Breast implant rupture occurs when the outer shell of a breast implant breaks, leading to leakage of the filling material. While this sounds emergent, if often is not. However, the management for an implant rupture differs depending on whether the implant is filled with saline or silicone gel.
Saline Implant Rupture:
When a saline implant ruptures, the saline solution (which is simply sterile saltwater) leaks out quickly, leading to a noticeable decrease in breast size or shape. Most often, the sudden deflation of a breast is the most obvious sign. The body simply absorbs the saline, and it is harmlessly expelled through the kidneys when you urinate. No long-term physiological effects have been associated with saline leakage.
10-Year Rupture Rate: The rupture rate for saline implants is typically slightly lower than that of silicone implants, ranging from 5-10% over a 10-year period.
20-Year Rupture Rate: Like silicone implants, the risk of rupture increases with time, and over a 20-year period, the rupture rate may approach 20%.
Silicone Implant Rupture:
Silicone gel is thicker and may stay within the surrounding scar tissue (capsule) that forms around the implant, leading to a "silent rupture" where the rupture might not be immediately noticeable. Many women don’t experience any symptoms, but with time, a few effects may begin to show.
Over time, the silicone gel can migrate out of the capsule and into surrounding tissues, potentially causing pain, inflammation, or changes in breast shape (breast will appear to sit higher and shift laterally).
As a result of the free silicone, silicone granulomas (lumps around the silicone as an immune response) or capsular contracture (scar tissue around the implant tightens, causing the breast to feel firm or even painful), can cause discomfort or changes in breast texture.
10-Year Rupture Rate: The rupture rate for silicone breast implants is generally reported to be around 10-15% over a 10-year period.
20-Year Rupture Rate: Over a 20-year period, the rupture rate is be higher, potentially reaching up to 20-30%.
Screening Recommendations:
All breast implants are considered long-term temporary devices, with a finite lifespan. Even without rupture, implants may need to be replaced every 10-15 years due to the risk of rupture increasing over time.
Regular monitoring through physical exams (saline and silicone) and imaging (silicone only) is recommended for women with implants to aid in early detection of possible complications.
Even if you have no symptoms, the FDA recommends MRI screening at 5-6 years after your initial silicone implant surgery and then every 2-3 years thereafter. If you have symptoms for breast implant rupture, an MRI is recommended.
Recently, the use of ultrasound in substitution of MRI screening has been explored, however with ultrasound there is a larger opportunity for human error in detection, as ultrasound quality is largely technician dependent. MRI remains the gold standard.
If a rupture is confirmed, the standard treatment involves surgical removal of the ruptured implant and possibly the surrounding tissue. A new implant can be placed during the same surgery if desired.