Rupture during a mammogram

Question

This may sound silly, but I want to be prepared.  Is a doctor responsible to cover the cost to replace implants if it is ruptured when they perform a regular mammogram?

Lewis Albert Andres, MD · Answer

It is highly unlikely for a mammogram to rupture an implant.  Any costs for implant rupture will be on the patient, unless covered by the implant manufacturer for warranty.

Richard H. Tholen, MD, FACS · Answer

With the present generation of cohesive silicone gel implants, rupture or leakage is (virtually) impossible. Though substantial forces are generated with mammogram machines, both Allergan Natrelle and Mentor MemoryGel implants are much more durable than the amount of pressure generated by these machines. Here are the exceptions or limitations:

	Older silicone gel implants CAN leak or rupture, and implant damage can occur with mammography, particularly if the patient has capsular contracture. Every mammogram technician with any experience performs mammograms on augmented breasts, and are trained in the Ecklund (displacement) technique. "Accidentally" compressing the entire breast AND implant can in some cases cause rupture of the scar capsule around a woman's implants, similar to the closed capsulotomies we plastic surgeons performed years ago for treatment of capsular contracture (no longer recommended precisely because of potential damage to older implants that COULD rupture or leak). If the breasts are soft (no capsular contracture), this is less likely of an issue, but perversely, more likely to inadvertently occur because the breasts look and feel so "natural."

	I have had a patient who thought her implant was ruptured by an improperly-performed mammogram, and in fact her chest and breast turned black and blue, further frightening her. I re-operated on her 13-year post-op (previously completely soft) breast and found a perfectly intact and undamaged implant and a ruptured capsule with a small collection of blood in the pocket.

	Saline implants, particularly ones with textured surfaces, can leak or rupture, and pressure from mammogram machines can be the inciting cause.

	Any implant that ruptures or leaks is replaced without charge by the manufacturer, but surgery and anesthesia costs are the responsibility of the patient (or her warranty, if purchased).

	Regardless of the cause for re-operation, the patient is always responsible for surgical costs, and the mammographer has usually been released from responsibility by the patient's acknowledgement that she HAS implants, and understands and accepts the risk of possible implant damage by mammography.

	So, to be best prepared, purchase the extended warranty that is offered by the implant manufacturers, though rupture with the latest generation of silicone gel implants is virtually impossible. Re-operation for capsule rupture that "seems" as if the implant was damaged (like my patient) is the more likely scenario, though coverage for this may be questioned.

	Second, avoid saline implants that can leak or deflate.

	Third, always let the mammographer know you have implants and ensure you are having a true displacement mammogram technique that keeps the implant away from the mammogram pressure plates.

	Finally, understand that your plastic surgeon is NOT responsible for replacement of your implants if anyone else (including you) somehow manages to damage them! It is more likely that your cosmetic result will be affected, and you and your surgeon should have already discussed revisional surgery and who pays for what!

	Bottom line: this is a truly unlikely issue to be concerned about. Worry more about smoking, driving without a seatbelt, or taking unnecessary risks. Be well and enjoy your new look!

Farbod Esmailian, MD · Answer

Rupture during a mammogram
	This may sound silly, but I want to be prepared.  Is a doctor responsible to cover the cost to replace implants if it is ruptured when they perform a regular mammogram?

	This would be a very rare incidence but always possible, especially if the implants are old.  But no, the physician or the tech perform the mammogram would not be responsible.

	As the other surgeons explained this would be partially covered under the implant warranty.

	Hope that helps.

Edward J. Bednar, MD · Answer

I have yet to haer of a rupture during a mammogram-typically staff performing mammograms are very familiar with dealing with implants. Your best bet is to sign up for any upgraded warranty when you get your implants-that way you are able to defer some of the costs assocated with replacement.

Scott C. Sattler, MD, FACS · Answer

Implant rupture or leak is a risk of breast augmentation - the implants can fail mechanically in a variety of traumatic situations. Fortunately this is very rare- I've never had a patient where this event has actually happened. Implant replacement is the patient's responsibilty in my practice.

Tom J. Pousti, MD · Answer

Thank you for the question.

	it would be highly  unlikely for breast implant to be ruptured during mammography. If it did occur, patients are still responsible for costs of further surgery ( beyond the stipends provided by the breast implant manufacturers).

	Best wishes.

Douglas J. Mackenzie, MD · Answer

I have seen this once, and every couple years I get a call from some attorney asking me if I would review the records of someone who had a breast implant rupture during a mammogram. Here's the thing: Breast implants don't last forever! Although they are extremely strong and resilient, just like anything else, the implants are devices which suffer material fatigue and given enough time, they WILL fail. That final event which "causes" the failure could be some minor trauma, such as that experienced during a mammogram. That doesn't mean it was the mammographer or radiologist's "fault", and so no, they would not be responsible. But like the other posts mention, review the implant warranty for details regarding possible coverage.

Peter E. Johnson, MD · Answer

You should let your mammographer know that you have breast implants when you go for a study, as compression views are not possible, and additional views are needed to see fully around the implant. Good mammography centers will be familiar with implants and have a routine. Implants will not rupture during a mammogram unless very old and worn near the expected end of life for the implant. We are not aware of any mammography center bearing the responsibility if your implant should leak after a study.

	Best of luck,

	peterejohnsonmd

Todd B. Koch, MD · Answer

What you describe is very uncommon. Your surgeon and radiologist are NOT responsible to cover the costs to replace the implants. I recommend to all my patients to obtain the manufacturer's warranty. This will help defer most of the costs if anything like this was to happen.

John Whitt, MD (retired) · Answer

The incidence of rupturing breast implants during mammograms is extremely low. I have been performing breast augmentations for over 25 years and have never seen this occur. Should it occur, however, replacement would be your responsibility rather than that of the radiologist. Both major implant companies would replace the implant at no cost. The other costs would be your responsibility, but both companies offer a warranty which would cover most, if not all, of the other costs for a period of time which can be lengthened by the purchase of fairly low-cost "insurance".

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