Following breast augmentation, patients who have silicone implants often wonder about the likelihood of rupture of their implant. Modern implants, such as "memory gel" implants, are described by one manufacturer as being of a "gummy bear" consistency and suggest that since this resembles a solid, leakage is much less of a risk.
The most important factor patients with older implants should consider is the age of the implant. The older the implant the more likely it is to leak. Some studies suggest that after ten years 4 out of 5 implants may leak or "bleed". The medical significance of this is unclear.
If an implant appears ruptured then it should be replaced. This is not an emergency and can be arranged at a convenient time for the patient. There is no evidence it will cause long term health problems. Any free silicone is usually contained by the capsule around the breast implant.
If silicone is suspected in the lymph nodes it is not usually necessary to remove them but it is worth having it checked to exclude some other cause for an enlarged lymph gland. It is likely that most people have molecules of silicone in a lymph node somewhere in their body. Injection needles are lubricated with silicone so after most medical injections or IVs some silicone can stay in the body or blood. This is usually filtered through the lymphatics to the lymph nodes.
All implants shed molecules from their surface and this may be found in the layer of scar - capsule- around the implant. It has not been shown to have any medical significance.
Surprisingly, trauma (including mammography) is a rare cause of implant rupture. Any association with closed capsulotomy is not clear.
Most ruptures are silent - there are no symptoms - and there is no perfect test to detect a ruptured implant, but MRI scans may be the most reliable. Unfortunately false positive studies, sometimes show rupture in an implant that is really intact.
Whether or not the implant is placed above or below the pectoral muscle is not related to the rupture rate.
Even if the implant leaks it does not mean that it is harmful to the patient's health.
Because of the cohesive nature of the gel a break in the outer envelope may have little significance. Only further studies and time will tell, but at this point it seems unlikely.
If an implant were damaged and a part broke away it is likely that this piece would then be contained within a new layer of scar tissue or capsule . In other words the concern that pieces of the implant might break off and enter the circulation going to distant areas in the body are unfounded.
Over the last few years, studies have not shown an association between silicone breast implants and auto-immune diseases, such as rheumatoid arthritis.