Contrary to popular belief, patients are rarely responsible for rupture of their implants.
Breast implants used in modern day breast augmentation procedures are silicone shells which contain either saline or silicone gel inside as a filler. Once these implants have been inserted into a patient, it is normal and natural to witness the formation of scar tissue around the surface of the implant shell, which can cause the implant to deform slightly. In turn, this deformity can cause the implant wall to develop a slight fold, which will create stress along the shell where the fold exists. Over time, and likely most of the time after many years, this stress on the silicone envelope can cause a crack to form, which as a result will weaken the structural integrity of the implant wall. Ultimately, this crack in the implant shell can extend all the way through the shell, resulting in rupture or deflation of the prosthesis.
Generally, when a saline breast implant ruptures, all of the fluid contained within it will start to leak out, causing the implant shell to collapse. Although there is such a thing as a slow leak, most saline deflate within 24-48 hours of the loss of integrity of its shell. As a result, the breast becomes significantly smaller, depending on the size of the implant. When a saline implant deflates, there is generally an obvious change in the size of the breast. Therefore, no special tests are necessary to diagnose a rupture of a saline implant.
Silicone Gel Ruptures
The rupture and the deflation process with a silicone implant are quite different to the saline version. Once ruptured, the gel contained within a silicone implant will gradually work its way out of the ruptured shell, but the majority of the gel will stay inside of the scar capsule around the implant. As a result, the size of the breast in such a patient may not change much and this can therefore make the diagnosis of the rupture more difficult. In order to correctly diagnose such an event, the FDA recommends that patients who have silicone implants undergo an MRI scan three years after their surgery and every two years after that.
While it is rare to sustain significant trauma to the breasts, substantial injury can certainly take place at the time of an automobile accident or a fall. In general, even with this type of injury, the breasts are generally subjected to more indirect impact as opposed to receiving the main brunt of the trauma. Even with direct trauma, breast implants surface shells are much more substantial than what the used to be and can sustain substantial trauma without loss of integrity. When saline implants were tested by my son in a science experiment, larger implants in the 300+ cc range could tolerate in the area of 175 pounds of pressure while smaller implants in the 200cc range could take up to 300 pounds of direct pressure before rupturing.