I've been researching breast implants and am vaguely aware that they aren't permanent. What do i need to know? Will they need to be replaced, and if so, when? Will i have to have any routine tests to see if they are still ok? Are there signs that they need to be replaced (other than for things like capsular contraction)? If i got implants at the age of 41, what would be the typical outcome expected for the next 40 years?
What to Expect over the Lifetime of Implants?
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Breast Implant Lifetimes
You are correct that breast implants will not last forever, and will likely need to have them replaced in 10-15 years. Patents with implants can develope capsular contracturs, which is painful scar tissue on the inside of your breast, or they may rupture.
If you have saline implants, and they rupture, that breast will go flat, like a flat tire. If a silicon implant ruptures, it may not be apparent and if you are experienceing problems or think they may be ruptured, then you may need an MRI to have them checked out.
If you choose saline implants then you will not need any routine tests, except for routine mamograms as appropriate for your age. If you choose silicone implants, it is recommended to get an MRI every three years to confirm that everything is okay.
If you are not having any problems, then there is no reason for them to replaced. You would only have them replaced if you are experiencing a problem.
Breast implants, Breast Augmentation,
Like any mecanical medical device breast implants can fail. The consequences of a failed silicone gel implant are different from a saline implant.
If a gel implant fails generally the silicone stays within the scar tissue around the implant...no big deal...and the breast stays enlarged. If the silicone gets out of the scar tissue then it can cause lumps to form and migrate into the lymph nodes. This can be a mess to fix and can happen with even the newer cohesive gel implants. When the Food and Drug Administration allowed the gel implants back on the market they did so with the recommendation that women who had silicone implants have an MRI test at 3 years after surgery and every 2 years after that to check for implant integrety (MRI is the most sensitive way to look at implants for leakage). Leaking silicone gel implants should be replaced. If a woman elects not to follow this recommendation for MRI's then changing the implant at some point is a reasonable strategy. Whether that is 6 years, 8 years, or 10 years is open to debate.
If a Saline implant fails it goes flat. Obviously this can be disconcerting but the saline is the same saline you get when you get an IV so it is harmlessly absorbed by your body. Replacement is fairly easy and since the implants have a lifetime replacement warrenty the cost is just the surgical cost. Since the consequences of a failed saline implant are very mild there is no need for MRI's. I generally don't have my patients replace thier saline implants at any defined time. The only reason to replace a sailne implant is if there is a problem.
Nothing lasts forever, not even breast implants!
Saline implants do have a leak rate, and when they deflate, re-operation is necessary. This probably occurs no more frequently than 10% per decade (most studies quote a lower rate), but this really has more to do with the actual fill volume that the surgeon used than any innate "problem" with the implants. True manufacturing defects are quite rare. Textured saline implants leak more commonly than smooth implants. Under filled implants leak more commonly than properly-filled implants (actually anywhere from 5-15% "over" fill to reduce rippling which can eventually flex into a shell failure and leak). Over or under the muscle makes no difference. Surgeon technique has lots to do with leak rates.
Silicone gel implants are the most commonly chosen implants since November 2006, when the FDA released silicone gel implants for general use in cosmetic breast enlargement. The latest generation (5th by most counting methods) of silicone gel implants by either US manufacturer consist of a highly-crosslinked polydimethylsiloxane polymer whose properties depend on the length of the polymer chains. Earlier implants contained silicone oils or sticky soft gels that could and did rupture, increasing capsular contracture, distortion in the appearance of breasts, and difficult re-operations for plastic surgeons whose careers spanned the time those earlier implants were being used (mine is now 25 years and counting, and I have operated on many of these patients).
Present silicone gel implants are cohesive, cannot rupture, and if physically cut in half, act like two pieces of solid Jell-O. They do not ooze, leak, or "travel" throughout the body. MRI scan is unnecessary in this generation of implants, in my opinion, and the FDA booklet that recommends MRI every 2-3 years to look for "hidden rupture" is nonsensical for this newest generation of implants. Furthermore, the FDA's own data tell us that the MRI will incorrectly identify "rupture" 21% of the time when intact implants are present, leading to unnecessary re-operation. Of course, you can choose to obtain the scan, but if it says "Rupture" and is known to be wrong 21% of the time, do you want an unnecessary operation when there is nothing wrong at all with your breasts other than a (possibly) incorrect scan? I prefer to re-operate if there is an identifiable problem or concern, such as malposition, capsular contracture, or request for different size (the most common reason for re-operation).
Most plastic surgeons who do significant numbers of breast enlargements have a very low re-operation rate, and most patients can expect that their implants will "last" longer than the ten years that has become urban legend. The FDA doesn't want plastic surgeons to tell our patients that silicone implants "last forever." This is one area where I agree with the FDA, but not because implants "wear out" or need replacing every now and then. I agree only because NOTHING lasts forever, including pacemakers, artificial knees, dental implants, and organ transplants. If you are a candidate for breast implants and wish to proceed, you should know that the present generation of implants are the most thoroughly studied of any medical device in the marketplace, and are the safest implants ever offered to the public. If you are fortunate enough to live to 81, I suspect that you may have the nicest breasts in the nursing home! By then, let's hope it's the nicest breasts on the golf course or dance floor!
