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How to Detect a Rupture in a Breast Implant?

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Saline vs silicone

Implant integrity cannot be guaranteed for your lifetime. If you have a saline implant a "deflation" will usually become obvious as the implant volume shrinks over a period of time. This can be fast and dramatic or occasionally may take place slowly over a longer period of time. If you have gel implants, a "rupture" will not cause the breast to shrink because the gel stays together. The breast doesn't feel any different either. An MRI is the only reliable way to detect modern gel implant rupture.

Implant Rupture: Gel and Saline


With saline implants you will know within hours that your implants are leaking. The saline fluid is similar to intravenous fluid and should be absorbed harmlessly by your body.

With gel implants you will generally not be able to tell if and when your implant leaks or ruptures, unless you develop adverse reactions to the material. The most common reaction is scar lumpiness called silicone granuloma. This may show up on ordinary mammograms. As noted by other surgeons, magnetic resonance imaging (MRI) is fairly reliable at detecting ruptures and recommended by the FDA on a routine basis for gel implant patients.

Sutton Graham II, MD
Greenville Plastic Surgeon
4.5 out of 5 stars 4 reviews

Most Silicone Gel Breast Implant ruptures are "silent", MRI recommended periodically in all patients

The majority of silicone gel breast implant ruptures are "silent", i.e., the patient, nor the surgeon or examining physician can definitively make the diagnosis of silicone gel breast implant rupture. For approximately 15 years, the FDA placed a moratorium on silicone gel breast implants, because of concerns about occult implant rupture, interactions of silicone gel with tissues surrounding the implant, effects of silicone gel outside the area of the breast, possible immune reactions to silicone within or outside the implant, and other common sequelae such as scar tissue formation (medically termed, capsular contracture) and its effect on the breast shape and constrictive pain syndromes.

The FDA released the moratorium in November of 2007, after a research committee of renowned specialists from all the involved specialized medical fields found that they were safe for implantation with several stipulations. The FDA recommended that plastic surgeons inform their patients that it is very difficult to detect silicone breast implant rupture, since the silicone gel stays in the “pocket” (space that surrounds the breast implant) and the breast does not appear “deflated”. It is difficult for both the patient and the surgeon to detect silicone gel breast implant rupture.

MRI (magnetic resonance imaging) is the best technique to detect silicone gel breast implant rupture, as this test can look for small amounts of silicone that are outside the shell of the implant suggesting rupture that is difficult to detect. The FDA recommends that all patients be informed by their plastic surgeons that they should obtain an MRI 3 years after the breast augmentation, and then every 2 years thereafter, to detect silent rupture at an early stage, so the implants can be removed and replaced before any long term sequelae of silicone breast implant rupture occurs.

I am certain that during all of my consultations that my patients are informed of “silent” rupture of silicone gel breast implants and the need for them to be committed to having MRI’s taken to detect any potential rupture at an early stage. Patients should continue to be vigilant about doing monthly breast exams and if there is any abnormality that they detect, the patients know that they should call my office for an evaluation. Silicone gel breast implant ruptures can sometimes present as a lump, change in shape of the implant and other physical changes in the breast, but this is less common than “silent” rupture.

I also inform my patients that they will still need to have mammograms yearly at age 40 and every year thereafter to detect breast cancer and that the mammogram is the test for breast cancer and the MRI is for breast implant rupture and one does not replace the other. Each patient is advised to return to my office at the advised intervals to have the MRI scheduled at the appropriate time. My patients feel very well informed about their option of seeking a breast augmentation with silicone gel breast implants, as I feel it is important for my patients to make intelligent, non-emotional decisions when deciding the type of implant they desire.

Christine A. Petti, MD
Los Angeles Plastic Surgeon
4.0 out of 5 stars 15 reviews

MRI scan is best way to detect "silent implant rupture"

First of all, the previous concern about health risks associated with silicone ruptures have been disproven since 1998. So let's get to your question. Silent ruptures occur at a certain percentage per year, just like life expectancy of anything. The longer you have implants , the higher the likelyhood of them being ruptured. Usually this occurs at a rate of about 1/2 of 1 % per year per implant. The best way to detect a rupture is by MRI scan. This is a good idea about 6-10 years after implants are placed, or at any time you are worried about it. The MRI scans will play bigger part or early breast cancer detection in the future.

Manuel M. Pena, MD
Naples Plastic Surgeon
4.0 out of 5 stars 4 reviews

Rupture vs. significance of rupture

Most of the concerns with rupture or leakage in silicone gel implants have to do with the physical, not chemical, risks. Rupture rates are difficult to come by which is why there are ongoing clinical studies and a registry for these implants to keep track of complications. Rupture is related to length of time of implantation: the longer you have implants, the higher the risk of rupture.

Rupture does not mean they explode, but just that the shell loses its integrity and allows gel to leak. Some studies show that a majority of the implants leak after 10-15 years. All leaks start out as intra-capsular leaks contained within the capsule of the implant.

However, 15-18% of the leaks become extra-capsular and these are the leaks that cause problems because they allow the gel to migrate away from the capsule. The idea of the cohesive nature of the gel is that the more cohesive it is, the less any leaking gel will be able to migrate. If you have no signs of symptoms of leaks, then you have a silent leak. The breast looks and feels normal. That is the dilemma for patients and surgeons: what to do with silent leaks.

Some doctors, and most lawyers, say you need to have the implants removed and replaced. Some doctors feel you can leave a silent rupture untreated as long as you keep vigilent of changes to size, change, or consistency of the breast. The problem is many patient will have no health issues related to silent ruptures so if you force all women with silent ruptures to undergo secondary surgery at great cost, you are probably over-treating a great number of them. However, it is difficult to tell a woman not to do anything if the implant in her has "failed".

The most accurate method of detection is surgery, but MRI scans are the most sensitive non-invasive test and is why the FDA recommends scans every 2-3 years. Mammograms can be helpful but have higher false negative and false positive rates.

When you undergo breast augmentation you should be aware of all the significant risks and accept the fact that it is a potentially highly beneficial but imperfect procedure. Breast implants require ongoing 'maintenance' and follow-up, and invariably, ongoing future expense.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 10 reviews

Saline is apparent, silicone rupture may require MRI/ultrasound.

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.

Breast implant ruptures

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. 

How to detect a leaking gel implant

You did not mention why you believe that your implant is leaking.  With the new form of breast implants produced after 2009 there is little chance of the implant gel material migrating since the gel is more cohesive than it was prior to this time.  Therefore it may be difficult to tell if it is ruptured since the implant tends to keep its original shape. The problem is non an emergency.  You would need some type of diagnostic study to determine if it was actually ruptured such as a  mammogram, MRI or ultrasound.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 13 reviews

Detecting implant rupture

Detecting a leak or rupture depends on whether you have saline or silicone gel implants. If you currently have saline implants, a rupture or leak would be very obvious due to a deflation in the implant causing the breasts to shrink in size or look smaller. Unfortunately, with silicone gel implants because they are now a cohesive gel, it would be difficult to detect a leakage or rupture. An MRI or ultrasound is recommended every 4-5 years to rule out any possible silent leak. Since the gel is cohesive, it does not cause any obvious deformity or side effects. The gel stays within the chest cavity and only an MRI may confirm any rupture.

Failure of a saline implant is easy. Failure of a gel implant is hard.

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. 

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 20 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.