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Implant Leak or Rupture

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Modern implants from Mentor and Allergan have relatively low leak or rupture rates compared to older implants. The older second generation silicone implants manufactured in the 1970's had a very thin shell and were prone to leakage.

Newer implants from Mentor on their Memory gel  silicone implants show a 1.1% rupture rate at 6 years while saline implants have reported leak rates of 7-16% at 10 years. Please note that textured saline implants have a higher leak rate than smooth saline implants. Further information is available from Mentor corporation and Allergan or the FDA

At Sanctuary Plastic Surgery we are a referral center for breast implant complications. We see a fair amount of both ruptured silicone and saline implants on a regular basis.

Saline Leak/Saline Rupture
In the case of a saline leak or rupture there is usually a rapid decrease in size much like a balloon deflating. The saline is absorbed by the body and breast appears flattened. Occasionally saline implants will have a partial leak with a gradual decrease in size over a few week period. It is usually necessary to change ruptured implants within a short time since waiting too long will cause a change in capsule shape and make the implant exchange more difficult.

Replacement of ruptured saline implants usually involves general anesthesia, but IV sedation or in some cases local anesthesia. The old incision is opened, the deflated implant is removed and replaced with a new implant. Often patients choose to have a size change with an implant deflation and surgery is similar to that outlined in those sections. If the implants are over the muscle we may perform a submuscular conversion and/or capsulectomy if indicated.

The case above is more complicated. Ruptured right subglandular implant. Repair following bilateral capsulectomy and submuscular conversion. Note the shrunken right capsule indicating that this was ruptured for some time.

It is  difficult to detect a silicone leak based upon physical exam. Mammograms and ultrasound examinations may detect a leak but MRI is currently the best way to detect a silicone rupture. However, MRI's are not completely diagnostic and they may miss a leak, or mistake a folded implant as one leaking. If someone is unhappy with breast shape, size or position and wishes to have this corrected; preoperative exams to diagnose a ruptured implant are not indicated. Older implants that were soft and became firmer are considered ruptured until proven otherwise. The question, "When do I replace older silicone implants that are not problematic?" often arises. We previously advised patients to leave them alone if they are asymptomatic but after having seen too many asymptomatic ruptures, we currently recommend replacement of older implants at 15-20 years. Current generations of implants should have a longer lifespan.



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