"Silent" break
Breasts look and feel as before; the gap is found only on MRI or ultrasound.
CONDITION / BREAST
Rupture and displacement of the breast implant.
Breast implant replacement or removal is needed when the implant has ruptured, shifted, or turned, as well as for some other complications. Rupture of a silicone implant is mostly "silent": it is found on MRI or ultrasound, not by touch. Such operations are also performed when the implants were placed in another clinic.
CONCEPTUAL VISUALIZATION- What it is
- Rupture of the implant shell, displacement of the implant from its place or rotation of the anatomical implant.
- When it becomes more frequent
- According to manufacturer studies, ruptures are very rare at first and become more common after 6-8 years with the implant.
- How to find
- Rupture of a silicone implant usually has no symptoms. MRI detects it most accurately, ultrasound is an acceptable alternative.
- Separately
- BIA-ALCL is a rare lymphoma near the implant. The most common symptom is fluid around the implant and breast enlargement years after surgery.
01 / WHAT IS ITWhat happens
What happens
with an implant.
Breast implants are not permanent. According to the NHS, they will most likely need to be replaced at some point; some women need repeat surgery after about 10 years — because of a problem with the implant or because the breasts themselves have changed.
A rupture is a break or hole in the implant shell. When the saline implant ruptures, the solution is safely absorbed into the tissue and the breast is reduced immediately or in a few days. The silicone gel usually remains inside the scar capsule around the implant, and the rupture itself usually does not manifest itself in any way - it is called "silent".
Displacement — when the implant is out of place: higher, lower, or sideways. Rotation is when the anatomic (teardrop) implant turns inside the breast and the shape becomes incorrect.
Separate from rupture, there is a rare lymphoma associated with implants, BIA-ALCL. This is not breast cancer, but a tumor of cells of the immune system; it is found in the fluid or capsule around the implant.
If the implants were placed in another clinic, this is not an obstacle: the doctor evaluates what is available now and makes a plan.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSWhat can
What can
to alert
Rupture of a silicone implant often does not reveal itself. But sometimes there are changes that should be shown to the surgeon.
Changes after a breakup
Breasts have shrunk or changed shape, hard nodules, asymmetry, pain, tingling, swelling, numbness or burning.
Saline implant "exploded"
Breasts decrease immediately or within a few days, the implant loses its shape.
Breasts have hardened
Rupture may be accompanied by sealing of the capsule around the implant.
Capsular contractureDisplacement or rotation
The implant has noticeably shifted, the shape of the breast has become irregular or asymmetrical.
Late breast enlargement
Years after the operation, one breast, sometimes both, will become noticeably larger or firmer within a few weeks. There is often no pain.
03 / REASONSWhy is it tearing?
Why is it tearing?
whether the implant is dislodged.
Often there are several reasons. Here are the ones called by the FDA and the studies.
Damage during surgery
Based on a review of manufacturers' data, the most common cause of rupture is damage to the implant by tools during placement.
Age of the implant
The longer the implant is in place, the more likely it is to break: the shell ages over time.
Trauma and pressure
Impact, strong pressure on the breast, as well as punctures or biopsies of the breast can damage the membrane.
Contracture
A sealed capsule can cause rupture, and rupture is associated with contracture: in a study of 105 women with one ruptured implant, contracture occurred in 50% of ruptured breasts and 24% of intact breasts. The relationship was observed only for implants with a less dense (low cohesive) gel.
What displaces the implant
The implant can dislodge under its own weight, after trauma, or due to contracture.
Two-stage reconstruction
In a retrospective study of 1134 women, the anatomical implant returned in 11% after two-stage reconstruction (with an expander) and in 5% after one-stage reconstruction.
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
Rupture, displacement or rotation of the implant are planned situations: they usually do not require emergency care. Do not delay signs of complications after surgery and late breast enlargement years after it.
103 immediately if:
- it suddenly became difficult to breathe;
- pain in the chest or upper back;
- the heart beats very often;
- the person fainted;
- very frequent breathing;
- confusion or slurred speech;
- bluish, pale or mottled skin;
- very high or very low temperature, chills or shivering;
- a rash that does not go away when pressed.
