title: PIP silicone breast implants: rupture rates based on the explantation of 676 implants in a single surgeon series.
abstract: BACKGROUND
  To determine the true rupture rates of PIP implants from a large single surgeon cohort and to assess whether rupture rates varied depending on time of implant insertion. In addition, the efficacy of ultra sound scanning (USS) in determining rupture is examined.
  
  
  METHODS
  Predominantly prospectively based analysis of patient records, investigations and surgical findings.
  
  
  METHODS
  338 patients (676 implants) were included in the study and they all had removal of their implants. The senior author operated on all patients at some stage of their treatment. 160 patients were imaged pre-operatively with USS. Patients had implants inserted between 1999 and 2007 for cosmetic breast augmentation.
  
  
  RESULTS
  A total of 144 ruptured implants were removed from 119 patients, giving a rupture rate of 35.2% per patient and 21.3% per implant over a mean implantation period of 7.8 years. A statistical difference (P < 0.001) in rupture rates between implants inserted prior to 2003 and those inserted from 2003 was demonstrated, with higher failure rates in the latter group. There was a significant difference in rupture rates depending on pocket placement of the implants. The sensitivity and specificity of USS at detecting rupture was 90.6% and 98.3% respectively. A proportion of patients (29.4%) demonstrated loco-regional spread of silicone to the axilla on scanning.
  
  
  CONCLUSIONS
  Our paper has confirmed high rates of PIP implant failure in the largest published series to date. The significant difference in rupture rates between implants inserted prior to 2003 and those after this time supports the view that industrial silicone was used in the devices after 2003. Implants are more likely to rupture if inserted in the sub muscular plane compared to the sub glandular plane. USS is highly effective at detecting rupture in PIP implants and loco-regional spread is high compared to other devices. We believe this paper provides hard data enabling more informed decision making for patients, clinicians and providers in what remains an active issue affecting thousands of women.
authors.affiliation: Department of Plastic Surgery, Level 5, Ninewells Hospital, Dundee DD1 9SY, UK.
authors.forename: Omar
authors.initials: O
authors.lastname: Quaba
authors.forename: Awf
authors.initials: A
authors.lastname: Quaba
mesh_terms: D000328:Adult; D019928:Breast Implantation / Q000009:adverse effects* / Q000379:methods; D018427:Breast Implants; D016009:Chi-Square Distribution; D015331:Cohort Studies; D020878:Device Removal; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012422:Rupture, Spontaneous / Q000453:epidemiology / Q000209:etiology; D020034:Silicone Gels / Q000009:adverse effects*; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D020034:Silicone Gels
keywords: PIP breast implants; Silicone breast implant rupture