My implants, 35 yrs ago, were above the muscle and still look good. I have had encapsulation and lumps which are sometimes painful. The mammogram and ultrasound show no cancer but a rupture and two lumps in the left breast that apparently has not changed in 5 years. Does the risk of surgery outweigh the risk of the rupture? And is it better to have the replacement under the muscle or where the old one was? I do like to lift weights.
Best Course for Replacement of Slightly Ruptured Silicone Implants of 35 Years?
Doctor Answers (6)
Surgery for Ruptured Silicone Breast Implant?
Although it is not possible to give you precise advice without consultation and a full communication of your goals, some general thoughts may be helpful to you.
Generally speaking, most plastic surgeons would recommend that you remove ruptured silicone gel breast implants. Some patients will elect to re-augment the breasts, some elect to remain breast implant free.
With a history of breast implant encapsulation, it may be in your best interests to have the new breast implants placed in the sub muscular position if at all possible. Doing so, may require additional surgery ( such as breast lifting) depending on the condition of the patient's breasts.
As you can tell, the decision-making is individualized based on the patient's specific examination and goals.
In person consultation with well experienced board-certified plastic surgeons will be most helpful to you.
35 Year Old Implants
With all due respect, it's hard to believe that your breasts 'still look good' with 35 year old subglandular implants that have extracapsular leakage and encapsulation. They must be very hard and uncomfortable. Obviously there are risks to any surgery, and most have a low probability of occuring; the most common is capsular contracture, something you already have. Going to a reputable, well experienced surgeon who specializes in revision breast surgery will likely give you a great enhancement to how your breasts look and feel. Your tissues are more than likely thinned from the pressure of the hardened and contracted implants, so you should replace them with implants under the muscle; you will still be able to lift weights after your recovery. On the other hand, there is no risk to keeping your ruptured implants in place, except continued thinning of your overlying tissues, making the situation more visually apparent as time goes on.
Best of luck!
Replacing old silicone breast implants
I would typically recommend to patients that they replace silicone implants that are over 30 years old. If you suspect rupture I would replace the implants even if they are almost new.
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If you have ruptures implants, it sounds like you need to have them removed. As for adding new implants, it is up to you.
Slightly Ruptured Silicone Implants of 35 Years
Ellen, this is a tough question. The "textbook" answer would be to encourage you to have them removed and replaced, and that would be my inclination.
But the fact that they have been leaking and are unchanged in 5 years really makes be question the textbook answer. I have seen a small number of patients referred to me for leaks who have the newer implants, and several years of mammograms which show the leak and are unchanged, and I have suggested that we just follow with yearly studies unless any clinical changes occur. But these are the newer cohesive gels that are much thicker and are quite unlikely to have fluid that can move around in the tissues.
I think an in person exam and discussion with a plastic surgeon will lead you to the best decision for you. Thanks and best wishes.
Replacing a ruptured implant
If your implants have been in place for 35 years and you have evidence of rupture, it would be in your best interest to have the implants exchanged. You mention that you have encapsulation and lumps. If by that you mean that you have capsular contracture and distortion of the breast, then there is an advantage in placing the implants under the muscle. If your breast shape is still good and you don't have much of a capsule, it might be preferable to keep the implants on top. As a weight lifter, keeping them above the muscle carries a slight advantage.
I would consider the risk of surgery to be negligible compared to the ongoing risk of living with the ruptured implant.
Good luck with your decision,
Douglas Hargrave, M.D.