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One of the key differences between silicone and saline breast implants is what happens in the face of a rupture. Saline breast implants are filled with essentially water, making rupture easy to detect– you get a hole in your implant, water leaks out, and your implant deflates. This process can happen rapidly, over a day or two, or more slowly over a number of weeks. Silicone breast implants, on the other hand, are filled with an entirely different substance which imparts an entirely different presentation upon rupturing. It is important to remember that silicone implants are no longer filled with liquid silicone. Current generations of silicone implants are filled with a thick, cohesive gel that, due to its crosslinking, is more akin to a gummy bear. Even if the outer shell of the implant is ruptured, the gel maintains its shape and hence there will be no leaking of silicone or deflation of the implant.
Causes Of A Rupture:
The two most common reasons for a rupture to occur are (1) manufacturer flaw/defect or (2) general wear and tear over time. This term ‘manufacturer defect’ sounds purposefully vague; however, just about every product we utilize– from cars to laptops– are subject to some flaw in its manufacturing that causes it to prematurely fail. This is one of the key reasons why pricier purchases often come with a warranty– to protect consumers against that unfortunate reality that sometimes you just get a lemon.
The chest is a highly mobile area of the body. Consequently, breast implants (both placed over and under the muscle) are subject to constant motion over time. Motion leads to creases that, with chronicity, can lead to cracks in the implant shell. The general perception amongst patients is that a rupture occurs from some acute, impact event to the chest (fall, car accident, etc.) Any venture down the rabbit hole of YouTube, however, will illustrate the incredibly durable nature of your average breast implant.
Symptoms of a Silicone Breast Implant Rupture:
I always counsel my patients that there are two scenarios that can happen with the rupture of a silicone breast implant. The most indicative sign of a silicone breast implant rupture is the development of a capsular contracture, or hardening of the body’s layer of scar tissue that naturally surrounds the implant. Basically, if your body detects the crack in the shell by reacting to the inner substance it is now exposed to, its response is to contain the ‘other’ by thickening this capsule and essentially walling off the implant from the rest of the body. A capsular contracture presents as firmness of the implant but can also include displacement of the implant and even pain. The other scenario that can occur with a silicone implant rupture is a Silent Rupture, where no reaction from the body or symptoms are produced as a consequence. Basically, your body just doesn’t even recognize the crack in the shell and goes on about its business as if nothing was wrong, the silicone doesn’t leak out because it’s not liquid, and you go about your business without any idea anything has changed with your implant.
Screening For A Silent Rupture:
So, if there are no symptoms associated with a silent rupture, how do you know if you have one? The answer is to screen for one. Imaging of the breast implant is really the only way to detect a silent rupture. The Food and Drug Administration recommends anyone with silicone breast implants undergo routine screening:
5-6 years after your implants are placed
Every 2-3 years after that for the lifetime of your implants
Up until around 2021, the imaging modality recommended was an MRI. Unfortunately, MRI imaging is expensive (a couple thousand dollars usually) and, because its indication was considered ‘cosmetic,’ was not covered by insurance plans. Consequently, most women did not follow through with screening recommendations. In an effort to create better compliance with the recommendations, the FDA has now included ultrasounds, which are relatively inexpensive and much more accessible to patients. Many plastic surgeons will already have ultrasounds in their office, though not every Plastic Surgeon is trained or skilled to be able to detect a rupture with one.
I Have A Silent Rupture, Now What?
If you have been diagnosed with a silent rupture, your first move is to contact your Plastic Surgeon. If your imaging was not performed through or at the direction of them, make sure to bring a copy of your imaging results to your appointment for their review. Another invaluable bit of information is located on your breast augmentation card given to you after your surgery. Each patient is provided with one of these cards which contains vital implant information such as size, profile, implant company and individual serial number. If you are returning to your original Plastic Surgeon, they will have all this information readily available. However, many patients do not return to their original Plastic Surgeon for a number of reasons (retirement, a move, etc.) so this information will be critical in future decision making. Just as a side note, I recommend after you read this post to go find your card, take a picture of it, and either email it to yourself or save it to your cloud. You can thank me later.
The treatment recommendation for a silent rupture is replacement of your implant. Though this can be a distressing diagnosis, this is not an emergency and can be addressed in a time frame that doesn’t have to feel overwhelming for you. There are benefits to addressing this earlier, such as mitigating the potential development of a capsular contracture; however, I have treated patients who have had ruptures and even capsular contractures for years and, for one reason or another, waited to get them addressed. Implant exchange in the absence of a capsular contracture is a straightforward surgical procedure with minimal downtime. Much of the discomfort you experienced during your initial surgery was from the creation of the implant pocket– creating a space that didn’t exist before and placing an implant. Now, that space is already there and we are just replacing the implant that is in it.
Take Away Points:
A Silent Rupture is unique to silicone breast implants because of the cohesivity of current generation silicone fill. The only way to detect a silent rupture, since it is ‘silent’ in terms of symptoms, is to screen with either an ultrasound or MRI. If detected, the recommendation is implant exchange which, although requires a trip back to the operating room, is a relatively straightforward procedure with minimal downtime. Despite this unique risk, silicone implants are incredibly safe medical devices and are overwhelmingly the most popular type of breast implants we use. My goal is to give my patients and readers all the tools and information they need to make informed and educated decisions for themselves.
Dr. Megan Dreveskracht is a Seattle-based Female Plastic Surgeon who specializes in Aesthetic Surgeries of the Breast, Body & Face. To schedule your consultation, call 206.860.5582 or fill out a contact form here.
