Breast augmentation is a widely performed cosmetic procedure, and a frequent question concerns the longevity of implants. The idea that breast implants must be automatically replaced every ten years is a common misunderstanding. This belief often stems from early manufacturer warranties and monitoring protocols, but the reality is more nuanced than a strict decade-long expiration date. Modern implants are medical devices that are not intended to be lifetime devices, and their replacement is typically driven by complications or personal choice rather than a mandatory date.
The Lifespan of Implants
No, you do not have to replace your breast implants every ten years. This misconception traces back to the initial decade-long studies the U.S. Food and Drug Administration (FDA) required manufacturers to conduct following the reintroduction of silicone implants to the market. These studies tracked device integrity for ten years, leading to the popular belief that implants had a strict ten-year lifespan. Current-generation saline and silicone gel implants are designed to last much longer, often ranging from 10 to 20 years. The FDA states that implants are not lifetime devices, meaning future surgery for replacement or removal is highly probable, but it is not mandated at the ten-year mark unless a complication arises.
Factors Driving the Need for Replacement
Breast implant replacement or removal is necessary when medical issues develop or when a patient’s aesthetic preferences change. The most common medical reason for a revision procedure is capsular contracture, which is the hardening of the scar tissue capsule that naturally forms around the implant. This contracting tissue can cause the breast to feel firm, become distorted in shape, and lead to discomfort or pain.
Another primary reason for revision is implant rupture, where a tear or hole develops in the implant shell. For saline implants, a rupture is immediately apparent as the sterile saltwater filling is absorbed by the body, leading to noticeable deflation. Silicone gel implants may experience a “silent rupture,” where the thick gel remains contained within the scar tissue capsule, making the rupture difficult to detect without imaging.
Implant malposition or shifting can also necessitate revision surgery. This occurs when the implant moves out of its intended pocket, potentially affecting breast symmetry or creating an unnatural contour, such as a “double bubble” deformity. Changes in a patient’s body over time, like significant weight fluctuations or the effects of gravity and aging, can also prompt a desire for revision.
Recognizing Implant Complications
The detection of implant issues often begins with a patient’s self-examination and routine clinical checkups with their plastic surgeon. Patients should monitor for physical symptoms such as persistent pain, a change in breast shape or size, or an increase in breast firmness, which may indicate capsular contracture or a rupture. Since silicone ruptures can be asymptomatic, objective diagnostic imaging is recommended to assess implant integrity.
The FDA recommends that women with silicone gel-filled implants undergo screening, even if they are not experiencing symptoms. The first screening should occur five to six years after the initial surgery, with repeat screenings every two to three years thereafter. Magnetic Resonance Imaging (MRI) is considered the gold standard for detecting an intracapsular silicone rupture because of its high accuracy in visualizing the implant and its surrounding capsule. Ultrasound is also an effective and less costly screening method, but an MRI is often needed for a definitive diagnosis of a silent rupture.
Options for Revision Surgery
Once a complication is identified, or a patient chooses an elective update, several surgical options are available for revision. Revision surgery is generally more complex than the original augmentation because the surgeon must address pre-existing scar tissue and anatomical changes.
Implant Exchange
An implant exchange involves removing the old implant and immediately replacing it with a new one. This procedure is often used for rupture or to change the size or type of device, and it is the most common form of revision surgery.
Capsulectomy
If capsular contracture is present, the surgeon will often perform a capsulectomy in conjunction with the implant exchange. A capsulectomy is the surgical removal of the scar tissue capsule surrounding the implant. This can be done partially, totally, or en bloc, depending on the capsule’s condition and the presence of free silicone.
Explantation
An explantation procedure involves the complete removal of the implant and, often, the capsule without immediate replacement. Some patients choose this option due to medical concerns or a desire to return to their natural size.