I want to know whether I should now remove my 40 year old silicone breast implants.

Question

I had silicone implants put in at the age of 27 in 1978. I now feel very self conscious of having very hard and prominent breasts for a woman of 65 years. I am embarrassed to go to the doctors and lay on my back with hard unnatural looking breasts. I worry that they may have ruptured though I have no actual symptoms to say this has happened. I feel the time has come to have them removed. Your opinion would be greatly appreciated I'm sorry but I don't have any photos.

Gary Lawton, MD, FACS · Answer

Breast implant removal should be performed with complete en bloc capsulectomy without lift. The capsule should not be left in place or the space will not heal. In patients that believe that their implants are causing them illness, leaving the capsule behind will not result in any improvement in their symptoms. Because the removal of the capsule and lift performed together can compromise the blood supply to the skin, breast and nipple to a potentially devastating degree, they should never be performed together. After the explantation with capsulectomy is healed, you can develop an plan for further surgery if it is warranted and is safe from a technical standpoint.

Raffy Karamanoukian, MD, FACS · Answer

Removal of breast implants, intact or ruptured, may have positive implications if patients are symptomatic. A constellation of symptoms associated with breast implant illness, and autoimmune disease are considered when treating patients who have breast implants and are concerned about foreign body reaction. In our office, we begin this journey with a consideration of symptoms and exclusion of obvious autoimmune problems. In many of our patients, en bloc removal of breast implants with capsulectomy is important and beneficial. Further clinical evidence about breast implant illness is evolving and will continue to guide treatment. I would suggest removal if there is a possibility of foreign body reaction.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Allen Gabriel, MD, FACS · Answer

Thank you for your question.  Unfortunately you have the first or second generation silicone implants that had weak shells.  We know that these implants are probably ruptured and that's why you have developed such aggressive capsular contracture.  The reason for removal is due to discomfort and it's a good idea to remove hard implants. These don't pose any health issues, however, given the nature of the issue, insurance companies can cover removal of the implant and capsule.  I am sure mammograms are very difficult and this is another reason why they should be removed so you can start getting more comfortable annual screenings.  Hope this helps and best of luck.

Payman Danielpour, MD, FACS · Answer

Thank you for your question.  It sounds like you may have a  capsular contraction due to the description of your breasts being hard it is very common after many many years to develop this. It's much easier to comment on this if  you had provided photos and even better for an in person examination. I recommend that you see a board-certified plastic surgeon to assess whether or not you have a capsular contraction and treat you accordingly. I do recommend that you had your implants removed and either replaced or completely taken out due to preference.

Jane M. Rowley, MD · Answer

First of all please do not be embarrassed, there are literally thousands of women just like you.  Your implants are most likely ruptured and it sounds like you have significant capsular contracture.  I would recommend removal of the capsule and implant material and at that time placing a new implant is easy or you can leave the implant out.  I do tell my patients that I think a saline or the new structured saline IDEAL implant is a good option because if you do leak again it will be easier to deal with. If you leak again you will probably be in your late seventies or even older and saline is a clearly easier to remove.  Please see a plastic surgeon certified by the American Board of Plastic Surgery and no that you are not alone.  Jane

Camille Cash, MD · Answer

As you no longer want the implants and they are causing your breasts to feel hard, and are potentially ruptured it is a good idea to have them removed.  Visit with a board certified plastic surgeon near you for a consultation.  She/He will examine you to look for signs of concern including rupture.  I've included a video I hope you find helpful.

Connie Hiers, MD, FACS · Answer

I do recommend having your old implants removed. The hardness is probably from scar tissue forming around the implant, and your implants have a high chance of being ruptured. I recommend meeting with a board certified plastic surgeon who can discuss all your options.

Alan M. Engler, MD, FACS (retired) · Answer

Implants can be removed for aesthetic reasons (ie if you're not happy with the way they look or feel) or if there is a problem with them (such as a ruptured implant).  That be assessed non-invasively with an MRI wiht a breast coil.But for a full discussion of what is involved you'll do best seeing a board-certified plastic surgeon who can examine you in person and go over the various options.  You may not have to do anything about them - but it sounds like you may want to, even if not.  In making that decision you'll need to know what the surgical options are, and what the consequences are (ie what you'll look like afterwards).  For example, would you want smaller implants inserted?  No implants, etc.I hope that this helps and good luck,Dr. Alan EnglerMember of #RealSelf500

Robert E. Zaworski, MD (retired) · Answer

Your hard unnatural looking implants should be removed with the capsule.  Most likely they are ruptured as they are the first or second generation of silicone implants.  Consult with a board certified plastic surgeon for an evaluation.

Scott L. Replogle, MD (retired) · Answer

There are no specific symptoms associated with rupture or failure of silicone breast implants. There are also no known medical indications to remove old implants. But the decision to put them in was a cosmetic choice and you should have the choice of removing them for your own reasons, regardless of medical issues. Silicone gel implants before the more modern type in the 80's do have a high percentage chance of failure and there is no simple and completely reliable way to determine this short of a direct look. For removal the surgeon needs to be prepared to do a rather difficult explantation and may need to remove part or all of the capsule around the implant, particularly if it is calcified or thickened. With a high or known risk of implant failure it is sometimes advisable to do what's called an "en bloc" or surgical removal of the capsule around the implant without entering it into the area of the implant. This is not a simple procedure and involves a sizable incision and recovery.

I want to know whether I should now remove my 40 year old silicone breast implants.

Answers (11)

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