Q: Dr. Eppley, I want to know if my breast implant got ruptured. I got in a car accident last week. My car was from the side and the air bag was deployed, striking my right breast with considerable force. Although both cars were badly damaged, no one was injured. The only injury I got was a big right breast bruise and pain. I still have pain and numbness on the right side of breast as well as the bruising. Is there any chance that my breast implant ruptured? I had silicone gel breast implants placed five years ago. I am worried about tearing my implant bag. There is no sign of any difference in size between the breasts and the pain is slowly becoming less. Do you think my breast implant is ruptured?
A: The majority of silicone breast implants fail (breast implant rupture) by the development of a small tear or hole that develops from fatigue fracture of the shell in one area. But acute high impact trauma, like from the deployment of an airbag, is one example of the type of force impact that could cause breast implant failure. With considerable bruising of the breast and pain you understandably have legitimate concerns about the integrity of the underlying breast implant. For a variety of reasons, including legal documentation, you should have the breast implant evaluated. Either an ultrasound or an MRI would provide a good assessment of the integrity of your breast implant. You should see a board-certified plastic surgeon for an evaluation and to have the appropriate test ordered.
Dr. Barry Eppley
Q : Dr. Eppley, I have had silicone gel implants for 31 years and am still very pleased with them. I am presently 65 years old and in good health. I regularly had mammograms every two years until five years ago. At that time, the place where got my mammograms asked me to sign a disclosure form stating that I would not hold the clinic or technicians responsible if one or both of my implants as a result of the test. This was alarming to me and I walked away without the mammogram and have not had one since!
I realize that foregoing mammograms is foolish. My doctor encourages me to have it done even though I have shared my fear. Is there a better way to examine the breast with silicone implants other than a mammogram? My breasts are small and when the paddle compresses them, it does feel like the implants could burst especially since they are such old implants. How do we know that the bag that encloses the silicone will not leak or burst? I’ve also had an ultrasound but they said that is not a good substitute and will not detect cancer cells.
Dr. Eppley, if you have any suggestions or answers to these concerns, I would certainly appreciate hearing from you.
A: Your fears about rupture of breast implants with mammograms is understandable, particularly in light of their age. While today’s breast implants have improved shells (the bag containing the implant filler) that are known to be resistant to the compressive forces of mammograms, the physical characteristics of implants thirty years ago are undoubtably less so.
I have seen breast implants of this age before on removal and most of them are either ruptured or no longer have any identifiable shell remaining. (meaning it has completely disintegrated)At thirty-one years of age, it is very likely that your breast implants are already ruptured or the shell is no longer intact. Even in asymptomatic, capsular contracture-free breasts, old breast implants will often, if not usually, not be intact.
That being said, I think your concern about breast implant rupture should not outweigh the potential benefits of mammography. Mammograms are still the simplest and most cost-effective screening tool that exists for breast cancer detection. An MRI of the breast can be done but it is more sensitive to look at whether breast implant rupture exists than to detect breast cancer.
Dr. Barry Eppley