Profiling Breast Implant Rupture: A Systematic Review and Meta-Analysis of Patient, Surgical, and Device Characteristics
This systematic review and meta-analysis aims to address the need for a comprehensive understanding of the factors that contribute to breast implant rupture. By synthesizing the available evidence on patient demographics, surgical techniques, and implant characteristics, this study seeks to provide clinicians with a clearer and more complete picture of the risks associated with this complication, ultimately informing clinical decision-making and improving patient outcomes in breast implant surgery.
Methods/Technique
:PubMed, Embase, CINAHL, Scopus, and the Cochrane Library were searched (last search date: October 26, 2024). Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this systematic review and meta-analysis included observational studies of adult women who experienced breast implant rupture; aesthetic and reconstructive patients were. Studies involving animal models, published prior to 2010, focused exclusively on male-to-female transgender patients, and involving outdated or uncommonly used implants in the United States (e.g., Poly Implant Prothèse) were excluded. Study selection involved two phases—title/abstract and full-text screening; screening was performed independently by two reviewers, with disagreements resolved through discussion or a third reviewer. Results were synthesized using random-effects models, and heterogeneity was assessed using the I² statistic.
Results/Complications
:This meta-analysis of 20 studies (15,811 implants) found that round implants were associated with a significantly higher rupture risk compared to anatomical implants (RR = 2.27 [95% CI: 1.04-4.94], p = 0.0387). Similarly, implants placed in the subpectoral plane had higher risk of rupture compared to those in the prepectoral plane (RR = 1.63 [95% CI: 1.22-218], p = 0.0007). No significant differences in rupture risk were found between saline and silicone implants, smooth and textured implants, or aesthetic and reconstructive patients.
Conclusion
:While individual studies have explored specific risk factors, clinicians lack a clear and synthesized overview of how various patient, surgical, and implant characteristics contribute to rupture. This meta-analysis is the first study to fill this gap by providing a comprehensive evaluation of these factors, ultimately informing clinical decision-making and improving patient outcomes in breast implant surgery.
This meta-analysis highlights the significant impact of implant shape and surgical plane on rupture risk, with round implants and subpectoral placement associated with higher rupture rates. The increased risk observed with subpectoral implants is consistent with the understanding that compressive forces from the pectoralis muscle may contribute to implant shell damage and rupture. While the association between round implant shape and higher rupture rates aligns with existing literature, the underlying mechanisms and physical forces contributing to this phenomenon remain poorly understood and warrant further investigation.
This abstract contributes to evidence-based practice in mitigating risk of breast implant rupture. These findings can inform surgical planning and technique, potentially leading to improved surgical performance and reduced rupture rates. By identifying modifiable risk factors, this systematic review can empower clinicians to make more informed decisions, leading to better patient outcomes, reduced complications, and improved patient satisfaction. The information can also facilitate shared decision-making between clinicians and patients, allowing for more informed discussions about different implant types and surgical approaches as they reconcile the risk of implant rupture with other complications.