How does damage from surgical instrumentation during implantation occurs?

While there is a planned sequence to any plastic surgeon's breast augmentation, there is always a theoretical risk of implant injury as it is being placed into its breast pocket.
The most likely culprits of implant damage during surgery would be sharp or metallic instruments, such as scissors, skin retraction hooks (which have sharp ends), tissue forceps, and even smooth retractors (such as ribbon retractors, or Army Navy retractors), which is pushed up against an implant with enough force, can induce enough pressure to weaken the integrity of the implant shell, leading to a rupture.
A silicone rupture is not nearly as concerning as it was with older generation implants, as the silicone is much more form stable and cohesive (the way the molecules of silicone bind or cross link to one another). If a rupture were to happen, chances are that a patient would not have symptoms and that the gel would nonetheless stay contained within the implant shell, as implants nowadays are 5th generation with 'gummy' characteristics.
A saline rupture would be evident immediately or over the course of a few days, as saline would leak out the implant, and the appearance of the ruptured side would look as if no implant were placed (i.e., look deflated), while the other side would remain augmented. A bilateral rupture would be highly unlikely from accidental instrumentation during surgery, but it could in theory happen if bad technique were applied equally to both sides.