When to Change Breast Implants: Signs, Timelines & Expert Advice
This last month, I removed several ruptured silicone breast implants from patients that had had them for many years. The shortest was 11, and the longest was 22. In all cases, the implants were very shredded, and the silicone had spread. I was not the original surgeon who had placed their previous set of implants, so the patients had been unaware that they needed imaging or implant replacement. I felt it was important to review long-term breast implant management and care.
Monitoring
The FDA recommends getting imaging 3 years after placing silicone implants and then every other year to check for a leak. This is because silicone leaks may not be obvious since most silicone is highly cohesive, and the breast can still have a similar shape. Physical signs of a potential leak are capsular contracture, where the breast starts to feel hard and sometimes starts to move upward, asymmetry of the breasts, or swollen lymph nodes in the armpits. Capsular contracture occurs when scar tissue forms tightly around the implant, making the breast feel hard or distorted. However, many leaks are not obvious on physical exam which is why it is important to get imaging. A good imaging place can determine a leak with mammography and ultrasound however a breast MRI is diagnostic. Make sure you tell the technician or ordering physician to make a note that you have breast implants and you are checking for a leak – there are often several special views that need to be done as well as displacement techniques to make a proper diagnosis. For saline implants, because there is sterile saline in the implants, a deflated implant will be flat and obvious on physical exam. Therefore checking for a leak with imaging is usually not necessary, however for overall breast health it is recommended you get routine breast imaging according to your age and personal risk factors.
Removal and Replacement
It is recommended you get a removal and replacement with a new implant BEFORE you get a leak. For silicone implants it is recommended you replace your implants every 8-10 years to minimize chances of having a leak. At around 10 years the leak rate is just under 20% so statistically this improves your changes of replacement before getting a leak. Saline implants have looser guidelines – I would recommend around 15 years but can be longer if you aren’t having any issues.
Why is this important?
Taking care of your implants is important to avoid complications or the need for complex revision surgery. For a routine removal or replacement surgery – the previous implant is removed, the pocket is washed with antibiotic solution, depending on if you are changing the implant size, some adjustment to the pocket may need to be performed. However, if there is a ruptured silicone implant the revision is significantly more complex. Not only does the old implant need to be removed and replaced but the entire capsule around it must be removed as well. Loose silicone is very irritating to the body so it must be extensively cleaned and even then it can leak into the surrounding tissues causing capsular contracture or inflammation. To prevent reactive capsular contracture, often an internal sling must be placed. This results in a much longer surgery time, recovery and higher complication rate. Proactively managing your implants greatly reduces the risk of complications, simplifying surgeries, shortening recoveries, and improving long-term outcomes.
If you have had silicone implants for longer than 10 years, please make an appointment to discuss removal and replacement. We will prioritize your appointment to avoid further delay. Your health and peace of mind are our top priority.
This post was written by Dr. Cat Begovic
