Magnetic resonance imaging has become the state-of-art technique to diagnose the loss of silicone gel-filled mammary implant integrity (rupture, gel leak). In a series of 39 patients considering implant removal (40 procedures, 74 devices), the impact of magnetic resonance imaging on the decisions made by the patient and surgeon was examined. In this selected group of patients, implant rupture or gel leak was found in 17 patients (16 grossly ruptured devices and 7 with gel leak). In 9 (53%) of these patients, magnetic resonance imaging was the decisive factor leading to the request for explantation by the patient. Diagnosis of implant rupture based on history and physical examination was made in 4 patients (confirmed in 3 and negated by magnetic resonance imaging and intraoperatively in 1). In 10 of the 14 remaining patients (26%) with "unexpected" loss of implant integrity (negative history and physical examination), magnetic resonance imaging evidence was the decisive factor for advising explantation by the surgeon. Negative magnetic resonance imaging results did not influence the patient's or surgeon's decisions. Magnetic resonance imaging appears to be a sensitive and specific technique, and there were no false-negative and one false-positive (gel-leak diagnosis) findings in this series.