Because all modern silicone implants are filled with a fairly thick silicone gel, leakage or rupture of a silicone implant is not always obvious. Generally, a rupture will cause capsular contracture; however, this is certainly not always the case and there is a phenomenon called a “silent rupture,” which is a fairly rare occurrence. In such a case, the only way to diagnose the rupture is with an MRI or very high quality ultrasound. When a silicone rupture is caused by a violent event such as falling off a horse, there can be a visible deformity caused by a change in shape of the implant and silicone breaking through the capsule of tissue which surrounds the implant. Unlike saline implants, which are simple to replace, silicone ruptures require the removal of the gel which has leaked, as well as treating the surrounding capsular tissue if a contracture has also occurred. It is for these reasons that silicone ruptures are almost always treated via a scar under the breast (inframammary).
During the period in the early 1990s when there was a true “scare” in the country surrounding ruptured silicone implants, Dr. Rapaport was an assistant professor at the University of South Florida. A rheumatologist there was very prominent in promoting this scare, and wrote a book claiming that silicone implants cause a variety of problems ranging from depression to lupus. As a result, Dr. Rapaport saw and treated hundreds of patients with implant removal and total capsulectomy. Fortunately, it has now become clear that although ruptured silicone implants create a local cosmetic problem, they DO NOT pose any threat to overall health. The FDA has made it quite clear that there is no evidence of a cause and effect relationship between silicone and any diseases outside the breast.
It is obvious but worth reiterating that the best way to avoid breast implant revision is to have the original surgery performed by a physician who is expert in the field and possesses a large body of experience in breast implant surgery.