How Will I Know if My Breast Implant Has Ruptured?

Question

I was out running and fell on my breasts. How will I know if they are ruptured. I have silicone implants which were done 13 years ago.

Kendall Roehl, MD, FACS · Answer

Hope you are doing well after your incident. It is highly unlikely that your breast implants will burst after a fall. However, if you notice bumps in your breasts, deflation, chest pain and/or swelling, or if your breasts suddenly become hard, it is very likely that your implants have ruptured and I advise you to see your surgeon immediately.

Larry S. Nichter, MD, MS, FACS · Answer

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. A silicone implant that has a rupture 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.

Ronald Schuster, MD · Answer

Good question. Silicone implants do not deflate like saline implants. So most women do not know the exact time when their gel implants have "broken, ruptured, leaked". Implants are very strong so I doubt that you broke them with your fall, but it is normal to be concerned. I would suggest taking some NSAIDs for about a week or two to let your body heal and then see how you feel. If you notice any change in your breasts in the way they feel or look, you should see your surgeon for an exam. If there is any further concern an MRI can be obtained. You are not in any imminent health risk having an undetected broken implant. Good luck.

Kenneth Hughes, MD · Answer

If there is no real shape change or pain or problem with the implants, there may be no need to change them. If you want to know about rupture, an MRI is the most sensitive and specific. Another thing to consider is replacement of the silicone implants after 10 years.

Brian K. Reedy, MD · Answer

Cheap and easy is a combination of Mammogram and ultrasound. However, the most accurate is an MRI. Unfortunately, most insurances dont cover the cost which can run $900-1200. Given that your implants are 13 years old, there is a very good chance that they are already ruptured just from age. I recommend to my patients that they consider replacement at 10 years. Hope this helps. Good Luck!

Edwin C. Pound, III, MD · Answer

Implants are pretty durable and will take the wear and tear that a breast might normally endure. Still, they are not stainless steel and, at some point, one or both might break. With a saline implant it is easy to tell if one breaks because you have a "flat tire" within a couple of days. It is harder to tell with the new cohesive silicone gel implants. These tend to hold their shape so ruptures may not show up easily on a routine mammogram. Even MRI's (which the FDA suggested that patients have at one to two year intervals) may not show a rupture 100% of the time. In my mind, if you are not having any problems with your breasts as a result of this fall then you are probably okay. Still, if you are concerned then you might schedule an appointment with your plastic surgeon so he can evaluate them clinically and see if further tests might be required.

James Motlagh, MD · Answer

How can you know if your breast implant ruptured? Answer: with silicone you may not know for some time. Unless the implant becomes hard or deformed there is no way to know if it is ruptured.  A mammogram or ultrasound may not show a silicone rupture. Only MRI may be able to detect it. When it leaks the body may surround the silicone with scar tissue to contain it and therefore lead to deformity.

	 

	A saline implant on the other hand, when ruptured will become smaller over a period of hours to days depending on the size of the hole. It will rarely become deformed since the body doesn't see saline (salt water) as foreign.

Jourdan Gottlieb, MD · Answer

It would be unusual to break the implant with a fall.

	It is easy to diagnose rupture saline implants, because they deflate and the size change is obvious. However, physical exam in an unreliable way to detect ruptured silicone implants. When the studies done in the 1990ies after the silicone scare were reviewed, one finding was that surgeons could identify leaks in only about one-third of patients whose leaks were documented by MRI, which is the gold standard. Often a leak can be identified by a simple mammogram, sometimes combined with an ultrasound when indicated.

	So if you really need to know, get an MRI.  In my community, these run about $2000, and it is rare that an insurer will cover that. 

	The issue is, what to do if there is a small leak. With the current generation of gel, the material is thick and viscous, and unlikely to move even if the shell is interrupted. Outside the shell is another barrier, the capsule that your body has formed around the implant. Many surgeons would not recommend surgery to replace a micro-leak implant. 

	Best practice is to be seen by your surgeon and follow advice that is based on an actual exam and question and answer interaction. All the best.

Tom J. Pousti, MD · Answer

Sorry to hear about the trauma you have sustained.

	 With silicone gel breast implants, unlike saline breast implants, you may not know that there has been a rupture ( this is called a “clinically silent rupture”). If you wish to rule out rupture of a silicone gel breast implant, an MRI study will be necessary.  If you  are otherwise pleased with the shape, size, feel of your breasts,  I would not suggest removal/replacement surgery unless there is a specific indication.

	 Best wishes.

John Whitt, MD (retired) · Answer

First of all I think that very few implant ruptures are related to trauma. There is no "sure-fire" way of determing a ruptured silicone implant. MRI, although not 100% accurate, is the most accurate test, but it is also the most expensive. Sometimes the diagnosis can be made with mammogram or ultrasound.

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