Breast Implant Ruptures
While we’ve covered the issue of breast imaging and breast implants (just a few times), we haven’t addressed other issues for women who have had augmentation mammoplasty. Implant rupture or loss of integrity of breast implants is one issue which may bring a woman with breast implants to see her friendly radiologist.
Breast implants come in a wide range of types, but in the US the majority contain either silicone or saline. These can be placed in one of two positions: subglandular (behind the breast glandular tissue and in front of the muscle) or subpectoral (behind the pectoralis muscle of the chest wall).
Implants have a defined “lifespan” – that is, the implants will after a period of time lose their integrity. Loss of integrity is more common the longer the breast implants have been in place. In most cases, there is no defined event or trauma leading to the implant rupture or lost integrity. For saline breast implants, implant rupture will often be symptomatic with sudden loss of contour of the implant and flattening of the breast. The saline fluid disperses in the tissues and is resorbed by the body.
For silicone implants loss of integrity and/or rupture may be completely asymptomatic. For saline implants, a rupture may be confirmed on a mammogram which will show a deflated implant.
Occasionally a woman will notice a change in the contour of the silicone implant or may present with redness or swelling. A thick capsule develops around the silicone implant, so there can be an implant rupture with no overall change to breast size or shape. For silicone implants there are two major types of rupture or loss of integrity including intracapsular rupture and extracapsular. Imaging for silicone implant integrity is more complex requiring mammography, breast ultrasound and often breast MRI for complete evaluation. An intact silicone breast implant on mammography, ultrasound and MRI has a smooth inner and smooth outer contour. Both intracapsular rupture and extracapsular silicone are well shown on the MRI. MRI also allows the whole implant and chest wall to be seen in their entirety – an advantage of MRI for the implant patient. There are some who recommend routine MRI evaluation of silicone implants after 10 years – but this is not universal.
Intracapsular rupture of a silicone implant has an intact thick capsule around the broken implant. An intracapsular type rupture will not be visible on mammography, although contour changes of the implant may be seen. Intracapsular rupture may be seen on ultrasound as abnormal coiled membranes within the implant.
The extracapsular type of breast implant rupture has disrupted thick capsule around the implant and disrupted implant so silicone can leak or bulge into the breast and surrounding tissues. Extracapsular silicone can at times be seen on a mammogram as a dense area – a white area of tissue similar in whiteness to the implant in the adjacent breast tissue. By ultrasound extracapsular silicone will show up as a shadowing “snowstorm”” appearance. MRI is the most sensitive and accurate in evaluation of silicone implant integrity showing in the case of extracapsular rupture the ruptured implant, disrupted capsule and location of any extruded silicone.
So, in summary, be aware of your breasts and if you have them, know the feel of your implants. Please be aware of changes in the size and contour of your breasts and implants. If a persistent change or area of concern develops, contact your doctor for evaluation. Imaging, particularly with MRI for silicone implants, can provide your doctor and breast surgeon with valuable information and help get you on your way to your best breast health.
Originally published 3/14/14 on mammographykc.com.