Once the diagnosis of ruptured breast implant is made, the implant should be removed enblock.
Breast implants are made to be contained in a shell. Before silicone migrates, remove it.
You have several options, discuss with your plastic surgeon the pros and cons and the risks of each recommendation.
Removal of a ruptured implant
For a ruptured silicone implant, I would prefer to do a full capsulectomy (en bloc removal of capsule and implant) to minimise any spill of the escaped silicone. Though silicone is relatively harmless, it still can travel to the lymph glands in your armpits and cause enlargement of the glands/discomfort etc. With cohesive gel, theoretically, the risk for spread of the silicone is lower - but perhaps not completely eliminated. So I would agree with your surgeon's proposal.
I favor removal with complete capsulectomy if possible. En Bloc sounds very severe but is not really more than a complete capsulectomy since this is still an intracapsular rupture. En bloc is much more substantial procedure for extracapsular rupture into the breast parenchema.
While it remains an intracapsular rupture, risks of any problems are minimal. The problem is that we do not know when it may progress to an extracapsular disruption. For this reason I favor removal while it is a relatively simple and easy procedure.
Chen Lee, MD, MSc, FRCSC, FACS
Ruptured implants should be removed
My recommendation is to remove ruptured implants. I would not recommend leaving them in. If the rupture is intracapsular the goal of surgery is to remove the ruptured implant as well as any silicone. That requires removal of the capsule in order to assure containment of the silicone that has "leaked" out. I would agree with an en-bloc removal.
Removal of ruptured silicone implants
Most surgeons would recommend removal of a ruptured silicone implant however if you are not having any symptoms (pain) you do not necessarily have to remove them. If you are on a special study or trial with the 410 implant, removal may be required. There are no known health risks of having a ruptured silicone implant in your body.
Consult with you surgeon to find out the specifics of the study with regard to implant removal.
Explant of Ruptured Sub-muscular Cohesive Gel Implant: is En Bloc Necessary?
Hello! Thank you for your question! It is a matter of surgeon
preference as well as what is seen during your procedure that will
determine whether or not a complete capsulectomy is performed. If
significant capsule formation is seen intraoperatively, a full capsule
removal may be warranted with a drain in order to completely remove all
of the tissue and allow better adherence of your breast back to its
normal anatomic position down on your chest wall. If minimal contracture
is seen, it may be possible to leave the capsule, or place cuts within
the capsule to allow better adherence. It truly is dependent on what is
seen with your capsule and the issues that may be causing you to have
such a procedure (e.g., contracture from rutptured implant vs pain vs
simple pocket adjustment, etc).
Without knowing your issues and
without an examination, it is difficult to tell you what may be the
best thing for you. I tend to favor performing capsulectomies (in an en bloc fashion) in order
to create a fresh pocket, reshape the pocket, allow better shape and
adherence of the overlying breast. I would discuss your issues with your
plastic surgeon who will assist you in determining the right modality
for you. Hope that this helps! Best wishes!
Treatment of a possible rupture of a Style 410 highly cohesive anatomic implant
If you have a Style 410 implant then it is unlikely that you would have any migration of silicone since the implant is made of highely cohesive gel. This could just be a fracturing of the gel and not rupture. If it is causing problems then consider a remove and replace.