Is Your Breast Implant Ruptured? The Easiest Way To Check Your Implants Whenever You Want

Monique Ramsey (00:03):
Did you know the FDA recommends routine imaging for silicone breast implants, but most people never do it. It's not because they don't care, it's because MRIs are expensive, stressful, and hard to access. Today. Dr. Salazar's back to talk about a simpler solution that's changing everything. Breast implant ultrasound. Welcome Dr. Salazar.

Dr. Salazar (00:24):
Thanks so much, Monique. Thank you so much for the invitation that I always enjoy our conversations and I love to share, clarify demystify things for our patients. So let's tackle this topic. I love it.

Monique Ramsey (00:39):
Yeah. Good. Okay. So let's first talk about why somebody might want to think about imaging their breast implants. Can you explain what a silent rupture is and why it can go unnoticed for so long?

Dr. Salazar (00:53):
So a silent rupture is basically, as it name states, it's a rupture loss of integrity of an implant, but that you don't realize that it's completely asymptomatic. There's nothing going on and you're walking around, you're carrying your implant broken. It's ruptured, it's not intact anymore. One of the things that I always share with my patients is that an implant is no different than any other foreign body that has been implanted, that has been introduced to your body. So what I mean by that is it could be a medical device or even a non-medical device that was implanted in your body such as a splinter or even think about a bullet that was never removed, or something that gets inside and then your body recognizes it as not part of your own system. And then your body is going to protect you regardless of which type of foreign body that is, this case, a breast implant, but it could be a pacemaker, forming a capsule around your implant, depositing some cells around your implant. So that happens a hundred percent of the time. After implantation, patients will develop a capsule made out of their own tissue. And I know that we have many, many chapters on this topic about the capsule around the implant, but just to remind everybody that since that capsule is formed, most of the time around 90% of the time when an implant is ruptured, it suffers an intracapsular rupture, meaning that the rupture stays within that capsule that your body has formed to protect you from that foreign body.

Monique Ramsey (02:43):
Okay, I have an analogy. See if I'm right. I feel like it's like a flat tire. If you had a saline implant, you would know right away. You would know right away if that implant fails because you're going to deflate. That saline's going to go through your body and then it's like a run flat, run flat tires where you have, it's failed, but yet you can still keep driving. So is that kind of exactly my real world analogy.

Dr. Salazar (03:14):
The analogy is perfect and you don't realize it until either you don't have an image study, a random image study, or you get operated and then you are told by your surgeon, by the way, your implant was ruptured. But for that reason is that the FDA recommends monitoring those silicon gel implants.

Monique Ramsey (03:36):
And what is their recommendation? What is the timing of what they think people should do?

Dr. Salazar (03:42):
So timing has changed. In the past, used to be after three years of obtaining an MRI and then every other year. Now the recommendation has changed to five years after you have your implants placed and then every two to three years after that. But it has always been an MRI until recently, relatively recently, that the recommendation has changed as technology has caught up.

Monique Ramsey (04:12):
So few patient, I would think only a very few patients are actually following through on the MRI screening just because it's expensive, right?

Dr. Salazar (04:22):
It is expensive. It's hard to get, since it's expensive, it can reach up to 2,500 up to $2,800 if you're paying an out pocket. So you say well, why not pursue it through your insurance and through your primary care doctor, you go to your primary care doctor says, how do you feel? I feel fine that there's no problems. I have no symptoms. By the way, I was told by a plastic surgeon that I should get an MRI to check up on my implants. And what happens is the primary care doctor will put in the order, as you know, through insurance, everything has to be approved. If it's not an emergency, MRI. And what will happen is insurance company will not approve it. Basically, they would claim, well, you are not born with implants. You elected to have implants and for that reason you have to pay for it out pocket. And then it becomes very, very difficult at some point. If you think about it, I mean the FDA also recommends to have your implants exchanged every 10 years. So that means that if you're getting an MRI around three to four years after you have it, and then every other year, and then basically by year number 10, you practically have paid for another pair of implants while you were trying to figure out if they were intact or not. So that makes that recommendation in practical.

Monique Ramsey (05:46):
Right. So if you don't have an MRI, what are the alternatives?

