Am I endangering my health if I don't have my ruptured implant removed?

Question

Hello, I am 69. My implants are 45 years old. One is ruptured. They are silicone and the manufacturer is Cox uphoff. I'm thinking if it's not causing symptoms, at my age, why mess with them? Not to mention the expense on a pension. Can silicone travel or does the body, recognize the silicone that leaks as foreign and automatically form a capsule around it?

Kenneth Hughes, MD · Answer

If you have not noticed any distortion, shrinkage, or discomfort in the breast, it may be okay to not explant.  If remaining silicone material has extruded, the implants should be replaced but this is not an emergency situation. In fact, they may have been ruptured for quite some time.  The free silicone will not travel to other parts of the body because the capsule around the implant  prevents that from happening. Silicone is relatively inert, and I would not anticipate a change in antibodies after removal.

Farbod Esmailian, MD · Answer

In general when a capsule is formed and there is a rupture of silicione gel, the capsule encloses the  implant and gel material and prevents any of the gel getting into the breast tissue.  In certain cases I have seen the gel travel thru a thin or ruptured capsule and get into the tissue and skin which can be a big problem.  Although this is very rare it could have been prevented.  A capsulectomy and removal of silicone implants, especially when in front of the muscle, is a very simple procedure and can be done very quickly and safely in experienced hands.I would recommend you see a board certified plastic surgeon to discuss things further.Hope that helps.

Nelson Castillo, MD · Answer

Thank you for sharing your question.  The rupture alone does not result in any health related issues but for comfort purposes it would be wise to have the implants removed or replaced.  Often the edges of the shell can poke and pinch patients.

Donovan Rosas, MD · Answer

While saline ruptures are easily identified, silent silicone gel ruptures or bleeds are more difficult to appreciate (without imaging). They look the same, feel the same, and behave the same intact or ruptured. As such, many patients are living with silicone ruptures unbeknownst to them.
A ruptured gel will either remain within the capsule or if rupture is extracapsular, the leak itself will become encapsulated (as you described above).With regards to your specific question, while there is no urgent need to replace/remove, the issue should be addressed. 
Replacement of a saline implant if addressed quickly is fairly uncomplicated and involves re-entering the pocket removing the failed device and replacing.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).Donovan Rosas MD
Board Certified by the American Board of Plastic Surgery
Member: American Society for Aesthetic Plastic
Surgery, American Society of Plastic Surgeons
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Daniel Barrett, MD · Answer

Dear ivymae,
new silicone implants are cohesive, so even when they rupture they won't leak. But the old silicone implants are not made like that and there is a higher risk of leakage. It would be best to remove the implants in order to avoid possible complications. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Camille Cash, MD · Answer

It is recommended that ruptured implants be removed.  Further contracture of the capsules can cause breast deformity or pain. There is no emergency to have them removed, however.  For older silicone implants there may be medicare coverage for removal.

Connie Hiers, MD, FACS · Answer

Medicare does cover the removal of old ruptured gel implants. The longer the silicone stays, the more risks of scar tissue and thicker capsule occurs. It would be best to removed your old implants.

Arian Mowlavi, MD, FACS (license on probation) · Answer

You really should remove your implants and the capsules in order to get all the silicone out of you. Otherwise, it will continue to deform your breasts as capsular contracture continues. This is covered by insurance and even Medi-Cal so you can find a provider like myself to help you. If you should desire a new set or a lift you will have to pay for this yourself. Most recently, breast implant illness syndrome has become a topic of discussion so you should educate yourself on it. Although there has been no scientific proof to verify it, it is definitely become a concern of patients that I see weekly.

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