Implant rupture: risks, causes and implant replacement in breast implants

An implant rupture – that is, a tear in the shell of a breast implant – is one of the potential long-term complications following breast augmentation or reconstruction. Although modern implants, as medical devices, are very durable, the risk of rupture – particularly with older implants – cannot be entirely ruled out.

This article explains what an implant rupture is, what might cause it, how it manifests itself, and when an implant replacement or other surgical procedure becomes necessary. Regular check-ups are essential for every patient with breast implants.

What is an implant rupture in the case of breast implants?

An implant rupture is a defect or tear in the outer shell of a breast implant, a medical device. This can cause the contents – usually silicone gel or saline solution – to leak out. A distinction is often made between two main types of this complication:

Intracapsular rupture: The implant shell has ruptured, but the silicone gel remains within the body’s own capsule (fibrous capsule) that forms around every implant. This is the more common type of rupture with silicone implants.

Extracapsular rupture: Both the implant shell and the tissue capsule have ruptured. Silicone gel may leak into the surrounding breast tissue. With saline implants, any rupture leads to the leakage of fluid, which is absorbed by the body, resulting in a visible loss of volume. This may result in deformation of the breast.

A „silent rupture“ is often asymptomatic, particularly in the case of intracapsular silicone implant ruptures.

Possible causes: A risk associated with breast implants

Various factors can lead to implant rupture, which is a known risk associated with breast implants:

Material fatigue/ageing: Breast implants have a limited lifespan; the material can degrade over the years. The incidence of implant rupture increases as the implants age.

Trauma: Severe external impact (e.g. an accident) on the breast tissue.

Mechanical stress: Rarely due to severe compression or damage during surgery (iatrogenic injury caused by the surgeon).

Capsular fibrosis: Severe pressure caused by a hardened fibrous capsule (a form of capsular fibrosis) can damage the implant.

Manufacturing defects: Rare, but possible with any medical device.

Symptoms: Signs of a complication such as a rupture

The symptoms of an implant rupture can vary depending on the nature of the rupture and the type of implant, and may indicate a serious complication:

Silicone implants (silent rupture): Often there are no symptoms, or only subtle ones. There may be slight deformation of the breast or a change in how it feels to the touch.

Silicone implants (symptomatic/extracapsular rupture): Changes in the shape or size of the implant, pain, swelling, hardening or the formation of lumps (silicone granulomas) in the breast tissue, and breast asymmetry. These breast deformities are often clinically significant.

Salt implants: Usually a rapid, visible loss of volume in the affected breast.

Any new symptoms or changes in the breast should be investigated by a surgeon. It is important to realise that not every rupture necessarily leads to serious health problems straight away, but a medical assessment is essential.

Diagnosis: Detection of implant rupture through examination

Following a physical examination by the surgeon, imaging techniques are used as part of a follow-up examination to confirm the diagnosis of an implant rupture:

Ultrasound (sonography): It can often provide the first indications of a rupture or free silicone in the breast tissue.

Magnetic Resonance Imaging (MRI): It is regarded as the gold standard for diagnosing silicone implant ruptures, particularly silent ruptures, as it can provide a highly detailed picture of the condition of the implant.

Mammography: Of limited value for diagnosing a rupture.

The doctor decides which procedure is most suitable for the patient.

The need for surgery and implant replacement

If an implant rupture is diagnosed, surgery is usually required. The standard treatment is the removal of the implant (explantation). The tissue capsule is also often removed (capsulotomy), particularly if capsular fibrosis is present or silicone has leaked. This replacement or removal of the implant is referred to as an implant replacement or explantation.

Depending on the patient’s wishes and the medical indication, a new implant may be inserted at the same time (implant replacement) or another form of breast surgery (e.g. a lift) may be performed. The surgical treatment is planned on a case-by-case basis. Sometimes this procedure becomes necessary due to a complication such as severe capsular fibrosis or an infection, not just in the event of a rupture.

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Prevention, aftercare and the role of capsular fibrosis

There is no way to completely prevent implant rupture. However, regular follow-up examinations with a specialist are important. Routine check-ups (e.g. ultrasound, or MRI if necessary) are often recommended, even in the absence of symptoms, to monitor the condition of the breast implants and detect silent implant ruptures at an early stage. Good aftercare can also help to manage the risk of severe capsular fibrosis, which in turn can pose a risk of rupture. It is important that women with implants are informed about potential risks, such as the rare breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), although this is a different complication from mechanical rupture.

Important: This article is intended to provide initial information only and is no substitute for a consultation with a doctor. If you suspect an implant rupture, capsular fibrosis or any other complications relating to your breast implants, please consult a specialist in plastic, aesthetic and reconstructive surgery.

FAQ – Frequently asked questions about implant rupture