PSA: Get Your Silicone Implants Imaged Before Any Breast Surgery

This one is quick but important, and it applies to anyone with silicone breast implants who is going back to the operating room for any breast surgery.

Before you go to the OR, get your implants imaged.

I see this miss happen far more often than it should, and it can meaningfully change both your surgery and your insurance coverage. Here's why it matters.

If you have silicone implants that are:

• A couple of years old or older (and especially 5+ years old), and
• You are scheduled for any breast operation

…you should have an ultrasound or MRI to evaluate implant integrity before surgery.

This applies whether the procedure is cosmetic, reconstructive, or something unrelated to the implant itself.

If you're already planning an implant removal, replacement, or revision, imaging is especially critical.

A "straightforward removal and replacement" is a very different operation from one where the implant has ruptured:

• If intact: a relatively quick exchange
• If ruptured: often requires a capsulectomy (removal of the surrounding scar capsule)

Your surgeon needs to know this in advance so they can:

• Plan appropriate operating room time
• Discuss the expanded scope with you beforehand
• Order the right supplies
• Make sure you're mentally and logistically prepared for a bigger operation

Here's a piece most patients don't realize: if your silicone implant is ruptured, insurance may cover portions of your surgery, even if the original implant was placed for purely cosmetic reasons.

• Imaging in advance gives you documentation of the rupture
• That documentation can be submitted for pre-authorization
• It's always much easier to get insurance permission up front than to try to get reimbursed after the fact

The old saying "ask forgiveness, not permission" does not work with insurance companies. Ask permission.

This is the part people really miss. If you have silicone implants in place and you're going to the OR for:

• A breast biopsy
• A lumpectomy
• A revision of a previous breast lift
• Any other breast procedure

…you still need that implant looked at before surgery.

A general surgeon is doing a breast biopsy and takes a sample of tissue. In the process, they:

• Nick the capsule
• Discover silicone is already leaking into the breast tissue
• Realize the implant is ruptured

At that point, the general surgeon does not have the skill set to properly manage a ruptured silicone implant, which is plastic surgery territory. You end up in a situation where:

• Your biopsy becomes more complicated than planned
• The rupture issue doesn't get fully addressed at the same sitting
• You now need a second surgery with a different surgeon to clean it up

That is avoidable with one ultrasound done ahead of time.

If it turns out your implant is ruptured and you're already going to the OR for something else, this can actually be a perfect opportunity to deal with it all at once:

• One anesthetic
• One recovery
• Often one coordinated trip to the OR with your plastic surgeon and the other surgeon working together

That only works if we know about the rupture before you go under.

Everything above is about ruptures, because that's the surprise nobody wants in the middle of an operation. But I'd go further than "get imaged."

If you have breast implants and you're going to a breast surgeon for a biopsy or a mass removal, whether it's something benign like a fibroadenoma or a breast cancer, you should always talk to your plastic surgeon first. I see patients all the time who had implants placed years ago, had a tumor removed by a breast surgeon, and then developed problems. Here are two more reasons.

Many women have capsular contractures, and sometimes these develop slowly over time, slowly enough that you may not even recognize how bad it is.

And many breast surgeons really aren't skilled at diagnosing capsular contractures. So it can easily go unaddressed. (I've made this case to breast surgeons directly.)

Since you're already going to the operating room, this is the perfect time to manage it.

If you're having a lumpectomy for cancer, the timing matters even more, for reasons that have to do with radiation.

We know that implants weaken with time, and your rates of rupture go up.

So if you have an aging implant and you're already planning on going to the operating room for a biopsy or a cancer removal, this is a great time to switch that implant out for a newer, less-likely-to-rupture model. (If you're not sure whether yours is due, here's how I think about replacing implants.)

When you have implants placed, you need a long-term relationship with your plastic surgeon. Follow up with them occasionally, so you can make sure you're doing the proper screening and that no implant problems have developed.

That matters most when you're about to have surgery in the area with a different type of surgeon, because they are not equipped to manage implant problems the way we are.

Do not roll the dice and hope they're fine. Do not assume "I'd know if something were wrong." Silicone ruptures are famously silent (which is why I've written in detail about the real problems ruptured silicone implants cause over time and what happens if you just leave them in).

Insurance is much more willing to cover the surgical management of a documented ruptured implant than to retroactively reimburse you after the fact. Get the imaging, submit the report, and request authorization before the date of surgery.

If you have silicone implants, especially ones that are 5 years or older, and you're heading to the operating room for any reason related to the breast, get implant imaging done first.

It may:

• Change the scope and plan of your surgery
• Prevent a much messier intraoperative surprise
• Open the door to insurance coverage you didn't know you were eligible for
• Let you fix a problem you didn't even know you had, at the same time as the procedure you were already scheduled for
• Give your plastic surgeon the chance to treat a contracture, or replace an aging implant, in that same operation

It's one ultrasound. It's often done in under half an hour. And it can genuinely change the entire arc of your care.