Breast implants are devices that sometimes fail. Failure rates are exceedingly low because of recent improvement in materials and designs. The rate of rupture among breast implants ranges from one to five percent over ten years. Think about how often a person must replace a DVD player over the course of ten years. Realize that a one to five percent rupture rate is very low. When a saline implant ruptures, the body simply absorbs the leaking saltwater. The scar tissue surrounding the implant usually holds any silicone gel material that leaks out of an implant, which is an intracapsular rupture. In rare cases, particularly after a longstanding ruptured silicone implant, the gel may slowly reach beyond the capsule layer and make its way into the breast tissue itself and beyond in an extracapsular rupture and gel migration. Migrated silicone gel is difficult or impossible to remove. The ruptured silicone causes increased inflammation around the implant leading to firmness of the implant and the breast. An implant can rupture due to injury, trauma, during a mammography, failure of the implant shell, or from no identifiable cause at all. Since the body cannot absorb silicone, doctors do not immediately identify a ruptured silicone breast. Eventually the implant changes shape and the body reacts to the silicone as a foreign, thereby alerting doctors that something is wrong. Surgeons cannot repair damaged or broken implants. According to the FDA, ruptured or damaged implants require replacement or removal. Breast implants can wear out; manufacturers do not guarantee implants to last a lifetime and patients will need to undergo future surgery to replace or remove one or both implants. Surgeons can easily diagnose when a saline implant fails because the breast will simply deflate over a period of one to seven days. Doctors have a harder time diagnosing a ruptured silicone implant. If a patient has an implant that is over 10 years old and is from the generation before cohesive implants, doctors can mostly accurately determine the condition of a silicone implant by having the patient undergo an MRI (magnetic resonance imaging). A "linguini sign" or an image that reveals an implant shell free floating in a capsule of ruptured silicone, indicates a rupture. Yet MRIs may not be 100 percent accurate in diagnosing implant integrity, particularly in modern "cohesive" implants, which do not leak liquid silicone as quickly or heavily. High clinical suspicion and images from the MRI help doctors to determine whether or not to remove an implant. The FDA recommends regular screening and MRI examinations. Specifically, doctors advise patients to undergo serial MRI examinations, starting at three years after surgery and then every two years thereafter.

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