And yes, Google Plus continues to generate even more questions! So, after-another follow-up question is this one-
“Thanks for your insights Dr. Kim. I have read a clinical case of a patient with a possible contained intracapsular leak from a silicone implant for breast augmentation (more or less 5 years old). It was noted on her routine mammogram but the patient is asymptomatic. Implant removal vs exchange?”
So, the short answer is- yes, you have to remove the breast implant. Of course, it’s technically optional to replace it, but I would imagine that most women would want it replaced. The replacement can be done at the same time as the removal.
The longer answer is- yes, you have to remove it, but it may be difficult to actually notice a tiny leak unless you get a mammogram or MRI. And even then, the mammogram or MRI may not be 100% accurate.
The FDA panel on silicone breast implants, radiologists who interpret MRI’s and mammograms, and even other plastic surgeons have all commented on the same phenomenon- if you have a very tiny problem with your silicone breast implant, it may not be noticeable, or that noticeable, even with a test. On physical examination, the patient may not notice any difference at all. In fact, plastic surgeons have commented that even plastic surgeons may not notice a difference- and we’re the ones who are actually performing and seeing the patient after breast reconstruction or breast augmentation.
I’ve written a previous article on what the FDA panel has said about silicone breast implants here but even radiology papers have shown that MRI is not 100 % infallible.
This paper shows that sensitivity and specificity is not 100% with silicone breast implants, even with MRI. ( http://emedicine.medscape.com/article/345877-overview#a21). If MRI was perfect, which it’s not, then these numbers would be higher. As most doctors know, but not the average person- the test performed is only as good as the technician doing the test, as well as the interpreter of the test. This is not really anyone’s fault, but rather, a limitation of what a test can show.
Even taking out the breast implant in the operating room and physically looking at it may not be the best test out there- very small defects may not be visible to the naked eye.
So, given that there is an abnormality on some test, I would always recommend removing and replacing the breast implant, but there’s always the possibility that the test result may not be 100% accurate, due to limitations with technology.