Breast implant rupture: symptoms and testing

What is implant rupture?

Implant rupture is a condition in which the outer shell of the implant tears or is damaged and its contents leak out. A 2017 review explained that over the decades silicone implants have been in use, their design and the way they are used have changed greatly, and that their use was even halted for nearly 10 years while they underwent rigorous review of their safety and effectiveness ^[1].

Rupture is divided into intracapsular rupture, in which the silicone stays inside the capsule surrounding the implant, and extracapsular rupture, in which silicone leaks out of the capsule into the breast tissue ^{[1, 3]}.

When a saline implant ruptures, the saline is absorbed by the body and the breast contour changes, so the rupture is usually visible ^[2]. By contrast, most silicone implant ruptures cause no symptoms, so they are difficult to detect by physical examination alone ^[1].

How often does it happen, and why?

A 2017 review gathered data from manufacturers' long-term follow-up studies and summarized that the rupture rate is very low at first but begins to increase 6 to 8 years after placement ^[1]. A 2014 publication also explained that although implants have advanced greatly, rupture is still a common and expected complication, especially with earlier generations of implants ^[3].

Damage caused by surgical instruments when the implant is placed was cited as the most common cause of rupture ^[1]. In rare cases, injury can also be a cause. A 2020 case report stated that because of the nature of implant materials, rupture may first appear about 10 years after placement. It described the case of an athlete whose implant ruptured from an impact during competition, and expressed the opinion that implants are not recommended for women who take part in contact sports such as boxing ^[6].

However, this opinion is based on a single case and a literature review, so there are limits to how far it can be generalized. In addition, the data on when rupture occurs come from manufacturers' long-term studies, so the timing may differ depending on the type and generation of the implant.

What are the symptoms?

Silicone implant rupture often progresses without symptoms, which is why the term silent rupture is used ^[3]. When there are symptoms, they can appear as capsular contracture, a lump in the breast, or a change in breast shape ^[1].

When a saline implant ruptures, the size and contour of the breast often change noticeably ^[2]. With either type, if the shape or size of your breast suddenly changes or the breast becomes firm, it is a good idea to have an examination to find the cause.

What tests are used?

Rupture can be detected with a physical examination, ultrasound, and magnetic resonance imaging (MRI) ^[1]. A 2014 publication described MRI as the main test for assessing whether a silicone implant is damaged and explained that it has excellent sensitivity and specificity ^[3]. Intracapsular and extracapsular rupture are each distinguished by characteristic findings on MRI, and special imaging that suppresses water and silicone signals is needed to tell rupture apart from other lesions and image artifacts ^[3].

Another 2014 publication summarized the purposes and indications of implant MRI, normal findings, and the various patterns of rupture, and introduced a system that divides intracapsular rupture into 4 stages ^[4]. A 2022 review also named suspected implant rupture as one of the established indications for breast MRI ^[5].

2018 criteria from the American College of Radiology suggested choosing different tests depending on age, implant type, and symptoms ^[2]. When a complication of a silicone implant is suspected, the criteria call for MRI without contrast or ultrasound for people under 30; one of MRI without contrast, mammography or digital breast tomosynthesis, or ultrasound for people aged 30 to 39; and MRI without contrast or mammography or digital breast tomosynthesis for people aged 40 and older ^[2].

For saline implants, when physical examination findings are unclear, the criteria call for ultrasound for people under 30, mammography or digital breast tomosynthesis or ultrasound for people aged 30 to 39, and mammography or digital breast tomosynthesis for people aged 40 and older ^[2]. When implant-associated lymphoma is suspected, ultrasound is to be performed first regardless of age or implant type ^[2].

Should I be tested even if I have no symptoms?

Recommendations on this point have differed by organization and over time. A 2014 publication noted that the US Food and Drug Administration (FDA) recommends MRI at regular intervals to detect silent rupture ^[3]. On the other hand, the 2018 American College of Radiology criteria did not recommend imaging when there are no symptoms, regardless of age or implant type ^[2].

Both recommendations are US standards, and they were published at different times. How often you should be tested in Korea is best decided with your doctor, taking into account the type of implant, when you had surgery, and your individual risk factors.

What happens if rupture is confirmed?

A 2017 review summarized that, based on close study of patients with ruptured implants, the consensus in the literature is that there are no health risks associated with rupture ^[1]. It took the view that patients with symptoms should be given the opportunity to choose between observation and removal of the implant and capsule, with replacement by a new implant if needed ^[1].

Which option is right depends on the extent of the rupture, your symptoms, the breast shape you want, and your overall health. If silicone has leaked outside the capsule, the extent of surgery may be different, so it is important to discuss it thoroughly based on the results of imaging tests.

• The type of implant (silicone or saline) and when you had surgery
• The testing method that suits your current symptoms and age
• The extent of the rupture and whether silicone has leaked outside the capsule
• The pros and cons of observation and of revision surgery