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Life Expectancy of Implants
Implants will usually last 10-20 years but like the other doctors have mentioned, they wont lasts forever. You will know when the Saline implants break because the implant will deflate. The Silicone require X-rays periodically to see if there is a break in them. Both implants are guaranteed by the company for life so they would give you new ones if they were to break.
How long do breast implants last?
Most implant manufacturers have a ten year warranty on their implants, where they will help with the expense of having surgery if the implant deflates or leaks, and they have a lifetime warranty on replacement of the implant itself. So it is important to keep your implant information in case your surgeon should retire and not have access to your records anymore. Some women may be lucky and have their implants for a lifetime, but it is better to assume that at some point you will need to have them replaced. If a saline implant leaks, it will go flat and you will know you have a problem. With silicone implants the FDA now strongly suggests that women get an MRI every two years after the first three to determine if there might be a silent leak.
All Breast Implants Will Require Replacement at Least Once and Maybe Twice Over A Patient's Life
The lifetime of any breast implant can not be predicted with any certainty. The manufacturers have statistics and warranties which do provide insight into this common patient question. All of that aside, you can say with certainty that at age 41 your breast implants will not last for the rest of the your life. You are going to have replacement implants done and may even have to have them replaced more than once. The need to replace a saline implant is obvious as there is a visible deflation. Silicone implants do not deflate and have non-obvious silent ruptures. These may be picked up coincidentally on mammograms or may require MRIs for diagnosis if there is suspicion of implant failure.
What to expect over lifetime
I look at this from the point of view of the implant company. the company has a warranty that replaces both implants even if only one leaks. They are not planning on having you buy one set at age 41 and giving you free ones very often if ever in the next 40 years.
Implants and guarantee
I will tell you that implants are not a lifetime product that will last forever. More than likely you will require another operation down the road to have them replaced.
Breast implant expiration
I get the "how long will my implants last?" question a lot. I tell my patients who are considering breast implants that they will likely get 10, 15 or maybe even 20 years out of their implants. This is based on the low leakage and rupture rates of the current generation of implants and the fact that a woman’s body can go through a lot of changes in 10, 15 or 20 years. I am as likely to do an implant removal and/or replacement for naturally occuring changes in a woman’s body and/or life circumstances as I am to do the surgery for an implant leak or rupture. Here are a couple of examples:
Very lovely and sweet 20 something wants her implants out because she has become a Buddhist nun and the implants don’t fit her spiritual identity. I took her implants out and her breasts returned to a similar shape and size that she had before breast augmentation.
Vibrant, slender and healthy 65 year old grandmother whose implants have stayed perky but her breasts have sagged giving her an odd shape and she feels silly having implants “at her age”. I took her implants out and did a breast lift. Her breasts are small but with a nice shape.
Healthy but heavier postmenopausal lady who was “flat” 20 years ago when she had breast augmentation but is now 30 pounds heavier and way bustier than she ever wanted to be. I took her implants out and did a small breast reduction and lift. Her chest went from matronly back to full and voluptuous.
I sometimes see women in my office who have implants 20+ years old and are doing fine. There is no reason to remove these implants unless there is a good reason to do so.
As far as FDA recommendations for MRI's for gel implants are concerned:
Here is an article written by Dr. Thomas Wiender, a Houston plastic surgeon to help each patient make her decision. I cannot improve on his writing so this is an exact copy of his article:
MRI Recommendation After Silicone Gel Breast Augmentation
1. The FDA has recommended an MRI of the breasts at three years post-op and every two years after. You are currently at one of these postoperative time frames.
2. Most silicone gel implant ruptures are silent. In other words, there are no symptoms.
3. MRI is not 100 percent accurate. Some intact implants will appear ruptured, and some ruptured implants will appear intact. This is not a fault of the radiologist or the MRI – this is the limitation of the technology.
4. Over many years of research, there is no indication that a ruptured implant will cause any disease.
5. If an MRI indicates a ruptured implant but at surgery it is found to be intact, for Allergan implants, the manufacturer’s full warranty still applies. For Mentor implants, the manufacturer will provide the implant replacement but no financial assistance.
6. You must understand that because of the limits of MRI technology, you may have surgery for an implant that is found to be intact, but you will still have undergone the possible risks and complications of surgery.
7. In most countries outside of the United States, the equivalent of the FDA does not recommend routine follow-up MRI.
8. The cost of the MRI is your responsibility. You insurance company and the implant manufacturer will not pay for this.*
The decision to proceed with a postoperative MRI must be made by you, the patient, based on the above information and the information provided to you prior to surgery in the manufacturer/FDA brochure.
* First Hill Imaging in Seattle charges $1,955 for a breast MRI to look for implant rupture. If the patient pays cash up front, the fee is $1,271. I obtained this information in early 2010. Their fees are subject to change.
If you have silicone implants you would need to get regular mri's to check for leaks. Saline implants deflate when they leak so you wouldn't need to get the mri's for that. There is no typical outcome. Some patients can have implants for many years without any problems. Others will have to go back to surgery possibly for leaks , capsular contracture, shifting, rippling etc. There are many reasons that may come up for going back into surgery.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.