To increase accuracy, ultrasound and mammography can be used to verify the MRI findings, but that was not done in this study. The best way to diagnose a rupture is removal and examination of the implant. This method was not used in this study either. This leads to an artificially high rupture rate, since silicone from earlier implants, from injections and from other procedures may be present. Even if rupture is the correct diagnosis, the study does not determine if the cause is manufacturer error.
Implants can rupture for many reasons, including trauma and surgical error.
There is even a medical procedure, called a closed capsulotomy, in which trauma is intentionally inflicted to loosen normal scar tissue surrounding the implant. This procedure, which is not recommended by implant manufacturers, can cause rupture. Another warning sign is that the study examines a nonrepresentative sample of women. The study drew participants from a larger study of 17,424 women found through 19 plastic surgery practices, but only took women from two of those practices, both located in Birmingham, Alabama. Birmingham is the unofficial capital of breast implant litigation.