Five, and they are not equal. Rupture (silicone gel implants can rupture silently, which is why the FDA recommends periodic imaging). Capsular contracture, where the scar capsule tightens and hardens the breast; grades III and IV may need reoperation. Age of the implant: the FDA's boxed warning says implants are not lifetime devices and complications rise the longer they are in, so many women choose removal rather than a second exchange. BIA-ALCL, a rare lymphoma of the immune system seen more often with textured implants, where removal of implant and capsule is the treatment. And systemic symptoms, often called breast implant illness: fatigue, joint pain, brain fog, rash, which the FDA says may be associated with implants and which some women report reverse after removal.