How would a person know if they had silicone implants and there was a leak and and what would be the danger if there was a leak?

Question

What is the danger of having an encapsulation or a leak of silicone implants?

Mert Demirel, MD · Answer

A silicone implant leak is often “silent,” meaning many patients do not feel anything obvious at first. Unlike saline implants, silicone implants usually do not suddenly deflate.
Possible signs can include a change in breast shape, new firmness, pain, swelling, asymmetry, lumps, or worsening capsular contracture. But many leaks are found only on imaging, such as ultrasound or MRI.
Encapsulation, or capsular contracture, is different from a leak. A capsule naturally forms around every implant. It becomes a problem when the capsule tightens and makes the breast feel hard, painful, distorted, or higher than normal.
A silicone leak is usually not an emergency, but it should be evaluated. Silicone can remain inside the capsule, or in some cases spread outside the capsule and cause inflammation, lumps called silicone granulomas, discomfort, or lymph node enlargement.
My advice would be to see a board-certified plastic surgeon if you suspect rupture or have firmness, pain, swelling, or shape change. Imaging can confirm the diagnosis, and if rupture or significant contracture is present, implant removal or exchange with appropriate capsule treatment is usually recommended.

Serdar Bora Bayraktaroglu, MD · Answer

Silicone leaks are often "silent ruptures," meaning they cause no noticeable symptoms and require an MRI or ultrasound to detect. When symptoms do appear, they include subtle shape changes, persistent pain, increased firmness, or new lumps. The primary dangers of a leak and capsular contracture include chronic inflammation, severe hardening of the surrounding scar tissue, and silicone gel migrating into nearby breast tissue or lymph nodes to form painful nodules. While systemic health risks remain low, local complications cause significant discomfort and require surgical removal or replacement of the compromised implants.

Donovan Rosas, MD · Answer

Manufacturers recommend regular surveillance imaging to diagnose silicone ruptures. Most are silent. There are rarely external signs of rupture. They will look and feel the same. Patients will demonstrate no clinical sign of rupture.

Recommendations are for MRI at 3-5 years post augmentation and then serially at 2-3 year intervals moving forward.

As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Daniel Barrett, MD · Answer

Dear Practical642190,

silicone implants rupture can be detected using MRI or in some cases ultrasound. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Waylon Zeng, MD · Answer

Hi there thank you for your question. Silicone implant rupture is typically very difficult to detect when only examining/feeling the breast. Usually, if there is a concern for rupture, an ultrasound or MRI would be the best way to diagnose a leak or rupture. When an implant is placed in the body, your body will naturally form a layer of scar tissue, called a capsule. When older types of implants rupture, they will leak within the capsule. Newer generation implants (gummy bear implants) will typically crack but will not ooze out. 
Regardless of the type of implant or when the implants may have ruptured, silicone that was safely inserted by a board eligible or board certified plastic surgeon would typically be done sterilely using known implant companies. This type of silicone is safe for the body and would not cause issues as long as it remains in the capsule. Injected silicone polymer is something I've seen done in certain parts of the world; these are NOT sterile or safe for the body. Hope that helps!

Yasemin Aydinli, MD · Answer

Thank you for this important question. Modern silicone implants are filled with a cohesive ("gummy bear") gel, so when the shell tears the gel tends to stay in place rather than spreading. This is why most silicone ruptures are "silent" &mdash; they often cause no symptoms at all, and many women have no idea anything has changed. When there are signs, they can include a change in breast shape or size, new firmness, lumps, a different feel to the breast, and sometimes discomfort. The encapsulation you mention &mdash; capsular contracture &mdash; is the scar tissue your body forms around any implant; when it tightens it can make the breast feel hard, look distorted, or become tender.
Because silent ruptures are common, the FDA recommends periodic imaging &mdash; an MRI or high-resolution ultrasound &mdash; to check the integrity of silicone implants over time. An examination alone cannot reliably confirm or rule out a rupture. As for danger: a contained silicone rupture is generally not a medical emergency and does not cause the systemic illness people often fear, but a ruptured implant should be removed or exchanged, and a tight capsule may need to be released or removed at the same time.
My advice is to have an examination together with an ultrasound or MRI so we can see exactly what is happening, and then decide whether implant exchange, removal, or capsule treatment is right for you. I would be happy to see you in consultation to evaluate this properly.

John LoMonaco, MD, FACS · Answer

The best way to determine if your silcone implant is leaking is an MRI, and in some cases a high-resolution ultrasound can be used by an experienced operator.

If your implants have been in over 8 to 10 years, or of they are older models, or if you have changes in size/shape then I would be suspicious for rupture or leak.

Leaking silicone, especially from older devices, can migrate or move through the tissues and is hard to remove.  Always best to be on the safe side and have things checked out by a board-certified plastic surgeon.

Camille Cash, MD · Answer

With silicone implants sometimes the rupture is not very obvious.   Patients may find them through routine exams such as mammograms or ultrasounds.  If a rupture occurs it is recommended that the patient have the implant removed as soon as she is reasonably able to do so.

Daniel Kolder, MD · Answer

Unlike saline implants, which deflate visibly when they rupture, modern silicone implants are filled with a cohesive gel that tends to stay in place even when the shell tears. That’s why they’re called “silent ruptures” – many women have no idea anything has changed. When symptoms do occur, they can include a shift in breast shape or size, new firmness or hardness, a lump, or a vague sense that something feels different.

Because you can’t reliably detect a silicone rupture from the outside, the FDA recommends periodic imaging, either via MRI or high-resolution ultrasound.

A contained rupture where the gel stays within the capsule is not a medical emergency and is not associated with the systemic illness that many patients fear. However, in older implants, particularly those from before the cohesive gel era, loose silicone can potentially migrate into surrounding tissue, which is harder to address. That’s why staying current with monitoring is so important.

If a rupture is confirmed, removal or exchange should be planned. If you have concerns about your implants, talk to a board-certified plastic surgeon about your options.

Joseph A. Kelling, MD · Answer

Hi, thanks for this great question. 
To start, the FDA recommendations for silicone implant monitoring are to perform a MRI or a high frequency ultrasound of the breast implants starting five years after the implants have been placed and then every 3 years after this. For my patients over the age of 40, I typically tell them to replace their regular screening mammogram with a breast MRI or ultrasound every 5 years so that the breast implants can also be investigated. Also, many plastic surgeons, myself included, have ultrasounds in our offices to look at the implants of our own patients or prospective patients so it may be worth it to start with the surgeon that has placed your breast implants. 
The second part of this question is related to the dangers of silicone implant rupture. All implants will form a layer of scar tissue, also known as a capsule, around the implant. Because the current silicone that is used in breast implants is a semi-solid, the silicone will typically stay within the shell or within the capsule formed. If this happens, the most common thing that I have seen is that the rupture stimulates an inflammatory response that can lead to a capsular contracture of that breast implant. If the silicone extends beyond the capsule, then you can get silicone migration into surrounding tissues (breast and lymph nodes primarily) or the silicone can form silicone granulomas. These granulomas will feel like firm nodules and could also potentially interfere with your breast cancer screening and look like a breast cancer on the imaging study. 
If you do have a ruptured breast implant, it is recommended that the implant is removed due to the previously stated risks. Although, this is not an emergent issue and can be managed electively.

How would a person know if they had silicone implants and there was a leak and and what would be the danger if there was a leak?

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