Treatment of ruptured breast implants and possible replacement

How is capsular contracture corrected?

Your cosmetic surgeon will likely diagnose your capsular contracture based on its grade in what is called the Baker scale:

• Grade I: The breast is normally soft and looks natural

• Grade II: The breast is somewhat firm but remains normal in appearance

• Grade III: The breast feels firmer than normal and has some changes in shape

• Grade IV: The breast is very firm, with clearly visible distortion in shape, and the patient may experience pain

Early, mild cases of capsular contracture can be reduced with breast massage and/or minimal surgical release. However, in Grade III and IV cases, contracture may be so severe that the scar tissue needs to be removed and the implant replaced. Even if the implant is replaced, capsular contracture can reoccur. A closed capsulotomy is a technique that is not recommended to treat capsular contracture. This involves a very forceful squeezing of the breast capsule to release or tear it. This technique is highly controversial as it can result in implant rupture and localized bleeding. Be advised that having a closed capsulotomy may in fact void your breast implant manufacturer’s warranty.

How are leaking or ruptured implants treated?

The only means to treat leaking or ruptured implants of any kind is through surgical removal, and replacement with another breast implant appropriately recommended for you. Leaking silicone-filled implants may be detected by decreased breast size, hard knots in the breast, uneven appearance of the breasts, swelling, tenderness, numbness or burning, or the development of significant capsular contracture. However, the best currently available test to determine whether your silicone implants are leaking is magnetic resonance imaging (MRI). It is recommended that leaking or ruptured silicone implants of any kind be removed even if the silicone is contained. Saline implants simply deflate when they are ruptured or leaking, and are therefore easy to recognize and simple to replace if treated early. Again, these implants may only be replaced surgically. Any woman who chooses only to have a leaking or ruptured implant removed but not replaced faces the possibility of highly disfigured breasts. Once the breast implant that provided volume for your breasts is no longer present, you will likely have flat, droopy breasts.

Literally, they will have the appearance of an outstretched and empty pocket. Problems of drooping breasts and dimpled or puckered breast skin can only be corrected through additional surgery, the outcomes of which may be highly variable. Implant manufacturers’ warranties may cover the cost of implant replacement in certain cases, and contribute to the cost of anesthesia fees and operating room facilities. Read your implant warranty carefully to understand exactly what it covers and how you can claim benefits. According to the American Society of Cosmetic Surgeons and the American Society for Aesthetic Plastic Surgery publication, Silicone Breast Implant Surgery: Information for Women, breast implant manufacturers’ statistics demonstrate a re-operation rate for breast implants of 20%–30% after five years for breast augmentation patients, and 30%–40% after five years for breast reconstruction patients.

Is there any other reason why my implants may need to be replaced?

Leaking or ruptured implants are not the only reason for implant replacement. Capsular contracture may require implant replacement as well as any other risks associated with breast implants. More commonly though, women choose to have their breast implants replaced when:

• A woman desires a change in her breast size

• Newer types of breast implants that offer the advantages a woman desires become available

• The nature of a woman’s body and breasts change somewhat, and she chooses to replace her implants to maintain the body image she desires

• Your cosmetic surgeon recommends having your implants replaced

The U.S. FDA defines that breast implants are not lifetime devices.Whether you choose to have your implants replaced, or for any reason your cosmetic surgeon recommends they be replaced, you must accept that it is likely in your lifetime that your implants will be replaced. Even if you are experiencing no complications of any kind with your implants, it is wise to have your plastic surgeon evaluate the condition of your implants as he or she recommends. This can be done in a simple, inoffice examination that takes only a few minutes. Having breast implants is a lifetime decision, and it also offers a lifetime of personal reward. Take the time to ensure the health and condition of your breasts and your breast implants. The investment in your time is minimal compared to complications that can result.

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