Concerned about ruptured silicone breast implant

Hi Jody, sorry to hear about what you are going thru. I would say, though, that the real test for a ruptured implant is an MRI, and if it suggests rupture, it's correct about 98% of the time. Mammo/ultrasound are not sensitive nor specific enough to really diagnose. You should see your surgeon, before or after the MRI, and be evaluated. If it is ruptured, it should be removed, and if done well, can be removed completely and another placed without significant leakage or silicone left behind. Best. 

I am sorry for your turmoils, but I think this is a good question to address since most plastic surgeons have to evaluate patients after trauma such as car accidents.
I am glad you have started your evaluation with a 3D mammo and ultrasound. I think your next step should be to have an evaluation by a board certified plastic surgeon. This is important for several reasons. First of all, a physical exam may be able to detect a rupture by compression on the implant. The physical exam will also determine if you have any masses, fluid build up or stiffness (contracture) which might be present with an implant rupture. In addition to a physical exam, the plastic surgeon may suggest you obtain an MRI of the breast. The MRI is probably the best test to determine if a gel implant is ruptured.
If an implant is determined to be ruptured by MRI, most implant companies have a limited warranty that will cover you as long as you had your gel implants in the United States after 2006. The warranty consists of two parts. If the implant is determined to be ruptured by MRI or at the time of surgery, the implant company will replace both implants. If the augmentation occurred within the past 10 years, they may also give you financial assistance to pay for any revisional procedures. 
On the issue of living with silicone leakage, most plastic surgeons would advise you to remove a ruptured implant.  It is true that there is no hard evidence linking silicone ruptures to autoimmune diseases such as lupus. However, long term exposure to a ruptured implant can create some problems for the patient. The breast can form calcifications which appear as suspicious white spots on future mammograms. This can make future mammograms more difficult to interpret. In addition, long standing breast implant ruptures can lead to breast contracture or hardness of the breast implant. Contractures can progress over time from mild stiffness, to severe stiffness, to upward displacement of the implant and constant pain. It's much easier to deal with a contracture at an earlier stage.
I think this is an important question and I hope the answer has been helpful. Again, I advise you to seek the guidance of an experienced Board Certified Plastic Surgeon. Good luck and I wish you the best!