Breast implants are more resilient than ever, and though they may last some women a lifetime, this certainly isn't the case for every woman. The truth is that breast implants are not indestructible. At times they fail and become prone to ruptures. Here's information on ruptures and what to do about them.
Silicone Breast Implant Ruptures
Silicone implants have had major improvements since their introduction in the 1960s. First generation silicone implants had a thick silicone rubber shell. While durable, the shell was too firm and many women were unhappy with the way the implants felt. In the 1970s and 1980s, breast implant shells became thinner and softer. Even though they were much softer, this change made the implant shells more prone to rupture. The silicone gel was not very cohesive at that time and when a rupture occurred, the silicone would migrate out of its shell and into other parts of the body.
Today, silicone breast implants are made of a strong, durable silicone shell with cohesive silicone gel inside—some are more cohesive than others. When the shell is broken, the gel will not ooze out of the shell like it would with the older silicone implants; the implant will still maintain its shape even after a rupture has occurred. Many surgeons have a sample implant that has been cut into two parts in their office to show their patients how cohesive the new silicone gel is to ease any fears associated with stories of implants of yesteryear.
Even with the improvements made to increase the durability of implant shells and the cohesiveness of the silicone gel over the years, a rupture still can happen. Since breast implants are not lifetime devices, the older they are, the risk of having an implant rupture increases about 1 percent each year. After 10 years, the risk of the implant rupturing is 10 percent.
Types of Silicone Implant Ruptures
Not every rupture is identical. An intracapsular rupture is when the implant has a small tear, the scar capsule has not been compromised, and the silicone gel is contained within the scar capsule. This is commonly known as a silent rupture. An extracapsular rupture is when the silicone breast implant ruptures and the scar capsule has been ruptured as well. This is not very common, as an extracapsular rupture is usually caused by trauma to the breast.
With extracapsular ruptures, the shape of the breast with the ruptured implant may look different than the non-ruptured breast. There could be a noticeable bulge, gradual hump, or you may feel a little lump. You may feel a burning sensation, tenderness, or the area may be a little numb. In many cases of silicone implant ruptures, the capsule remains intact and the silicone does not migrate to other areas outside of the scar capsule. For this reason, you may not know that your implant has ruptured for a few years.
Saline Implant Ruptures
One of the benefits of saline breast implants is that you can visually detect the rupture. The rupture may be a small leak that can go unnoticed for a week or even a few months. However, the typical saline rupture is noticeable within a couple of hours. The breast with the ruptured implant may appear deflated, you may have some loose skin, rippling around the top of your breast, and it may feel heavier at the bottom, while feeling very empty at the top of the implant. Unlike silicone, the saline will leave the implant shell and it will be absorbed by the body. The saline is not harmful to your body at all.
What Causes Breast Implants to Rupture
There are many reasons why implants may rupture:
- Underfilled saline implant: A saline implant that is filled below the manufacturer’s recommended minimum fill is more prone to rupture than an implant that is filled at or above the recommended maximum fill amount. The friction from the repetitive folding motion of the underfilled implant can wear the implant shell down, causing a rupture.
- Extreme overfilling of a saline implant: Overfilling far beyond the manufacturer’s recommended maximum fill amount will put you at a greater risk of your implant rupturing. The manufacturer has the right to deny any warranty claims associated with ruptures that are due to overfilling.
- Capsular contracture: The pressure from the contracted capsule may rupture a saline or silicone implant.
- Pressure from mammograms: Pressure from the flat support plate and the paddle (the parallel plate) used during mammograms may rupture implants placed over the muscle. For this reason, surgeons, radiologists performing the mammogram, and OB/GYNs prefer implants to be under the muscle.
- Surgical error: Scalpel or other surgical tools may puncture the implant without the surgeon realizing it.
- Valve malfunction (this only applies to saline implants): Unlike silicone, saline breast implants are filled through a tube after they are inserted in your breast. If the valve is not seated correctly or malfunctions, the saline will leak out over time.
Detecting a Ruptured Breast Implant
Not every rupture can be detected by a change in size. There are a few other symptoms of a ruptured implant that have no effect on the size and shape of the breast:
- Fever (very rare)
If you notice any of these symptoms, you should contact your surgeon for an examination. If your surgeon suspects a rupture, he or she will suggest a test to diagnose a ruptured silicone breast implant. If you have saline implants, a test is usually not required to diagnose a rupture unless you have a slow leak.
The US Food & Drug Administration (FDA) recommends having a MRI (magnetic resonance imaging), mammogram, ultrasound, or a CT (computed tomography) scan to detect a ruptured silicone implant.
A Rupture Is Found, What's Next?
If an implant has in fact ruptured, the surgeon will surgically remove it. In most cases, the implant will be replaced in the same surgery. But before this option is determined, the surgeon will need to look for signs of infection after the breast has been opened up, while he or she cleans out the pocket. If an infection is detected, you will have a waiting period before a new implant is inserted. Inserting an implant while an infection is present can cause the new implant to become contaminated and for complications such as capsular contracture to occur. The waiting period, should one be imposed, could be up to 2-3 months, depending on your health status and your surgeon's preferences. Even if no infection is suspected, your surgeon may wish to prescribe antibiotics as a safeguard.
Some patients see a rupture as an opportunity to go up or down in implant size. If you wish to go to a different size, the capsule may need to be removed (capsulectomy) and recreated to make the accommodation. If you are going to have the same implant size inserted, the capsule may be left intact.
By Emily Ballew
Created September 2016