I have a ruptured implant with silicone leaking in arm pit free floating and a couple impregnated nodes? (Photos)

Question

My doctor wants to leave the silicone in my arm and not do anything about it I've been having pain in my shoulder didn't realize I had this leak until after I had gone to many Drs. I'm also concerned I am 5ft 8 and 115 pounds and she wants to put the new implants on top of the muscle I have thin skin and not a lot of tissue she did my original surgery which entailed A periareolar lift with mentor high profile silicone implants of 350 cc on both sides placed under the muscle in June 2002 .

Dallas Buchanan, MD · Answer

Thank you for your pictures and questions. This can be a very complicated problem and I would advise a very well planned surgical approach before going under the knife. I think you would benefit from additional imaging such as a mammogram, ultrasound, or even an MRI to further evaluate the extent of the rupture and location of the silicone. In addition, this workup could evaluate you for possible other sources for the problems and rule out any type of more serious problem such as malignancy, but this may require workup and biopsies. Once those issues are resolved and there are no other concerns, only then would I discuss with my chosen board certified plastic surgeon on how to proceed with cosmetic surgery. I would say that someone as thin as you would certainly benefit from placement of the implant below the muscle, but those determinations can only really be made after an in-person exam and consultation.Best of luck!

S. Larry Schlesinger, MD, FACS · Answer

Your breast without the tattoo appears to have a capsular contracture with a small bulge on the superior lateral edge of the implant which is indicative of a hard breast.  Also, this breast implant appears to be intact.  Your other breast with a tattoo, since it is hanging lower, may have a capsular rupture without a silicone implant rupture.  I have seen these several times.  I can't comment on the swelling in your armpit, and it may or may not be silicone that has migrated from your breast to your armpit.  This, by the way, is a very unusual situation, especially with a perioareolar subpectoral approach to your implant pocket.Before you decide that the implant has ruptured, I would certainly see your primary physician and make sure that the mass in your armpit is related to your breast implant.  Swollen lymph nodes and a mass in one's armpits do not scream ruptured breast implant to me.  My comments are not meant to alarm you, but instead point out that there are any number of reasons for a mass in an armpit, the least of which would be free floating silicone.If you were my patient, I would get appropriate studies up to and including an MRI to delineate what this mass appears to be.  I agree with your personal plastic surgeon that going into an armpit with swollen lymph nodes, probably unrelated to the breast implant, is certainly not the purview of aesthetic plastic surgery.  I would recommend forgetting about the breast implants for awhile, and focus on the mass and lymph nodes first and foremost.

Donald W. Hause, MD · Answer

I agree with my friend and colleague Dr. Wong from Redding.  Re-operation beyond the confines of the original pocket can be very challenging. I would discuss these issues in detail with your surgeon. Did you get any clinical studies such as an MRI to further delineate the situation?  If you feel you are confused or getting mixed messages, it is reasonable to get a second opinion from a Board Certified Plastic Surgeon who performs a lot of Breast Augmentation.

Curtis Wong, MD · Answer

wondering how you got silicone in 2002 unless you were part of a study.  As for the gel itself, how do you know its 'free floating' in your arm pit?  In general, silicone gel is inert and should not create problems for you and trying to get it out can be very hard and not worth the damage it could cause.  And what is the reasoning for your surgeon to want to go above the muscle as she may have a good reason.  So ask your surgeon for the reasons behind her recommendations and it may help you understand them better.

I have a ruptured implant with silicone leaking in arm pit free floating and a couple impregnated nodes? (Photos)

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