Following breast augmentation, patients who have silicone implants often wonder about the likelihood of rupture of their implant. Modern implants, such as "memory gel" implants, are described by the manufacturer as being of a "gummy bear" consistency and suggest that since this resembles a solid leakage is much less of a risk.
The most important factor patients with older implants should consider is the age of the implant. The older the implant the more likely it is to leak. Some studies suggest that after ten years 4 out of 5 implants may leak or "bleed". The medical significance of this is unclear.
Surprisingly, trauma (including mammography) is a rare cause of implant rupture. Any association with closed capsulotomy is not clear.
There is no perfect test to detect a ruptured implant, but MRI scans may be the most reliable. Unfortunately false positive studies, sometimes show rupture in an implant that is really intact.
Whether or not the implant is placed above or below the pectoral muscle is not related to the rupture rate.
Even if the implant leaks it does not mean that it is harmful to the patient's health.
Because of the cohesive nature of the gel a break in the outer envelope may have little significance. Only further studies and time will tell, but at this point it seems unlikely.
Over the last few years, studies have not shown an association between silicone breast implants and auto-immune diseases, such as rheumatoid arthritis.