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Management decisions for possible ruptured silicone gel implants previously placed over muscle

Prior to the late 1980’s it was commonplace and standard practice to place silicone implants under or within breast tissue over the muscle. As awareness of breast cancer surveillance became increasingly important along with the general understanding that implants were better off under muscle, implant placement underwent a renaissance by the late 80’s early 90’s.

Now we are seeing many women in their late 50’s to late 60’s with 30 year old disintegrating implants. They are not experiencing health issues, but rather cosmetic concerns of hardened malshaped breasts.

My solution has always been to remove all existing implant and scar capsule called total capsulectomy. This is combined with new implants (usually silicone gel) placed under muscle with the addition of a-cellular dermal matrix as a needed tissue graft support for the new implant space. Often a breast lift is necessary at the same time to optimize aesthetics.

This procedure is done as an outpatient and the recovery is fairly simple.

Occasionally, patients will request that no implant be replaced. This may present a challenge to create an aesthetic appearing breast. I use auto augmentation techniques when applicable to solve the dilemma of camouflage.

Finally, it should be restated that there are numerous options for women with “old tired” implants that need attention.

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