Implant Rupture

What is breast implant rupture?

Breast implants contain an outer ‘shell’ and inner gel, made from a variety of substances, that aims to mimic the size, shape and feel of natural breast tissue. Implant rupture is when the shell has a tear, break, or hole, and the breast implant gel leaks. A scar capsule naturally forms around a breast implant to envelope the breast implant. Breast implant ruptures are often contained within this capsule, termed ‘intra-capsular rupture’. Occasionally, silicone leaks through the capsule and into the breast tissue. This is called ‘extra-capsular rupture’. Both types of implant rupture can be diagnosed by imaging.

How common is breast implant rupture?

The longer breast implants are inside the body, the greater the chance of implant rupture. The mechanism is due to a break in the implant shell, which causes the internal contents of the breast implant to leak. ‘Silent Rupture’ is a term used to describe a rupture that has occurred without the patient knowing. Rupture has been extensively studied by plastic surgeons, and numerous scientific articles exists. One article published in 2018 aimed to summarise the key papers looking at implant rupture risk, and suggested the range is between 6% and 18% at 10 years after surgery. Another recent study from the USA scanned 584 women with breast implants, and found that 14% of women had breast implant rupture. This demonstrates the importance of having implant check-ups to look for rupture, especially if the implants have been in for some time.

References:
El-Haddad R, Lafarge-Claoue B, Garabedian C, Staub S (2018). A 10-Year Prospective Study of Implant-Based Breast Augmentation and Reconstruction. Eplasty. 18: e7.
Salzman MJ (2022). Silent Rupture of Silicone Gel Breast Implants: High-Resolution Ultrasound Scans and Surveys of 584 Women. Plastic and Reconstructive Surgery.149(1):7-14.

When does implant rupture happen?

The chance of breast implant rupture increases over time. This applies for all brands of breast implants.

References:

El-Haddad R, Lafarge-Claoue B, Garabedian C, Staub S (2018). A 10-Year Prospective Study of Implant-Based Breast Augmentation and Reconstruction. Eplasty. 18: e7.
Salzman MJ (2022). Silent Rupture of Silicone Gel Breast Implants: High-Resolution Ultrasound Scans and Surveys of 584 Women. Plastic and Reconstructive Surgery.149(1):7-14.

What causes breast implant rupture?

Breast implant rupture can be caused by:

  • Time: The greater the time since your breast augmentation surgery, the greater chance the implant rupture. This is the reason why the FDA advises women with breast implants to have a breast implant scan performed 5 years after the initial surgery, and then every 2 years thereafter. Early changes can be detected by imaging even before a patient experiences symptoms or notices a change in the breast shape or feel.
  • Trauma: This can be from any type of excess force applied to the breasts. Examples include a car seatbelt after a car crash, needle insertion during a biopsy, or during the breast implant surgery.
  • Type of implants: Breast implant technology has improved over time, but a number of older implants were more likely to rupture than current implant designs.

What are the signs of silicone implant rupture?

Most breast implants in the UK have a shell made of silicone and a central gel core made of silicone gel. In these cases of silicone implant ruptures, the gel leak is gradual over time due to its thickness. Often the scar capsule around the implant is in tact, and therefore the gel leak is contained.

What happens if breast implants rupture?

If a breast implant ruptures due to a tear or hole in the outer shell of the implant, the filling material leaks out of the implant. The consequences of a ruptured breast implant depend on the type of implant and the filling material.

1. Silicone gel-filled implants: If a silicone implant ruptures, the breast may not change in size or shape. This is because silicone implants have cohesive gel filling, which means that the gel is thick and sticky, rather than free-flowing. It can therefore go unnoticed. The gel leak may stay confined within the implant capsule or spread into the surrounding tissue. In the UK, the majority of breast implants are silicone filled, with a silicone shell. Below are the types of changes that can occur following implant rupture:

a. Silent rupture: In some cases, a silicone gel implant rupture may not cause any noticeable symptoms or changes in breast appearance. This is known as a ‘silent rupture’, and it may only be detected during breast implant scans.

b. Breast shape changes: If the silicone gel migrates outside the capsule, it can cause changes in the shape, size, or feel of the breast.

c. Formation of a silicone granuloma: In rare cases, silicone that leaks into the surrounding tissue can cause the formation of small lumps called silicone granulomas. These are usually harmless but may require monitoring or removal. These may be felt around the breast or in the armpit (axilla).

d. Capsular contracture: Ruptured implants, whether saline or silicone, can sometimes contribute to the development or exacerbation of capsular contracture (the tightening of scar tissue around the implant).

2. Saline-filled implants: It is much easier to diagnose rupture in a saline implants, as the size reduction after a rupture is often immediate. In the USA, many breast implants are saline filled with a silicone shell. In the UK, saline implants are mostly used for breast reconstruction after treatment or cancer.

