Breast

Featured Procedure

• Suppose you have had a breast augmentation, especially more than 8-10 years ago. In that case, this article may be of interest to you. Last month, my anaesthetist commented before we started our Wednesday list that coincidently, the patients on the list were all the same age, weight, and height and had the same operation. Namely, the removal of a ruptured silicone breast implant with replacement. Furthermore, all implants were inserted more than 10 years ago. As these patients had recently turned 40, they had all gone for a routine Ultrasound and Mammogram to exclude breast cancer. It is important to note that there is no evidence demonstrating an increased risk for breast cancer in patients with breast implants, either Saline or silicone, if they undergo routine cancer screening with mammography.1 The Ultrasound results had indicated that there were abnormalities suggestive of implant rupture, which prompted their visit to my practice. These patients had not shown any clinical indications that an implant rupture had occurred. Silicone implants are in their fifth generation and have been used for more than 60 years. In the USA, implants have been approved for all patients over the age of 22 and saline implants for those over 18 years old. 2 The FDA has advised that all patients with silicone breast implants have an MRI at 3 to years after implant insertion and then routinely every 2 years. This has not occurred in the USA due to the high costs of this exercise, time constraints, and lack of facilities.2 In South Africa, medical aids also do not routinely cover the cost of MRIs to exclude breast implant rupture. Another more user-friendly and cheaper option is to regularly perform routine High-resolution ultrasound studies of the breast, which yields similarly reliable results.1 This can be done in the Plastic Surgeon’s rooms. If a suspicious finding is present, further investigations can be done. In a recent study published in PRS, 10 % of patients undergoing routine screening were noted to have silent rupture of implants. 3 Device rupture is a major complication of implant-based reconstruction and augmentation. The reported incidence is 1% per year for silicone and saline devices. Although saline implant rupture is usually evident because of the rapid deflation, silicone implant rupture can be occult and challenging to detect on physical examination. Even though silicone implant rupture is often asymptomatic, it can be associated with symptoms of breast shape changes, asymmetry, silicone granulomas, lymphadenopathy, capsular contracture, pain, and swelling.2 Although detecting a ruptured implant is an unwanted finding, it may be a blessing in disguise. It may be an ideal time to upsize and uplift saggy breasts after pregnancy and breastfeeding. In those patients with textured implants, this gives them an opportunity to change to smooth implants. Due to the association of Anaplastic Large Cell Lymphoma (ALCL) with textured implants, these have generally been taken off the market in South Africa. Lastly, certain implant companies provide a 10-year warranty on ruptured implants, allowing a replacement at a lower cost. Tissue samples are sent for further investigation if any suspicious findings are noted during the surgery. It is recommended that ruptured implants be removed and replaced as soon as possible to avoid these problems. It is now a routine in my practice to schedule regular checkups on previously implanted patients with high-frequency ultrasounds. So, suppose your breast implants were inserted more than 3 years ago. In that case, it is definitely worth your while to schedule a routine checkup with your Plastic Surgeon to have your implants assessed to make sure you are not in that in that 10 % group.   Carr LW, Roberts J, Mericli AF, Liu J, Arribas EM, Clemens MW.: Breast Implant Imaging Surveillance among U.S. Plastic Surgeons U.S. Food and Drug Administration Recommendations versus Clinical Reality. Plast Reconstr Surg. 2020 Jun;145(6):1381-1387. doi: 10.1097/PRS.0000000000006812. PMID: 32459768. Canzoneri CN, Moyer KE. Challenges in Breast Evaluation: Breast Asymmetry, Macromastia, and the Surgically Altered Breast. Obstet Gynecol Clin North Am. 2022 Mar;49(1):73-85. doi: 10.1016/j.ogc.2021.11.004. PMID: 35168774. Salzman MJ. Silent Rupture of Silicone Gel Breast Implants: High-Resolution Ultrasound Scans and Surveys of 584 Women. Plast Reconstr Surg. 2022 Jan 1;149(1):7-14. doi: 10.1097/PRS.0000000000008632. PMID: 34936597; PMCID: PMC8687613.