Ruptured implants need to be removed and replaced by additional surgery.
Capsular Contracture
When a foreign object is inserted in the body, the latter reacts by forming a physical barrier of scar tissue around it. This scar tissue may compress the breast implant, causing the breast to become hard and even painful. Surgeons use a grading system called the Baker Grade to assess the extent of capsular contracture as follows:
Grade I breast is normally soft and looks natural
Grade II breast is a little firm but looks normal
Grade III breast is firm and looks abnormal
Grade IV breast is hard, painful, and looks abnormal

The risk of capsular contracture is augmented if:
There has been germ contamination during implanting
Fluid has accumulated around the implant after surgery
There is internal bleeding
Infections have arisen
The patient is a smoker
Implant has been placed above the muscle
Revision surgery will be needed for Grades III and IV. Furthermore, there is no guarantee that it will not occur again. Surgery will involve either by cutting the capsule (scar tissue layer) in order to release the implant (known as open capsulotomy) or removal of the entire capsule (open capsulectomy). The latter is usually more successful.
Bottoming out of Implants
Bottoming out is when the breast implant moves down, forcing the bottom crease lower onto the chest. This can occur if tissues at the bottom of the breast weaken as a result of:
Over-dissection of the implant pocket
Implant is too heavy for underlying tissue
Placing the implant above the muscle
Bottoming out can be corrected through additional surgery usually by cutting the tissue surrounding the implant and rolling it back into place and held in place by sutures.
Symmastia
This is when two implants placed underneath muscle touch each other, giving the impression of having a single large breast. Additional surgery is required to correct this.