When a silicone breast implant develops a tear or hole in its outer shell, it is known as a rupture, allowing the inner silicone gel to leak into the surrounding tissue. This complication can happen due to trauma, damage during surgery, or the natural wear and tear as the implant ages. Because the thick, cohesive silicone gel leaks out slowly, a rupture often goes unnoticed by the individual, creating a situation commonly referred to as a “silent rupture.” Understanding what happens when this integrity is compromised is important for anyone with silicone implants.
Understanding Silicone Implant Ruptures
The body naturally forms a fibrous capsule, a layer of scar tissue, around the implant. A silicone implant rupture is classified based on whether the leaking gel remains contained within this scar tissue layer.
An intracapsular rupture occurs when the implant shell breaks, but the surrounding fibrous capsule remains intact, keeping the leaked silicone gel contained. This is the more common type of rupture. Because the silicone is held in place, it usually does not cause immediate physical symptoms or changes to the breast shape.
An extracapsular rupture happens when the leaked silicone gel breaks through the fibrous capsule and migrates into the surrounding breast tissue or beyond. This type of rupture implies an intracapsular rupture occurred first, as the shell must break before the gel can escape the capsule. The distinction between these two types is important because the location of the silicone determines the likelihood of symptoms and the complexity of treatment needed.
Detecting and Diagnosing a Leak
Detecting a silicone implant leak can be challenging because most ruptures are initially intracapsular and asymptomatic, or “silent.” The U.S. Food and Drug Administration (FDA) recommends routine screening using Magnetic Resonance Imaging (MRI) to monitor for these silent ruptures. Screening should occur three years after the initial surgery and then every two years afterward.
Symptomatic ruptures are typically extracapsular leaks that cause noticeable changes in the breast. Symptoms can include a change in the breast’s shape or size, new lumps, or increased firmness, also known as capsular contracture. Pain, soreness, or swelling experienced by some individuals relates to the body’s inflammatory reaction to the free silicone.
For diagnosis, MRI is the gold standard due to its high accuracy in visualizing the implant and detecting subtle signs of rupture, such as the “linguine sign” indicating a collapsed implant shell. Ultrasound can also be used, particularly to confirm an extracapsular rupture, where it may show a characteristic “snowstorm appearance.” However, ultrasound is less sensitive for detecting intracapsular ruptures.
The Body’s Biological Response to Silicone
Once the silicone gel escapes the implant shell, the body recognizes it as a foreign material, triggering a physiological immune response. Immune cells, particularly macrophages, attempt to engulf the silicone particles but cannot break the material down.
This attempt to isolate the foreign material leads to the formation of localized, hardened masses within the breast tissue called granulomas, or “siliconomas.” The presence of free silicone induces a chronic inflammatory response, which contributes to symptoms like pain and hardening. If the rupture is extracapsular, the silicone can migrate away from the breast area.
The gel can travel through the lymphatic system, causing the lymph nodes, particularly those in the armpit (axilla), to swell in a condition known as silicone adenopathy. Migration can also affect surrounding structures like the chest wall or muscle tissue, potentially causing discomfort and requiring complex removal procedures. Ongoing immune system activation in response to silicone exposure has also been linked to systemic symptoms in some individuals.
Treatment and Removal Options
Once a silicone implant rupture is confirmed, surgical intervention is recommended, even if the rupture is asymptomatic. The standard procedure involves explantation, which is the removal of the ruptured implant itself.
If the silicone has breached the fibrous capsule, the surgeon performs a capsulectomy, the removal of this scar tissue capsule. This ensures all leaked silicone and inflamed tissue are addressed. The primary goal is to remove as much of the free silicone gel as possible from the surrounding tissue, often requiring a thorough washout of the implant pocket.
For extracapsular ruptures where silicone has migrated, the surgeon attempts to excise any siliconomas or migrated silicone deposits found in the breast tissue or lymph nodes. Following the removal of the ruptured implant and surrounding material, the patient has options. They can immediately replace the implant, choose a different type of implant, or opt for no replacement and undergo a procedure to reshape the breast.