Ruptured breast implant poses risks
Dear Dr. Roach: I’m 73 and had silicone implants put in when I was 29. Other than getting firm, I’ve never had a problem with them. I have had a mammogram every year since I was 45 and all has been well except for this year, when the right implant showed up as ruptured. This was five months ago. I’ve had three opinions, two from plastic surgeons and one from my primary doctor, that I should replace.
Please convince me that I need to do this when I have no pain and they are so encapsulated that the silicone is going nowhere.
V.C.
Answer: As your doctors have told you, removal is the standard recommendation for a woman with a ruptured silicone implant. There are three reasons why: cosmetic result, symptoms and possibility of developing medical problems from the ruptured silicone.
If you are satisfied with the cosmetic result and have no symptoms, then your concern should be about development of medical illness, and this is a controversial area. Some studies have shown an increase in risk of problems, while others have not.
One concern is anaplastic large cell lymphoma, a rare cancer, for which breast implants are a risk factor, particularly when the breast implant is “textured.” The risk for this cancer is low, thought to be between one person in 1,000 to one person in 30,000 with an implant.
Another concern has been the development of autoimmune diseases, such as Sjogren syndrome, scleroderma and rheumatoid arthritis, all of which have been reported after breast implants. However, a Danish study showed no increase in risk of any connective tissue in women with ruptured silicone implants. There is a risk of capsular contraction (a kind of scar tissue), which affects the appearance of the breast.
In my opinion, the risk of developing a medical complication due to the implant rupture is low, especially since the leak is encapsulated by the breast. There are risks associated with the surgery as well as expense. It is certainly your decision, and close follow-up is a reasonable alternative to surgery.