Poly implant breast implants (PIP) and the rupture risk in asymptomatic patients: a warning for greater clinician suspicion in assessment and counselling
A 45-year-old female presented to the breast clinic with concerns over bilateral breast implants which she had implanted over 10 years ago. These had been carried out under the NHS, but she had had no follow-up since and wondered whether these should be removed given recent publicity regarding PIP implants.\nShe had neither noticed any change in the shape of her breasts nor any lumps, although she had experienced some mild breast pain recently (possibly related to cyclical hormonal changes). On examination, the implants were non-tender but appeared to have migrated laterally towards the axilla. There was no axillary lymphadenopathy. There was no clinical suggestion of rupture or leak.\nWith the patient keen for explantation if there was proven rupture, an MRI scan was organized as the recommended imaging modality. This showed no silicone in the breast or axilla. However, there was extensive silicone between the chest wall and the lung. Although there was no definite sign of intracapsular rupture, the appearances were suggestive of a gel bleed. These findings were seen bilaterally; however, they were worst on the right side as shown in Figure a and b.\nA respiratory opinion concluded that intrathoracic removal of the silicone was not recommended. However, following a discussion with the patient, it was decided to remove the implants to prevent further leakage.