Should Folded Breast Implants Be Replaced?

Question

I recently found a lump in my left breast. Upon diagnostic mammography it showed a fold in the upper part of my saline breast implant. While relieved it was not cancer, I now have this question: Do I need to get this replaced or can I just deal with it because it does not bother me? I had my implants done just 2 years ago and really do not want to go through it again for awhile. Thanks...

	P.S.: The implants are above the muscle.

Brian S. Glatt, MD, FACS · Answer

As others have mentioned, a fold seen in a saline implant on mammogram is not that unusual and does not necessarily indicate an acute problem. You may, however, be at a higher risk of implant failure at some point. IF that should happen, you would be very aware of it as your breast will deflate at which point you would need surgery to replace the ruptured implant. I would certainly not undergo surgery prophylatically for this though.

Larry S. Nichter, MD, MS, FACS · Answer

An asymptomatic finding on a mammogram such as a fold in a saline implant in a woman with symmetric breasts does not need to be replaced. Folds, Rippling and Wrinkles in Saline Implants are common and one of the reasons many women prefer silicone implants which have a decreased tendency towards this problem.

David Shafer, MD, FACS · Answer

Amy,
In most cases, if the implants are not causing you a problem, then you should leave them along.  However, if you are symptomatic for any reason, then the implants can easily be replaced.  Good luck.

Armando Soto, MD, FACS · Answer

Hi there,
As long as you are still pleased with your breast shape and size, you shouldn't need to do anything about this.  The folding of your implant shell will eventually lead to a deflation, but you will know when that happens, because the implant will go flat as your body absorbs the saline. Until then, or until you become unhappy with your appearance, there should be no need to replace your implants.  I'm glad you don't have a larger problem.

Steven Wallach, MD · Answer

If the implant is folded because it deflated then obviously you should have the implant exchanged. If there is a fold that is from underfilling the implant, then if it does not bother you, I would leave it alone.

Michael C. Edwards, MD, FACS · Answer

Saline breast implants aren't meant to be so filled that they are firm to the touch and therefore rippling or wrinkling are not uncommon, especially in implants placed above the muscle. The most common place this is felt is in the lower outside part of the breast. As long as your breasts are soft and you are pleased with the shape and feel, there is no need to change them.
Dr Edwards

Sirish Maddali, MD · Answer

If the implant has a fold, then it has a higher likelihood of a rupture in the future. Since this is a saline implant, rupture does not pose any risk. If the fold is not very visible, then there is no necessity to replace your implants. I agree with the other physicians. Good luck.

Peter E. Johnson, MD · Answer

Amy,
The saline implant has been a very good choice in augmentation, and we have many happy patients wearing them. The saline implant has benefits such as small incisions for placement, very low capsule contracture rates, longer duration of softness, and ease of replacement. The detraction of the saline breast implant is the tendency to ripple or show visible folds, especially when the tissue of the breast is thin and does not have good cover to hide the implant.
The solution has been submuscular placement of the impant, as this hides the upper portion of the implant and prevents the ripple or fold from showing. Sometime the implant can still be felt along the side of the breast, however this usually does not cause a problem for most.
In a subglandular placement, it can be hard to hide the implant if your tissue is thin. There are three solutions which can be considered, though all require surgery. The first is filling your present implant to the maximum allowable volume. This can smooth out the folds at a cost of slightly more projection and firmess in the implant texture. The second is replacment of the saline implant into a submuscular position. This has an excellent chance of smoothing the upper edge and improving the breast. The last option is replacement of the saline implant with a silicone gel one as the gel implant will look smoother with the thin cover available.
Of course there is no need to replace your implants or modify your augmentation if you can accept the fold or wrinkle as it is. You can delay until the implants have worn, perhaps in ten years or so, and consider your options then.
Best of luck,
peterejohnsonmd

Scott E. Kasden, MD, FACS · Answer

At first blush, my reaction is "if it ain't broke...", especially if it isn't bothering you. However, experience tells me that the implant should not have significant folds in it. This may not hold in every case (especially in the case of a textured implant, where some folds may be present and OK). 
The folds may indicate that  a slow leak, or nothing to worry about. So I would recommend that you call your doctor, have him review your mammograms, and examine you to determine what is next. Hopefully, it will be nothing to worry about.

George J. Beraka, MD (retired) · Answer

Hi!  The fact that there is a fold makes it more likely that this implant will leak in the future, but you will know if that happens because your breast will go flat.

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