Long-term Care of Silicone Gel Breast Implants
Reviewed by Roger J. Friedman, MD, FACS
The FDA’s re-approval of silicone breast implants for use in cosmetic breast augmentation has led many women to explore this option. We have had many questions on our discussion board about the proper long-term care for silicone breast implants. This article is a high level overview of the main issue women have been asking about—detecting potential ruptures in silicone breast implants. This article is not meant to worry anyone or make anyone think silicone breast implants are unsafe. The FDA would not have approved them if it felt they were unsafe. Rather this article is intended to help consumers understand the evolving nature of the long-term care recommendations regarding silicone breast implants.
Background on Silicone Breast Implant Studies & Evolving Guidelines
The FDA approved silicone breast implants manufactured by both Mentor and Allergan (formerly Inamed) in November 2006 for use in cosmetic breast augmentation. The FDA approved the use of these breast implants because it believes them to be both safe and effective. Each company still maintains study groups to help determine the longevity of the breast implants and to come up with more definitive long-term care guidelines. Given that the studies are ongoing, the recommended long-term care for silicone breast implants is still evolving. We strongly urge you to consult with your breast surgeon to get the most current recommendations! Your breast surgeon will have the most recent results of the Mentor and Allergan studies and will be able to guide you as to long-term care.
About Detecting Ruptures in Silicone Breast Implants
Detecting ruptures in saline breast implants and silicone breast implants differs. Ruptures in saline breast implants are usually very simple to detect. When a saline breast implant ruptures, the saline leaks out and is absorbed by the body. The implant naturally deflates as the saline leaks out causing the breast to decrease in size. The change in size is readily noticeable so detection is easy.
The silicone breast implants used in breast augmentation or breast reconstruction today generally do not leak the way saline implants leak. The silicone gel is what is known as “cohesive”, meaning that it is thick and does not move freely the way water (saline) will move. If a silicone breast implant ruptures, there is unlikely to be any apparent change in observable breast size because the fluid does not leak out. Therefore, detection is very difficult if not impossible through observation and examination of the breast. Even your plastic surgeon probably can’t detect a rupture in today’s cohesive silicone breast implants. However, silicone implant ruptures are detectible through other methods.
Screening for Ruptures in Silicone Breast Implants
Silicone breast implant ruptures may not be detectable through self examination or observation, but they can be detected with proper screening through the use of an MRI. The FDA issued guidelines for recommended MRI screening when it approved silicone breast implants. The FDA states, “The best method of screening is currently MRI at a center with a breast coil, with a magnet of at least 1.5 Tesla. The MRI should be read by a radiologist who is familiar with looking for implant rupture.”
While that information sounds very technical and daunting, rest assured that the surgeon who performs your breast augmentation should be able to recommend a good radiologist who can perform the MRI screening for you. You won’t need to worry about asking different radiologists about magnet size! In no case should the MRI screenings be seen as a replacement for your regular follow-up visits with your plastic surgeon. Your plastic surgeon will look for other issues in addition to ruptures, so please, please go to your regular follow-ups!
Frequency of MRI Screening - Silicone Breast Implants
The FDA initially recommended that patients begin MRI screening of silicone implants 3 years after implant surgery and then every two years, thereafter. This recommendation is only a guideline and has not been updated by the FDA as the study results continue to evolve. Many breast surgeons believe that an MRI is not needed after 3 years given the low failure rate of silicone breast implants after 3 years. If the studies show that failure rates remain low for many years, it may not be necessary to have an MRI for many years.
Special Circumstances
There are special circumstances that would dictate an MRI screening at any point in the life of a silicone breast implant. Any kind of trauma to the chest area such as that sustained in a car accident or anything capable of breaking ribs warrants an MRI study. The study will determine if the trauma ruptured the implant or if the implant is still intact. Again, your breast surgeon can recommend a qualified radiologist to perform the screening for you.
Conclusion
Silicone breast implants are as viable a choice today as saline. Your personal preferences and your plastic surgeon’s recommendations and guidance will help you to determine which choice is right for you. Make sure to have regular follow-up visits with your surgeon so that he/she can guide you with respect to long-term care of your breast implants. As the Mentor and Allergan studies evolve, so will long-term care recommendations, including the timing of any recommended MRI screenings.