if they are not bothering you and your breasts still look and feel good? Is there any real science that proves it is worth the surgical risks to replace them if they are found to leak? If indeed they cannot cause cancer or other diseases, why is it so widely recommended to replace if a silent leak or leaks have been discovered? My leaks have been there 5 years and I just found out.
Why Do Docs Other Than Plastic Surgeons Seem to Say It is Ok to Leave Silicone Silently Leaking Implants Alone?
Doctor Answers (4)
Leaking Silicone Gel Implants
You bring up a very good point about leaking silicone gel implants! Why do plastic surgeons (as mandated by the FDA) say you should change your implants if they are found to be leaking by MRI? There are probably many reasons, some altruistic, some for personal gain. First, I must state that an MRI reading of a 'leaking' silicone gel implant is correct only about 50% to 60% of the time (even though this is the FDA's 'gold standard'), so you should take that into account before making your decision to have another operation.
I have been removing (and replacing!) silicone gel breast implants for 15 years and have never seen an implant made with cohesive gel leak past the capsule into breast tissue or lymphnodes, and have rarely seen that with non-cohesive implants, roughly from the pre-1990's era. Early, non-cohesive implants had a substantial amount of liquid silicone oils that could exude past the apparently intact scar capsule into the tissues, creating harmless but sometimes scary lumps called granulomas. Biopsies of normal looking lymphnodes would also show microscopic collections of silicone oils as well; although this might sound dangerous, there are no diseases that have ever been attributed to this clinical situation. Modern implants (last 20 years) are filled with silicone gel that has been formulated with 'cross links', binding all the molecules together, changing its physical state from liquid to solid. This is known as cohesion or cohesivity.
I tell my patients what the FDA wants me to tell them, but I also give them some data to help them make their own decisions. I know as a practitioner, I would hate to meet a woman in my office with perfectly normal breasts, but with MRI positive for rupture, have a surgery and subsequently have a complication like capsular contracture! Especially if her implants were found to be intact! Have I helped her? Have I kept to my Hippocratic Oath of 'first do no harm'? I don't think so.
I hope this helps you. Please feel free to contact me if you would like to discuss this further. I will give you the best info possible so that you can make the best decision possible for yourself.
Why Do Docs Other Than #PlasticSurgeons Seem to Say It is Ok to Leave #Silicone Silently Leaking Implants Alone? ANS:
I think we recommend that because it is probably more of a "breast risk" than a "health risk" and we tend to think more along those lines than most GP's. By that I mean that if you have free floating old type silicone gel inside of your capsule, most of the time it stays there. But should you fall or ever do anything that cracks your capsule (which doctors years ago used to do on purpose!) then that get could migrate out into your breast tissue and could present a visible or uncomfortable problem..Therefore, more of a breast risk than a health risk....
Leaking breast implants
Silicone implants if leaking should be removed/exchanged with new ones. Most of the time the silicone remains within the capsule surrounding the implant, but it also can potentially leak outside the capsule.
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Removal of Leaked Silicone Gel Necessary?
Thank you for the question.
I would agree with plastic surgeons who recommend that silicone gel breast implants that have leaked should be removed. One of my concerns with the presence of leaked silicone material is potential for movement of the silicone out of the breast implant capsule. Having seen silicone “integrate” with breast tissue and/or involve lymph nodes, it is much better to avoid this type of contamination and potential with confusion in regards to breast cancer diagnosis ( by self breast exam and/or mammography).
I hope this helps.