Silicone breast implants are medical devices used for both cosmetic augmentation and reconstructive surgery. These implants consist of a silicone outer shell filled with a cohesive silicone gel. A rupture occurs when the outer shell develops a tear, allowing the internal silicone gel to escape. Rupture is a significant event, though the thick, sticky nature of the cohesive gel means that a leak often happens slowly and the implant may largely retain its shape.
Physical Indicators of a Leak
While many ruptures go unnoticed, a leak that progresses can cause noticeable changes in the breast. A common physical indicator is a gradual change in the breast’s shape or size. The affected breast may appear smaller, more asymmetrical, or subtly misshapen due to the slow loss of volume.
Changes in texture are also signs of a problem. Leaked silicone can cause the scar capsule around the implant to tighten and harden, a condition known as capsular contracture. This results in the breast feeling unusually firm, tight, or hard to the touch. Conversely, the implant may feel softer or more yielding if it has lost significant volume.
Pain or tenderness may signal irritation of the surrounding tissue. The leaked silicone can trigger an inflammatory response, leading to discomfort ranging from mild aching to persistent pain. If the silicone migrates outside the scar capsule, it can form palpable lumps called siliconomas, which may appear in the breast or travel to the armpit. Swelling, redness, or warmth in the breast area can also occur as the body reacts to the escaped gel.
The Challenge of Asymptomatic Rupture
Relying solely on physical signs is often insufficient for detecting a silicone implant leak because most ruptures produce no outward symptoms. This phenomenon is known as a “silent rupture.” Silent ruptures occur when the tear in the implant shell is contained within the fibrous scar tissue, or capsule, that the body naturally forms around the implant. The cohesive gel remains trapped inside this capsule, preventing noticeable changes in the breast’s contour or firmness.
Since the risk of rupture increases over the life of the implant, medical screening is required to detect these silent leaks. The U.S. Food and Drug Administration (FDA) recommends routine screening via magnetic resonance imaging (MRI) for individuals with silicone implants. This screening is typically recommended starting three years after the initial surgery and every two years thereafter. This proactive approach identifies rupture before the silicone gel leaks through the scar capsule and into the surrounding breast tissue.
Diagnostic Tools Used by Physicians
When a leak is suspected, or for routine screening, physicians use specific imaging tests to confirm the integrity of the implant. Magnetic Resonance Imaging (MRI) is considered the gold standard for detecting both symptomatic and silent ruptures. This technique provides high-resolution images that clearly distinguish silicone gel from surrounding tissue.
A radiologist looks for specific signs of rupture on the MRI scan. The definitive sign of an intracapsular rupture is the “linguine sign,” which appears as wavy lines inside the implant representing the collapsed outer shell floating within the gel. The presence of silicone outside the fibrous capsule, known as extracapsular rupture, indicates the silicone has migrated into the breast tissue.
Ultrasound is another common tool used for initial screening and evaluation. It is less expensive and more accessible than MRI, though it is not as reliable for detecting subtle intracapsular ruptures. On an ultrasound, a contained rupture may appear as a series of parallel lines known as the “stepladder sign.” Extracapsular silicone is often visualized as a “snowstorm sign,” a pattern of bright dots caused by silicone mixed with tissue. Mammography is less helpful for rupture detection, as the implant can obscure breast tissue.
Management and Treatment Options
Once imaging confirms a silicone implant rupture, the established protocol involves surgical intervention. The primary goal is explantation, which is the removal of the ruptured implant. This is often necessary even for silent, intracapsular ruptures, though timing may be monitored by a surgeon in asymptomatic cases.
If the silicone has breached the scar capsule and leaked into the breast tissue, a capsulectomy is also performed. This procedure involves removing the entire fibrous capsule along with any surrounding free silicone. The patient then has the option to replace the damaged implant, choose a different type of implant, or forgo replacement entirely.