Intracapsular rupture

Intracapsular rupture - with capsule created by the body to wall off (silicone implant) foreign object
Extracapsular rupture - Single lumen silicone implants ruptured a few years before their removal in 2004Implants should not be expected to last a lifetime. When saline breast implants break, they often deflate quickly and can usually be easily removed. Silicone gel breast implants are more of a concern, because when they break they rarely deflate, and the silicone from the implant can leak and migrate outside of the scar tissue that the body creates around the implant. This is known as "extracapsular silicone." The health effects of extracapsular silicone are still being investigated. See Breast Implants Risks & Controversy

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Capsular Contracture
Capsules of tightly-woven collagen fibers naturally form around a foreign body (eg. breast implants, pacemakers, orthopedic joint prosthetics, etc..), tending to wall it off. Most of the time, these tissue capsules are soft-to-firm, and unnoticeable. Capsular contracture occurs when the capsule tightens and squeezes the implant. This contracture is a complication that can be painful and distort the appearance of the implanted breast. Bacterial contamination, gel implant rupture or leakage, and hematoma are the main identified factors in these complications. However, the exact mechanism of capsular contracture in most cases is never identified. Correction of capsular contracture ranges from surgical removal of the implant capsule tissue to removal (and possible replacement) of the implant itself. Capsular contracture may happen again after this additional surgery. There are four grades of capsular contracture, from soft to hard and painful.

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Hematoma/Seroma
Hematoma is a collection of blood inside a body cavity and a seroma is a collection of the watery portion of the blood around the implant or around healing. A small scar can form or a rupture may occur if the implant is damaged during draining the incision. Post-operative hematoma and seroma may contribute to infection or capsular contracture.

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Changes in Nipple and Breast Sensation
Feeling in the nipple and breast can increase or decrease after implant surgery. The range of changes varies from intense to no feeling in the nipple or breast after surgery. Changes in feeling can be temporary or permanent and may affect sexual response or the ability to nurse a baby.

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Extrusion
Unstable or weakened tissue covering and/or interruption of wound healing may result in extrusion, (when the breast implant comes through the skin). Surgery needed to correct this can result in unacceptable scarring or breast tissue loss.

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Necrosis
Necrosis, the death of tissue around the implant, may prevent wound healing and require surgical correction and/or implant removal. A permanent scar may form.

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Tissue Atrophy/Chest Wall Deformity
Pressure of the breast implant may cause the breast tissue to thin and shrink. This can occur while implants are still in place or following implant removal without replacement.

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Mammography
Compression on the breast during mammography can cause implant rupture. Breast implants may require additional displacement images to be taken. In addition to making tumors more difficult to detect, implants cause "false positive" results as well when extensive scarring and calcium deposits mimic the appearance of cancer, making the deposits difficult to distinguish from tumors on a mammogram.[20] Biopsy may be necessary to determine whether these are cancerous.

Specific mammogram techniques have been developed to ensure that as much breast tissue as possible is examined in the woman with implants. This requires taking extra images, called displacement views, which expose the woman to more radiation. In 2004, Miglioretti and her colleagues published a study in the Journal of the American Medical Association indicating that 55% of breast tumors were not initially detected on mammograms for women with implants, although the extra images were used.[21] This compares to about 30% of tumors that were not initially detected for women who did not have breast implants. These tumors were subsequently detected in later mammograms. Another problem is that calcium deposits can be seen on mammograms and can be mistaken for possible cancer, resulting in additional surgery to biopsy or remove the implant to distinguish these deposits from cancer. Calcium deposits may be felt as modules or bumps under the skin around the implant. The displacement views do not protect against rupture, which becomes a greater problem as implants age. Dr. Lori Brown, an FDA scientist, published an article in 2004 in the Journal of Women's Health, indicating that the FDA has received dozens of reports of implants rupturing or leaking during mammography.[22] Sonograms and MRIs can be used to detect breast cancer instead of mammograms, but this adds to the cost of screening and may not be covered by health insurance.[17]