It is essential to monitor your breast implants regularly and seek medical evaluation if you notice any changes in the shape, size, or feel of your breasts. If you suspect your breast implants may have ruptured, at Breast Implant Solutions, we provide a personalised clinical assessment, examination with a chaperone, and high-definition ultrasound implant scans. This allows us to assess the implant’s integrity and recommend the best course of action based on your individual situation. In most cases, a ruptured implant will require removal or replacement surgery to address the issue, but this is a discussion that we can have the same day in our one-stop clinic.

What is gel bleed?

‘Gel bleed’ is when there is a diffusion of silicone gel from inside implant and across the implant shell. This can occur as the implant shell, made of silicone, is a semipermeable membrane. This means fluid can move in one or both directions. Studies suggest that higher concentrations of ‘gel bleed’ are associated with capsular contracture in a dose-dependent relationship. This means that if you have capsular contracture and your breast changes shape, one of the causes might be a silicone gel bleed from the implant.

References:
Moyer HR, Ghazi BH, Losken A (2012). The effect of silicone gel bleed on capsular contracture: a generational study. Plastic and Reconstructive Surgery. 130(4):793-800.

How do I know if my breast implants have ruptured? What are the signs of silicone implant rupture?

Signs of breast implant rupture include a change in breast shape or size, with or without pain, firmness, and swelling over time. Some patients tell us they feel more of a sense of having a balloon in their chest, and are worried about bursting, rupture or leak. Breast implant rupture can also cause capsular contracture, which is where the breast implant capsule tightens and can change the shape of the breast. Some patients do not realise their implants have ruptured as they look and feel normal. ‘Silent ruptures’ can be detected by ultrasound scan of the breast implants. We offer implant scans at Breast Implant Solutions to provide a ‘monitoring service’ for women with breast implants to look for signs of rupture.

If you have concerns about your breast implants you may benefit from having an ultrasound scan

If you had a ruptured implant, would you want to know?

A recent study showed that 99% of patients would want to find out if their breast implants had ruptured. This aligns with patients who tell us they ‘feel they have a ticking ‘time-bomb’ is inside them’ and are desperate to know if there is a rupture, burst, or leaking. Please book an appointment with one of our Breast Implant Solutions consultant plastic surgeons for breast implant scan of both breasts, and discussion of the results and same day report.

If you have concerns about your breast implants you may benefit from having an ultrasound scan of your breasts and blood tests.

References:
Salzman MJ (2022). Silent Rupture of Silicone Gel Breast Implants: High-Resolution Ultrasound Scans and Surveys of 584 Women. Plastic and Reconstructive Surgery.149(1):7-14.

How do you know if a breast implant has ruptured?

It can be very difficult to tell if an implant has ruptured. Many patients come to see us at Breast Implant Solutions because they have noticed a change in the shape or feel of the breast, or breast pain, and they are worried if the implant may have ruptured. At Breast Implant Solutions, we offer a full assessment by a consultant plastic surgeon, together with a comprehensive high-definition implant scan of both breasts, giving you the confidence to make an informed decision about your implants.

Is a ruptured breast implant an emergency?

Ruptured breast implants are not typically considered a medical emergency in the sense of requiring immediate life-saving intervention. However, it is still essential to address a ruptured implant promptly to prevent potential complications and to plan appropriate treatment. Breast Implant Solutions offers prompt appointments for a combined breast implant scan, clinical examination, and personalised breast implant discussion, so that a diagnosis can be made to alleviate any concerns and provide you with the information you need.

If you suspect a breast implant rupture or experience any concerning symptoms, such as changes in breast shape, size, or feel, and looking for reassurance of your breast implants, then we at Breast Implant Solutions offer everything you need to put your mind at rest.

If your implants have ruptured the general recommendation is to either remove or replace them at some point, but this is not urgent. The urgency of addressing a ruptured implant varies according to your individual circumstances, and we offer a bespoke service at Breast Implant Solutions tailored to your personal breast implant history and requirements.

What’s the best test for breast implant rupture

Imaging of the breast implants, using either ultrasound scan or MRI, are the two modalities suggested by the FDA to identify implant rupture.

What are the signs of saline breast implant rupture?

Saline implants are more commonly used in the USA and after tissue expansion following breast reconstruction. The smallest hole in the shell will allow the saline to leak causing the breast to ‘deflate’.

What is the screening advice and recommendations for breast implants?

The FDA recommends that women with silicone breast implants receive breast implant screening for silent rupture five years after having breast implant surgery and every two years after that. Ultrasound or MRI are the two imaging modalities typically used to diagnose breast implant rupture.

Is breast implant rupture dangerous?

The FDA advises breast implant scanning to diagnose implant rupture. The safety profile of the implants are designed to be safe when the shell is intact and the implant contents remain inside the shell. If the implant is ruptured, there is consensus within the medical profession that the safest course of action is to remove the ruptured implant, clean out the silicone, and replace the implant. However, we are seeing more patients who choose to remove their implants all together and not replace them.

What is the treatment for breast implant rupture and will I need surgery?

There is consensus amongst plastic surgeons that ruptured breast implants should be removed. Depending on the reasons for removal and any concurrent symptoms, the breast implant capsule may also be removed. This is called a ‘capsulectomy’.

