Silicone breast implant rupture

I suspect I have a leak in my silicone breast implant, what now?

Breast implants can fail, either saline or silicone.  If a saline breast implant fails, this results in deflation of the implant which is quite easy to diagnose most of the time.  Rupture of a silicone breast implant can be a more significant diagnostic dilemma.  There are often no external signs with an early rupture.  This is the so called “silent rupture”.  With time, this could eventually lead to capsular contracture, deformity of the breast and/or silicone migration into the breast tissue. 

The rate of silicone breast implant failure is a little less than 1% per year.  Recent studies of Mentor Memory Gel silicone implants demonstrated a failure rate of 1.1% at 6 years.  This is lower than the failure rate of saline implants which could be due to a number of factors including missed “silent ruptures”, intrinsic resistance to failure of silicone implants, or fewer “fold-flaw” ruptures. 

Signs of a possible silicone breast implant failure include:

• Change in implant or breast shape
• Hardening of the implant
• Deformity around the implant (see your doctor if there are concerning “lumps”)
• Older implants (>20 years)

The most accurate method of diagnosis of a ruptured implant is MRI.  The FDA has recommended MRI studies at 3 years after augmentation and at regular intervals thereafter to diagnose “silent ruptures”.  This is controversial as an MRI is quite expensive and would only benefit the less than 1% of patients who have a rupture at 3 years.

Silicone implant rupture generally requires removal and replacement to avoid more significant problems in the future.  The research would suggest that silicone implant rupture is not causing patients to be “sick”, however local breast problems can certainly occur. 

As opposed to saline implant deflation, silicone implant rupture can be difficult to deal with surgically.  When a saline implant deflates, the saline is absorbed by the body.  The silicone is not absorbed and can be difficult to remove completely surgically.  Oftentimes, the capsule around a ruptured silicone implant becomes hard (capsular contracture) requiring removal of the capsule in addition to the implant.

The good news is that the newer generation of silicone implants are more resistant to failure and more cohesive (less liquid) decreasing the rates of some of these problems.