Which combination of signs is associated with implant rupture?

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Implant rupture shows a spectrum of imaging signs that reflect silicone leakage and shell collapse. The step ladder parallel sign appears on ultrasound as multiple, evenly spaced parallel echogenic lines within the implant area, signaling folding or collapse of the implant shell as rupture occurs. The snow storm sign is a diffuse echogenic haze from dispersed silicone droplets, either inside the implant cavity or in surrounding tissues, a classic marker of silicone extrusion. Peri-implant fluid collection, a surrounding serous fluid, can accompany rupture due to inflammatory reaction or seroma formation around the compromised implant. Because rupture can manifest with any of these patterns, seeing all of them together is consistent with rupture.