Rupture of silicone breast implants is a recognised complication. We report a 36-year-old lady that 16 years post-augmentation presented with a unilateral gradually swollen breast with no associated lymphadenopathy. Ultrasound examination reported implant rupture, and exchange of implants was subsequently performed, only to reveal serous fluid (negative to culture, cytology and microscopy) and a macroscopically intact implant. A review of the literature has revealed that other imaging modalities are, either in isolation or in combination, more sensitive and specific for implant rupture. We therefore aim to raise awareness of this in the hope that we can potentially prevent further unnecessary operations.