Eric A. Marchant, MD

Yes, silicone gel implant rupture is difficult to detect.  There are actually two types of rupture- one is intracapsular and the other is extracapsular.  The "capsule" is the scar tissue that naturally forms around the implant.  Thus, an intracapsular rupture is where the implant has an opening but the silicone gel "leak" is contained within the scar capsule sack.  An extracapsular rupture is where the silicone gel "leak" is found outside the scar capsule sack, as well.  Most ruptures are intracapsular.  Regardless, it is difficult to determine if a silicone gel implant shell has lost its integrity.  One may feel an irregularity or "nodule" as opposed to a completely smooth shell.  Very rarely, one may also feel a tinge of pain or tenderness at the site of a rupture.  What all women should know is that there may not be any symptoms at all and that the FDA has recommended that women with silicone gel implants undergo a MRI of the breasts every 2 to 3 years to determine the integrity of her implants.

Although it is a little easier to determine if saline breast implants have leaked or deflated, it is still possible to have a rupture of a saline breast implant and not know it.  Many times patients who experience leaks with saline-filled implants see the difference and may have a feeling of general discomfort as the implant deflates and "collapses" the scar capsule as surrounding tissue is pulled with it.

In the case of silicone gel-filled or saline-filled implants, if one suspects a rupture or deflation, the patient should feel comfortable returning to her plastic surgeon to have him/her order appropriate studies and, if needed, surgery to remove and/or replace the implant.