Breast implants are medical devices used in both breast augmentation and reconstruction. They are not designed to be permanent or lifetime products, as the materials, whether saline or silicone, are subject to natural wear and tear. Ultimately, all implants will likely require surgical intervention, either removal or replacement, due to aging, complications, or changes in personal preference. The decision to replace or remove implants is based on the device’s lifespan, the presence of specific medical complications, and the results of routine monitoring.
Expected Lifespan and Monitoring Requirements
Manufacturers and regulatory bodies confirm that breast implants have a finite lifespan. While modern implants are durable, the average time before they require replacement or removal is generally 10 to 20 years. Approximately 20% of women need replacement within 8 to 10 years, and the risk of rupture increases the longer the devices are in place.
The need for routine monitoring is particularly important for silicone-filled devices. Silicone implants can rupture without showing external signs, a condition known as a “silent rupture.” Because the cohesive gel is thick, it often remains contained by the scar tissue capsule, requiring detection and management.
The FDA recommends that patients with silicone implants undergo routine screening for silent rupture. This screening should begin five to six years after the initial surgery and be repeated every two to three years thereafter. This proactive imaging is intended to catch issues before they lead to more significant problems, such as a localized silicone leak.
Medical Complications Requiring Intervention
Beyond general aging, certain medical complications necessitate the removal or replacement of breast implants. The most common reason is capsular contracture, the tightening of scar tissue around the implant. This condition is graded using the Baker Scale; Grades III and IV involve significant hardening, distortion, and pain, requiring surgical correction.
Implant rupture is another frequent driver of intervention, though presentation differs by implant type. A saline implant rupture is immediately obvious, as the sterile salt water is absorbed by the body, causing rapid deflation. A silicone rupture requires removal because the cohesive gel can potentially migrate to surrounding tissues or lymph nodes.
Malposition or displacement occurs when the implant shifts from its intended position, causing asymmetry or a distorted appearance. This may be due to trauma, changes in surrounding tissue, or breakdown of the surgical pocket. A distinct and rare reason for removal is Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), a form of non-Hodgkin’s lymphoma. This condition is associated with textured implants and typically presents as a late-onset fluid collection, mandating complete surgical removal.
Diagnosing Implant Issues
Diagnosing a potential implant issue relies on patient awareness and professional imaging tools. Patients should monitor for changes in breast shape, size, symmetry, new pain, swelling, or unusual firmness. While saline implant deflation is easily detected, the “silent rupture” of a silicone implant requires specific technology.
Magnetic Resonance Imaging (MRI) is considered the most accurate method for detecting silicone implant rupture, identifying both contained and uncontained leaks. The FDA recommends routine MRI screening for asymptomatic patients. Ultrasound is a valuable supplementary tool for screening, though mammography is less accurate for detecting rupture. If a patient experiences symptoms, an MRI is typically recommended to confirm the diagnosis before surgery.
Options When Replacement Is Needed
Once an issue is diagnosed or the decision to change implants is made, there are three primary surgical options available. The most common choice is an implant exchange, where the old implant is removed and a new one is placed during the same procedure. This is frequently done for prophylactic replacement, rupture, or when the patient desires a change in size or type.
Another option is explant, which is the removal of the implant without replacement. Patients may choose this if they wish to return to their pre-implant state or if they have concerns about long-term device safety. The third option is explant with capsulectomy, which involves removing the implant along with the surrounding scar tissue capsule.
A capsulectomy is medically necessary in cases of severe capsular contracture (Baker Grade III or IV) or for the treatment of BIA-ALCL. The surgeon may perform a total capsulectomy, removing the entire capsule. In high-risk situations like BIA-ALCL, an en bloc capsulectomy is preferred, where the implant and the capsule are removed together as a single unit.