At my consultation, I felt both saline and silicone and as soon as I touched the silicone, I was sold on getting HP silicone implants. From watching videos (saline vs. silicone), silicone implants seem pretty indestructible. But my only reservation of silicone is not being able to detect a leak as easy as saline ones. I tried to do a search for "silicone ruptures" and there is a lot of information on saline ruptures but not silicone. How does one really know when it leaks/ruptures?
How Do You Know when There is a Rupture with Silicone Implants?
Doctor Answers 16
Silicone Breast Implants all Rupture Eventually...100% of all breast implants eventually rupture.
All breast implants eventually rupture. Yes 100 % . Salines are just baloons with salt water and they wear out eventually. Some early, some late. All silicone gel implants rupture eventually....months to many years etc. When salines break you go flat. Whe gels rupture you may notice nothing and you do not go flat. I have had patients come in saying somehting felt different with their gels and ultrasonund studies have shown disruption. I havd had patients experience an onset of firness as the first sign the gels had ruptured. Some patients complained of pain as the first symptom of gel rupture. Some were not aware of rupture and the broken implant was noted at the time of mammography or ultrasound studies. There is something about the loose gel that seems to irritate the tissues of some and cause capsule formation, firmness, pain, and aggrivation. When we go in to remove a broken gel implant it is not unusual to see a collection of dark bloody fluid about it. In others the loose gel seems tolerated. The loose gel is not dangerous but certainly can cause collagen deposition, capsule contracture, inflammation , and pain. And remember, silicone gel implants always have had and still do have a higher rate of capsule contracture when compared to saline. Nothing is perfect. In 2011 both gels and salines are pretty good but not perfect. Although I frequently use gels I find more amnd more patients are requesting salines maximally inflated. Both feel great and I often cannot tell the difference. Saline implants cost exactly 1/3 the price of the gels......! Are the gels worth 3x the cost of the salines? Some patients thnk yes and some no. A family member is considering breast implants and I am leaning toward saline. I think the tide is turning from gel to saline somewhat. Of coure on the internet its gel, gel, gel but think hard. Neither are perfect. Both produce nice results. A well done saline and a well done gel feel nearly the same. Often I cannot tell what a patient has till I review the record. Good luck and my best. Dr G Commons
Knowing when silicone implants leak
When you compare saline and silicone gel breast implants the leak rates are very similar and silicone gel implants are not indestructible as you might think. Silicone leaks are 'silent' early on and are slowly followed by change in implant texture or shape, and by a drawing sensation and tenderness in the breast. Capsule contracture develops as the gel irritates the capsule and the implant will 'round up' and become firm. Over a longer period the capsule will calcify and show up on mammogram, though an MRI is a more sensitive test and may detect a rupture much earlier. Silicone gel implants have been back on the market for four or five years and yes you do not hear much about silicone leaks. But wait five more, as the average implant life is ten years and you will hear plenty.
Best of luck,
MRI is the best test
The silicone implant rapture in many cases can be difficult to detect. It is usually asymptomatic although You need to pay attention to changes in the overall health. Symptoms can vary from patient to patient. It can be pain, tenderness, numbness, tingling and burning. Patient can experience also changes in the breast shape, size and contour. Currently FDA recommends to perform MRI screening of the implants after 3 years to detect silent rupture.
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Prevention makes this a moot point
The most accurate way to detect a silicone rupture is by MRI study. On physical exam, the breast may take on a different shape and it may be hard to detect.
MRI detects leaking silicone implants
Most silicone implant leaks are "silent". That is, there is no shape or volume change which would alert you. Silicone breast implant rupture is best detected by an MRI. Occassionally, someone will have a new onset capsular contracture. Your insurance may or may not pay for MRI to screen for rupture. Definitely check with your insurance carrier to find out if this is covered, so you have this information. In NYC, for example, breast MRI costs about $2500, so you want to know this cost when considering your implant options. Hope this helps.
Tracy M. Pfeifer, MD, MS
Detecting a Leak in Ruptured Silicone Breast 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.
Rupture of Silicone Breast Implants
You are right, Silicone Implant rupture is hard to detect. About the only way to do so is with an MRI. With the newer cohesive gel implants, rupture will be even harder to detect. However, in my estimation, it really does not matter. The only person I would do anything about is someone with symptoms. In those, we would obtain an MRI to evaluate the problem. In my carrier, I have had many patients with ruptured implants (the old style, non-cohesive ones). The only ones I did anything about were a few with some vague symptoms who just wanted to “be sure,” or those with cosmetic shape problems. All the rest, we just followed. None ever developed any problem.
Excellent question. The usual signs we look for on exam is change of shape, change of size, or change or texture orconsistency. But this is complicated. Some leaks produce a hardening due to capsular contracture. However, a harden implant that because soft may also signal a leak. A leaking implant that is not hard is ofter more soft than an intact implant; it feels very mushy and gooey. Mammograms and ultrasound exam might show some signs but MRI is the most sensitive test. In fact the FDA recommends MRI every 2-3 years although many plastic surgeons do not feel this guideline is justified since there may not be any medical necesiity to treating silent leaks. Silent leaks are a clinical dilemma.
Robin T.W. Yuan, M.D.
Ruptur rates after Gel Breast Implant Augmentation
A patient may never know about"silent ruptures" in silicone gel implants. There may be no change in the breast. We know that every patient will develop a capsule around an implant, saline or gel. Implants from the 70s and 80s have a rupture rate of 50-60% after 12 years and should be replaced or imaged by MRI or combination mammogram and ultrasound. Yearly examinations by your plastic surgeon are recommended to detect silent ruptures. Rupture rates with the new gel implants are lower than before because the outside shell of the implant is thicker and the gel inside is more cohesive or thick. Physical signs of a rupture are a lump representing a silicone granuloma or capsular contraction of new onset. Radio-graphic evidence of rupture are the linguine sigh on a MRI. The manufacturers of implants tell us there is a 1% to 2% rupture rate of new gel implants per year.
Leo Lapuerta MD
Triple Board Certified Plastic Surgeon