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Question of the week: are routine MRI scans necessary for implants after breast augmentation?

How can I tell if my implant has ruptured? I had breast implants last year and was wondering if I need to get routine breast ultrasounds or MRI scans? I don’t have a family history of breast cancer.
- patient

Brisbane breast implant replacement
Dr David Sharp, plastic surgeon in Brisbane, profile image

Dr Sharp:

Routine MRI or ultrasounds are not recommended unless you:

  • Ehave a history of breast cancer
  • Ehave noticed changes in your breasts such as the onset of pain, distortion or discharge
  • Esuspect your implant/s may be ruptured
  • Ehave experienced trauma to your chest and there are concerns that your implant/s may have been damaged

So if you don’t have a history of breast cancer (and aren’t of an age – or family history – to need routine screening yet), regular scans to check on the condition of your implants is not recommended in Australia.

The specific silicone gel filled implants I use are of a high quality; they have lifetime warranty options for rupture and capsular contracture. This means the manufacturers back the implant quality, and they will replace them for free if they are to rupture.

Surgeons can also take certain steps to reduce the risk of breast implant rupture at the time of implant placement, including using a Keller funnel to place the implant with minimal impact on the implant itself. I use a funnel for this and other safety reasons when inserting implants.

In the case of silicone implants, if the implant shell develops a small opening, due to its cohesive nature, the silicone gel will most likely remain inside the implant’s outer shell. If a tear develops in the outer shell, the silicone gel may leave the implant, but will usually be contained within the natural scar tissue capsule that forms a few weeks after the implant is placed.

That means you might not notice an immediate difference in your breast. If you do notice a change in your breast, it might be a shape our outline/profile alteration. You might notice some persistent discomfort in the area. As silicone gel is biologically inert, it does not react with your tissues and research shows that when modern cohesive gel implants rupture, they don’t pose an immediate risk to your health.

 

If you think you might have a rupture:

  • EVisit your GP; they will assess your breast (and symptoms) and may refer you to have a scan. Ask for a referral to see your plastic surgeon; a referral from your GP will enable you to receive a Medicare rebate on your specialist consultation fee.
  • EIf you aren't going back to see your original surgeon, and you don't have the implant details that were given to you at the time of your augmentation, contact your surgeon to obtain these. This will help you ascertain the type of implants (cohesive gel, saline etc) and the manufacturer's warranty provisions. Knowing your warranty provisions will help you ascertain the out of pocket costs of any potential revision surgery.

Implants do not last forever; I have seen patients with first-generation implants that have been in place for over 40 years, while other patients have required replacement due to capsular contracture, rupture or migration after 8-10 years.

The good news for women who wish to undergo breast augmentation with modern silicone gel implants is that early data from the Australian Breast Device Registry shows low complication and high satisfaction rates at 1 year post op.

The implant brands I use have a low rupture rate, as documented in this review article in the Journal of Gland Surgery and the TGA-approved breast device information provided by the implant manufacturers.

When complications such as rupture occur, they are usually contained within the capsule and removed during surgery. 

Whether you have implants or not, it is important to visit Breastscreen Queensland’s website here to learn more about the recommendations around breast screening. If you live elsewhere in Australia or the world, visit the relevant breast screening service’s website for information applicable to your state. 

For more information, read our checklist for caring for your breast implants , which includes:

  • ESelf-examination
  • EScreening when you reach the age where screening is recommend - or if you have a family history that makes you a candidate for early screening
  • EWatching for changes

Regular MRI Scans for Women with Breast Implants: Are They Necessary?

The necessity of regular MRI scans for women with breast implants depends on the specific advice of their specialist plastic surgeon. It’s not always required, but certain situations may prompt the need for an MRI. For instance, your surgeon might recommend an MRI if there’s a suspicion of breast implant rupture. Some surgeons advocate routine MRI scans post-breast augmentation surgery, while others may advise an MRI before undergoing breast implant or revision surgery, particularly around the 10-year mark. However, it’s important to note that regular MRI scans after getting implants might not be essential and may not detect all ruptures.

MRI scans are particularly useful in identifying what is known as a ‘silent rupture’. This occurs when there are no noticeable symptoms indicating a rupture, yet the integrity of the implant shell has been compromised. An MRI can help reveal such a rupture, allowing for further evaluation of treatment options.

Understanding ‘Silent Breast Implant Rupture’

A silent rupture means that the patient experiences no obvious symptoms, even though there has been damage to the breast implant. MRI scans can be instrumental in detecting such ruptures, showing signs like the ‘linguine sign’—where the implant shell appears as wavy lines, indicating an intracapsular rupture contained by the fibrous scar tissue.

Symptoms of a Potential Breast Implant Rupture

If you experience symptoms, they might include changes in breast size or shape, pain, swelling, or the formation of lumps. Different types of ruptures can occur, such as intracapsular (contained within the fibrous capsule) or extracapsular (where silicone may leak). Modern implants are often made with cohesive gel, reducing the likelihood of leakage even if a rupture occurs.

Considering an MRI for Breast Implant Concerns

If you suspect a breast implant rupture or have been advised to undergo regular MRI scans, it’s important to discuss this with Dr Sharp. Despite some implants being less prone to leakage due to their cohesive gel composition, complications can still arise, such as increased scar tissue formation.

Comparing MRI with CT and Ultrasound Scans

CT Scans are typically used for viewing bones and chest problems, while MRIs are better suited for examining soft tissues. MRIs take longer than CT scans and may involve the use of contrast. Some women opt for ultrasound checks for their implants, but these may not always provide accurate results, and an MRI might still be necessary.

If you have concerns about a potential breast implant rupture or wish to schedule an MRI for reassessment, please contact your surgeon’s practice and book an appointment with your GP, as a referral to your surgeon will also be required. 

For more information about breast implant risks, benefits and recovery please visit the breast augmentation page on our website.

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The images on this page show a patient of Dr Sharp’s before and 3 months after breast implant removal and replacement surgery.  

The above information is general in nature and does not constitute medical advice. All surgery carries benefits and risks, and we recommend visiting the specific page related to the procedure you are interested in to learn more.

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