Implant Rupture
Although rupture is one of the main causes of implant removal, its real rate is difficult to quantify, especially in breast reconstruction. Most of the ruptures have no obvious traumatic origin, and are silent or intracapsular, thus asymptomatic, and diff
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Implant Rupture Mauricio Resende, Cicero Urban and Mario Rietjens
33.1
Introduction
Failure of a breast implant means either a deflation of a saline implant or rupture of a silicone gel device. Although rupture is one of the main causes of implant removal, its real rate is difficult to quantify, especially in breast reconstruction. Most of the ruptures have no obvious traumatic origin, and are silent or intracapsular, thus asymptomatic, and difficult to diagnose with conventional examinations (mammography and ultrasonography) [1]. Rupture is clinically defined as a breach of any size in the implant shell. All implants are susceptible to silicone bleeding. However, because of the high molecular weight molecules of the silicone, the gel cannot diffuse through the shell and the gel does not appear outside the implant, unless the shell has ruptured. Rupture has been suspected to occur as a result of biochemical degradation of the silicone, physical trauma to the elastomer at the time of implantation, fold-flaw failures, or as a result of mechanical injuries during mammograms, closed capsulotomies, or accidents. Loss of integrity of the implant shell is diagnosed when silicone gel is present outside the implant but within the intact fibrous capsule (intracapsular rupture). Extracapsular implant rupture is less common and is defined as rupture of both the implant shell and the fibrous capsule with leakage of silicone
M. Resende Department of Mastology, Federal University of Sergipe, Aracaju, Brazil e-mail: [email protected] C. Urban (&) Oncoplastic and Reconstructive Division, Breast Unit, Hospital Nossa Senhora das Graças, Positivo University, Curitiba, Brazil e-mail: [email protected] M. Rietjens Division of Plastic and Reconstructive Surgery, European Institute of Oncology, Milan, Italy e-mail: [email protected]
into surrounding tissues. Both require implant removal and removal of as much of the silicone as possible [2, 3]. More than 93,000 breast reconstructions were performed in 2010 in the USA according to American Society of Plastic Surgeons [4]. Esthetic results have improved with the FDA reapproval of silicone implants in 2006 and the introduction of a variety of new implant types. Cohesive silicone gel breast implants are composed of a textured silicone elastomer shell and are filled with cohesive silicone gel. Cohesive gel is formed by increasing the number of cross-links between gel molecules, which results in an implant that has better retention of shape and is less likely to fold or collapse, especially in the upper pole. In consequence, implant-based breast reconstruction (IBBR) is now the main technique for breast reconstruction [5]. In 2012, the worldwide crisis with Poly Implant Prosthèse implants occurred, and this exposed the need for better evidence regarding effectiveness and safety of these devices [6]. The aim of this chapter is to address the incidence, evaluation, and management of implant rupture in breast reconstruction.
33.2
Incidence
The incidence of implant ruptu
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