Intracapsular rupture vs extra capsular rupture with saline implants under the muscle?

How does one diagnose one vs the other? Ultrasound confirmed the R implant is half the size of the other, however, it's been two, maybe three, weeks since I started noticing the difference, especially in the upper portion. Is one type of rupture more urgent to remove than the other? My BA was October of 2011.

Doctor Answers 3

Ruptured breast implants

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Thank you for your question. We only differentiate between intracapsular and extracapsular rupture when referring to silicone implants. Even with silicone, an implant rupture is not an emergency situation. When diagnosed, a ruptured implant should be addressed and exchanged or removed as soon as the pre-op preparation and scheduling can be arranged, however this is an elective surgery situation. There is no danger requiring rushing to surgery but treatment should not be unnecessarily delayed. An intracapsular rupture is diagnosed when imaging reveals a defect in the implant shell and silicone gel outside of the implant shell but contained within the capsular tissue sac surrounding the implant. When the silicone appears to have extended through an additional defect in the capsule and into the surrounding breast tissue, an extracapsular rupture is diagnosed. Ultrasound and mammography is fairly sensitive in diagnosing implant ruptures. MRI is the most sensitive.

With saline implants, when a rupture or leak occurs saline leaks out of the implant and is immediately absorbed. We generally do not know whether the leaked saline is or was inside or outside of the capsule and clinically it makes no difference one way or another. A ruptured saline implant again is not an emergency situation. The longer the deflated breast remains so prior to revision surgery, the more opportunity there is for the capsular tissue sac surrounding the implant to shrink and contract, resulting in the implant pocket being more tight and possibly requiring adjustment at the time of revision in order to maintain symmetry with the unaffected breast. When revision surgery for a deflated saline implant is delayed for one reason or another, surgeons will sometimes elect to intentionally puncture and deflate the implant on the unaffected side well in advance of surgery, in order to allow the capsule on that side to equally contract and improve the chance to maintain symmetry. This is performed as a simple and relatively painless office procedure with minimal risk.

I recommend that you consult with a plastic surgeon in your area who is certified by the American Board of Plastic Surgery as soon as you are able to make an appointment.

Good luck.

Dr. Polo

Miami Plastic Surgeon
4.9 out of 5 stars 41 reviews

Saline rupture

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Thank you for your question.  Intra-capsular vs. extra-capsular only applies to silicone gel implants.  If you have saline implants and have a rupture, your body absorbs the saline and you are left with the empty silicone bag (shell) within the capsule.   This will not harm you, but you will be asymmetric.  Typical treatment would be to remove both and replace with silicone gel implants, but this will vary based on patient wishes and surgeon preferences.   Best to follow up with your surgeon.  Good luck.  

Ruptured saline implants

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If you truly have saline implants, and not silicone ones, there's no need to make a distinction between intra-capsular and extra-capsular.  The saline is absorbed by your body, no matter where it is.

Since it sounds like you have a deflation, you simply need an implant replacement to improve your symmetry.

If you had silicone implants instead, the surgery to correct it would be more involved if you had extra-capsular spread of silicone.

All the best,

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.