Are Your Breast Implants Leaking? How to Check for Silent Rupture

Dr. Kuruvilla (00:11):
Welcome back to the Behind the Double Doors podcast. I'm Dr. Shannon Kuruvilla. Today I'm going to be talking to you about the ins and outs behind breast implant screening using ultrasound. So it's really important to monitor any sort of prosthetic device and its integrity that you have in your body. Thankfully, due to newer generation of technology that we have with our implants today, the risk for things like silent rupture or just overt rupture are a lot lower. The actual rates for implant rupture are very low, quoted about one to 2% for silicone implants, which is great. These are very safe devices, very stable. However, if you are in that 1%, your body might have an over inflammatory reaction that can then lead to things like capsular contracture and pain. What's more common these days is something called silent rupture, so you wouldn't know, and that's why this ultrasound is recommended also MRI, and that is to catch things like silent rupture.

(01:08):
The reason is called a silent rupture, also kind of known as what's called an intracapsular rupture. When you have a prosthetic device in your body like an implant, you're going to form a capsule around it, and thanks to the technology behind the implants we have these days or gummy bear implants, they do kind of hold their form when they rupture. So it's not like the silicone leaks out of the shell and goes everywhere in your body. It kind of holds its form like a gummy bear. However, if you do have that, some people might develop what's called capsular contracture, so your body might react to that kind of orin substance coming out of the shell. You might be able to feel a small irregularity, but it's usually very much contained or kind of camouflaged by your muscle. If it's under the muscle or your tissue, you are more likely to feel capsular contracture if that is a sequela of your rupture.

(01:58):
So it starts off by your breast implants will actually look a little bit different, or it'll feel a little bit hard when you're pushing on your breast. It can then progress to causing overt pain and distortion of your breast. So the implant all of a sudden is riding a lot higher on one side versus the other, or it looks a little bit more constricted versus the other. So you can look at two things. You can have a physician do a physical exam and confirm with you that it is capsular contracture, and then you can get an ultrasound to identify a potential cause of that if it is a rupture or if you just have capsular contracture, which can be idiopathic. If you have breast implants, is silent, rupture something you should be worried about? It's something you should be cognizant of. You understand that there is a risk of putting a medical prosthetic device and your body.

(02:46):
We don't know how everybody's body is going to react to a breast implant. However, the rates are so low, and like with anything in healthcare screening, the FDA has started these guidelines just to help you stay on top of monitoring the integrity of your breast implants. FDA recommends that you have either a screening MRI or a breast ultrasound, a high definition breast ultrasound of your breast implants at five years after placement, and then every two to three years after that, MRI is considered the gold standard. However, MRIs are very expensive and they are hard to schedule and they take a long time, versus an ultrasound is a fraction of the cost. It's much quicker and easier procedure to perform. So I do offer ultrasounds. So you can set up a clinic appointment with me and I have this wireless handheld ultrasound that's high definition, and we can look at your implants together.

(03:43):
You're able to watch it as well, and it's very fun educational process for both of us to assess your implant, the implant shell, the capsule, and just make sure that there's no obvious signs of that shell rupturing or any kind of silicone leakage. If you've got your implants somewhere else, I am happy to do an ultrasound to look at your implants. It takes about 20 minutes to perform the entire ultrasound on both sides, and it just depends on where your implants are sitting, if they're under the muscle, how much tissue you have. It's a fun process. We both get to watch the screen together and I can point out different parts of your implants and also your anatomy. I can identify some rippling. So rippling is when you see an irregularity of that shell, but if you kind of put some pressure on opposite where that rippling is, you'll see that shell fill up, which can help tell you that that step off is not in fact a rupture.

(04:34):
I've also used it to identify if there's any fluid between the shell and the capsule. It's a great tool to have in case a patient comes in after breasts augmentation, and of course, hope this never happens, that if they have a hematoma, you can identify where that hematoma is. Those are the main uses I've gotten out of it thus far. If you are worried about your implants for whatever reason, and you come in and we identify an issue such as a rupture, then the cost of your visit with me will go towards a credit for the surgical costs if you elect to then have your implants taken out or exchanged. Inconvenience and knowledge, so a lot of even staff who work here that have breast implants or patients that I've had in the past are unaware of this FDA recommendation, and it might be because the technology that we have these days is so good and that rate of silent rupture is going down, but it is really great to find a problem before it becomes an even bigger problem.

(05:34):
So doing an implant exchange with a small rupture that hasn't formed capsular contracture is technologically a lot easier than taking out an implant that has overt capsular contracture, calcifications. You're weakening the strength ligaments of the breast at that point when you're taking that implant out, and it just becomes a much more complex procedure. If you look at the literature, ultrasound, they will say is user dependent, so it's going to be as effective as experienced as the operator is, so there's always some room for error by the user. I will say that the main difference between the two in terms of identifying rupture is, and the reason why MRI is called the gold standard is that MRI can visualize the back wall of the implant, whereas an ultrasound cannot. However, the majority of ruptures don't happen on the back wall. They happen on the front where the breasts are more prone to trauma, if you're in a car accident, if your dog jumps on you.

(06:32):
Are there ruptures that are potentially missed on the backside of the implant with an ultrasound? The answer is yes, and that is why the MRI is considered the gold standard. In the setting of saline implants. I think you're more likely to have an ultrasound identify some sort of other pathology going on, whether it's a seroma around within the capsule because you don't really need the ultrasound to tell you if a saline implant ruptured. It's pretty clear kind, a blessing and a curse of the saline implants. You have an obvious deformity, so you know, but then you also have an obvious deformity. I am still seeing women come in today with saline implants and asking about replacement, and kind of the most common complaint they have is that they feel very heavy. The silicone implants feel a lot more like more natural breast tissue and can be a little bit lighter.

(07:17):
Those are the main reasons patients are coming in to talk about implant exchange. If you are somebody who has breast implants and you have not had them imaged yet either through MRI or breast ultrasound, and I will say that mammography does not do a great job of detecting intracapsular ruptures, so that is why we don't really consider mammography as a great modality to screen for rupture of your implants. We do perform high resolution breast ultrasound at Basu Aesthetics and Plastic Surgery. You can call our phone number. That phone number is in the show notes, and I'd be happy to do a quick in-office ultrasound for you. We do recommend thinking to do this before that 10 year warranty is up as well, so if there is, for whatever reason, an issue that we identify, we can get those implants exchanged for you quickly.

Announcer (08:05):
Basu Plastic Surgery is located in Northwest Houston in the Towne Lake area of Cypress. To learn more about the practice or ask a question, go to basuplasticsurgery.com/podcast. On Instagram, follow Dr. Basu and the team @BasuPlasticSurgery. That's BASU Plastic Surgery. Behind the Double Doors is a production of the Axis, theaxis.io.