References:
Salzman MJ (2022). Silent Rupture of Silicone Gel Breast Implants: High-Resolution Ultrasound Scans and Surveys of 584 Women. Plastic and Reconstructive Surgery.149(1):7-14.

How long can you leave a ruptured saline implant in place?

After having a scan to confirm breast implant rupture, we would suggest proceeding with surgery to remove or replace the implants in the near future. Occasionally there are medical reasons to delay surgery, but for an otherwise fit patient, the recommendation is that the ruptured implant is removed.

How long can you leave a ruptured silicone implant in place?

Ruptured breast implants have potential health risks due to the foreign material within the breast pocket, and therefore prompt explant surgery is suggested. This is more apparent in cases of extra-capsular rupture, and the surgical goal is to not only remove the implant, but to thoroughly washout the entire breast pocket so that no foreign material remains internally.

Should I remove the other implant if only one is ruptured?

If only one breast implant ruptures, it is important to discuss the pros and cons of removing the other implant as well. In the majority of cases, the non-ruptured implant is likely to be the same age and type as the ruptured implant with an ongoing risk of rupture. Most surgeons would therefore recommend removing (or replacing) both implants. Furthermore, this creates an opportunity to improve the appearance of both breasts should you wish.

Is there a difference if my breast implants were inserted as part of breast reconstruction after cancer?

Implants used for breast reconstruction after cancer are treated the same way and if ruptured still require replacement or removal. However, the decision making is more complex and we at Breast Implant Solutions have extensive experience of all types of breast reconstruction. After a full assessment, including implant scan, we can advise you on your treatment options.

What is the problem with a ruptured breast implants?

Ruptured breast implants can cause breast pain or changes to the shape or aesthetic look of the breast. However, it is reassuring to note that ruptured implants have no known link to breast cancer, reproductive issues, or connective tissue diseases including rheumatoid arthritis. Breast implant ruptures can go unnoticed if the silicone is contained with the surrounding implant capsule. Imaging using ultrasound scans in the consultation room are especially good for identifying these intracapsular ‘silent ruptures’ so that patients can make the best decision on how to proceed. Other consequences of breast implant rupture include breast pain, irritation, swelling, additional internal scar tissue formation, changes in size or shape, breast lumps, hardening, and other aesthetic issues.

What should I do if my surgeon tells me my breast implants have ruptured?

First, accurate diagnosis is important. Imaging of the breasts using high-definition ultrasound will accurately view the implant shell and surrounding tissue and determine if the implant has ruptured. In cases of silent intracapsular rupture — where no signs or symptoms exist — the recommendation would be to remove or replace your breast implants. There is no rush for this to be performed, and we would normally suggest scheduling a date at your convenience.

If ruptured silicone implants are causing signs or symptoms, surgical removal is recommended, with replacement of a new implant if requested. If you decide you no longer want breast implants, you may choose to have a breast lift (mastopexy) or other corrective surgery.

By the time many patients have an implant rupture, the breast has often changed aesthetically due to pregnancy, breast feeding, weight fluctuations or as part of the natural ageing process. Therefore, after explant surgery, your breast may be very different in appearance to how it was before breast augmentation. As a result, often other treatment options are open to you after implant removal / explant surgery, such as a breast uplift (mastopexy) or fat transfer (lipofilling).

Should you ask about implant rupture before breast augmentation?

Having a knowledge on the risks of surgery and what can be expected over time is an important part of the consent process. It is therefore important that you are aware of the risks of breast implant rupture before undertaking breast augmentation surgery, and speak to your surgeon about their experience of this.

How long can you keep a ruptured breast implant?

If a breast implant is ruptured, it is generally advisable to seek the expertise of a consultant plastic surgeon, and have both breasts assessed promptly. The specific timeline for removal or replacement of a ruptured breast implant can vary based on several factors, including the type of implant (saline or silicone gel-filled), the severity of the rupture, and individual circumstances.

See ‘Is a ruptured breast implant an emergency’ above.

Will the NHS replace a ruptured breast implant?

The National Health Service (NHS) in the United Kingdom provides medical care and treatment to eligible residents based on clinical need, regardless of the cause of the condition. Whether the NHS will replace a ruptured breast implant depends on individual circumstances, including the severity of the rupture, the presence of symptoms or complications, and the availability of resources. Typically, NHS hospitals do not perform replacement of breast implants. Explant surgery is occasionally performed in the NHS setting, but there are an array of techniques and approaches to treatment, and some patients choose to pursue treatment with their preferred surgeon in the private sector.

In the UK, the NHS primarily covers medically necessary treatments, including those related to complications arising from medical procedures, such as breast implant ruptures. If a ruptured breast implant is causing significant discomfort, pain, or aesthetic concerns, and removal or replacement is considered medically necessary, the NHS may provide the necessary treatment. However, if the rupture is not causing significant symptoms or complications and the treatment is deemed more of a cosmetic concern, it may not be covered by the NHS. In such cases, individuals may need to seek private healthcare options for removal or replacement of the ruptured implant.

If you have concerns about your breast implants you may benefit from having an ultrasound scan of your breasts and blood tests.