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Breast Implant Rupture

  • Breast implants may be retroglandular/subglandular (placed deep to glandular tissue) or retropectoral/subpectoral (deep to the pectoralis major muscle).
  • A fibrous capsule forms around the implant as a normal physiologic response to foreign material.
  • Single lumen implants are the most frequently used device and is composed of a single polymer shell filled with saline or silicone.
    • Saline implants have a valve allowing for volume adjustment.
    • Saline implants decompress when ruptured and are readily diagnosed clinically.
  • Silicone implant ruptures are categorized as intracapsular or extracapsular.
    • Intracapsular rupture is contained by fibrous capsule.
    • Intracapsular rupture is more common (77% to 89%) than extracapsular rupture.
  • Risk of rupture is directly related to age of implant, with most ruptures occurring 10 to 15 years after implantation.
  • Median life span of a silicone implant is 10.8 years.
  • Most ruptures have no obvious traumatic origin and can present as palpable nodules, asymmetry, tenderness, or may be asymptomatic.
  • Imaging:
    • Mammogram:
      • Intracapsular rupture can be difficult to detect and may present as a contour bulge that can be difficult to differentiate from an implant herniation.
      • Extracapsular rupture presents as extruded silicone into the adjacent breast parenchyma or within axillary nodes.
      • Tangential views may be helpful in mammographic evaluation of implant rupture.
    • Ultrasound:
      • 50% to 77% sensitive and 55% to 84% specific.
      • Intracapsular rupture presents with the “stepladder sign” — multiple linear/curvilinear lines traversing the interior of the implant at various depths.
      • Extracapsular rupture presents with the “snowstorm sign” — free echogenic silicone with well-defined anterior margin and dirty posterior shadowing. Free silicone can be seen in the breast parenchyma or axillary nodes.
    • MRI:
      • 72% to 94% sensitive and 85% to 100% specific.
      • Early sign of intracapsular rupture where the shell has not completely collapsed presents as the “teardrop/keyhole/noose/subcapsular line sign,” which represents a small amount of silicone outside implant but within fibrous capsule.
        • Radial folds can appear similar to this sign.
        • However, radial folds emanate from the implant surface with silicone on only one side of the shell, while a rupture will have silicone on both sides of the shell.
      • More extensive intracapsular rupture presents with the “linguine sign”.
      • Extracapsular rupture presents with extruded silicone separate from the implant.