How to Detect a Rupture in a Breast Implant?

This is a great question! We are in the latest generation silicone devices with the shells getting stronger and the gel much thicker or "cohesive". I am an Allergan guy but you may be surprised that the round gel implants filler inside is essentially the same gel, memory or not. It is like a thick jello material so even if the shell does fail, most of the gel stays inside the implant itself. If some knucles out it nearly 100% stays inside the implant capsule or internal "zip-lock" bag your body forms around your implant (called an intra-capsular rupture). The latest generation form stable implants like the Natrelle 410 or CPG that are currently available in the US in clinical trials only...hopefully approved soon...contain even thicker more cohesive gel with even lower shell failure rates less than 1% at 8 years.
The FDA when approving gel implants back on the US market about 3 years ago have recommended MRIs at 3-5-7 years looking for shell abnormalities. We are just beginning a very exciting IRB study with GE looking at gel implants with high resolution ultrasound looking at shell abnormalities and comparing them with MRI. Early results are exciting...so hopefully in the future we will have an easy inexpensive test to follow and screen your implants over time.
Nearly All implants will need to be replaced at some point so you should be prepared for that but it is very straightforward to replace a current generation implant because the gel is so much more thick and your pocket is already stable.
Even with this potential of "silent rupture", the research shows that every disease a woman can get including autoimmune disease and breast cancer is the same in women with a silicone gel implant or a woman with no implant.
All my Best!

Implants can fail over time. Gel implant failures occur less than 1% a year. Rounding it off in 10 years there is a less than 10% chance of failure; in 25 years about 25%, etc. There is usually no signs or symptoms of failure. Implant failure is best diagnosed with an MRI and soon a type of ultrasound may be available to accomplish this. You should consider getting an MRi sometime after breast augmentation with gel implants, perhaps 10 years or so. This is a good way to check on the status of the devices.

It's a great question. The answer really depends on what type of implants you have. If saline implants leak, they simply deflate, your body absorbs the saline fluid, and there are no issues. It's important to know that the latest generation of silicone implants are made of a solid silicone gel, so they don't leak out if the shell were to break. This is an important safety feature. Older liquid silicone can cause irritation of the tissues when it leaks out around the implant. If you suspect a rupture, it's important to contact a board-certified plastic surgeon so that you can be seen in person. They will examine you and may order imaging (typically an MRI).

Thank you for your question.  Detection of an implant rupture or shell tear depends upon what type of implant a patient has.  With saline breast implants, patients will know if they suffered a implant rupture or leak almost immediately as they will see a natural deflation in the size of the affected breast.  Saline implants contain saline fluid which your body can easily absorb, however, I do not recommend leaving a ruptured or leaking implant in for any prolonged period of time.  With silicone gel implants, on the other hand, patients are not generally able to tell if there is an issue or any compromise to their implants.  Most silicone implant issues are silent, meaning that there are no noticeable signs or symptoms of any issue, and require an MRI for detection.  I inform all of my patients that 3 years after their breast augmentation procedure that they will be sent for a MRI to check the integrity of their silicone gel implants.  I do recommend that patients with implants of any kind (either saline or silicone) perform monthly breast exams.  Furthermore, any issues, concerns or differences that a patient may notice should always be addressed at a follow up appointment for evaluation.  I hope you find this helpful! 

For Saline implants - its simple - just look in a mirror and see if you are flat on one side. For silicone implants prior to 2006, ruptures occur at rates of approximately 1-2% per year for the first ten years then markedly increases after that time period. A rupture or deflation of the implant may be experienced at any point after the initial augmentation; this complication may be increased by an under-filling or overfilling of saline solution into the implant, excessive compression, trauma, and other causes. (If the implant shell if not filled with the correct amount of saline, there may be a crease or fold in the shell which often leads to a rupture). You will be able to self-diagnose the need for an implant exchange (if using a saline implant) because if the current implant ruptures, the breast will shrink to approximately its preoperative size. To detect a silicone implant rupture, it is usually noted on a routine mammogram or MRI scan. In either case although the situation needs to be corrected on a timely basis, it is not dangerous to your health from our current knowledge base. Silicone implants after 2006 are more cohesive and less likely to leak.

In the majority of patients
undergoing breast augmentation, implants last a lifetime.Occasionally, implants deflate and need to be
replaced.Current data suggests that
implants deflate at a rate of 1% at one year and 3% at three years.Over time, this number can be expected to
grow.Implants may deflate with no
apparent cause or may deflate secondary to trauma.When saline implants deflate, the
diagnosis is relatively easy to make.These implants lose volume and flatten quickly.Silicone implants present a much more
difficult problem when they deflate.Rupture of silicone implants may not be apparent for years.Signs of deflation include soreness, redness,
loss of volume, change in shape and sometimes, capsular contracture.These signs may be subtle and a history of
trauma may be the only early indicator.Because of the difficulty of making
this diagnosis with physical examination, ultrasound and MRI studies may
occasionally be necessary.Even with
these aids, the diagnosis can be uncertain and, in some cases, surgery may be
necessary to resolve this issue.Consultation with a plastic surgeon will be necessary to resolve this
issue, in most cases.

Saline implant ruptures can be detected relatively quickly as the saline generally flows quickly out of the shell. You'll probably notice deflation within a day or so. Cohesive silicone gel implants take longer to notice if they have ruptured as they stay relatively intact for a longer period of time. You may feel firmness or notice the affected breast look misshapen. For better confirmation of rupture you will need to get an MRI performed. 

Saline implants collapse as the salt water escapes the capsule the body places around the implant.  The breast goes flat.  Not a health issue but requires replacement.

Silicone not so easy.  The gel is contained by the capsule and the volume of the breast does not change.  MRI scan is the best test but it is 10% inaccurate.  That's a lot when you consider an operation hangs in the balance.  Failure to detect silicone leakage is not a big problem however.  The silicone is not going anywhere and will not cause health problems. 

Given enough time, all implants can get a break in the outer shell. Saline implants deflate when the shell integrity breaks down, so it's obvious that the shell is broken. Silicone implants do not deflate, so an MRI exam is required to evaluate the shell.

There is a wide range of time for the shell to break down. I have seen it in a year or less, but commonly it takes about 10 years. Having said that, I have also seen people with implants for 20 or 30 years without a problem. You should discuss this with your surgeon at the time of your consultation.

Many women, especially with older generations of silicone implants may have had 'silent ruptures'. Some data suggest that with older generations of silicone implants that there were 50% silent ruptures after 10 years based on MRI studies. With current Mentor Memory Gel implants, there is a 1.1% rupure rate after 6 years for first time breast augmentation patients based on their 6-year 'core' data, and a 3.8% rupture rate for first time reconstructive patients. The best way to detect a rupture would be with an MRI as this can detect 99% of ruptures.
The FDA has recommended women with silicone implants consider having an MRI every 3 and then 2 years following augmentation. This may be a bit extreme. Check with your plastic surgeon to find out their recommendations. Mammograms can also detect approximately 85% of ruptures and ultrasound can detect approximately 90-95% of ruptures depending on the type of ultrasound used.