The majority of silicone gel breast implant ruptures are "silent", i.e., the patient, nor the surgeon or examining physician can definitively make the diagnosis of silicone gel breast implant rupture. For approximately 15 years, the FDA placed a moratorium on silicone gel breast implants, because of concerns about occult implant rupture, interactions of silicone gel with tissues surrounding the implant, effects of silicone gel outside the area of the breast, possible immune reactions to silicone within or outside the implant, and other common sequelae such as scar tissue formation (medically termed, capsular contracture) and its effect on the breast shape and constrictive pain syndromes.
The FDA released the moratorium in November of 2007, after a research committee of renowned specialists from all the involved specialized medical fields found that they were safe for implantation with several stipulations. The FDA recommended that plastic surgeons inform their patients that it is very difficult to detect silicone breast implant rupture, since the silicone gel stays in the “pocket” (space that surrounds the breast implant) and the breast does not appear “deflated”. It is difficult for both the patient and the surgeon to detect silicone gel breast implant rupture.
MRI (magnetic resonance imaging) is the best technique to detect silicone gel breast implant rupture, as this test can look for small amounts of silicone that are outside the shell of the implant suggesting rupture that is difficult to detect. The FDA recommends that all patients be informed by their plastic surgeons that they should obtain an MRI 3 years after the breast augmentation, and then every 2 years thereafter, to detect silent rupture at an early stage, so the implants can be removed and replaced before any long term sequelae of silicone breast implant rupture occurs.
I am certain that during all of my consultations that my patients are informed of “silent” rupture of silicone gel breast implants and the need for them to be committed to having MRI’s taken to detect any potential rupture at an early stage. Patients should continue to be vigilant about doing monthly breast exams and if there is any abnormality that they detect, the patients know that they should call my office for an evaluation. Silicone gel breast implant ruptures can sometimes present as a lump, change in shape of the implant and other physical changes in the breast, but this is less common than “silent” rupture.
I also inform my patients that they will still need to have mammograms yearly at age 40 and every year thereafter to detect breast cancer and that the mammogram is the test for breast cancer and the MRI is for breast implant rupture and one does not replace the other. Each patient is advised to return to my office at the advised intervals to have the MRI scheduled at the appropriate time. My patients feel very well informed about their option of seeking a breast augmentation with silicone gel breast implants, as I feel it is important for my patients to make intelligent, non-emotional decisions when deciding the type of implant they desire.