When to the surgeon:
Immediately - to the surgeon who operated; if it is not possible to contact - to the reception department: after surgery, severe pain or increasing pain; in the first days after the operation, the breasts increase rapidly, become tense and painful. On the same day: to the surgeon who operated, or if this is not possible, to any surgeon, if in the first weeks after the operation there is a burning sensation, unusual swelling of the breast or a change in the color of the skin; the wound is reddened, pus flows from it, the stitches have come apart, or the implant is visible through the skin. Likewise, on the same day, see a doctor (family or in the reception department) if one leg (usually the calf) or arm hurts and is swollen, or you cough up blood: these may be signs of a blood clot. In the coming days: if a year or more after the operation, one or both breasts have noticeably increased in a few weeks, compaction or swelling around the implant has appeared - contact the surgeon who placed the implants or another plastic surgeon: such changes must be examined. Likewise, do not delay if your breasts have suddenly shrunk, changed their shape, or have hard lumps. Planned: "silent" rupture found on MRI or ultrasound, displacement, rotation or desire to replace old implants.
05 / DIAGNOSTICSHow they check
How they check
implant
- Documents
When the implants were placed, the manufacturer and model - from the implant card or statement. These data should be stored all the time while the implants are in place.
- Review
The surgeon evaluates the shape, symmetry, density of the breast and the position of the implant. But you can't find a "quiet" gap to the touch.
- ultrasound
In a meta-analysis of 20 studies (1987 patients), ultrasound detected 73.7% of ruptures, and whole implants were correctly recognized as whole in 87.8% of cases.
- MRI
According to the FDA, the most accurate way to find a "silent" rupture is a silicone implant. However, in most studies, MRIs were performed on women already with complaints, so the accuracy of a routine check-up may be lower.
- Liquid analysis
If fluid appears around the implant years after surgery, it is taken under ultrasound guidance and investigated to rule out BIA-ALCL.
06 / TREATMENTHow we treat
How we treat
and what they decide.
The main question is whether to replace the implants, remove them without replacement or observe for the time being, and whether to remove the capsule together with them. The answer depends on what happened, on complaints and wishes.
01
Gap
- Salt implant
- The solution is safely absorbed; a "bloated" implant is removed and, if desired, a new one is placed.
- Silicone implant
- According to the NHS, a ruptured implant will have to be removed. In a review of manufacturers' data, women with complaints are offered a choice: observation or removal of the implant with a capsule — with or without a new implant. The surgeon decides when to operate.
- Gel outside the capsule
- If the gel has gone beyond the capsule into the breast tissue, it can be difficult to remove it.
02
Shift and rotation
- Repeat operation
- The surgeon opens the incision and moves the implant into place, if necessary, the implant is changed. In a study of 1,134 women after reconstruction, reoperation corrected 62 of 85 rotations (73%).
- Texture does not guarantee
- In a meta-analysis of 9 studies, displacement occurred in 5.2% of breasts with textured implants and 8.9% with smooth implants, but no statistically significant difference was found.
03
Replacement or deletion
- Only the implant
- The implant is removed, and the capsule is left. It is a smaller operation with less risk of bleeding. Removal of the capsule gives more complications, and damage from the capsule left after removal of implants without a tumor has not been described.
- Together with the capsule
- According to the 2026 review, available data support four indications: BIA-ALCL, other capsular tumor, capsular calcification interfering with mammography, and grade III–IV contracture when capsular dissection is insufficient.
- Without a new implant
- After removing the implants, the breasts may sag, skin indentations or wrinkles may appear; the volume can be restored with your own fat.
- Feeling of well-being
- Some women associate fatigue, joint pain, "fog in the head" with implants. According to the FDA, the causes of these symptoms are poorly understood; in some cases, after removal of implants without replacement, the symptoms disappeared. In a 2026 meta-analysis, after removal of capsular implants, most such patients did not achieve complete improvement, although the data from the studies are heterogeneous.
04
BIA-ALCL
A rare lymphoma near the implant.
- To whom does it concern?
