Autoinflation of Saline-Filled Inflatable Breast Implants

Abstract

Spontaneous autoinflation of saline-filled breast implants is a rare phenomenon; only 20 cases have been reported in the world literature. Over the past seven years, three patients have presented with significant unilateral autoinflation of their smooth, single-lumen, round, saline-filled implants. This developed at various times: progressively over 23 years with a Simaplast implant; between the ninth and 10th year after augmentation with a leaflet valve implant; and slowly over the first four years with a leaflet valve implant. The etiology of the autoinflation was shown to be different for the two types of implants. The Simaplast implant had likely been injected with a hypertonic filling solution -one that was twice as concentrated as 'normal saline'. This would have created an osmotic gradient, which would have facilitated autoexpansion by diffusion. The implant solution remained clear and transparent. In addition, there were no detectable levels of glucose, uric acid or albumin in the fluid. By contrast, auto-inflation of the leaflet valve implants likely resulted from mechanical alterations of the valve mechanism. This type of implant is known to have a high deflation rate, with frequent partial deflations. It is interesting that one of the patients with the leaflet valve implants presented with an autoexpansion on one side and a partial deflation on the other side. Both implants were from the same lot number. The same mechanism that caused partial deflations may have also allowed fluid from the implant pocket to pass through the valve into the lumen of these implants. This could allow glucose, protein and cellular elements to enter into the lumen (these would not pass through an intact elastomeric shell) which would create an osmotic gradient, allowing water to enter the elastomeric shell by diffusion. The fluid in these leaflet valve implants was brownish yellow, very viscous and turbid. It contained elevated levels of glucose and uric acid which would not have passed through the elastomeric shell. Over the past 10 years, four different theories have been proposed in an attempt to explain the etiology of autoinflation. However, the findings of the present study indicate that there are only two mechanisms -a hypertonic filling solution and alterations of the valve mechanism.Key Words: Autoinflation; Saline-filled breast implants L'autogonflement des implants mammaires remplis de sérum physiologique L'autogonflement spontané des implants mammaires remplis de sérum physiologique est un phénomène rare, puisque 20 cas seulement ont été déclarés dans les publications mondiales. Depuis sept ans, trois patients ont présenté un autogonflement unilatéral important de leurs implants remplis de sérum physiologique ronds, souples et monolumières. Cette occurrence se déclare à divers moments : progressivement, sur une période de 23 ans, avec des implants Simaplast; entre la neuvième et la dixième année suivant l'augmentation mammaire avec des implants avec valve; et lentement, au cours des quatre premières années, avec...

Unilateral autoinflation of a saline-filled breast implant initially diagnosed as capsular contracture: a case report and review of the literature

“…During that time, saline-filled mammary implants had lower complication rates than silicone breast implants, which had presented with complications such as capsular contracture, rupture, gel bleed, and migration [1]. The most common complication unique to saline implants was deflation [2]. Although saline breast implants are outdated in current practice, the long-term complications can still be seen, as in this case.…”

Seroma tardio após implantes mamários de silicone: três formas diferentes de apresentação, evolução e conduta

“…Peters 14 , who also investigated saline implant enlargement, discussed the possible existence of osmotic gradients between the body and the fluid used to fill the implants; however, the author considered that the probable cause of the event was the mechanical changes in the valves.…”

“…Late seromas after breast implants have developed after both silicone 6,9,15 and saline implant placement 7,13,14 . In silicone implants, the fluid accumulates outside the implant.…”