This is a very good question and one I am often asked by patients with an ultrasound report indicating implant rupture. There is no straight answer.
Implant rupture are classified into two types: intracapsular and extracapsular. Intracpasular (IC) rupture means that the implant has ruptured inside a tissue capsule which the body has formed around the implant. So in theory, it is 'contained'. It is very difficult to diagnose, as the implant often feels normal and the breast itself looks normal. It is most commonly an incidental finding on an ultrasound when it has been ordered for other breast disorders. Ultrasounds in general have a very high false positive rate for IC rupture (i.e. reporting it as IC rupture when in fact it is not ruptured). This is because sometimes there are normal folds in the implant shell which under an ultrasound may mimick the appearance of an IC rupture. To accurately diagnose an IC rupture, an MRI is the most sensitive tool (although the most expensive).
Extracapsular (EC) rupture on the other hand is much more easily and accurately diagnosed with an ultrasound. This is where the silicone has broken through the tissue capsule that the body has formed around the implant. This can be associated with palpable lumps or irregularities around the implant; sometimes specific pain or discomfort at a particular site of the breast. It could also be, like IC ruptures, completely asymptomatic.
What happens if you leave the ruptured implants in? An IC rupture will eventually become an EC rupture. When EC rupture occurs, the silicone will either seep into the breast tissue or overlying/underlying muscle. Eventually, a few things may occur: they can become walled off by scar tissue (your body's reaction to foreign material) to form 'silicomas'; the implant may become very hard as capsular contracture develops in an attempt to prevent further leakage; they can also infiltrate through the muscle/breast tissue and in some, work their way into the skin and break through as an open sore which leaks sticky silicone gel. This open sore can become a track for infection to the underlying implant. This is often a very late stage, and can be seen in patients who has had radiotherapy to their chest wall for breast cancer.
The most concerning thing about leaking silicone from an implant rupture is that it may affect breast screening for breast cancers. Silicone deposits in breast tissue look like opaque white irregular lumps on mammograms and sometimes may hide underlying breast cancers. Mammograms itself (as it compresses the breast) may also worsen the rupture of the implant sometimes making an IC rupture into an EC rupture due to the amount of force applied to the implant, especially in women whose implants are above the muscle.
Silicone itself is one of the most inert material on Earth. There has been no evidence that silicone from a ruptured implant causes cancer, autoimmune diseases or systemic problems. Thus, yes, theoretically, one can leave it there, but the breasts will become harder and lumpier (due to formation of silicomas) and breast screening would become less effective considering the risk of breast cancer in 1 in 8 women.
Technically, an implant with IC rupture is much easier to remove and there is a greater chance of removing the majority (if not all) of the silicone. However, the speed at which an IC rupture progresses to an EC rupture is not at all predictable (especially when one considers that the IC rupture may have been present undetected for a long time already). Removing an implant with EC rupture can be tricky and most of the time, not all silicone material will be removed, especially those that have widely infiltrated into the chest wall or breast tissue. However, serial mammograms (after implant removal) can often differentiate between silicomas and breast cancers as the breast patterns are compared at each screening.
So, my recommended advice is, the best time to have them removed is when IC rupture is diagnosed. However, there is no significant urgency associated with this procedure. Often there is time for one to think about her options and the timing of her procedure around other life commitments.
We will cover the surgical options with implant revisions in our next blog.
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