Since the introduction of the 4th generation silicone gel implants, number of breast augmentation
using so-called ‘cohesive gel’ implants has increased rapidly. Still, implant rupture remains the most
annoying complication of breast implant surgery. Recently, magnetic resonance image (MRI) is used
as the gold standard in diagnosis of implant rupture. We experienced patients diagnosed as implant
rupture with MRI finding, whose implants were found not to be ruptured, but only folded. These
patients underwent breast augmentation with cohesive gel and presented to our center with
complaint of breast asymmetry and texture-related discomfort. We recommended MRI imaging for
diagnosis and the result of radiological diagnosis were ‘rupture of implant’. After surgical exploration,
we found intact implants without rupture. They were severely folded and fixed with folded form. With
our experience, we conclude that cohesive gel implants, due to their more cohesive and form-stable
characteristics, sometimes tend to fold and fix in stable folded form and in such cases, MRI image can
be similar with the image of ruptured implant. Therefore, in diagnosis of cohesive gel rupture,
surgeons should consider both radiologic finding and physical examination carefully before the
decision of exploration. (J Korean Soc Aesthetic Plast Surg 16: 00, 2010)