Implant rupture: Pathophysiology, diagnosis, and management

Despite advances in breast implant design and technology, rupture continues to be a significant complication and increases with time. The exact incidence of implant rupture varies by the implant model, age, and purpose (augmentation vs. reconstruction, primary vs. secondary) and may be calculated using the Kaplan-Meier analysis. One should be cautious in making direct comparisons of the data from different manufacturers. The most common cause of implant rupture is iatrogenic damage by surgical instruments. Magnetic resonance imaging is the gold standard for diagnosing and confirming suspected ruptures. Ultrasound may be a useful adjunct under appropriate circumstances. The US Food and Drug Administration recommends MRI surveillance of implant rupture starting 3 years after implantation and recurring every 2 years afterward. Compliance with this recommendation remains poor. Saline implant rupture is easy to diagnose, as there is a noticeable decrease in volume shortly after rupture. Management includes surgical removal of the implant and capsulectomy with or without replacement. Most silicone implant ruptures are silent and intracapsular. To avoid conversion to extracapsular rupture or avoid an inflammatory stimulus that may lead to capsular contracture, elective explantation is still indicated. Extracapsular ruptures can be symptomatic and are managed by surgical removal and capsulectomy with or without replacement.