I operate on patients, not X-rays or MRI scans, and that I have to be able to identify a surgically-correctable problem (pain, unfortunately is not one of these) in order to recommend an operation. So, what do you and he do when you are confronted by a scan that says "Ruptured Implant"? (And, by the way, if the decision is surgery, do you agree that it is your responsibility to pay if the implant is found to be absolutely intact, and the nerve pain is no better after everything heals a second time?) Rupture or not, adopting a "blaming" or "See, I told you" attitude is not the way to get either help or answers. Sure, I understand that payment for more surgery is yet another sore topic. Your original payment was for performance of surgery to the highest degree of skill and talent available to the surgeon YOU chose; results are as variable as each and every patient and can NEVER be guaranteed.

Again, the newest generation of soft solid silicone gel implants have a more crosslinked silicone gel filler that is cohesive like Jell-O. These implants do not leak, do not rupture, and do not require, IMHO, an MRI scan every two years to look for "hidden rupture," especially when these scans are WRONG 21% of the time! I have operated on patients with not one, but two scans that don't even say "Possible ruptured implant" or Probable ruptured implant" but "Ruptured implants" and found intact and normal implants in these patients. But you still have the pain issue, and that is what needs to be focused on, not this red herring of a possible ruptured implant as a cause for your pain. And unfortunately, even if the implant was found to be defective and was replaced, there would be no free silicone in your breast pocket, no implant cause for your pain, and probably no improvement in your symptoms post-re-operation! If you have capsular contracture, malposition, or want a different size, these are reasons to re-operate. Pain is due to surgery and healing and scar tissue, not presence of implants, unless capsular contracture is tugging at your sensory nerves.

You and your surgeon should have discussed at the time of your original surgery his redo or revisional surgery policy. Typically, surgeons will not charge a surgeon's fee, but OR and anesthesia costs are the patient's responsibility. Very few surgeons "build-in" a "free" redo surgical cost into the original fees charged, since the best surgeons have few (but still have some) re-operations. And again, pain is unfortunately both normal and very subjective, so this is not usually a good reason (alone) to re-operate. If you purchased implant insurance offered by the manufacturer, your surgical costs may be covered, and your implant (if truly damaged, but not ruptured, since it can't rupture--see above) will be replace by the implant manufacturer for free.

Dear KimHeaven:

Breast implant rupture is not usually painful. Saline implants will deflate rapidly, so there can be some aches, but usually nothing severe.  The loss of volume is easy to see, and an MRI is unnecessary.  I am assuming you have silicone gel filled breast implants. These implants are filled with a cohesive gel, so when the shell breaks, the gel can stay in the implant pocket with no symptoms. The volume is usually maintained, and there is no pain. This is called a silent leak, and it the reason the FDA recommends a screening MRI at three years and then every two years after breast augmentation. 

The pain you were/are experiencing is not explained by the leaking implant. Usually there is no pain. Leakage rates for gel implants are about less than 1% at three years. While it is unusual to have a leak so soon after surgery, it can happen. MRI is the best test available, short of surgery, to detect leaks, and is correct 10% of the time. I have had patients who have been told they have a leak on MRI. The correct thing to do is to operate, and replace the defective implant, but once in a while the implant is ok.

With the MRI finding of a leak, the implant should be explanted and replaced if you desire to maintain the augmentation. Information on the US manufactures' warranties, Allergan and Mentor, can be found on the link below. During surgery ,the capsule should be carefully inspected to see if a cause of your pain can be identified and hopefully corrected. Not to make you more upset, but there are rare cases of women having pain from implants that is only corrected by removing the implants and leaving them out. Hopefully, this will not be your experience.