Breast Implant Screening: A Message to Primary Care and OB-GYN

About 4 million women in the United States have breast implants, and too many serious implant problems are being missed. Dr. Killeen is asking for help from every clinician who examines breasts — primary care doctors, OB-GYNs, and radiologists — to improve how we screen and monitor these patients.

If your patient has breast implants, you need to know:

1. What type of implant they have (silicone vs. saline)
2. When the implants were placed

This matters because silicone implants require monitoring: an MRI or ultrasound starting five years after placement, and every two years after that. Patients often don't see their plastic surgeon consistently — but they do see you for annual visits. Ordering these studies can make an enormous difference.

Dr. Killeen has seen too many imaging studies where obviously ruptured implants weren't called by radiology. She's even been told by a radiologist that assessing breast implants "is not their protocol."

A ruptured implant is a damaged medical device. If you see it on imaging, it needs to be reported and the patient needs to be informed.

Every clinician who performs breast exams should know what a normal breast implant feels like and document it in the chart:

• Breast implants should be soft — they should never be hard. A normal implant blends into the breast tissue.
• If the implant is hard, that's a problem — likely a capsular contracture
• The implant should sit evenly within the breast with the nipple centered. An implant sitting too high can also signal a contracture.

By recording what the implant feels like each year, you create a baseline. If it feels different at the next visit, you can intervene early. A mild contracture is a much easier and less expensive problem to treat than a severe one.

Dr. Killeen sees patients every week with horrific contractures causing terrible pain — contractures they've had for 10 or more years while being told by their doctor that their breast exam was "normal." That is not normal. Those patients deserve to live without pain.

Treatment for capsular contracture is often covered or partially covered by insurance. The same goes for ruptured silicone implants. These are health maintenance issues, not purely cosmetic concerns.

There are cancers associated with breast implants — related to both textured implants and long-standing capsular contractures. Patients deserve proper screening for these conditions, and that starts with clinicians who know what to look for during routine exams.

Once a patient gets breast implants, they are the proud owner of a medical device — and there is maintenance that comes with it. But plastic surgeons can't do it alone. Patients see their primary care doctor and OB-GYN far more regularly than their plastic surgeon.

Dr. Killeen's ask is simple: know the implant history, examine and document properly, order appropriate imaging, and refer when something isn't right. Together, we can take much better care of these patients.