Many patients have confusion about when a breast implant exchange is necessary. Some of the confusion is because plastic surgeons have differing opinions. Here I share my thoughts.
If you have a saline implant and you are doing well, look good and are happy, then I see no need to replace it. Basically, if it’s not broke don’t fix it. While the leakage rate of saline implants starts to climb after 10 years, I have seen patients with saline implants placed more than 20 years ago who are doing just fine, having no problems. If a saline implant leaks, it is just salt water and is easily absorbed by your body. When a saline implant leaks it’s usually quite clear. Just give your plastic surgeon a call and get it replaced. Replacing a saline implant is usually a very quick surgery with little or no down time.
I feel differently about silicone implants. The older generation of silicone implants had a climb in the rupture rate at about 10 years as well. When a silicone implant leaks the silicone usually stays in the implant pocket, so it can be difficult on examination to know if it has ruptured. An MRI is the best way to see if the implant is leaking. In this older generation of implants, when they leak the rate of capsular contracture (breast tightness) goes up. If you have a silicone gel implant manufactured before the 1990’s or earlier I would recommend exchanging it now. It is much easier to change a silicone implant before it leaks and certainly before a capsular contracture develops.
The new silicone gel implants that returned to the market about 5 years ago, regardless of the manufacturer, have a thicker shell and a more cohesive (sticky) silicone inside. It makes sense to me that these will be proven to last much longer and behave better than first generation implants. Guidelines currently suggest looking at the implants with an MRI 3 years after surgery and every two years thereafter. At the moment I still discuss the possibility of a silicone gel implant exchange with my patients at about 10 years, but as more longevity information rolls in I suspect we will wait even longer.