title: Analysis of 109 Consecutive Explanted Breast Implants: Correlation Between Suspected Implant Rupture and Surgical Findings.
abstract: BACKGROUND
  The use of breast implants is on the rise due to increases in breast reconstructive and aesthetic surgery. Implant rupture is a possible complication. Among assessment modalities for implant rupture detection, MRI is considered the gold standard.
  
  
  METHODS
  We conducted a prospective analysis of 57 women after breast augmentation or postmastectomy reconstruction (109 implants), admitted to our department between 2010 and 2015 due to suspected implant rupture. We correlated surgical findings with symptoms, physical examination, imaging, and device specifications.
  
  
  RESULTS
  Seventy-four explanted implants were preoperatively suspected as ruptured. Over a third were intact and unjustifiably explanted. MRI evaluation was the most accurate modality. Interestingly, 61 % of ruptured implants were left-sided. Patient's age, comorbidities, smoking, medications, presenting symptoms, implant duration, and volume did not correlate with implant rupture.
  
  
  CONCLUSIONS
  Our study confirmed preexisting data regarding the importance of imaging diagnosis, with MRI being the most accurate modality in both diagnosing and ruling out implant rupture. Interestingly, our study showed that MRI was accurate in detecting all intact implants, unlike lower detection rates reported in previous studies, thus preventing unnecessary explantation. Another unique finding was that the left-sided implants were significantly prone for rupture. As iatrogenic damage is the most common cause of implant rupture, with most surgeons being right-handed, awareness during surgery must be augmented, with further investigation required for potential causes of this unexpected difference. Our study emphasizes the importance of understanding the causes of rupture and the need for evidence-based indications regarding imaging and replacement of implants.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors: Department of Plastic & Reconstructive Surgery, Shaare Zedek Medical Center, POB 3235, 91031, Jerusalem, Israel. lotan.adi@gmail.com.
authors: Adi
authors: A
authors: Maisel Lotan
authors: Department of Plastic & Reconstructive Surgery, Shaare Zedek Medical Center, POB 3235, 91031, Jerusalem, Israel.
authors: Meir
authors: M
authors: Retchkiman
authors: Department of Plastic & Reconstructive Surgery, Shaare Zedek Medical Center, POB 3235, 91031, Jerusalem, Israel.
authors: Izhak
authors: I
authors: Tuchman
authors: Department of Plastic & Reconstructive Surgery, Shaare Zedek Medical Center, POB 3235, 91031, Jerusalem, Israel.
authors: Rami
authors: R
authors: Binenboym
authors: Department of Plastic & Reconstructive Surgery, Shaare Zedek Medical Center, POB 3235, 91031, Jerusalem, Israel.
authors: Yoav
authors: Y
authors: Gronovich
mesh_terms: D000328:Adult; D019928:Breast Implantation / Q000009:adverse effects* / Q000379:methods; D018427:Breast Implants / Q000009:adverse effects*; D015331:Cohort Studies; D020878:Device Removal / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D011446:Prospective Studies; D011475:Prosthesis Failure; D012086:Reoperation / Q000379:methods; D018570:Risk Assessment; D012422:Rupture, Spontaneous / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
keywords: Breast augmentation; Breast implant rupture; Imaging of breast implants; Implant explantation; Implant replacement