Deflation & Rupture

Disruption of the Implant Shell

On this page, Dr. Loftus explains the difference between deflation and rupture, how to prevent them, how to detect them, and how to treat them.

Saline and silicone breast implants both have a shell made of solid silicone. This shell is soft and pliable, but it may also tear. When there is a problem with the shell, deflation or rupture of the breast implant may occur. When a saline breast implant shell tears, it is called a deflation, because the enclosed saline leaks out and is absorbed by the body, resulting in marked shrinkage of the breast. When the silicone breast implant shell tears, it is called a rupture. The enclosed silicone gel might extrude to varying degrees, but the breast does not usually change in size. A ruptured breast implant is usually noticed only upon occurrence of a capsular contracture. Once again, saline implants deflate, whereas silicone implants rupture.

Risk of Deflation and Rupture

The risk of saline implant deflation and silicone implant rupture are similar. It is about 4% during the first year and about 1% each year for every year thereafter, which makes them roughly equivalent during that time frame. Rates thereafter have not yet been determined, but studies are underway.

Fill Volume

Saline deflation may be reduced by overfilling the breast implant to the manufacturer’s recommended specifications. Yes, you read that right: overfilling reduces deflation. This is because deflation results from repeated folding of the implant shell. Underfilled breast implants tend to fold more often. An implant shell that has folded hundreds or thousands of times may weaken and tear—not unlike a piece of paper which is folded multiple times along the same crease. There is no advantage to having minimum fill volumes.

Overfilling does not apply to silicone gel breast implants, as they are always pre-filled to their optimal volume by the manufacturer.

Saline Implant Deflations

If your saline breast implant deflates, chances are that it will be obvious and almost immediate. When a deflation occurs, the breast typically shrinks over hours. One patient of Dr. Loftus reported having symmetrical breasts when she got in the bathtub, but noticed obvious shrinkage by the time she got out. It is possible, although unlikely, to have a slow deflation (over weeks or months) or to have a partial deflation such that the breasts appear only slightly asymmetrical. In general, these are rare occurrences, and such asymmetries are more likely due to change in implant position, change in weight, or change in perception.

Silicone Implant Ruptures

If silicone breast implants rupture, the silicone gel may extrude and cause a capsular contracture which is usually the first and only sign of a rupture. However, not all ruptures lead to capsular contractures, which is why women with silicone gel implants are encouraged to consider an MRI scan every two years (following the third year after the implant was placed). Unfortunately, MRI scans are only about 90% accurate in identifying ruptures, so a negative scan does not necessarily mean your implant is intact; nor does a positive scan (one showing a rupture) necessarily mean that you truly have a rupture. For this reason, many women choose to forego MRI scans unless or until they notice problems.

Treatment of Deflations and Ruptures

If deflation or rupture of your breast implant occurs, treatment options are available. Saline breast implant deflations require surgery for placement of a new implant. Silicone breast implant ruptures require replacement in addition to capsulectomy, which is surgical removal of the surrounding scar tissue.

If I Treat My Breasts Delicately, Can I Prevent Deflation or Rupture?

Intuitively, it makes sense that doing so might help prevent deflation or rupture, but it does not. You should treat your breasts the same as un-implanted breasts. Do not be guarded or concerned about your significant other handling your breasts. Also, mammograms do not cause deflation or rupture, so you should not defer annual mammography (recommended for all women over 40).

Women frequently ask if implants need to be replaced after a certain period of time. There are even some rumors out there about needing new implants after ten years. Find out the truth in our breast blog, do I need new implants in ten years?