Removing Silicone Gel from Breast Tissue?

Medical Grade Silicone in the breast tissue is often left in place unless it is symptomatic by forming an inflammatory, symptomatic or palpable nodule or appears suspicious on a mammogram or MRI. Silicone nodules are removed surgically typically when they are symptomatic, are inflammatory, or causing problems such as recurrent infection but not just because they are seen on a MRI scan or mammogram. First of all the likelihood of this happening would be more likely prior to 2006 especially after trauma as the capsule tends to keep the silicone within this membrane. After 2006 silicone implants were all more cohesive (more gel like).  It is often impossible to remove all traces of silicone because it is widely distributed and would potential cause harm to important structures as well as deformity and other problems. Weighing pros vs cons, risks and benefits are often difficult in this situation.  I recommend that you have a lengthy conversation with a board certified plastic surgeon and if necessary seek a secondary consultation.

 

If a silicone implant has ruptured, it is best to remove all the silicone gel.  It usually just stays within the pocket and needs to be removed.

If silicone gel is left in the breast cavity, the shape will be distorted. Silicone is not absorbedly the breast tissue. It can cause a foreign body reaction and produce a false positive on mammography. Therefore, the breast cavity should be cleaned out completely.

Good question- why do we remove ruptured silicone gel from outside the capsule. The answer is for a number of reasons. The gel is considered inert and should not lead to long term problems but usually is very firm. This may cause contour defects, may be uncomfortable, may interfere with cancer screening as it may always feel like a lump. Better to remove unless it is in a very difficult position such as deep in the armpit.

Silicone gel breast implant ruptures, which are seen with the older breast implants, can result in gel migrating beyond the implant capsule and into the surrounding breast tissue and fat. The breast could become painful, hard ,and distorted.  The old gel can stimulate local thickening of the tissues (silicone granulomas).  To control the body's reaction to the free gel, removal of the residual gel and gel thickened tissue is advisable. The amount of affected tissue removed should be modified by good judgement.  Excessive tissue removal can have untoward cosmetic consequences.  Discuss these potential consequences with your surgeon prior to your surgery.

Fortunately, the new generation of gel implants, currently approved by the FDA, appear much safer.  The new gel is thicker and (if the outer envelope is disrupted) should not spread through the tissues like the old fashioned silicone gel. To date, we have not seen, in our practice, a cohesive (gummy bear) gel implant rupture.

Best Regards,