All breast implants need to be replaced at some point in time, whether they are filled with a silicone gel or a saline solution. Most manufacturers state that their implants will last around 10 years, though many women report their implants lasting much longer with no problems. If implants are not removed or replaced, they will come to the natural end of their lives after a period of time and in some cases they will rupture. There is usually no danger when this happens, though it is important to contact your surgeon as soon as you suspect this may have occurred.

Up to 50% of implants older than 15 years may have a rupture; however, silicone is usually held within the capsule – this is known as intracapsular rupture. Around 5% of these will progress to giving lumps outside of the capsule and this is called extra-capsular rupture.

Below is a guide designed to help you spot signs of a rupture and show you what to do when this occurs.

Possible warning signs

A little background information first. The shell, or “bag”, of both saline (salt water) and silicone gel filled implants are both made of silicone and are essentially identical. Whenever a foreign body is placed into our tissues, whether this be a pacemaker, artificial joint, or breast implant, be it saline or silicone, thin layer of scar tissue called a “capsule” forms around the device within about three weeks. Normally, this scar tissue has no role, and is of no detriment. This is just the way our bodies react to having something that is not our own living tissue placed inside us. Silicone gel filled implants are pre-filled by the factory.

Saline implants are inserted into the breast deflated and rolled up like a cigar. There is a small valve on the surface of the implant. A thin “fill tube” is attached to this valve just prior to insertion into the breast. It is through this tube that saline is placed into the implant. The tube is removed after filling and the valve is sealed, all while the implant is in place in the breast. Saline implants are prone to device failure by either leakage of saline through the valve or by failure (a tear) of the implant shell. A silicone gel implant doesn’t have a valve, but failure can occur by a tear in the implant shell.

When an implant ruptures, you may notice the following effects:

Silicone gel

• Numb or tingling feeling in the breast
• Soreness and discomfort in and around the breast
• Lumps in and around the breast, armpit or arm
• Change of breast size and shape
• Softening or hardening of the affected breast
• Breast asymmetry
• Hyper sensitivity

Saline

• Marked reduction in size
• Change of shape
• Observable rippling or indentation of the breast
• Change of breast size and shape
• Slight tenderness
• Breast asymmetry
• Hyper sensitivity

What happens inside the breast when an implant ruptures?

When a rupture occurs, the material inside the implant leaks into the cavity of the implant. In some instances some of the material can move into local breast tissue or through the lymph node system. The type of implant will determine where the filling may migrate to and the speed with which it disperses.

Silicone gel

In most cases, silicone gel from a ruptured implant will stay within the capsule of tissue formed by the body around the implant. This is known as an intracapsular rupture. As there may be no symptoms, either physically or visually, this type of rupture can go unnoticed for several years.

When the silicone gel does move outside the capsule, the shape of the breast may be altered. In some cases, the gel will migrate away from the breast and collect together in the chest, armpit or arm area to form small lumps. The area around these may feel sore and tender. This type of rupture is known as ‘extracapsular’. Ruptures that show symptoms usually happen outside of the capsule. However, some ruptures are called “silent ruptures.”

A “silent rupture” doesn’t change the way an implant looks or feels to a woman because the rupture occurs within the capsule. Silent ruptures are not usually evident by a physical examination by a doctor. Magnetic resonance imaging (MRI) is the most effective method for detecting silent rupture of silicone gel-filled breast implants.

Silicone gel that leaks outside the capsule surrounding the implant may travel (migrate) away from the breast. The leaked silicone gel may cause lumps to form in the breast or in other tissue, most often the chest wall, armpit or arm. It may be difficult or impossible to remove silicone gel that has travelled to other parts of the body.

Saline

When a saline implant ruptures, the shell quickly deflates and harmless salt water escapes into the surrounding area. This water is then absorbed by the body’s cells and offers no medical problems, such as migration or lumping. However, if left unattended, a number of issues can arise:

• Capsular Contractur: Tightening of the tissue capsule around an implant, resulting in firmness or hardening of the breast and squeezing of the implant if severe.
• Extrusion: Edges, now sharp after deflation, work their way to the surface of the skin causing pain and scarring.

What are the health implications of a ruptured breast implant?

There is no definitive research to suggest that there are any serious health implications connected with the rupture of breast implants beyond the presence of physical material in the body, which can be removed. However, once a rupture has occurred and is extracapsular then replacement is recommended. Intracapsular ruptures are also usually changed but this is not urgent.