Ruptured implant after many complications. What should I do?

Question

I had cohesive gel implants under the muscle in 2016. The right one became infected. The surgeon removed it and replaced it with another which also became infected. It was then removed for eight months to give me time to heal. Once it was put back in it fell below the scar line. They then put them over the muscles on both sides. This again fell on the right and had to be corrected. Now it’s 2022 and I just Found out that my left implant has a rupture. What should I do I am scared To do this again

Raffy Karamanoukian, MD, FACS · Answer

Removal of breast implants, intact or ruptured, may have positive implications if patients are symptomatic. A constellation of symptoms associated with breast implant illness, and autoimmune disease are considered when treating patients who have breast implants and are concerned about foreign body reaction. In our office, we begin this journey with a consideration of symptoms and exclusion of obvious autoimmune problems. In many of our patients, en bloc removal of breast implants with capsulectomy is important and beneficial. Further clinical evidence about breast implant illness is evolving and will continue to guide treatment. I would suggest removal if there is a possibility of foreign body reaction.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Michele A. Shermak, MD · Answer

Hello!
Well this is a complicated history. You should undergo treatment to address the ruptured implant. I would recommend you see a board certified plastic surgeon who specializes in breast surgery. Infection should not be an issue in an upcoming revision. To be on the safe side you should find out which bacteria was responsible for last infection and pretreat. The implant replacement will be covered with the rupture as long as you stick with the same company.
Best of luck to you!

Alan Gonzalez, MD, FACS · Answer

Hello @katiebianchi, thank you for your question. It depends on priorities. Implant rupture has 2 options: to remove the implants for good or replace them. However, ruptured implants must be removed. My suggestion is a definitive total Explantation with the removal not only of the implant but also the capsules and the reconstruction of the breast tissue to reconfigure it. Due to the experience of so many explantation surgeries practiced in these 21 years I consider that the L-shaped incision is the minimum and smallest scar possible in this surgery. I link to a video about asymmetry with breast prostheses rupture that will shed some more light. To obtain more information and recommendations, it is best to consult one or more board-certified plastic surgeons. Best wishes! Alan Gonzalez MD, FACS.

Anna Steve, MD · Answer

Ruptured implants should be remove and/or replaced. In cases where there has been problems with the implant remaining well supported by the IMF (or breast fold) it can be helpful to re-inforce the IMF or inframammary fold with an internal bra, such as ALLODERM or galaFLEX.

Daniel Barrett, MD · Answer

Dear katiebianchi,
in case of implant rupture, you have two options you can get it removed or replaced. Generally speaking, you should not leave a ruptured implant inside. If you are considering surgery, I would suggest you 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

Heather Vande Ven, DO · Answer

Experiencing a ruptured implant can be distressing, especially after dealing with multiple complications. Here are some steps you should consider:
1.	Seek Medical Attention: If you suspect that your implant has ruptured, it's crucial to seek medical attention immediately. Contact your plastic surgeon who performed the implantation procedure. They will assess the situation and recommend appropriate next steps.
2.	Diagnostic Imaging: Your plastic surgeon may order diagnostic tests, such as an ultrasound, MRI, or mammogram, to confirm the rupture and evaluate the extent of the damage. These tests can help determine the best course of action for treatment.
3.	Discuss Treatment Options: Depending on the severity of the rupture and your individual circumstances, treatment options may vary. Your plastic surgeon will discuss the available options with you, which may include implant removal, replacement, or alternative procedures.
4.	Address Complications: If you've experienced multiple complications related to the implant, it's essential to address these issues as well. Your plastic surgeon will assess any complications you've experienced and develop a comprehensive treatment plan to address them effectively.
5.	Emotional Support: Dealing with a ruptured implant and its complications can take a toll on your emotional well-being. Don't hesitate to seek support from friends, family, or a mental health professional to help you cope with the situation.
Remember that each case is unique, and the appropriate course of action will depend on various factors, including the cause and severity of the rupture, your overall health, and your treatment goals. Always follow the guidance of your plastic surgeon and communicate openly about your concerns and preferences.

Camille Cash, MD · Answer

I'm sorry to hear of the numerous issues you've had with your implants!  If your implant has ruptured it is best to remove it along with the capsule.  I encourage you to visit with a board certified plastic surgeon about your situation to discuss possible reasons for your problematic history.  Perhaps it was the size of the implant? The technique used? Were you a smoker? If the potential reason can be uncovered perhaps it will give you some comfort going forward.

Connie Hiers, MD, FACS · Answer

If you decide to keep implants, I would suggest going down in size so there is less stress and weight on your tissue. You did not say what size implants you have, but I suspect they are too large for your tissue.