A 50-year-old female was referred to the X-ray department with a complaints of slowly growing mass in the lower outer quadrant of her left breast and a sudden strong pain with change in the breast size and shape.

Her past medical history reported an augmentation mammoplasty silicone breast implant 15 years ago. Physical examination showed a localized swelling in the lower outer quadrant of the left breast, with a presence of palpable mass given a high significant of breast implant rupture. Rest of physical examination were normal. A non-contrast magnetic resonance imaging (MRI) revealed a left side breast implant rupture (Figure 1).

Breast implants composed of silicone gel enveloped in a silicone rubber elastomer were introduced in 1963. The frequency of rupture of silicone-gel-filled breast prostheses is unknown, as are the associated health effects. [1] Brown SL et al. reported that on MRI, the prevalence of silicone gel implant rupture in a population-based study of 344 women in Birmingham, Alabama, was 55% and that 22% of ruptured implants showed extracapsular spread of silicon. [2] In 2003, Lisbet et al. reported 33 definite ruptures (10%) and 23 possible ruptures (7%) during a 2-year period. The overall rupture incidence rate for definite ruptures was 5.3 ruptures/100 implants per year. [3]

Rupture of silicone breast implants is caused by stress on the implant at the time of surgical placement, trauma, defects in manufacture, long-term repetitive stresses such as exercise, mammographic compression, and long-term detenionation of the implant. [4]

The risk of implant rupture increases with implant age. A minimum of 15% of modern implants can be expected to rupture between the third and tenth year after implantation [3].

The diagnosis is difficult to make on the basis of clinical findings on findings on film-screen mammograms. Hence, the value of other imaging techniques such as sonography, computerized tomography (CT) scan, and MRI needs to be studied. [4] The performance of MRI is superior to that of mammography, sonography and CT scan in depicting the rupture. [5]

MRI is the most accurate imaging examination for the evaluation of silicone gel breast implant SGBI rupture. [6] High-resolution MRI is needed to depict internal structure of implants accurately. High resolution can best be achieved through use of a dual shoulder coil or a dedicated breast coil. MRI done in a body coil does not provide sufficiently detailed information. [1]

Regardless the high costs of MRI scans and possible unavailability, MRI is the best radiological method in detecting breast implant rupture.

1. Brown SL, Barbara G Silverman, Wendie A Berg. Rupture of silicone-gel breast implants: causes, sequel, and diagnosis. Lancet 1997;350:1531–7.   [CrossRef]   [Pubmed]    
2. Brown SL, Middleton MS, Berg WA, Soo MS, Pennello G. Prevalence of rupture of silicone gel breast implants revealed on MR imaging in a population of women in Birmingham, Alabama. AJR 2000;175:1057–64.   [Pubmed]    
3. Lisbet R Holmich, Søren Friis, et al. Incidence of Silicone Breast Implants Rupture. Arch Surg 2003;138:801–6.   [CrossRef]   [Pubmed]    
4. Lenone I Evenson, Helena Parantainen, Tone Detlie, et al. Diagnosis of breast implant rupture: imaging findings and relative efficacies of imaging techniques. AJR 1994;163:57–60.   [Pubmed]    
5. Wendie A Berg, Thuy Khanh Nguyen, Michael S Middleton, Mary Scott Soo, Gene Pennello, S Lori Brown. MR Imaging of Extracapsular Silicone from Breast Implants: Diagnostic Pitfalls. AJR Am J Roentgenol 2002 Feb;178(2):465–72.   [Pubmed]    
6. Middleton MS, McNamara MP Jr. Breast implant classification with MR imaging correlation: (CME available on RSNA link). Radiographics 2000 May;20(3):E1.   [Pubmed]