Suspected breast implant rupture: our experience, recommendations on its management and a proposal for a model of informed consent

Nicola Zingaretti, Daniele Fasano, Franz W. Baruffaldi Preis, Carlo Moreschi, Silvia Ricci, Samuele Massarut, Francesco De Francesco, Pier Camillo Parodi

Research output: Contribution to journalArticle

Abstract

Background: Implant rupture may be detected by physical examination, ultrasound or magnetic resonance imaging (MRI); the majority of silicone implant ruptures are clinically undetectable. The absence of guidelines for behaviour in the face of a suspected implant rupture often entails sending these patients for prosthetic revision surgery rather than carrying out in-depth radiodiagnostics to confirm implant rupture. The aim of this paper is to report our multicentric experience, to indicate the correct diagnostic-therapeutic procedure and to propose a model of informed consent. Methods: We conducted a multicentric retrospective analysis of 183 women submitted to prosthetic revision surgery due to radiological diagnosis of suspected implant rupture after breast augmentation or post-mastectomy reconstruction, admitted to three different Plastic Surgery Departments between 2002 and 2018. We correlated surgical findings with purpose of examination, symptoms, physical examination, imaging and device specifications. Results: Two hundred and twenty-one explanted implants were preoperatively suspected as ruptured. One-third were intact and unjustifiably explanted. US associated with MRI evaluation was the most accurate method. Patient’s age, comorbidities, smoking, medications, symptoms presented, implant duration and volume did not correlate with implant rupture. Conclusions: Our study confirms that the association of US and MRI represents the mode of diagnosis with fewest false positives. Given the high number of errors associated with suspected intracapsular implant rupture, it seems necessary to submit an appropriate and specific informed consent that takes into account the emotional component and clearly and completely explains the possible alternatives and complications associated with possible prosthetic revision surgery. Level of evidence: Level III, risk/prognostic study.

Original languageEnglish
JournalEuropean Journal of Plastic Surgery
DOIs
Publication statusAccepted/In press - Jan 1 2019

Keywords

  • Breast augmentation
  • Breast implant rupture
  • Breast reconstruction
  • Imaging of breast implant
  • Informed consent

ASJC Scopus subject areas

  • Surgery

Cite this

Suspected breast implant rupture : our experience, recommendations on its management and a proposal for a model of informed consent. / Zingaretti, Nicola; Fasano, Daniele; Baruffaldi Preis, Franz W.; Moreschi, Carlo; Ricci, Silvia; Massarut, Samuele; De Francesco, Francesco; Parodi, Pier Camillo.

In: European Journal of Plastic Surgery, 01.01.2019.

Research output: Contribution to journalArticle

Zingaretti, Nicola ; Fasano, Daniele ; Baruffaldi Preis, Franz W. ; Moreschi, Carlo ; Ricci, Silvia ; Massarut, Samuele ; De Francesco, Francesco ; Parodi, Pier Camillo. / Suspected breast implant rupture : our experience, recommendations on its management and a proposal for a model of informed consent. In: European Journal of Plastic Surgery. 2019.
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abstract = "Background: Implant rupture may be detected by physical examination, ultrasound or magnetic resonance imaging (MRI); the majority of silicone implant ruptures are clinically undetectable. The absence of guidelines for behaviour in the face of a suspected implant rupture often entails sending these patients for prosthetic revision surgery rather than carrying out in-depth radiodiagnostics to confirm implant rupture. The aim of this paper is to report our multicentric experience, to indicate the correct diagnostic-therapeutic procedure and to propose a model of informed consent. Methods: We conducted a multicentric retrospective analysis of 183 women submitted to prosthetic revision surgery due to radiological diagnosis of suspected implant rupture after breast augmentation or post-mastectomy reconstruction, admitted to three different Plastic Surgery Departments between 2002 and 2018. We correlated surgical findings with purpose of examination, symptoms, physical examination, imaging and device specifications. Results: Two hundred and twenty-one explanted implants were preoperatively suspected as ruptured. One-third were intact and unjustifiably explanted. US associated with MRI evaluation was the most accurate method. Patient’s age, comorbidities, smoking, medications, symptoms presented, implant duration and volume did not correlate with implant rupture. Conclusions: Our study confirms that the association of US and MRI represents the mode of diagnosis with fewest false positives. Given the high number of errors associated with suspected intracapsular implant rupture, it seems necessary to submit an appropriate and specific informed consent that takes into account the emotional component and clearly and completely explains the possible alternatives and complications associated with possible prosthetic revision surgery. Level of evidence: Level III, risk/prognostic study.",
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AU - Moreschi, Carlo

AU - Ricci, Silvia

AU - Massarut, Samuele

AU - De Francesco, Francesco

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