What do I need to do if I have an intracapsuler rupture? Is this covered by Medicare?

I had silicon implants done 6 yrs ago. 4 days ago I developed severe swelling and pain. My breast is full, hard and nearly double size. Pain is mainly under my breast and armpit. Ultrasound revealed an intracapsuler rapture. Should I get an MRI? Who should I be referred to and will Medicare cover the cost of removal considering it's a rapture and the painful state my breast is in? What would you consider my best options. I did my implants overseas. Mentor implants used, placed over the muscle

Doctor Answers 5

Ruptured Gel Implants

It is unlikely that Medicare will cover complications from a cosmetic breast augmentation.  From your description, I believe that something else is going on, in addition to the ruptured implant which should not have caused your breast to get very large and painful.  You should seek consultation with a board certified plastic surgeon for evaluation and treatment as soon as possible.

Weston Plastic Surgeon
4.0 out of 5 stars 4 reviews

What do I need to do if I have an intracapsular rupture? Is this covered by Medicare?

Thank you for your question. Sorry to hear about your experience. It is best if you can contact your surgeon and discuss next steps. Medicare will most likely not cover the cost of a repair. 
Best of luck,

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 469 reviews

Implant rupture?

You need to see a plastic surgeon to be evaluated. They may start with a mammogram or an MRI. If your implants were put in for cosmetic purposes, then I doubt Medicare or any insurance will cover the costs. Good luck.

Scott W. Vann, MD, FACS
Savannah Plastic Surgeon
5.0 out of 5 stars 4 reviews

Intra capsular rupture

Thank you for your question.  I answer based on assumption that the implants were placed for elective cosmetic reasons and not reconstruction.  Typically Medicare or other insurance carriers will not cover implant related issues if placed for cosmetic reasons. With a known implant rupture the recommendation is removal and replacement of the implant and many surgeons would also remove the capsule.  Many of the implant manufactures have warranties for device failure but you would need to contact them for specifics if it were done overseas.  I recommend seeing a board certified plastic surgeon for an in person exam.  Best Dr. L

Andre Levesque, MD
Austin Plastic Surgeon
4.7 out of 5 stars 3 reviews


I would advise total capsulectomy, removal of silicone laden axillary lymph nodes, antifungals, immune and endocrine support, detoxification, and treatment of coinfections in order to regain your health.  Most doctors know nothing about this disease, so most patients come to our clinic for treatment that are ill.  I would not advise an MRI due to toxicity of the gadalinuim in silicone toxic patients (many patients become very ill after this).  We do a breast US with axillary views here that is very accurate due to the radiologist's and technician's experience with thousands of patients.  Medicare will not usually cover complications of cosmetic surgery but will cover if you had reconstruction surgery for cancer.

Susan Kolb, MD
Atlanta Plastic Surgeon
4.2 out of 5 stars 28 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.