Do Breast Implants Have to be Replaced?
The lifespan of a breast implant is a topic which should be on your mind if you are considering breast augmentation or breast reconstruction. You may be wondering: how long do breast implants last? How often do they need to be replaced? What happens to breast implants over time: do they sag or ripple?
Many women mistakenly believe that breast implants have to be replaced every 10 years. Although the average lifespan of a breast implant is 10-15 years, breast implants actually only need to be replaced if you have a problem such as implant rupture or capsular contracture. In the following blog post I’ll explain explain how to recognize an implant rupture or capsular contracture, and how often they occur. I’ll talk about treatment options, as well as how your breast implants may change over time.
Do you have to replace breast implants every 10 years?
When I see a patient for breast augmentation or reconstruction, one of the first things we talk about is the lifespan of a breast implant. Breast implants are not lifetime devices. Unless you have a fairly short life expectancy, you will need to have your breast implants removed or replaced at some point during your lifetime. 10 years is the magic number that often gets thrown around as the lifespan of a breast implant. But there’s nothing magic about the 10-year mark. Breast implants aren’t like an oil filter that needs to be changed every 15,000 miles. Unless you’re having a problem with your breast implants, there is no reason to change them out! I tell my patients their implants will last, on average, 10-15 years.
Why do breast implants need to be replaced?
There are two major reasons why breast implants would need to be replaced:
- Breast implant rupture
- Capsular contracture
Breast implant rupture
You may wonder what causes a breast implant to rupture. Although mammograms or trauma to the chest have been blamed, the most common cause of breast implant rupture is simply time. Breast implants wear out over time: eventually the shell cracks, causing a rupture. The rupture rate does start going up after 10 years, which is where that number comes from. What happens when a breast implant ruptures depends on the type of implant it is.
Both silicone and saline breast implants have a tough, silicone outer shell. With saline implants that shell is filled with saltwater solution (saline). If the implant ruptures the saline is gradually absorbed by your body. With silicone implants the shell is filled with a thick silicone gel called cohesive gel. In the newer gummy bear implants the gel is so thick that it stays within the implant, even if the shell cracks. (Want to see an implant rupture in action? Head on over to my Youtube channel where I ruptured both a silicone and a saline breast implant to show you what happens.) In the older generation silicone implants the silicone gel filling the implant was much thinner- about the consistency of honey. If you’ve ever heard about silicone traveling to the lymph nodes, it is usually with these older implants.
What percentage of breast implants rupture?
The rate of breast implant rupture varies by the brand of implant as well as whether the implant is above or below the muscle. The rate of rupture also increases over time. A rough estimate is that 1% of women will have a rupture per year the breast implant is in place. So after 10 years, 1 in 10 women will have a ruptured implant.
How do you know if a breast implant ruptures?
When a saline breast implant ruptures, you’ll know it’s happened because the breast will gradually get smaller as your body absorbs the saline. Silicone gel implants are a bit trickier. Because the silicone gel is so thick, it may stay contained within the breast capsule (called an intracapsular rupture). If this happens, you may have no idea that the implant has ruptured.
So-called “silent ruptures” are not dangerous. But because they do sometimes occur, the FDA recommends a screening MRI every two years beginning three years after the implant was placed. This test isn’t always covered by insurance, so many women opt to wait until they are concerned about a rupture to have the MRI done.
Implants may change in appearance or in the way they feel if they rupture. If this happens, your plastic surgeon will likely order an ultrasound or MRI to confirm the rupture. If you are no longer in contact with your original surgeon, don’t be afraid to follow up with someone new. Most plastic surgeons are happy to see you for breast implant concerns, even if we didn’t perform your original operation!
Capsular contracture is the other reason a breast implant might need to be replaced. Breast implants are a foreign body, and your body’s natural response is to form scar tissue around them. If the scar tissue becomes too thick, this makes the implant firm and possibly painful, a condition known as capsular contracture.
The actual incidence of capsular contracture is difficult to estimate, because it varies between implant types, whether the implant is above or below the muscle, and whether the implant was placed for cosmetic augmentation or breast reconstruction. In addition, capsular contracture isn’t an all-or-nothing phenomenon. An implant could be slightly firm but still look great, or it could be rock hard, distorted, and painful. The overall incidence is somewhere around 10%, and is higher in women who have had breast reconstruction or have a prior history of capsular contracture.
Capsular contracture is treated by removing the implants and the scar tissue around them. If new implants are placed, I move them to a new pocket (above the muscle if they were originally under the muscle, or vice versa). I will also treat capsular contracture with medications. In early cases this can nip the inflammatory process in the bud, preventing more scar tissue from forming. If given after surgery, medications such as Singulair can help prevent the capsular contracture from recurring.
What happens if you don’t replace breast implants?
As I mentioned earlier, breast implants don’t have to be replaced unless they rupture or develop a capsular contracture. If they haven’t ruptured and feel soft, you don’t need to replace them regardless of how long they have been in. But what happens if they rupture and you don’t replace them? Let me start this conversation by saying this isn’t something well-studied. There are no studies in which doctors leave ruptured breast implants in place simply to see what happens. So the information I’m giving you is a combination of anecdotal information combined with common sense.
With a ruptured implant I do recommend removal of the implant, whether it is silicone or saline. If a ruptured silicone implant is left in place, the silicone could cause inflammation that results in pain or the development of scar tissue (i.e. capsular contracture). For this reason, some insurance companies will cover removal of a ruptured silicone breast implant. Saline implants are less clear-cut however. Insurance generally will not pay for removal of a ruptured saline implant. This could be taken to mean ruptured saline implants do not cause problems. And anecdotally this appears to be true. But I still recommend removing the implant if it is ruptured.
In the case of capsular contracture, there isn’t a medical necessity to remove the implant, as long as it’s intact. But if the breast is hard or painful, most women will want to have the implant and capsule removed simply for comfort.
What happens to breast implants over time?
Breasts change over time, whether you have implants or not. Weight gain or loss will cause breasts to change size. Pregnancy and breastfeeding also cause changes in breast size and shape. And over time breast tissue shrinks and skin stretches, causing ptosis (i.e. droopiness). Breast implants can increase the amount of stretch on the skin, but the degree to which this happens depends on the size of the implant. The larger the implant, the more it will stretch the skin.
Why do breast changes over time matter? For two reasons. First, your breasts appearance will change as you age. Your breasts may drop lower (that pesky droopiness again!). Or as the tissue thins the implants may become more visible in the form of rippling. Second, if or when you have your breast implants removed, your breasts will look different than they did prior to breast augmentation. The changes are a combination of skin stretch from the implant and the natural changes breast undergo over time. Many women are totally fine with this. Others opt to have a breast lift (aka mastopexy) done at the time the implants are removed.
We covered a ton of information in this blog post. We’ve explained why breast implants need to be removed or replaced. We’ve explained what happens if you don’t replace your breast implants. And we’ve also discussed how breast implants change over time. If you have breast implants from either cosmetic augmentation or breast reconstruction, I recommend seeing a board-certified plastic surgeon once a year for a quick exam to make sure your implants are intact and don’t have capsular contracture. Even if you moved away or your surgeon retired, find a new surgeon to follow up with: you can find a plastic surgeon at the American Society of Plastic Surgery website.