Dr. Salazar (05:50):
As I was saying, technology has caught up and now we have high definition ultrasounds. And high definition ultrasounds would this actually allow the recommendation of the FDA to make it a little broader in terms of what image studies you can get. And as anybody, including all our audience out there, everybody knows that an MRI I mean, it's something that it's very technologically sophisticated. You require a big, big room. You require a dedicated facility for you to have that MRI. And then even you cannot, like for instance, even in hospitals, you have to place an MRI machine device in a special particular room that has to be away from certain other parts of the hospital because of how much electromagnetic force generates. So it's very expensive. And contrary to that high definition ultrasound, now they're portable. Now they are available for you to purchase at a doctor's office versus, I mean, if we would have to buy an MRI, we would have to cancel two three of our examine rooms and then to be able to get that in there. So it's very impractical and the ultrasound is great. So high definition has displays a better image, and now you can clearly see and follow the shell of the implant to make sure that it is intact.

Monique Ramsey (07:22):
Okay, so the technology in the office is called the Butterfly IQ 3 which means nothing to any of us, but that's what it's called. And it's ultrasound technology. And how is it different than regular ultrasound or is it not?

Dr. Salazar (07:39):
It is ultrasound. It's ultrasound with great definition. As a matter of fact, look what I have over here. Let me see if I can show it on camera. So that is the probe. As you can see, it's very portable. This gets connected to a screen and then that is number one, office-based, low cost. It is dynamic, meaning when you're in an MRI machine, you're just sitting there, they're doing, they're taking a picture in time over here, we can push and pull and make things tighter or let them go. And it's simpler. It's much simpler. It's quicker than an MRI process. And definitely it's I would say the way to go for monitoring your implants.

Monique Ramsey (08:25):
So if you're a woman who's had kids, you've probably had an ultrasound on your belly. Is this ultrasound like you put the gel on and you rub the little probe over? Is it kind of the same?

Dr. Salazar (08:36):
It's the same dynamic.

Monique Ramsey (08:37):
Okay.

Dr. Salazar (08:38):
We're not going to show you the head the arms and try to find out if it's a boy or girl, but it's exactly the same technology, exactly the same process. So as you know, if there's no problems, if the patient is routinely following up, there's zero pain involved in this procedure.

Monique Ramsey (09:00):
Okay. It'd be cool if we could have in the show notes a picture of what you see when you see an intact implant with the ultrasound and what you see if you saw that that implant might not be intact, what does it look like?

Dr. Salazar (09:18):
Well, there are several signs. One is, I mean, literally what we're looking for is we're following that shell of the implant. What an ultrasound shows you is the different layers, right? It's going to show you, the skin is going to show you the fat, the breast tissue, the muscle, and then it's going to go down to where the implant is. If the implant is underneath the muscle or on top of the muscle or show you on top of the muscle and you see different lines. And this ultrasounds, the depth that we focus on is we don't see, we don't look at the breast tissue per se. What we do is we go further down and we reach where the implant is, and then what we are looking for is we're looking for that shell for that layer to make sure that it's a continuous line. And when we are able to see that, then we are reassured. If we don't see that it's continuous, there are certain maneuvers that we can make or do in order for us to try to figure it out. Then what you want to see is that the inside of the implant is uniform. If you see that there is something called a snowstorm sign in which you see literally like a snowstorm during nighttime because the implant will show as black, which is called hypoechoic.Then you see that black night snowstorm, then that's concerning for a rupture.

Monique Ramsey (10:46):
So let's say you're having this little appointment, you're going along and we see a snowstorm. What, what is the next step that you would recommend?

Dr. Salazar (10:57):
If we find unequivocal signs and those keep adding, right? I mean that the break on that line a snowstorm, if we start seeing things that are very consistent with an implant rupture, then we can proceed and have or make several recommendations to the patient. If we want to be a hundred percent sure, then we obtain an MRI or if we have questions, we obtain an MRI, which is, do you want to hear the numbers of how they compare?

Monique Ramsey (11:29):
Yeah, absolutely.

Dr. Salazar (11:30):
Okay. So this is

Monique Ramsey (11:31):
You know me. I'm going to geek out on all of it.

