Introduction Breast implants have been used for decades now for two main purposes. The first purpose is reconstructive and targets women who had mastectomies, and the other is aesthetic. In this case, we are talking about women who want to increase the size of their breasts for cosmetic purposes and to have a more harmonious anatomy. The procedure is complex and requires the skills and experience of a board-certified plastic surgeon. Before scheduling the procedure, patients should be aware that despite the fact that it is among the two most performed plastic surgery procedures in the world, it is not without risks. The decision to undergo breast augmentation surgery is important and should only be taken after careful consideration of the reasons and after having the pre-operative consultation with the plastic surgeon. In this article, we will discuss some of the details of breast implant surgery and when breast implants can rupture or leak. How is breast augmentation surgery performed? The breast augmentation procedure starts with general anesthesia that is performed for the comfort of the patient. After the anesthesia takes effect, the plastic surgeon will perform the incisions that are required to create the pockets for the implants. The implants are inserted into pockets created under the mammary gland, under the pectoral muscles, or in an in between position called the dual plane. When performing the procedure, the plastic surgeon should make sure to use high-quality implants and treat them with care so as not to damage them. The implants used for breast augmentation can be made out of a silicone gel or a saline solution. Saline solution implants are inserted into their pockets as empty silicone bags, and the plastic surgeon fills them with the saline solution after they are positioned in their pocket. Silicone gel implants come pre-filled when inserted into the breasts. How can we notice that breast implants have ruptured?Despite what some people might think, it is not always very easy to notice that an implant has ruptured or is leaking. There are patients who find out that they have ruptured implants years after the situation has occurred. This can happen because in the case of silicone implants, it is quite difficult to diagnose the rupture when it comes to new generation implants and in the absence of an imagistic test. Good quality silicone implants won’t allow the silicone gel to spread in the breasts, even after the rupture has occurred. What happens is that the silicone gel will stay near the surface of the capsule of the implant, and this is also the reason why it is so complicated to detect. It is important to mention that the silicone used for breast implants is a medical product also used in medicine for other devices inserted into the body during heart surgery, for example. This means that it is not dangerous for the patient to stay with a ruptured silicone implant inside the breasts if it is a high-quality implant, but the recommendation is to have it removed and replaced as soon as possible. In the case of saline solution implants, the rupture of the implants is easier to detect. When the rupture occurs, the breast starts deflating and the difference can be noticed in an interval of 12 hours. What happens is that the saline solution in the implant is absorbed by the body and only left the silicone capsule that holds the liquid is left inside the breast. This means that often in a day the patient can go from having nice, big breasts to having one breast that is significantly smaller and looking deflated. When the breast implants rupture or leak, the only solution is to remove them and replace them with new implants. Rupture or leaking of the breast implants The rupture or leaking of the implants is a complication that all patients should be aware of before scheduling their surgery. When this complication occurs, the only thing we can do is replace the implants with new ones, so make sure to contact your plastic surgeon as soon as possible. So when can breast implants rupture or leak? During the first few weeks/months after the procedure When the rupture of the implants is noticed during the first weeks or months after the procedure, it is mostly the manufacturer’s defect or the plastic surgeon handling the implants wrong during the procedure. In a vast majority of cases, the implants are covered by warranty and the patient won’t need to pay for them again when the surgery to remove them is performed. This occurs in very rare cases, but it is important for the patients to know it can happen as it involves undergoing a new plastic surgery operation very close to the date of the initial breast augmentation. After a mammogram The mammogram is a special type of radiologic examination of the breasts performed with special equipment that can see tumors that are too small to be felt in a medical examination. A mammogram is one of the best radiologic methods available today to detect breast cancer in its early stages. It is the ideal method for women over the age of 40 years old who have an increased risk of developing breast cancer. While mammography, just like most medical tests, won’t have a 100% accuracy, but having them regularly is the best way to discover and treat breast cancer in its early stages. There are studies which show that the mammogram can reduce the rate of death due to breast cancer with by than a third. Mammography is performed with the help of a radiologic device called a mammogram and to get an optimal exposure, it is necessary to compress the breasts. Mammography is not painful, although it can be associated with a temporary discomfort while it is performed. However, for patients with implants, the mammograms can cause the rupture of the implants due to the pressure applied on the breasts during the compression necessary for the test. This doesn’t mean that you shouldn’t get a mammography every year, especially if you have implants and you are over the age of 40 years old, but what you should do without fail is to let the technician performing the test know that you have implants. For patients with implants, a good technician will use a special technique that will allow for proper exposure without damaging the implants. When the implants get older When getting breast implant surgery, especially at a young age, it is import to understand that there is a risk of rupture and leaking of the implants as they get older. Mammary implants are not guaranteed for life. The general recommendation is to have them removed and replaced after ten to fifteen years, even if no complications occur. I don’t necessarily advise my patients to remove them as soon as they hit the ten-year mark, but to pay more attention to the breasts after this period and contact the plastic surgeon if they notice any changes. However, for patients who have an old generation of implants or are also in need of a lifting, I recommend them to get the lifting while also having the implants replaced. Conclusion Breast implant surgery is a procedure that can give you breasts that are proportionate to the rest of your anatomy. However, you need to keep in mind that the procedure comes with potential risks of complications that are associated with undergoing surgery that uses external prostheses. Among these risks is the rupture of leaking of the implants. When the rupture occurs on patients with silicone implants, it might be difficult to detect and it might take an MRI test to see for sure that the implant has ruptured and is leaking. The rupture of the implants is easier to diagnose in the case of saline solution implants as the contents of the implant will just be reabsorbed by the body in a matter of hours and the breast will look empty and deflated. Breast implants can rupture immediately after the procedure, and when this happens it is usually the manufacturer’s fault and the implants will be free of charge. The implants can also rupture when a mammogram is performed. Mammograms are recommended for patients over 40 years old to be taken yearly to check for signs of tumors. The mammogram requires a great amount of compression when it is performed, and this could cause rupture of the implants. Make sure to let the technician know you have implants because a special method needs to be performed. The implants can also rupture due to old age, and this can occur after ten to fifteen years.