Silicone gel breast implants were introduced in 1963, and have since been widely used for breast augmentation and reconstruction after surgical mastectomy (removal of breasts).
Removal and examination of the implant is the best way to find out whether an implant has ruptured. Sometimes the rupture can be a mere pin-hole or in the form of visible tears. Sometimes the implant can rupture during mammography due to breast compression. Implants can rupture due to trauma resulting from motor vehicle accidents, falls, gunshot wounds, etc. Trauma related implant ruptures are uncommon.
Implant ruptures detected by physical examination are not always accurate. Imaging methods such as mammography, ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) are commonly used to assess the integrity of silicone gel breast implants. Imaging findings are subtle when there is minimal gel leakage as in disintegration of the shell or a small tear.
There is no general consensus on how to treat women with ruptured breast implants. Some plastic surgeons recommend removal of implants within 8 years after implantation to risk chances of rupture as the implant ages. Suggestions have included removal of implants from patients with symptoms of systemic disease. However, there is common agreement among plastic surgeons to remove the implant if the ruptured implant causes complications locally such as breast deformity, pain, etc. In 1992, Food and Drugs Administration recommended removal of a breast implant if it ruptured.
Manufacturers of implants, clinicians, patients, and regulatory agencies are concerned about the consequences of ruptured silicone-gel breast implants. The frequency and severity of implant ruptures is unknown as is any possible side effects due to exposure of silicone gel to other tissues or development of systemic disease. Previously undetected implant ruptures are now detected with advanced MRI techniques. Intracapsular and extracapsular ruptures are detectable on imaging.
It is clear that the incidence and prevalence of breast implant ruptures are higher than previously suspected, and the risks of rupture increases with the age of the implant. It is also known that the implant rupture may progress from a tiny rupture to a tear and visible leakage of silicone gel that could possibly cause severe disruption. In rare cases, the silicone gel can be expressed through the nipples. Implant rupture and ‘bleeding’ of the silicone gel can cause contamination of lymph nodes in the armpit. Silicone gel migration has been reported to the chest wall, lung membrane, ribs, upper arm, biceps, etc. Sometimes distant migration of the gel can occur to areas like abdominal wall, liver, and groin area.
Women opting for silicone-gel breast implants must consider risks and benefits of the procedure and discuss with their physician all available options for breast augmentation.