Ruptured Implant and Silicone in Lymph Node

Should ruptured silicone implants in the lymph nodes be removed as soon as possible? Can the implants be replaced? Some doctors say the silicone isn't harmful, and there's no rush to remove/replace the implants if they're not bothersome. Is this true? What can be done?

Doctor Answers 23

See your local board certified plastic surgeon

This is a very complex situation that you present, requiring an extensive discussion with a board certified plastic surgeon and possibly a breast surgeon. There is no great urgency, but it sounds like your implants can and should be replaced. It is possible that if your implants are older model technology, they may not be ruptured, but instead may be "bleeding" silicone (a microscopic leaking through an intact shell). This bleeding silicone may be taken up by the lymph nodes. The removal of the nodes would have to be discussed with your treating surgeons, as everything we do in surgery and life, has consequences and you need to know what those are. Good luck!

Manhattan Plastic Surgeon
4.6 out of 5 stars 47 reviews

Lymph Nodes

I have done extensive research on silicone lymphadenopathy over the last 20 years as a result of breast augmentation. As a result, I have published a peer-reviewed paper with scientists from the Armed Forces Institute of Pathology in Washington, D.C. as well as from Case Western Reserve University in Cleveland. Silicone in the lymph nodes can be diagnosed by ultrasound and localized by needle localization for precise removal. The polyurethane covered gel filled breast implants are associated with extensive silicone lymphadenopathy in the axilla, retropectoral, internal mammary, and sometimes neck nodes, but never in nodes below the diaphragm. The saline implants are never associated with silicone lymphadenopathy. Ruptured gel implants are only sometimes associated with silicone lymphadenopathy.  Silicone-laden lymph nodes, if they need to be removed, should only be removed after needle localization by a radiologist experienced with the technique. I have removed many silicone laden lymph nodes after needle localization in the past, but I have stopped due to the fact that the removal makes little difference in patient's recovery from implant illness. In addition, there are always risks of lymphedema of the arm, numbness in the arm, and seroma in the axilla. I am not aware of any medical literature showing benefit of lymph node removal in implant illness. Linked is my peer-reviewed research study on silicone and lymph nodes

Lu-Jean Feng, MD
Cleveland Plastic Surgeon
4.6 out of 5 stars 92 reviews

Silicone in the Lymph Nodes after Breast Augmentation

Axillary (armpit) lymph nodes most commonly occur following infection of the arm or upper extremity. They can occur from infection, cancer, and less commonly, from a ruptured silicone implant in the breast.

Lymph nodes in the armpit should never be ignored and must undergo complete evaluation to rule out malignancy. It should never be assumed that the lymph nodes are a result of a ruptured silicone implant. Seek the attention of a qualified plastic surgeon or general surgeon to examine the entire breast and axilla to determine the risk of malignancy.

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

Possible rupture of a silicone gel implant

You did not mention why you believe that your implant is leaking.  With the new form of breast implants produced after 2009 there is little chance of the implant gel material migrating since the gel is more cohesive than it was prior to this time.  Therefore it may be difficult to tell if it is ruptured since the implant tends to keep its original shape. The problem is non an emergency.  You would need some type of diagnostic study to determine if it was actually ruptured such as a  mammogram, MRI or ultrasound.  With the new form of implants there is little risk of migration of Silicone to the lymph nodes. 

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Management of Ruptured Silicone Implant and Silicone in Lymph Node

Ruptured Silicone Implants should be removed and replaced. Typically removal of the surrounding capsule (Capsulectomy) is also performed to remove traces of silicone. The likelihood of this happening would be more likely prior to 2006 especially after trauma. After 2006 silicone implants were all more cohesive (more gel like).

 I would recommend removal of  silicone filled lymph nodes (grossly filled, not microscopic) if lymph nodes are enlarged or easily accessible be removed and tested. The likelihood that is involved in serious condition is very rare and in fact, I reported on one of the few ever reported which occurred in more than 25 years of practice.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 154 reviews

Implant Rupture

Ruptured implants should be removed. The silicone can cause granuloma formation which in and of itself is not dangerous but makes it more difficult to remove later. I'm not sure what you mean by "rupture silicone in the lymph nodes" since the silicone should not be in the lymph nodes.

Jacob Freiman, MD, FACS
Miami Plastic Surgeon
4.5 out of 5 stars 269 reviews

Lymph nodes and ruptured silicone gel implant

A ruptured implant should be replaced at a convenient time for the patient. It is not an emergency and will cause no long term health problems. The silicone will be contained by the capsule that forms around all breast implants.

It is unnecessay to remove lymph nodes if silicone is suspected. Probably everyone in this country has molecular silicone in a lymph node somewhere. Injection needles are lubricated with silicone so anytime you get a medical injection or IV, some silicone is shed into the blood and ultimately filtered through the lymphatics.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.7 out of 5 stars 35 reviews

Remove silicone implants when ruptured

The treatment depends on which silicone implant was utlized.

The more cohesive gel impants are quite firm and do not easily spread when ruptured. However, the less cohesive gell implants can diffuse throughout the breasts. This can be quite a mess to clean up. Therefore it is best for you to find and treat these as soon as possible.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 81 reviews

Ruptured Silicone Implants probably should be removed.

Breast implants, like most medical devices, are not meant to last a lifetime. I advise our prospective patients that replacement will likely occur sometime over their life time. In 1999, the Institute of Medicine concluded that silicone implants do not cause any major health problems. Research and reports from the last decade have shown that silicone gel-filled implants do not pose additional risk to women’s short-term or long-term health. Most plastic surgeons would recommend removing the implant and/or implanting material. You are correct in that this is not an medical emergency.

The breast lump should be thoroughly examined. The best imaging for looking at the ruptured implant and silicone material is the MRI. I would strongly advise you to see a board certified plastic surgeon that is experienced in breast surgery in order to have the old implant and implant silicone material removed. A thorough medical history and physical examination will be performed and a surgical plan formulated specifically for you. Obviously, you will need to decide if you wish to have replacement with new implants.

Stephen A. Goldstein, MD
Englewood Plastic Surgeon

I would always recommend removal

I agree- if the implants are known to be ruptured, nothing good is going to come from leaving them in place. I wouldn't want you to think that dealing with the issue is an emergency, but the longer the silicone material is allowed to stay in place, the greater the chances of further silicone migration to lymph nodes or other locations.

This further migration will only make further diagnostic maneuvers necessary in order to rule out more serious problems like breast cancer- maneuvers you might avoid if further migration can be prevented by removing your implants sooner rather than later.

Fundamentally, a silicone implant is a foreign body- if you know it's broken, it's best to have it removed.

Armando Soto, MD, FACS
Orlando Plastic Surgeon
4.8 out of 5 stars 157 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.