Ruptured Gel Implant Removal with Total Capsulectomy and Implant Exchange, NC*

This 56-year-old woman had silicone gel breast implants placed in the 1980s. She noted changes in the implants fairly soon after surgery but waited nearly 30 years to have them changed. Dr. Lyle performed removal of the implants with total capsulectomy and replacement with silicone gel implants. The patient had significant capsular contracture and was found to have ruptured breast implants. Breast implants have been around since the early 1960s and have evolved and improved since that time. Silicone breast implant rupture rates have decreased significantly with new advances. At one time, the implant shell allowed low-grade leakage of silicone into the tissues called " silicone bleed" and this could lead to significant capsular contracture. More recent versions of implants no longer have this problem. In fact, most implant manufacturers report rupture rates about 1% per year so by 10 years- 10% or less of women have a breast implant rupture. Changes in the structure of the silicone material utilized to increase its cohesivity-or "stickiness" -reduce rupture rates. It is believed that over time, small creases in the implant shell lead to breakdown of the outer shell called "crease fold failure". More cohesive implant material tends to reduce these creases and thus reduce the rate of implant rupture. Monitoring for implant leakage should begin after about 6 years and includes ultrasound and/or MRI. Mammography is not a good method for detection of rupture.