Many patients are now consulting plastic surgeons for evaluation of their silicone gel breast implants. This study assesses the accuracy of a clinician's ability to determine if a silicone gel breast implant has failed. In addition, it sheds light on the long-term integrity of the silicone gel breast implant. This study examined the condition of 350 silicone gel breast implants in a group of 159 of the authors' patients who previously had undergone augmentation mammaplasty or breast reconstruction. These women underwent secondary open procedures including capsulotomy or capsulectomy for fibrous capsule contractures, exchange of implants, or other revisional surgery. The condition of the implant was noted at the time of this secondary operation. The preoperative evaluation, which included the patient's history and physical examination and often mammography, was then matched against the operative findings to determine the pertinent factors that predict the integrity of a silicone gel breast implant. A history of trauma and/or a reported change in shape of a patient's breast correlated with implant failure. An analysis of implant failure as a function of implant age revealed that 63 percent of silicone gel breast implants in place 12 years or greater in this study population were not intact. A change in the patient's physical examination, including a softened breast consistency and/or the presence of a nodule or mass adjacent to an implant, also was suggestive of implant failure. Several different mammographic presentations of implants that were not intact were identified. This modality predicted implant failure in 89 percent of implants studied. It is hoped that this information will help clinicians to make a more accurate assessment of the condition of a patient's silicone gel breast implant. It should be noted that all women in our study underwent secondary procedures, as stated above. The results obtained apply to this patient group but may not specifically pertain to the general implant-bearing population.