RUPTURED BREAST IMPLANT

It was a busy day in the E.R. For a change I was working the non-monitored section. That did not mean it was any less stressful. There was a high turnover rate for this area. I looked at the new charts in the unit secretary’s rack and noticed I had a new patient in bed 12. I quickly looked at the chief complaint and saw it was a 32-year-old woman who states her breast implant was leaking. I had to admit I had never had a patient come in with that particular complaint. I enjoyed new medical moments because I thought I had seen just about everything. I grabbed my charting paperwork to start my assessment on my new patient.

I walked over to bed 12 and saw a fairly attractive female lying on the stretcher with our hospital gown on. She smiled at me as I walked into the area. I introduced myself as the nurse that would be taking care of her while in the E.R. She seemed pleasant enough. She told me her name was Miriam. “It says you have a leaking breast implant on your triage paperwork,” I tell her. “Yeah. It is definitely leaking,” Miriam responded. I went to the curtains and quickly pulled them around so we could have privacy. “Let me see what you are talking about,” I said. She willingly pulled down her hospital gown. What I saw I had never seen before. Her left breast was definitely leaking. In fact, it looked like the implant had ruptured. Her breasts were asymmetrical. The fluid leaked around the left breast area up into her upper left chest up to the clavicle and towards her left armpit. I palpated the area. “Does this hurt?” I asked. “Yes a little but not too bad. It’s a little numb and tingly,” Miriam responded. “What kind of implant do you have? Silicone or saline?” I asked. “They are silicone,” she responded. “How did this happen?” I asked her. “I was in a fight last night in a bar. The bitch punched me in the chest and this was what happened. She started it. She said I was flirting with her boyfriend,” she responded. “Well, that was a cheap shot,” I said. “Yeah. But I got the best of her. Especially when I saw she damaged my implant. I really punched her after that until some guys broke it up,” Miriam said. “Was the police called?” I asked. “Yes. They came in after a while. The owner called,” she responded. “Was a report taken?” I asked. “Yes. They took it after talking to some of the people who saw the whole thing,” said Miriam. I would need to check out her story. All assaults needed to be reported to the police and they could decide if they wanted to take a report or not. I continued to palpate her left breast area. There was a fresh bruise around the fourth intercostal space in the midclavicular line. I was very impressed looking at what a damaged breast implant looked like. I knew she would have to go to surgery to get it cleaned out and repaired. About that time Dr. Stevens came around the curtains to do his assessment. He introduced himself as I charted my findings.  

Dr. Stevens returned to the nurse’s station with orders written on the chart. An order to call the surgeon on call for the E.R. was given to the unit secretary. She looked at the on-call list and began calling the surgeon. There also was an order to call the police department for the area the bar was located to confirm Miriam’s story. Miriam would need surgery to remove the ruptured implant and debridement of the tissue around the breast. There were complications from leaking silicone underneath the tissue. Miriam would need an IV and routine lab work before going to surgery. I got my IV and blood drawing equipment together and walked over to bed 12. I explained to Miriam she was going to be admitted to the hospital. “I had a feeling,” she responded. “I know I can’t go on looking like this. It is ugly,” she said.

I started an 18 gauge in her right forearm and drew blood from the site. She had good veins because she looked to be in pretty good shape. The surgeon returned Dr. Stevens call and told him he would take the case. Miriam would go to surgery later in the day when one of the O.R. rooms was open. He would call the floor when he had the time. Until then she would be admitted to the medical-surgical floor. She needed to be told she would not get a new implant when she had surgery. The area needed to be debrided and monitored otherwise she would have significant problems. She may never get another implant depending on her outcome after surgery. I could not imagine that scenario for a middle-aged single woman. The unit secretary called the police department to verify if a report was taken and it was. Miriam was telling the truth.

After getting the room number Miriam would be going I called the nurse on the floor and gave her report. She had many questions because she too had never had a patient with this type of problem. We had to have our “firsts.” I finished my paperwork to get ready to go to the floor. The E.R. technician Mark transported Miriam to the medical-surgical floor. I looked in the secretary’s rack and saw I had a new patient in room 14. I was off again to start my assessment on my new patient with abdominal pain.

For those who want to know more about leaking or ruptured breast implants here is the FDA website.