Dr. Salazar (11:33):
No, this is great because it's very interesting for patients. I mean, if you say, or the question is what's superior, an MRI or an high definition ultrasound? So an MRI is superior. An MRI is still better. So when we are talking about screening tests, there are two terms that we always use. One is sensitivity and the other one specificity. So those are two different things that we always want to look in a screening test. So the high definition ultrasound, it's 90% sensitive. So what that means is if the implant is rupture is going to catch at 90%, the MRI is 95 to a hundred percent sensitive, but both are in the nineties. So they're comparable, but still an MRI is better. So there's another value here, and the term was specificity. So what specificity is, is that if the test sees that the implant is rupture, is it actually rupture? Right? So 80 to 90% specificity for a high definition ultrasound and 88 to 98% on the MRI. So the MRI, as you can see, has this characteristic of if the implant is rupture a hundred percent of the time, the MRI is going to catch it.

(13:08):
Then when you talk about specificity, if the MRI says that it's rupture 88 to 98% of the time, so 98% of the time, let's keep that number, it is going to actually be ruptured. What that means is the MRI can over call sometimes ruptures a high definition ultrasound can as well, overcall sometimes ruptures. So that's why that's important that these tests, none of these tests are infallible, but if the implant is actually ruptured, they're going to catch it pretty well. I know that it's a little confusing and it's a little bit back and forward, but just for us to know and understand the following, one, high definition ultrasound compares to MRI, both are good image studies. The MRI is superior, and it would give you the last and final word if there is a rupture that you have a question about.

Monique Ramsey (14:10):
So it sounds like that first step is a lot of times if you want peace of mind, like you think, gosh, I've had these implants a little while now. Should I be getting them checked? There's also warranties on different implants, so sometimes they will warranty against the implant failing. And so if you're coming up on maybe whatever that warranty period is, just like with your car, you want to go get it checked. It sounds like the ultrasound is much more simple, right? They come in, see, you go in the exam room, what does it take? How long does it take?

Dr. Salazar (14:49):
I would say for their entire experience, for them to block 45 minutes of their time, they're going to come to the office. If they're already patients, they just update their information. If they're not one of our patients, they just need to fill out all the forms and everything, then they go to a room. Then what we do is literally we talk to them, we hear if they have, they're having any symptoms or anything that we need to focus on, and if it's purely routine, the only thing we need to do is literally dim the lights so we can see the image better on our screen. Then what we do is we apply a little bit of lubricant. That lubricant allows the ultrasound to work better, and then what we do is we start going pretty much back and forward throughout the breast gland and the breast implant, I'm sorry. And then what we do is if we sometimes have to push the implant a little bit, take a closer look at a certain area, and then we move on to the next breast, and then at the end that we always make it interactive. We always show to the patients, what is that we were looking for? For them to understand, but we don't do that as we are performing it. So they are not stressed or they're not trying to help us seeing that. But at the end, once we know exactly what's going on, then we point it out to them. And the best thing is this, when you go and have an MRI, then you're going to have to wait for the result for the interpretation. With this, patients actually leave the office reassured knowing. So after those 30 to 45 minutes, they know.

Monique Ramsey (16:31):
And I think that affordability part keeps the compliance high. Like if the FDA is recommending certain visits at certain times, I think in our office the ultrasound appointment is $450, whether you had your implants with us or you had your implants in Hawaii, it's the same. And then how often would you recommend that that patient come back and maybe do an ultrasound check?

Dr. Salazar (17:01):
So you're talking about every two to three years to have, and again, I mean, I wouldn't say that patients need to really stress and set up an alarm, and because implants are very good devices, they rarely, extremely rarely fail. But if they do, you want to know.

Monique Ramsey (17:22):
And they don't need any kind of referral. Right. It's not like with a health insurance where you have to get a referral to have this appointment.

Dr. Salazar (17:28):
Exactly. I mean, it's very simple. It's as a matter of fact, when we see them here on their last appointment for the included visits that they have for their breast augmentation, what we do is we tell them what, even if it sounds crazy, you can set up the appointment for your ultrasound. I mean, we always invite patients to come back every year for a follow-up. It's always, I mean, that visit adds a lot of value because we always take routine and standardized pictures, and if something changes, you can always go back and refer and see how were you looking a year ago? Or how we can compare that with the before pictures and then we can compare that with the six month pictures. But if patients don't want to opt for coming back every year, and then the only thing they want to do is set up the appointment for ultrasound, we could do it. We could go into the future and then set up the appointment and then going to get a reminder in three, four years, they'll get it.

