A 63 y.o. woman presents with a mass that moves around in her R breast.

The diagnosis: is a ruptured right saline breast implant.  It is clear on the lateral Xray that only one saline implant is visible.  It was even more apparent on examination of the patient.

Breast augmentation is a billion dollar industry in the US each year.  Augmentation consits of either a saline implant in  silicone shell or a silicone gel within a silicone shell.  The newest silicone implants are called "gummy bears" because they hold their shape when cut.  The first saline implant was done in 1962 and the first report of a lymphoma surrounding a breast implant was in 1997.  Because of the concern for immune reactions to the implants the FDA declared a moratorium on silicone implants from 1992 to 2006. At that time it was determined that there was no large increase in autoimmune disorders associated with implants. 

Where is the implant placed?

Placement can be cubpectoral, subfascial or subglandular and depends on several factors. In general, the more covering the implant has; the more natural it looks.  The most common placement is subpectoral.  it is the safest after radiation because radiation causes interference with the subcutaneous blood supply.  It is also easier to interpret future mammograms with this approach.  The problem with subpectoral placement is that with muscle movement, the implant can move into the axilla over time.  The subfacial approach avoids the problem of migration.  the subglandular approach is the most painless but can oly be done if there is sufficient breast tissue. 

Which is better saline or silicone?

Both types of implants can have problems over time: contractures, rupture, and migration.

Case conclusion:  This patient had her implants for over ten years and ten years is about the lifespan of an implant. She noted that as she would turn over in bed a mass would gradually migrate to the dependent area of her breast.  This was her ruptured implant.  She subsequently returned to her plastic surgeron for removal and replacement.


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