When a saline filled breast implant loses its integrity, all of the salt water eventually escapes and is gradually absorbed into the vascular system to be eliminated through the kidneys. As a result, once the implant is completely deflated, the breast loses all volume related to the implant and its size diminishes significantly. Therefore, no special tests or x-rays are required to diagnose a ruptured saline breast implant. It is generally very obvious because that breast becomes considerably smaller than the other breast in a short period of time.
Silicone gel breast implants are a different story. When a silicone gel breast implant ruptures, the gel leaks from the disrupted shell much more slowly than salt water from a saline implant. Because of the viscosity of silicone, the overwhelming majority of the silicone stays inside the scar capsule which formed around the implant soon after it was inserted. As a result, there is typically very little change size of the breast, if any at all. In fact, it can be difficult to diagnose a ruptured silicone breast implant because there is generally no change in the size of the breast and the shape may not change much either. CT scans, ultrasounds and mammograms are notoriously bad at determining implant deflations. At this time, an MRI is the best diagnostic test to detect a rupture. The FDA recommends that patients with silicone breast implants have an MRI three years after the insertion of their implants and every two years after that to detect ruptures. For patients who have silicone implants for breast reconstruction, the cost may be covered by their insurance; otherwise it is an out of pocket expense. Unfortunately, MRI's are not perfect tests and can miss a deflation as well as falsely report than an intact has ruptured.
Replacing a saline implant is a relatively simple process and can often be done in an office OR as a relatively minor procedure if it is a smooth implant. Textured implants that have tissue ingrowth into the shell can be much more difficult to remove and generally require more anesthesia than just local infiltration with mild sedation. Ruptured silicone implants are also more difficult to remove, as the gel must be vigorously cleaned out of the pocket, which also typically requires more anesthesia.
What To Do
Deflation of a breast implant, although concerning, is not a medical emergency. I inform all patients when they first get their implants that they should expect to have to replace one or both of their breast implants at some time in their life. If you feel that you have a ruptured implant, simply call your surgeon for an evaluation and the office staff can get the ball rolling towards having it replaced. Remember that all current implant manufactures provide warranties against implant deflation and will provide a free replacement implant in addition to financial assistance if the implant ruptured within one decade of the placement. In addition, some of their warranties also provide a free contralateral implant in the event that you want to change implant size at the time of replacing a ruptured prosthesis.