What are the clinical signs of a breast implant rupture?

Clinical Signs of Breast Implant Rupture

Breast implant rupture presents with distinct imaging findings, with extracapsular ruptures often showing visible changes while intracapsular ruptures are frequently asymptomatic and require specialized imaging for detection. 1

Types of Implant Rupture

Intracapsular Rupture

• Definition: Implant shell breaks but silicone remains contained within the fibrous capsule
• Clinical presentation:
  • Often asymptomatic (most common type of rupture)
  • May have no visible or palpable changes
• Imaging findings:
  • MRI: "Linguini" or "wavy-line" sign (most specific sign) 2, 1
  • Other MRI signs: "Inverted-loop sign," "keyhole sign," "teardrop sign," and "hang noose sign" 2
  • Ultrasound: "Step-ladder" appearance of collapsed implant shell, though findings can be equivocal 2

Extracapsular Rupture

• Definition: Both implant shell and fibrous capsule are disrupted, allowing silicone to leak into surrounding tissues
• Clinical presentation:
  • More likely to be symptomatic
  • May present with palpable masses, breast lumps, or changes in breast contour/shape
  • Capsular contracture may develop
• Imaging findings:
  • Mammography/DBT: High-density material outside the implant shell 2
  • Ultrasound: Classic "snowstorm" pattern (highly echogenic pattern with scattered and reverberating echoes, well-defined anterior margin, loss of detail posteriorly) 2, 1

Diagnostic Imaging Modalities

MRI (Gold Standard)

• Highest sensitivity (87-96%) and specificity (89.9-97%) for detecting implant rupture 2, 1
• Particularly valuable for detecting intracapsular ruptures that are missed by other modalities
• MRI without contrast is preferred (contrast is not indicated for implant evaluation) 2

Ultrasound

• Operator-dependent with variable accuracy
• Can detect extracapsular rupture with high specificity
• For intracapsular rupture: reported accuracy ranges from 72-94%, sensitivity 30-98%, specificity 77-89% 2, 1
• Mimics of rupture include: reverberation artifact, normal radial folds, and silicone implant impurities 2

Mammography/Digital Breast Tomosynthesis (DBT)

• Can identify extracapsular silicone as high-density material outside implant shell
• Cannot reliably detect intracapsular rupture 2
• Both standard views and implant-displaced views should be obtained

Important Clinical Considerations

Diagnostic Pitfalls

• Normal implant folds can be mistaken for rupture on ultrasound 2
• Clinical examination alone is unreliable for detecting implant rupture 2, 1
• Residual silicone from previous implants can mimic new rupture - comparison with prior studies is critical 2

Natural History

• Most untreated ruptures remain stable over time
• Only about 11% show progression of silicone seepage 3
• Progression can include:
  • Conversion from intracapsular to extracapsular rupture
  • Progression of extracapsular silicone spread
  • Increasing herniation of silicone within the fibrous capsule 3

Risk Factors for Rupture

• Iatrogenic damage during placement is the most common cause 4
• Mechanical irritation by bony protrusions 5
• Implant age (risk increases after 6-8 years) 6
• Trauma

Management Implications

• Symptomatic patients with ruptured implants should be offered explantation and capsulectomy with or without replacement 6
• FDA recommends screening with MRI or ultrasound at 5-6 years post-implantation and every 2-3 years thereafter for asymptomatic patients 2
• Women with untreated implant ruptures report increased nonspecific breast changes compared to women without ruptures 3

By understanding these clinical signs and imaging findings, clinicians can appropriately diagnose and manage breast implant ruptures to optimize patient outcomes.