How Do You Know when There is a Rupture with Silicone Implants?

The most reliable test (100% accurate) to check if a silicone breast implant is leaking is surgery, but this is not practical unless we are planning to operate anyway. Physical examination is only about 30% effective in detecting silicone breast implant leaks. So while it is simple, painless and cheap, it is not particularly effective.

Magnetic Resonance Imaging (MRI) is the most reliable "non-invasive" test to see if silicone breast implants are leaking. MRI is reportedly 90% accurate, painless and expensive. The research was done in women who had symptoms. There is evidence that MRI will not be as accurate in women with no symptoms. Regardless, the FDA has recommended women with silicone breast implants have an MRI at three years after breast augmentation surgery, and then every two years after that to check for silent leaks.

Mammography and ultrasound are not reliable means of evaluating silicone breast implant integrity, as they give too many false positives (detecting a leak when there isn't one) and false negatives (missing leaks). 

It should be said, an advantage of saline breast implants is that if there is a leak, the implant deflates, and no special test is needed to tell. For saline implants, physical examination is 100% accurate. No MRI is necessary.

More information is available is available at the link below, including warrantee information from Allergan and Mentor.

When a silicone implant leaks, the silicone generally stays around the implant. That means that the breast may not change in size, shape, or the way it feels. There is a lot of evidence suggesting that silicone on the outside of the implant didn’t usually cause problems, but the only way to know for sure is to obtain an MRI of the breasts, or to do surgery and replace them. 

It can be difficult to tell just by self-examination whether there is a leak in a silicone implant.So, the best method to tell is to get regular imaging of the breast, with an MRI or high-resolution ultrasound.  MRI is slightly more accurate, but more expensive.  That is an extra bit of "homework" that you should do, if you choose a silicone implant.