How Often Do Saline Breast Implants Need to Be Replaced?
There is a myth floating around the general community about this one. Often, patients will present to their plastic surgeon stating, "It has been 10 years and I was told I need to have my breast implants replaced". This is not necessarily the case.
Breast implants are not like tires which should be rotated every few thousand miles. The only reasons that implants need to be replaced is if there is are problems related to the implant. These problems can range from rupture, capsular contracture or implant displacement. The rates of these complications varies depending on the type of implant. The good news is that in the event an implant does need to be replaced, implant manufacturers currently replace both saline and silicone breast implants at no charge and will sometimes cover surgeons fees as well.
Saline breast implants have a similar silastic outer shell to the silicone implants but the fill material is saline instead of silicone. These have been shown in prospective studies to rupture at a rate of around 3-5% at 3 years and 7-10% at 5 years. This is roughly approximately 1-2% per year of implantation. With saline implants there is no fear of the "silent rupture" that can occur with silicone implants. If the implant fails it simply deflates and the procedure to exchange it for a new implant is usually fairly simple and can be done under local anesthesia. Because the implant filler does not hold its shape as well as cohesive silicone, there is a greater likelihood of a "fold flaw" (kind of like the crease in a newspaper). The repetitive folding is though to wear out the implant and can lead to a higher risk of rupture. The "fill valve" is another potential source of increased risk of implant rupture in saline implants relative to silicone implants.
There is a documented decreased risk of capsular contracture with saline implants relative to silicone implants. Newer generations of silicone implants will hopefully have decreased risk of contracture due to the cohesive material causing less "bleed" of silicone oil.
In conclusion, the risk of failure becomes higher the longer an implant has been in place. According the the FDA and the package inserts from the implant manufacturers, implants are not meant to be a permanent device and most patients will need to have them replaced at least once. For saline implants, so long as they do not rupture or cause problems, they never need to be replaced. The same is true for silicone implants, however there is the risk of the "silent rupture".
The FDA recommends frequent MRI studies to evaluate silicone implants to diagnose the silent rupture. This is cost prohibitive for many patients. There may be a recommendation to have silicone implants replaced at a regular time interval when the results of the post approval study come out. For now, both saline and silicone implants should be replaced only if they fail.