Rupture of a breast implant is a recognized complication of augmentation mammaplasty and reconstructive breast surgery. Due to concerns over the extravasation of silicone gel within adjacent tissue and distant body sites, considerable attention has been given to the radiographic detection of mammary implant rupture. A metaanalysis comparing the accuracy of various currently available imaging modalities was conducted and an algorithm suggested to guide clinicians in the detection of breast implant rupture. Advantages and limitations of mammography, xeromammography, ultrasonography, MRI, and CT are outlined as well as some of the most specific radiographic signs of each with illustrative examples from patients evaluated at our institution. Results of our retrospective analysis corroborated by a review of the most recent literature reveal that mammography supplemented with ultrasonography constitutes the most cost-effective initial study, followed by MRI if these are equivocal. MRI is the most sensitive and specific study to evaluate breast implant rupture.