The term “popping” a breast implant is a sensationalized description for what is medically known as an implant rupture or structural failure. While the outer shell of a modern implant is durable, it is not designed to last a lifetime, and its integrity can be compromised over time. Understanding this structural failure is important, as the consequences depend heavily on the material inside the implant: either sterile saline solution or cohesive silicone gel. A breast implant rupture requires medical consultation to determine the extent of the damage and the appropriate management plan.
Defining Rupture and Structural Failure
A breast implant rupture occurs when a tear or hole develops in the silicone outer shell, allowing the internal contents to escape. Implants are not considered lifetime devices, and the primary cause of failure is gradual wear and tear, or material fatigue, over many years. The strength of the silicone shell naturally decreases with time, as the material is constantly flexed within the breast pocket. One known mechanism of shell weakening is the migration of silicone fluid from the gel into the shell itself, a process called shell swelling. The risk of rupture is low initially but begins to increase significantly after the first six to eight years of implantation, declining more noticeably after about a decade. While chronic material fatigue is the most frequent cause, acute trauma, such as a severe blow to the chest or excessive compression during a closed capsulotomy, can also cause a sudden failure; other contributing factors include manufacturing defects, damage from surgical instruments during placement, or pressure from severe capsular contracture (the formation of a tight scar tissue capsule around the implant).
Different Failure Modes Based on Implant Type
The way a rupture presents differs between the two main types of implants. Saline-filled implants are characterized by an immediate and obvious deflation when the shell fails. Because the implant is filled with a sterile saltwater solution, the saline is quickly and harmlessly absorbed by the body. This rapid loss of volume causes a noticeable change in the size, shape, and symmetry of the breast, making the rupture easy to detect. Silicone gel-filled implants, in contrast, often present a phenomenon known as a “silent rupture.” This occurs because the modern silicone gel is highly cohesive, meaning the thick, semi-solid material tends to hold its shape even after the shell is torn. The gel may remain contained within the scar tissue capsule that naturally forms around the implant, which is called an intracapsular rupture. An extracapsular rupture is more serious, occurring when the silicone gel migrates beyond the scar tissue capsule and into the surrounding breast tissue or lymph nodes.
Recognizing the Signs of Implant Failure
Detecting a rupture depends on the implant type, as saline ruptures are self-evident due to deflation. For silicone implants, a silent rupture may present with subtle or non-existent symptoms, making regular screening important. Observable signs of any rupture type can include changes in the breast’s size, shape, or firmness, the development of palpable lumps or rippling, or pain, tenderness, and a burning sensation. For silicone implants, medical imaging is necessary to confirm the structural integrity of the device. The U.S. Food and Drug Administration (FDA) recommends routine Magnetic Resonance Imaging (MRI) screening for silicone implants three years after the initial surgery, and then every two years afterward. MRI is the most sensitive tool for detecting an intracapsular rupture, often revealing a characteristic “linguine sign” that indicates a collapsed shell. Ultrasound and mammography can be used as secondary tools, with ultrasound sometimes showing a “snowstorm” pattern indicative of free silicone outside the capsule.
Medical Management Following a Rupture
Once a rupture is confirmed, the standard recommendation is to remove the compromised implant. For a ruptured saline implant, the empty shell is simply removed, and the patient decides whether to replace it immediately. Management of a ruptured silicone implant is more complex, particularly if it is an extracapsular rupture; the surgical decision is between explantation (removal only) and removal with replacement of a new implant. The procedure for a silicone rupture usually involves a capsulectomy, which is the surgical removal of the surrounding scar tissue capsule, ensuring all free silicone gel and affected scar tissue are removed. If the rupture is extracapsular, the surgeon must diligently remove all migrated silicone material, which may require a delayed replacement or multiple procedures. Patients need one to two weeks off work to recover from the surgery, with strenuous activity restricted for about one month to allow for proper healing.