Management of Asymptomatic Breast Implant Rupture in Older Adult Patients: A Scoping Review, Discussion, and Recommendations

Summary: Breast implants are a fundamental adjunct in aesthetic and reconstructive breast surgery, with more than 3.5 million recipients in the United States. Implant rupture risk increases with device age, although modern cohesive silicone implants demonstrate markedly improved durability. The Food and Drug Administration does not mandate routine replacement, but recommends surveillance screening for silicone implant rupture beginning 5–6 years postplacement and every 2–3 years thereafter. However, no guidelines exist for managing asymptomatic ruptures in older adult patients. A scoping review was conducted in MEDLINE, Embase, and the Cochrane Library through January 2025 for guidelines on the management of asymptomatic implant rupture in older adult patients; none was identified. Evidence indicates that although surveillance can detect silent ruptures and minimize silicone migration, the clinical impact in older adult patients is limited given the low incidence of symptomatic complications with modern devices and reduced life expectancy. Risks of surveillance include false positives, overdiagnosis, patient anxiety, and unnecessary surgery—particularly relevant in older patients with higher perioperative complication rates. The authors propose discontinuing surveillance for asymptomatic silicone implants after age 75 years and foregoing routine implant exchange. In asymptomatic patients older than 75 with known or suspected rupture, observation is reasonable unless symptoms develop. Symptomatic cases should undergo diagnostic imaging and individualized risk–benefit discussion using a comprehensive geriatric assessment framework. A shared decision-making approach is emphasized, balancing surgical risks, patient comfort with uncertainty, and aesthetic concerns. These recommendations aim to optimize quality of life and avoid overtreatment in older adult patients with breast implants.