- Almost all the described cases are with textured implants. In the UK, at the end of 2024, confirmed primary cases included 62 with textured implants and none with smooth.
- How common
- According to a meta-analysis of 17 studies (525,475 women with implants), from 0 to 1 case per 1,000; on average, the diagnosis was made 13 years after the operation. The MHRA estimate for the UK is 1 confirmed case per 12,187 implants and expanders sold.
- How it presents
- In the review of the described cases (data from 83 patients), in 66% the first symptom was fluid around the implant, in 8% it was chest tightness; on average about 10 years after surgery.
- Treatment
- Mandatory — removal of the implant together with the capsule; in the case of a widespread process, chemotherapy or radiation therapy, conducted by an oncologist, is added. According to the MHRA, the 5-year survival rate is 89%; it is higher in stage I, when the tumor does not extend beyond the capsule, after complete removal of the capsule and implant.
- If there are no complaints
- The FDA does not recommend removal of uncomplaining implants because of the risk of BIA-ALCL alone. The European consensus of experts allows complete removal of the capsule as a risk reduction measure — depending on the woman's wishes and the doctor's decision.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Replacement and removal of implants at Dr. Valikhnovskyi's Institute of Surgery is carried out in the direction of "Breast reconstruction" - in particular, when the implants were placed in another clinic. If BIA-ALCL is confirmed, the clinic is responsible for the surgical part, and chemotherapy or radiation therapy, if needed, is administered by the oncologist.
CLINIC SERVICE
Breast reconstruction
Breasts after mastectomy - with own tissues, implants or fat, immediately or later.
View service
What we do for this condition
- Replacement of implants — old or damaged implants are replaced with new ones.
- Removal of implants — the implants are removed, if necessary together with the capsule.
- Capsulotomy and capsulectomy — the capsule around the implant is dissected or removed, usually through a previous incision.
- Lipofilling — breast volume is restored with own fat, taken by liposuction from other areas.
- Dermal matrices and grids — biological matrices or synthetic meshes serve as a "hammock" or shell for the implant.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Photo onlineSend a breast photo, implant card or clinic discharge, and ultrasound or MRI results, if applicable.
- ConsultationReview, talk about complaints and wishes: replace, remove or watch for now.
- ExaminationUltrasound or MRI of implants; if there is fluid around the implant — its analysis.
- SurgeryReplacement or removal of implants, with or without a capsule, fat, matrix or mesh as needed.
- RecoveryA few weeks — supportive underwear and limiting the load on the hands; then — regular control, in particular ultrasound or MRI.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
How do I know if my implant is intact?
The silicone gap is mostly imperceptible. It is most accurately found by MRI; Ultrasound is an acceptable alternative for examination without complaints. The doctor will tell you how often to be checked.
Is it dangerous to rupture a silicone implant?
The gel mostly remains in the capsule around the implant. But if it goes into the tissues, it is difficult to remove it, and the rupture is associated with contracture. According to the NHS, a ruptured implant will have to be removed; when - decide with the surgeon.
Is it necessary to remove textured implants if nothing bothers you?
The FDA does not recommend removal of uncomplaining implants because of the risk of BIA-ALCL alone. European experts allow removal of the capsule as a risk reduction measure, but this decision is individual - discuss it with the surgeon.
Many years after the operation, the breast suddenly increased. Is it dangerous?
The reason may be fluid around the implant — late seroma. It must be examined, because this is how BIA-ALCL most often manifests itself. This is not a reason for a 103, but see a surgeon in the next few days.
Is it possible to remove implants and not put new ones?
You can. Breasts may sag after this, indentations or wrinkles may appear on the skin. You can partially restore the volume with your own fat - this is discussed at the consultation.
Is it necessary to remove the capsule together with the implant?
Not always. Capsule removal is a major operation with a higher risk of complications. It is performed according to indications, in particular for BIA-ALCL, tumor or calcification of the capsule or severe contracture.
Will the malaise and fatigue go away if the implants are removed?
It is impossible to predict this. The causes of such symptoms are poorly understood; in a meta-analysis after implant removal, most women did not achieve complete improvement.
