Breast Implant Rupture: Then vs. Now

“Rupture” isn’t a word anyone wants to hear when it comes to breast implants. But, the experience and the treatment have changed dramatically over the years. Thanks to modern implant technology and materials, breast implant rupture is less of a hassle, has less clean-up and is less painful.

What is a breast implant rupture?

When the outer shell of a breast implant is pierced, a rupture has occurred. Implants are not meant to be lifetime devices, so rupture isn’t exactly uncommon. There are no associated systemic risks with ruptures, either. Rupture rates vary from somewhere between 1.1 and 17.7 percent, with fair consistency among brands and types. The exception to this rule, Mentor implants, have a rupture rate of 24 percent at 10 years.

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“Implants are designed to last between 10-15 years, after which they have an increasing risk for rupture,” explains Wichita, KS plastic surgeon Amy Sprole, MD. “The FDA recommends receiving a baseline ultrasound five years after placement, and again at 10 years. After that, you’re recommended to get [a] yearly ultrasound or MRI surveillance of implants.”

Diagnostic ultrasounds are an easy way to determine breast implant integrity, often performed as a simple screening during annual check-ups. Non-invasive and inexpensive, ultrasounds can also detect other potential issues, such as calcification or the presence of fluids.

Rupture 101

When an implant ruptures, what happens to it depends on what’s inside the implant.

“For saline implants, patients might notice an immediate or very quick decrease in size of the breast with the ruptured implant as the body absorbs the saline water,” notes New York plastic surgeon, David Shafer, MD. “For silicone implants, patients may notice a change in the shape or less firmness of their breast.”

And for modern, cohesive gel implants, you may not notice a rupture at all.

“These implants are a lot like frozen honey, where the material retains its shape and sticks to itself,” says McMurray, PA plastic surgeon Simone V. Pautler, MD. “So you may not be able to tell a rupture has occurred with the naked eye.”

Ruptures are not emergencies, but experts recommend removal and replacement as soon as a patient can. If a patient is pregnant, for example, there is no risk associated with waiting for surgery.

What happened in the past during a rupture?

“Patients with older-generation implants that contain the more liquid silicone gel are at risk for extracapsular spread of the gel if the implant has ruptured,” says Mark Jewell, M.D. Board-certified plastic surgeon Eugene, Oregon.

And this spread has to be cleaned-out surgically.

“Twenty years ago, implants were commonly hard-shell silicone with a liquid silicone interior,” explains Tuscon, AZ plastic surgeon Raman C. Mahabir, MD. “Imagine honey leaking out into the body…it’s sticky and it gets everywhere, including the instruments. It was nearly impossible to remove it all.”

While silicone itself doesn’t present direct harm to the body, being unable to clean all of it after a rupture was an issue. The leaking silicone often prompted a painful response: capsular contracture.

“Capsular contracture involves the formation of excess scar tissue around the implant,” explains Grand Rapids, MI plastic surgeon Bradley Bengtson, MD. “It’s not a matter of the body rejecting the implant, but rather the body’s response to the implant, creating a barrier around it.”

“The leak itself wasn’t painful,” Dr. Mahabir notes. “But the body’s reaction to it certainly was.”

What happens when modern breast implants rupture?

Modern implants, made of cohesive gels, are designed to stay together during a rupture.

“‘Cohesive’ refers to the gel used in silicone implants,” explains Chicago plastic surgeon Michael Horn, MD. “A cohesive gel implant maintains its shape even if the outer shell is damaged. This type of implant is often referred to as a ‘gummy bear’ implant, highlighting its durability and ability to mimic natural breast tissue.”

“Because a true gummy bear implant retains its shape, you’re also less likely to form capsular contracture as a response to a rupture,” Dr. Mahabir adds. “That lack of scarring is another reason why it can be hard to know an implant rupture has occurred.”

These are called silent ruptures.

“Silent rupture would be when there is no underlying cause identified or clinical signs,” says Dr. Shafer. “An example would be a patient that goes for their mammogram or ultrasound and unexpectedly is told that their implant appears ruptured.”

“It isn’t at all surprising when a patient has had a rupture for quite some time, sometimes even as long as several decades,” says Dr. Pautler.

What is the implant removal process?

When an implant ruptures, your surgeon will likely suggest a removal and replacement. Options like Natrelle®, the #1 surgeon-selected and the most requested implant brand in the U.S., are designed to retain its shape and are wrapped in a protective, medical-grade silicone shell made to last.

“The more cohesive an implant, the easier it is to remove because the silicone is not as messy,” Dr. Shafer explains. “The older and less cohesive implants are more like cleaning up spilled syrup or glue.”

“A true gummy bear implant is night and day to this experience,” Dr. Mahabir says. “You can essentially just reach in and take it out in one move, and then wipe it clean. And the cleaner and easier it is to remove, the less likely you are to have complications.”