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 with
- PDF / 537,129 Bytes
- 5 Pages / 595.276 x 790.866 pts Page_size
- 69 Downloads / 205 Views
Implant Rupture Cicero Urban, Mauricio Resende, Fabio Postiglione Mansani, and Mario Rietjens
49.1 Introduction Failure of a breast implant means either a deflation of a saline implant or rupture of 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 [1]. Reported mechanisms of implant rupture include iatrogenic damage, which is the most frequent cause, trauma, seat belt contusion injury, blunt trauma, compression during mammographic imaging, severe capsular contracture, and degradation of the implant shell. Patient’s age, comorbidities, smoking, medications, presenting symptoms, implant duration, and volume did not correlate with implant rupture [2, 3]. The significant contribution of iatrogenic damage to overall rupture rate suggests that rupture may be more often operator-related than device-dependent [2]. Radiation therapy in patients with breast implants does not seem to cause a significant increase in complication rates and seems to be feasible in the therapeutic management of patients undergoing implant-based breast reconstruction [4]. Most of the ruptures have no obvious traumatic origin and are silent or intracapsular, thus asymptomatic, and with difficult diagnosis with conventional exams (mammogram and ultrasound) [1–4].
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 large 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, and 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 rupture is less common and is defined as rupture of both the implant shell and the fibrous capsule with silicone leakage into surrounding tissues and embolized tissues at a distance, a situation that although rare is possible. Both require implant removal and removal of as much of the silicon as possible [5–8] (Figs. 49.1 and 49.2).
C. Urban (*) Breast Unit, Our Lady of Grace Hospital and Positivo University Medical School, Curitiba, Brazil M. Resende Department of Mastology, Federal University of Sergipe, Aracaju, Sergipe, Brazil F. P. Mansani Medicine, Breast and Gynecology Unit, State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil M. Rietjens Division of Plastic and Reconstructive Surgery, European Institute of Oncology, Milan, Lombardia, Italy e-mail: [email protected]
Fig. 49.1 Long-term clinical consequences of patient’s negligence in ruptured implant showing bilateral breast deformity
© Springer Internationa
Data Loading...
