A saline implant that fails is obvious — the breast deflates over hours or days. A silicone implant is different: modern cohesive gel holds together, so a rupture often produces no symptoms at all and is found on imaging rather than felt.
A ruptured implant is not an emergency. It is a reason to be assessed properly rather than to panic or to wait indefinitely.
What you might notice
| Sign | What it suggests |
|---|---|
| Sudden deflation of one side | Saline implant failure |
| A change in shape or size, gradual | Possible silicone rupture with gel movement |
| New firmness or hardening | Often capsular contracture, which can accompany rupture. More here |
| A lump in the breast or armpit | Needs assessment; has several possible causes |
| New pain or tenderness | Worth investigating rather than watching |
| Sudden swelling with fluid | Must be assessed to exclude BIA-ALCL |
| Nothing at all | The commonest presentation of silicone rupture |
Silent rupture
Because cohesive gel does not run, a shell can fail while the implant keeps its shape and the breast looks and feels normal. This is called silent rupture. It is the reason surgeons talk about imaging rather than relying on symptoms, and the reason a very old implant with no symptoms is still worth a conversation.
How it is confirmed
Ultrasound is usually the first test and is widely available. MRI is more sensitive for silicone rupture and is used where ultrasound is inconclusive or where the question needs settling definitively. Mammography is a breast screening test rather than an implant integrity test, though it may raise the question.
Bring your implant cards to any appointment. They record the manufacturer, type and serial numbers and they make everything that follows simpler.
What happens next
A confirmed rupture is generally treated by removing the implant. What happens at the same operation is the decision:
- Removal and replacement with a new implant, often with the capsule addressed at the same time. Implant replacement.
- Removal without replacement, with or without a lift. Explant surgery.
- Removal with capsulectomy where the capsule is thickened, contracted or contains a mass. En bloc capsulectomy.
Where gel has escaped outside the capsule, more dissection is needed to clear it, and occasionally silicone that has tracked into surrounding tissue cannot be removed completely. Dr Kumar will tell you what was found rather than leaving you to assume.
Cost and Medicare
Item 45548 covers removal of a breast prosthesis as an independent procedure. Item 45551 covers removal with excision of at least half of the fibrous capsule, not with insertion of any prosthesis — — and is intended for capsular contracture, a mass within the capsule, or evidence of BIA-ALCL or other malignancy, with the capsule sent for histopathology.
and cover the surgeon’s fee only. The hospital, anaesthetist and any new implant are separate, and your fund is checked before you are quoted. More about costs.
Common questions
Is a ruptured implant dangerous? Cohesive silicone staying within the capsule is not regarded as an emergency. It should still be assessed and usually removed.
How long can I leave it? There is no fixed window, but leaving it indefinitely makes the eventual operation larger if gel escapes the capsule.
Will the other side be replaced too? Usually both are addressed, since they are the same age and matching matters.
Does rupture cause illness? There is no established link between rupture and systemic illness. Breast implant illness.
Should I be scanned if I have no symptoms? Whether asymptomatic women should be scanned at intervals is not settled in Australian practice. It is worth discussing rather than assuming. When implants need replacing.
Next step
If your breast has changed shape, hardened or swollen, have it assessed. Bring a GP referral — it is required to see Dr Kumar — with your implant cards and any imaging already done. Call 1300 267 726. More about implant removal and revision.
The initial consultation with Dr Kumar is $400, with a Medicare rebate of approximately $88 where you have a GP referral. Surgical fees are quoted individually after your consultation, in a written itemised quote.
All surgery carries risks, and individual results will vary. Read more about the risks of surgery here. A GP referral is required to see Dr Kumar.
Dr Rohit Kumar (MED0001630444) Registered medical practitioner, specialist plastic surgeon (specialist registration in surgery – plastic surgery).
