The Blog

This is Dr. Jonathan D. Hall from Boston, coming to you with another episode of “A Thoughtful Patients Guide to Plastic Surgery”

Today I am going to talk about screening for implant rupture after breast augmentation.  This is not meant to represent specific medical advice in the absence of being examined by your doctor or plastic surgeon but is the advice that I currently give to my breast augmentation patients.

Breast implants are not meant to last your lifetime.  If you are like many of my patients, it’s been a few years since your breast augmentation and you are wondering “What should a thoughtful patient be doing now?

There has been a little confusion because the FDA shook things up a little bit with new recommendations that they released in 2022.

This video discussion is meant for patients who do not have any symptoms and are doing well after their breast augmentation.  If you are having symptoms, stop the video call your plastic surgeon, and make an appointment to be examined.

Look up the implant cards that we gave you after your surgery, or call your plastic surgeon’s office to look up what kind of breast implants you have.

If you had saline-filled implants, such as the traditional saline filler implant or the newer multimumen Ideal Structured saline implant, then you do not require any special screening for rupture.  The breast will get visibly smaller as a saline implant leaks and you will be able to tell if you have a full or partial deflation by looking in the mirror.  The saline is harmlessly absorbed like an IV.  You will typically not need an implant study such as an MRI or an ultrasound. ( photos of saline and ideal structured saline implants)

90% of breast implants used in the US for breast augmentation now are smooth, round silicone gel filler implants.  Rupture rates with breast augmentation vary depending on the implant study but around 10% of silicone breast implants have failed by 10 years.

I mentioned that the FDA changed things in 2022.  BEFORE 2022 the recommendation from the FDA in breast augmentation patients with no symptoms was to get a noncontrast  MRI every 2-3 years.  And a non-contrast MRI is still thought to be the gold standard for detecting breast implant rupture.  But patients weren’t generally getting routine screening mris— it was expensive, insurance companies often didn’t cover the cost in patients with no symptoms, and many patients don’t like being in an MRI scanner.

In  2022 the FDA changed to recommend MRI or ultrasound starting 5 -6 years after the initial surgery.  Why 5-6 years? Waiting 5-6 years was recommended because the chance of having a rupture in less than that time was very low and they didn’t feel that it made sense to screen before then.

Studies have been done showing that diagnostic ultrasound is very good at screening asymptomatic patients, as well as being more widely available and lower cost.

So the current FDA recommendation is ultrasound or MRI starting 5-6 years after breast implant placement and then repeating this every 2-3 years to monitor for asymptomatic silent rupture.

So the answer to “What does a thoughtful patient do to check their silicone gel implants?  Call and schedule your Ultrasound. Your plastic surgeon or primary care doctor you schedule this.  If you are getting mammograms This can be done at the same time. or you can schedule it independently.

I have put a Link below to the current  FDA recommendations.

This has been Dr. Jonathan Hall from Boston Thanks for reading.

https://www.fda.gov/medical-devices/implants-and-prosthetics/breast-implants