Sources
20 sources · systematic reviews, meta-analyses, consensus, FDA, MHRA and NHS datashowCollapse
- US FDA Breast Implant Postapproval Studies: Long-term Outcomes in 99,993 PatientsAnnals of Surgery, 2019doi:10.1097/SLA.0000000000002990 ↗
- Silicone breast implant rupture: a reviewGland Surgery, 2017doi:10.21037/gs.2016.09.12 ↗
- Accuracy of Ultrasonography in Breast Implant Rupture Diagnosis: Systematic Review and Meta-AnalysisPlastic and Reconstructive Surgery, 2021doi:10.1097/PRS.0000000000008408 ↗
- The effect of study design biases on the diagnostic accuracy of magnetic resonance imaging for detecting silicone breast implant ruptures: a meta-analysisPlastic and Reconstructive Surgery, 2011doi:10.1097/PRS.0b013e3182043630 ↗
- Breast Implant Rupture Is Strongly Associated with Capsular Contracture: An Intrapatient StudyPlastic and Reconstructive Surgery, 2026doi:10.1097/PRS.0000000000012443 ↗
- Breast reconstruction with mentor anatomical implants and the risk of implant rotation: A retrospective study of 1134 womenJournal of Plastic, Reconstructive & Aesthetic Surgery, 2024doi:10.1016/j.bjps.2024.05.018 ↗
- Do Textured Breast Implants Mitigate Malposition? A Systematic Review and Meta-AnalysisAesthetic Surgery Journal Open Forum, 2026doi:10.1093/asjof/ojag117 ↗
- Breast Implant-Associated Anaplastic Large Cell Lymphoma: A Systematic ReviewJAMA Surgery, 2017doi:10.1001/jamasurg.2017.4026 ↗
- The Risk of Breast Implant-Associated Anaplastic Large Cell Lymphoma; A Systematic Review and Meta-AnalysisAesthetic Plastic Surgery, 2024doi:10.1007/s00266-024-03956-9 ↗
- Breast Implant-associated Anaplastic Large Cell Lymphoma: An Evidence-based Systematic ReviewAnnals of Surgery, 2021doi:10.1097/SLA.0000000000004365 ↗
- American Association of Plastic Surgeons Consensus on Breast Implant-Associated Anaplastic Large-Cell LymphomaPlastic and Reconstructive Surgery, 2024doi:10.1097/PRS.0000000000011370 ↗
- 2024 EURAPS Expert Consensus on breast implant associated-anaplastic large cell lymphomaJournal of Plastic, Reconstructive & Aesthetic Surgery, 2025doi:10.1016/j.bjps.2025.07.045 ↗
- Capsulectomy Following Breast Implant Removal: Evidence-Based Indications and a Framework for Clinical Decision-MakingAesthetic Plastic Surgery, 2026doi:10.1007/s00266-026-06365-2 ↗
- Breast implant explantation and capsulectomy in symptomatic patients. Is there any improvement with the procedure? Systematic review and meta-analysisJPRAS Open, 2026doi:10.1016/j.jpra.2026.03.028 ↗
- Risks and Complications of Breast ImplantsFDA, 2023fda.gov/medical-devices/breast-implants/risks-and-complications-breast-implants ↗
- Questions and Answers about Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)FDA, 2019fda.gov/medical-devices/breast-implants/questions-and-answers-about-breast-implant-associated-anaplastic-large-cell-lymphoma-bia-alcl ↗
- Breast implant associated anaplastic large cell lymphoma (BIA-ALCL)MHRA, 2025gov.uk/guidance/breast-implants-and-anaplastic-large-cell-lymphoma-alcl ↗
- Breast enlargement (implants)NHS, 2023nhs.uk/tests-and-treatments/cosmetic-procedures/cosmetic-surgery/breast-enlargement ↗
- SepsisNHS, 2026nhs.uk/conditions/sepsis ↗
- Pulmonary embolismNHS, 2026nhs.uk/conditions/pulmonary-embolism ↗
The figures on the page are from these sources.
The implant is damaged
did it shift?
Send a photo, implant card, and ultrasound or MRI results, if available. The doctor will tell you what to do.