Can an ultrasound detect a ruptured silicone implant?

Question

Hello, I will be going for my mammogram, and an ultrasound. I suspect that my right implant has ruptured do to tenderness upon touching and that it is drooping. Question being, will an ultrasound be able to detect anything for this? I know that a MRI is the best way to go, but I am not sure that my insurance company will cover it. Please help. I am a 52 year old female with 27 year old implants. I haven't found a plastic surgeon doctor just yet, but I just want to make sure before I do anything

Gerald Minniti, MD, FACS · Answer

Hello,The quick answer is that ultrasound will probably regularly replace MRI due to improved resolution, and it is certainly available in select locations now.  Remember, just because the FDA website says 'gold standard', does not mean it really is best.  Regardless, you have relatively old implants and an unacceptable breast appearance. It seems that you would want a revision surgery just based on this appearance, so therefore no test is necessary and you can just proceed with surgery. when you are financially able. Remember, a ruptured implant is not dangerous. Best of luck!

Roger Tsai, MD · Answer

Unfortunately, MRI is still the best test to potentially detect ruptured silicone implant - and even then is not 100%.  Although it maybe possible to detect a rupture with a mammogram or ultrasound, the yield is significantly lower.  Therefore using these other tests, although cheaper, has a significantly higher chance of missing a rupture.  The only way to 100% know for sure is to undergo surgery and look at the implant itself.Best of luck and hope this information helps!Dr. Roger Tsai   @DrRogerTsai

Joseph Mele, MD · Answer

Other than surgery, the MRI is the most accurate way to determine if an implant is ruptured. It is about 90% accurate in situations when a problem is suspected, as opposed to surgery which is 100% accurate. If you are planning to have breast revision surgery, then put the money for the MRI towards surgery. If you are not planning to have surgery, the MRI is the best test. Other tests will miss problems (false negatives) or show problems that do not exist (false positives).

Urmen Desai, MD, MPH, FACS · Answer

Yes, an Ultrasound will be able to detect you rupture but not with the same accuracy.  I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS) and the American Society of Aesthetic Plastic Surgery (ASAPS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified Beverly Hills Plastic Surgeon

Daniel Barrett, MD · Answer

Dear toponderon,ultrasound might help you diagnose possible implant rupture. But an MRI is still the golden standard. If you are concerned, you can always consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations. Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Curtis Wong, MD · Answer

but an exam can easily tell that too.  If your implant is completely inappreciable when you push the mound around, its very likely your implant has ruptured.  If your implants are over 27 years old and you're having issues with changes where you are motivated to have a procedure done, why even bother with confirming a suspected rupture and pay the extra fees.  Your surgeon can do your case in anticipation that there could be a rupture and get everything fixed that is bothering you at the same time.  Ultrasound will likely become the screening exam for ruptured implants but in your case, you really need to simply return to the OR and have a replacement of your implants, removal of your presumed capsule, and a breast lift if indicated.

Jon A. Perlman, MD (retired) · Answer

In medicine, we talk about the sensitivity of a test.  An MRI is far more sensitive than an ultrasound but an ultrasound is a reasonable way to begin.  If it is positive then you have your rupture diagnosis, but if it is negative it does not eliminate the possibility.  Whether your implants are or are not ruptured you should consider changing them since they are now 27 years old and in my experience over three decades plus I find many implants are seeping or broken at that stage.Best wishes,Jon A Perlman M.D., FACSDiplomate, American Board of Plastic SurgeryMember, American Society for Aesthetic Plastic Surgery (ASAPS)ABC-TV Extreme Makeover SurgeonBeverly Hills, CaliforniaIG: jonperlmanmd

Ronald V. DeMars, MD (Retired) · Answer

Both mammograms and ultrasound are notoriously inaccurate in determining implant rupture. And I have never seen an implant rupture that caused tenderness, it is more likely you have capsular contracture. Mammograms certainly can cause the rupture of old implants, but they remain an important diagnostic tool.

Can an ultrasound detect a ruptured silicone implant?

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