Updated September 2018
Breast implants have evolved rapidly over the past 30 years, from a weak shell with liquid silicone to highly cohesive silicone gel. While the evolution meant a lower risk of silicone gel bleed, the potential for leaching has not been fully eliminated.
This means that if you have silicone gel implants or plan to get them, small amounts of silicone gel may bleed through the intact implant shell. Here's what you need to know.
What is silicone gel bleed?
The elastomer shell that surrounds a silicone gel implant has a semipermeable membrane or micropores. As your breast implants age and both external and internal factors wear on or compress the implant, small amounts of silicone gel can leak out.
Silicone gel bleed is simply a drawback to silicone implants and is considered to be a usual process that occurs over time.
Complications of silicone gel bleed
The amount of silicone gel that can bleed out is as minute as droplets of water. But like water, as the gel pushes to the surface of the implant, it can continue to migrate—though at a slower rate.
It can migrate into and through the breast capsule, causing an inflammatory reaction that results in late-stage capsular contracture, or even head further to the lymph nodes, causing lymphadenopathy. Calcifications can also form on the implant.
While the bleed may not increase your risk of scar tissue formation (capsular contracture), it can certainly contribute to the breast capsule becoming stiff and thick and, as a result, the breast itself may feel harder and thicker.
Should I be worried about silicone gel bleed?
Earlier generations of silicone implants were shown to have more bleed than later generations (third, fourth, and fifth). This is because the shell and the silicone within were not as cohesive and binding.
Today, the amount of gel bleed has significantly lowered—some surgeons saying the problem is no longer a factor—since the evolution of cohesive gel filler. Toxicology testing, at least in Allergan implants, found that even if large amounts diffused, it would not cause a toxic reaction.
This, however, doesn't mean the aforementioned complications like scar tissue formation, calcification, and lymphadenopathy may not occur. Patients who've experienced these complications from silicone gel bleed often had their implants for more than 10 years, signaling that bleeding and complication risks increase with implant age.
Diagnosing and treating silicone gel bleed
It can be difficult for imaging tests such as MRI and ultrasound to detect silicone gel bleed, as it often doesn't show in images. In instances where it does, the technician may notice fine wrinkles or ripples that appear like a tiny lasso or piece of thread. More times than not, however, it is only when the breast implants have been removed does the surgeon discover the problem.
Treatment is usually unnecessary unless a complication has occurred. What course of treatment follows thereafter would depend on the specific problem and its severity.
Aren't silicone gel bleed and implant rupture the same?
An implant rupture signals a break in the shell of the implant, which causes its contents to leach out. It may result from trauma to the breasts, natural wear-and-tear, severe cases of capsular contracture, or damage to the shell before or during breast augmentation.
Most silicone ruptures are silent, meaning there are no obvious symptoms, but in cases where the rupture is symptomatic, you may see a slow, but noticeable difference in the shape or size of your breast implant over time. This may be followed by:
- Hard knots
- Tenderness or pain
- Hardening of the breasts
- Breast asymmetry
- Lumps in the breast, armpit, abdomen, arm, chest wall
Moyer HR, Ghazi BH, Losken A. (2012) The effect of silicone gel bleed on capsular contracture: a generational study. Plastic Reconstr Surg. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22691845
Hacking C, Weerakkody Y, et al. Gel bleed in breast implants. Radiopaedia. Retrieved from https://radiopaedia.org/articles/gel-bleed-in-breast-implants
Kappel RM, Boer LL, Dijkman H. (2016). Gel Bleed and Rupture of Silicone Breast Implants Investigated by Light-, Electron Microscopy and Energy Dispersive X-Ray Analysis of Internal Organs and Nervous Tissue. Plastic Reconstr Surg. Retrieved from https://clinmedjournals.org/articles/cmrcr/clinical-medical-reviews-and-case-reports-cmrcr-3-087.pdf
Lourenco FR, Kikuchi IS, et al. (2011). Silicone Gel Bleed on Breast Implants. Faculty of Pharmaceutical Sciences, University of Sao Paulo, Brazil. Retrieved from https://benthamopen.com/FULLTEXT/TOBIOMTJ-3-14
Allergan. (2009). Natrelle Silicone-Filled Breast Implants: Smooth & Biocell Texture. Retrieved from https://www.fda.gov/downloads/medicaldevices/productsandmedicalprocedures/implantsandprosthetics/breastimplants/ucm245627.pdf