Implant Survival and Autologous Breast Augmentation in Rupture Management

Abstract Background Silicone breast implants remain a mainstay of aesthetic surgery; however, long-term rupture remains a significant complication. MRI offers superior sensitivity for detecting silent ruptures. In patients declining re-implantation, autologous breast augmentation using a pedicled transverse rectus abdominis myocutaneous (TRAM) flap combined with fat grafting presents a natural, durable alternative. Objectives The purpose of this study to evaluate long-term implant survival and the outcomes of hybrid autologous augmentation using pedicled TRAM flap and fat grafting following explantation for rupture. Methods A retrospective review was conducted on 150 female patients with 179 ruptured implants (June 2022–September 2024). Implant rupture was confirmed via 3T MRI. Implant longevity was analyzed using Kaplan–Meier survival. A subgroup of 41 patients underwent autologous reconstruction using a modified pedicled TRAM flap plus fat grafting. Intraoperative flap volume was calculated using a geometric model for truncated pyramids. Fat retention was quantified via MRI at 6–12 months. Patient-reported satisfaction was assessed using the BREAST-Q Postoperative Augmentation Module. Results MRI demonstrated linguine (25.1%), teardrop (15.6%), and combined rupture signs. Kaplan–Meier analysis showed a 20-year implant survival rate of 83%. In the autologous group (n=41), the average intraoperative volume was 328.5 cc, with 83.0% fat retention on follow-up MRI. The mean BREAST-Q satisfaction score was 62.7, positively correlating with volume retention (r = 0.317, p = 0.043). Conclusions Hybrid autologous breast augmentation using a TRAM flap and fat grafting is a reliable and aesthetically satisfying alternative to re-implantation. MRI facilitates accurate rupture diagnosis and postoperative volumetric monitoring. This technique also yields abdominal contouring benefits and reduced long-term costs, making it an attractive option for selected patients.