6 Mos PO, Gel Implant Ruptured And Dr. Doesn't Want To Revise, What Should I Do? (photo)

Right implant sags off to the side, chest pain on R is still intense after 6 mos. Recently had chest xray unrelated to breast surgery, saw what appears to be a rupture of the right (painful) implant. My surgeon (peeved) said xray was meaningless, revision surgery may not be needed even if it is ruptured, as women have ruptured implants for years and don't know it. I don't want a ruptured implant! Having MRI to confirm or R/O, but worried my surgeon will refuse to do a revision. What should I do?

Doctor Answers 11

Second Opinion Recommended if Confidence Lost with Surgeon

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Although your surgeon is correct that a MRI is the most sensitive method to detect an implant leak, should it be ruptured the standard of care is to remove and replace it. If you have lost confidence in your plastic surgeon I suggest that you seek a second opinion from an experienced plastic surgeon. See below link for hints on finding the best plastic surgeon for a second opinion.

Is your implant really ruptured?

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I'm sorry to hear of  your concerns and anxieties.  Its extremely unusual for a gel implant to fail so soon after augmentation.  As mentioned, a MRI is the gold standard for determining a rupture but if your implant is displaced and your affected breast looks different from your good side, you may want to consider simply going back for surgery to reposition your symptomatic implant and also check it for a rupture at the same time.  If it is ruptured, your warranty will kick in and help defray the costs.  Regardless, you should not expect surgery to resolve your pain issues as the etiology may be related to something else besides your implant. 

If you like your original surgeon, continue to see him/her.  If you do not, then consider seeing another board certified plastic surgeon who uses the same implants as your original surgeon did.

6 Mos PO, Gel Implant Ruptured And Dr. Doesn't Want To Revise, What Should I Do? (photo)

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Seek immediate second opinions from boarded Plastic Surgeons in your area. MRI allows a more definitive diagnosis of rupture. 

Ruptured implant?

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The best way to delineate a rupture is by MRI.  Get the study and go from there.  If it is true tht the doctor spoke to you like that, then I suggest find a different doc.

Breast implant rupture should be corrected

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A chest x-ray is not sensitive enough to confirm an implant rutpture and an MRI is a better examination. Your surgeon is correct in that women often have an implant rupture for several years without notice, though if the implant is indeed ruptured it should be replaced. It seems your relationship is poor and you might consider a second opinion.

Best of luck, peterejohnsonmd.com

Implant Rupture?

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I don't think a chest xray is adequate, the MRI will be a better tool to diagnose rupture.  But it sounds to me like you probably have a good implant that is too far to the side and cousing you pain. The correction is an internal capsulorrhaphy and can easily be done anytime now that 6 months has passed from the surgery. Your surgeon is right that many women have had ruptured implants for years without knowing it, but once we do know an implant is no longer intact we correct that problem.

Breast implant rupture

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You cannot and should not make a diagnosis of implant rupture based on a chest xray. Frankly I cannot determine what you are referring to in the photo you have posted. However, it is obvious that you have questions and concerns that should be addressed. Your surgeon, even though his opinion may or may not be valid, is not fulfilling your need for information and guidance. i would suggest getting a second opinion by a reputable plastic surgeon. One thing that I make clear on giving second opinions is that I will not take over the case. This avoids any perception or real conflict of interest. If you leave the original surgeon's care, then I would be willing to take on a case. I would make this clear to anyone you see.

Robin T.W. Yuan, M.D.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

Silicone Gel Implant Rupture

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Hello Ann,

I feel your anxiety and frustration in this post, so let me be as clear and calm (and helpful, I hope) as possible.

1. You say your right implant looks different than your left, hangs low and to the side, and is painfull 6 months after surgery.  This is called implant malposition, and is not associated with implant rupture.  It is very common that it hurts, because the implant is pressing on a nerve, or pulling on skin that is supposed to be on your chest wall, not around your implant.  By the way, ruptured silicone gel breast implants don't hurt.

2. XRays cannot diagnose a breast implant rupture, this includes mammograms.  By the way, the chest xray you posted is reversed (turned backwards, or mirror image). I know this because the cardiac silouette and the gas bubbles in your stomach which are on the left side of your chest are on the side that says 'right breast implant', and your liver which is on the right side of your chest is on the side that says 'left breast implant'.  I am hoping you labeled this and not a radiologist!  Additionally, the four white arrows point to the heart and left hemidiaphram.

3. There is no need to get a costly MRI because it wont change your course of action, which is to have a reoperation to fix whatever is the problem.  At the time of surgery, the integrity of the implant can be determined.  The likelyhood that the implant is rupture is extremely small, and would most likely indicate that it was accidentaly injured at the initial surgery.

4. Revisit your surgeon clamly to clarify the situation, armed with the information I gave you.  To recap, your right breast hurts, and your right implant seems to be too low and to the side, correct?  Implant rupture, although extremely unlikely, is not a factor here.

If he is unwilling to reoperate in the face of a true discrepancy in appearance (that wasn't predicted preoperatively) between the right and left breast/breast implants, then you should seek help from another surgeon.

Best of luck.


Ruptured implants need to be removed.

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The current recommendations are to remove ruptured gel implants (assuming there are no mitigating reasons). X-rays are not a very reliable diagnostic tool, but the MRI is the current gold standard. If the implant is ruptured, and the surgeon refuses to remove it, get another opinion! Good Luck!

Ruptured Implant

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Your doctor is right, you can not tell a rupture on a plain X-ray. Also, it is highly unlikely that your implant is ruptured, and even if it is, it is not causing pain. I am sure every plastic surgeon who did silicone implants in the 1980s has lots of patients walking around with ruptured implants that look and feel good and cause no problems. Also, MRIs have false positives, where they say it looks ruptured and it is not. Figure out about your pain first.

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.