When you have breast implants, you may wonder how you know if it is leaking? Ruptured? If you have a saline implant, a hole in the implant causes a loss of volume, and you will see it getting smaller over time. Sometimes it is fast, and sometimes it is slow or intermittent- think of when you get a hole in your car tire. Sometimes it happens quickly, and sometimes you can pump it up and keep it going for a while.
Silicone implants though are different. If they are leaking, they don’t go “flat.” You may notice a shape change, a change in the feel of them, they suddenly get firmer, or they look different.
This study was to identify the accuracy of ultrasound to diagnose breast implant rupture. They looked at studies which compared the ultrasound diagnostic test vs. what was found in surgery. Plastic and Reconstructive Surgery Journal November 2021, “Accuracy of Ultrasonography in Breast Implant Rupture Diagnosis: Systematic Review and Meta-Analysis.” There are 1,862,506 breast augmentation surgeries in 2018, an increase of 27% since 2014 data.
Study: 20 studies were analyzed, with a total of 1987 patients and 3297 prostheses. Different ultrasound equipment was used. Most patients had complaints of issues. Only 3 included asymptomatic patients. Ultrasound was better with better equipment and trained professionals.
- Sensitivity 73.7%
- Specificity 87.8%
- diagnostic odds ratio 11.04
They conclude it is an adequate tool in the diagnosis of rupture.
In their discussion they talk about necessity of screening asymptomatic people with breast implants. The new guidelines from the FDA include wanting to screen with ultrasound or MRI. They talk about how women 40 and older should be screening their breasts for breast cancer anyway, and if a woman has a capsular contracture, mammogram may be too difficult to do, so ultrasound offers another tool. MRI is 8.2 times more costly to do than ultrasound.
My thoughts?
I would love to see a current study of all women with implants – symptomatic and not- with a good tech and more recent technology to see what the rupture rates look like. I also would love to see the correlation with “rupture” on ultrasound and what we see in surgery. I have had patients with “rupture” on a scan, and when in surgery I don’t see any rupture. I also have patients with rupture seen, where it is ruptured. It would be great to be able to know with accuracy.