Silicone breast implants are used for both cosmetic enhancement and post-mastectomy reconstruction. These devices consist of a silicone elastomer shell filled with a cohesive silicone gel. Although designed for long-term placement, implants are not intended to last a lifetime, and the outer shell can develop a tear or hole, leading to a rupture. The consequences depend primarily on the location of the leaked silicone and whether the event presents with noticeable physical symptoms. Ruptures are classified as either symptomatic, where physical changes occur, or “silent,” where the compromise goes unnoticed by the patient.
Recognizing the Signs of Rupture
Patients often suspect a complication when observing physical or aesthetic changes in the affected breast. A common indicator is a noticeable alteration in the breast’s shape or size, which occurs gradually as the gel slowly escapes the implant shell. This change is often accompanied by increased firmness or hardening of the breast tissue. The body’s reaction to silicone outside the implant can trigger capsular contracture, where the natural scar tissue around the implant tightens.
Developing new or worsening pain, tenderness, or swelling in the breast is another symptom requiring medical evaluation. The irritation caused by leaked silicone can lead to inflammation and discomfort, sometimes manifesting as a palpable lump or irregularity. Unlike saline implants, which deflate instantly when ruptured, silicone gel is thick and viscous, meaning the changes are subtle and progressive.
Understanding Silicone Migration
When the implant shell fails, the fate of the silicone gel is determined by the fibrous capsule, the scar tissue the body naturally forms around the implant. In an intracapsular rupture, the silicone gel leaks out of the shell but remains contained within this capsule. Because modern silicone gels are highly cohesive, the material holds its shape and viscosity even when the shell is compromised.
The more concerning scenario is an extracapsular rupture, which occurs when the leaked silicone breaches the fibrous capsule and moves into the surrounding breast tissue. Once outside the capsule, the free silicone triggers a localized inflammatory response, leading to the formation of silicone granulomas (small masses of tissue). The material can migrate further, traveling through the lymphatic system and potentially reaching the lymph nodes in the armpit. Even without a full rupture, “gel bleed” can occur, where microscopic amounts of silicone diffuse through an intact shell, potentially increasing the risk of capsular contracture.
Medical Confirmation of Rupture
Because many silicone implant failures are silent, specialized imaging is required to confirm the integrity of the shell. Magnetic Resonance Imaging (MRI) is the most sensitive and accurate method for evaluating the implant and diagnosing a rupture. During an MRI, an intracapsular rupture is frequently identified by the “linguine sign,” which appears as thin, wavy lines representing the collapsed implant shell floating within the silicone gel.
Ultrasound is another useful tool, often used for initial screening or when a patient presents with a palpable lump. On ultrasound, an intracapsular rupture can sometimes be identified by the “stepladder sign,” which shows horizontal echogenic lines inside the implant. When free silicone has migrated outside the capsule, the finding is described as the “snowstorm sign,” characterized by an area of incoherent posterior shadowing. Imaging confirmation is necessary to determine the precise location of the silicone and formulate an appropriate surgical plan.
Required Treatment and Removal Procedures
Once a silicone implant rupture is confirmed, surgical intervention is generally recommended to remove the compromised device and any leaked silicone. The standard procedure involves explantation, which is the removal of the ruptured implant. If the rupture is intracapsular, the surgeon removes the implant and meticulously cleans the pocket to remove any residual free silicone gel.
In most cases of silicone rupture, a capsulectomy is performed, involving the removal of the entire fibrous capsule that formed around the implant. This step is important in extracapsular ruptures, as the capsule and surrounding breast tissue may be infiltrated with migrated silicone. The complete removal of all free silicone is a primary goal to prevent chronic inflammation and the formation of granulomas. Following removal, the patient and surgeon discuss options for reconstruction, which may include replacing the implant, using alternative tissue-based reconstruction, or choosing not to replace the implant.