Monique Ramsey (18:29):
Yeah. Yeah. It's like you got to set up your thing for your, I just had my dryer, the lint guy comes every year to clean out the lint.

Dr. Salazar (18:39):
There you go.

Monique Ramsey (18:40):
So you just stick it on that recurring event and whenever it come, oh yeah, I got to give him a call.

Dr. Salazar (18:45):
Exactly.

Monique Ramsey (18:46):
Now you were talking about how the ultrasound can go through different layers so you can see the skin and the fat and the muscle. And so in this way, since the ultrasound could see it could catch any other issues beyond implant rupture. Could you see a cyst or something like that?

Dr. Salazar (19:09):
Well, in theory, yes. So for instance, if you have a large collection of fluid, for instance, around the implant, we could see it. It's extremely rare, what I'm mentioning, it's very, very rare, but you could see it. If for instance, our patients are wondering, well, for instance, a mammogram, I mean I have to go and get my yearly mammogram. If I get this ultrasound, would that substitute for that mammogram? Absolutely not. Hey doctor, I had they found a little cyst or a little mass. Can you check up on that? So the thing is that for those things, we are not radiologists. So if you put it or put set to use layman's terms, if you make things simple and the way we monitor for breast implant integrity, you require a certain training, a basic training for that. And that's what we know how to do. We are not going to be checking for a cyst or saying, you know what, rest assured you don't have any cancer. Everything's fine. Because that requires a completely different level of skill. And that's where the radiologists and the ultrasonographers work together, and that's a completely different thing. So it's also important for our patients to know that if they were saying, well, I'm going to get my mammogram, but I got my ultrasound scheduled to check on my implants, I'm just going to go for that one. No, they need to come for both.

Monique Ramsey (20:42):
Now, are there any myths or misconceptions about implant safety or screening that you want to address today?

Dr. Salazar (20:49):
Well, I think mean we addressed it. The real myth that prevented patients from looking for, I mean for doing or undergoing their surveillance routine is cost. That was, I mean, everybody knew that an MRI is super expensive and you're not going to be spending all that much money on something that it's not going to give you or not giving you any problems. So I think that's the number one myth. The second one I would say is some patients still one and only advantage of saline implants over silicone implants that was out there was the fact that it fits rupture, you're going to know right away. I mean, it deflates, you go to the restroom the next day and you get rid of all that saline water from your implant, and that was it. So that's the one and only. And then some patients that actually and currently have saline implants, when we talk to them, we show them the saline implants, we show them the current silicone gel implants that they go like, wow, these are incredible, but you know what?

(22:00):
I'm still afraid that I'm not going to know if it's ruptured. And when they hear about this technology, then they go like, whoa, okay. So now I'm considering going with silicone gel implants because now it's very easy for me to be reassured that they're intact. And that's a great myth that I would say we have busted with this. And when patients come in for remove and replace of implants and they have saline implants, when we tell them that you can opt for saline, you can opt for silicone. And when they know all the facts, most of them actually choose to go with silicone.

Monique Ramsey (22:42):
We'll put in the show notes, we just did some, we have the whole breast, we did a live stream that you,

Dr. Salazar (22:51):
Oh, that great.

Monique Ramsey (22:52):
do on demand about breast fullness and about the different types, and we talk about the different types of implants and you show them, and I think it's so helpful for the audience to, if you're that person in the audience who's listening and you have saline, you're like, well, okay, what's new? Because like you say, technology catches up and what drove your decision-making process at the time? Now, if it's that one thing that I am worried about them rupturing, and now we have for this little test, you can just put that worry aside. You don't have to be having stress about it, I guess. Okay, let me just ask one more question. If we see some snow pattern on the breast implant in this screening that you do, and then they go and they get their MRI to maybe confirm, and let's pretend the MRI confirms that, yeah, this does look ruptured. Do they need to be stressed about, oh my God, I need to get in the OR to get them changed out Friday? Or do they need to be worried if in fact it is ruptured about what is happening inside them?

