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Ruptured Breast Implants Q&A for the St. Louis Area

Posted: February 27, 2012 in Board Certified Plastic Surgeon Breast Implant Information Ruptured Breast Implants

Ruptured Breast Implant Question and Answer Information

How do I know if my implant has broken? That is a important question. 50% of silicone gel implants from the 1980s have been found to have ruptured by 20 years. ARuptured implants should be removed.

If a saline filled implant breaks then the saline will re absorbed by the body and there should be an obvious change in volume. AIn theory there could be a very small hole with a very gradual leak and a slow change in volume over time. AThat is less likely. ABut with observation for a period of time it should become noticeable. AIf a silicone gel implant breasts and the silicone gets outside the capsule [the scar around the implant] then the body may react to it and form a lump that is palpable or can be seen on mammography. AIf there is rupture but the silicone stays within the capsule, which is the most common situation, then it can be difficult tot detect. ANeither physical examination nor mammography is a reliable method to detect intracapsular rupture. MRI is the best method but it is not 100% accurate; there can be false positives or false negatives.

Will my insurance cover this? AIf the implants were placed for reconstruction, i.e. following mastectomy for breast cancer, then insurers will cover treatment of complications. AIf the original procedure was cosmetic, i.e. elective augmentation mammoplasty, then some insurers may cover removal with documented rupture while others will not. AThe plastic surgeon has to write to them asking for preauthorization in order to find the answer. AIf the original procedure was cosmetic no insurers will cover placement of new implants. AThe warranty on the implants may provide a replacement implant.

Do the implants needs to be replaced? AIf there has been no change then the same rationale for improvement in body contouring is still there. AIf there has been a significant change in medical status or age, or if there has been a change in weight with change in breast volume, then some women may elect to do no reconstruction, or to do mastopexy, or to change the size of the implant. it depends upon the individual.

Does the implant on the opposite side also need to be replaced? AIf the implants are not very old then no change may be needed. AWhile if the implants are significantly older then it makes sense to also replace the other implant. AIf the size or type of implant were to be changed, then both sides would need to be done for symmetry.

Can this be done through the same scar? AIt may depend upon what exactly needs to be done. ARemoving all the silicone material may require a larger opening leaving a longer scar. AIt may be necessary to do this through an infra-mammary approach even if the original procedure was done some other way.

What about the PIP implants made with industrial grade silicone that have been in the news recently? Those implants were never released for use in the United States.

St. Louis Ruptured Breast Implants

Posted: February 21, 2012 in Ruptured Breast Implants

Dr. Robert Young Discusses Ruptured Breast Implants

I am often asked by women how to tell if their implant has ruptured. This is a serious concern because ruptured breast implants should be removed. AThe silicone gel implants placed in the early 1980s have a rupture rate of 50% by 20 years, so many of the implants from that era have ruptured. AThe current generation of implants, both saline and silicone, have about a 5% rupture rate by ten years.

There can be changes in the breast that are due to a cause other than implant rupture. AThe skin can stretch with the pull of gravity over time, or with weight gain or pregnancy. AThe breast tissue can change in volume with weight gain or loss. AIf the breast volume was different to start, then there could be an asymmetrical change in that volume. AThe capsule [the scar tissue surrounding the implant] could contract and make the implant feel harder or more spherical. ATrauma could tear the capsule causing asymmetry.

Rupture of a saline filled implant should be obvious. AThe fluid is absorbed and there is a change in volume. AIn theory there could always be a very tiny opening with a small leak and a more gradual change over a period of time.

Rupture of a silicone gel implant may be harder to detect. AIf a volume of silicone gets outside the capsule there can be a palpable mass or it may show on mammography. AHowever a broken implant with the silicone remaining within the capsule may be difficult to determine by exam or mammography. AIntracapsular rupture is twice as common. MRI is the best method for detection of rupture but even MRI is not 100% accurate. There can be false positives or false negatives. AIf there is silicone in the tissue and there has been a previous implant rupture, that silicone could be from the prior implant.

If there is clear evidence of implant rupture, then that implant should be removed. AIf there is loss of volume the surrounding capsule will contract over time so the procedure should be done without undue delay.

Please feel free to contact our office if you or somebody you know has any questions.

Dr. Robert Young

Before and After Photographs

Posted: February 14, 2012 in Before and After Photos

At a talk I was asked how much should a prospective patient rely on before and after photographsAwhen choosing a surgeon? One should always remember the same disclaimer for investment advisers applies here: past performance does not guarantee future results. In fact even if your anatomy was exactly the same and exactly the same procedure was done it does not mean you would look the same as any photograph. You should take the pictures with “a grain of salt.”

When you see before and after photographs there are are few things you should consider. #1 is patient selection. Were these pictures chosen to illustrate a typical result or to sell you? If a surgeon has done a hundred of the same procedure there should be some that look great. No one is going to show the unfortunate one with a poor result. #2 is time frame for the after picture. Plastic surgeons commonly wait at least six months before taking the after picture, because you want to see the results that will hopefully be long term. #3 has any other procedure been done to the patient?

Has there been other surgical or non-surgical treatment? You may see a brochure for a facelift and the patient has also had eyelid surgery and Botox for frown lines. #4 is there anything non-surgical done to change their appearance? The same brochure may have new make up, a new hairstyle, more flattering clothing and accessories in the after photograph. #5 is the patient posing the same way? Tilting up the chin helps to remove that extra skin in the anterior neck. Smiling makes all of us look better. #6 is there any difference in the photographic technique? Flash can wash out fine lines. A warmer light makes the subject look different than a cool light. #7 does it state that this was the result of a single stage? There may have been multiple stages required to achieve that result.

In summary looking at before and after photographs can be similar to the challenge in the children’s section of the comics in which the reader is asked to find the six differences between two sketches.

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