Dr. Salazar (24:08):
I think it's a great question. So it is not a medical emergency or urgency by any means, right? But it is not okay for you to have a ruptured device inside your body. So I mean, I would say that definitely they do not need to plan to have that surgery that day, that week, maybe not that month, but within the next, I would say within the next couple of months for them to plan for a remove and replace of their device, it would be the optimal, the most optimal time. We have seen, as you know, I mean, it's not that rare than when we see patients that actually had implants for a long time for saying they never followed the FDA recommendations, and then they just show up like 25 years after they had their implants,

Monique Ramsey (24:58):
And it happens

Dr. Salazar (24:59):
And it happens, and then we go and we open and they didn't have a single complaint. We were completely asymptomatic. We open, and then the implant was all completely, I mean, it was ruptured, and we tell them and they seem surprised. And then we are also surprised because we were not expecting that. So even an ultrasound can help you plan for your surgery, better have, because you need to perform some irrigation, some surgical maneuvers once you find that rupture of an implant to leave everything as clean as you can, and so an ultrasound will prepare you for that if you know. But it's not a medical emergency that needs to be addressed that day or when was the last time you had anything to eat or drink when you find out, let's go to the operating room?

Monique Ramsey (25:46):
Yeah, I mean, I don't know if you find something like how, I don't know, I'm the type of person, if it's like, don't be stressed about it, I won't, but if it's urgent, I will be stressed. So I think letting patients know like, okay, yeah, it doesn't have to be tomorrow that we take them out of you, because theoretically you're talking about that capsule surrounding the implant, and even if the shell is maybe ruptured a little bit, the capsules kind of holding everything in there, right?

Dr. Salazar (26:13):
It's kind of holding everything in there. Then sometimes what happens is that capsule, the capsule, again, I'm talking about the tissue that your body builds around the implant. So the shell is ruptured, and then the silicone is there, and then sometimes it touches that capsule that your body formed. Then sometimes your capsule gets a little upset and then starts shrinking, and guess what? Then you have capsular contracture. So then you're talking about a completely different surgery. It's not just a remove and replace of implants. Then you have to remove the implant with the shell. You have to clean up all the silicone and everything, and then you have to remove the entire capsule of your tissue, which is called capsulectomy. Now you're talking about now you've, instead of being a 45 minute to an hour surgery, then you go into a couple of hours surgery. So then that's why it's very convenient once you have seen it, especially if you're asymptomatic. You know what? Let's plan for this. Let's not delay it. Don't make it like a priority number eight in your life, and then maybe take care of it next year. It's probably better to do in the next couple of months.

Monique Ramsey (27:16):
Yeah. Well, it's like back to my cars. If the check engine light comes on, you're not going to go, oh, yeah, I'll get around to it in a second, like before Christmas. You think about it. And so I love the fact that for a low cost, low stress come in, have 45 minutes of your life just to, let's just make sure and let's kind of try to keep it in that FDA two to three year recommendation. I think that's wonderful for patients. So thank you for telling us all about this, and I think probably reassuring a lot of people, and I'm sure a lot of people didn't know we had it, so it's good to let them know.

Dr. Salazar (27:55):
No, that's great. Thank you so much. I mean, it's a great opportunity. I always like to talk about these topics that are sometimes, I mean, this is a little bit of a reverse topic because we always talk about what patients are actively looking for, and this is something that patients are not actively looking for. This is something that it's like, here's some new information for you, or some information that maybe you heard, but it's important. It's really important for them to come back, get their implants checked, and then continue life. I mean, most likely it's going to be fine, but you want to know if it's not okay. If it's not fine.

Monique Ramsey (28:30):
Right.

Dr. Salazar (28:31):
Okay.

Monique Ramsey (28:31):
Well, thank you, and if everybody who's listening today, if you have any questions, need information about scheduling, financing, read our reviews, look at the photos, but certainly get in touch with us. We'll put a link in the show notes how to get in touch if you're thinking you'd like to have a breast implant ultrasound appointment. So thanks Dr. Salazar, and thanks everybody for listening.

Dr. Salazar (28:54):
Thanks so much. Thanks, Monique. Always a pleasure.

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