I have 35 year old silicone, sub implants. The left one has ruptured found during mammogram 1 year ago.

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

Lifetime of silicone gell-filled breast implants range from 10 to 20 yrs as an estimate, the average 14-18 yrs; this means your implants are ruputured, broken and leaking as minimum 10 years ago, and nowday they are probably dissolved and inside your calcified periprosthetic capsule you just have a "silicone soup".The mammogram did not break anything there inside.Your options are removing the implants as standalone procedure or additionally and in the same procedure inserting new ones.You run no risk, obviously, or at least no additional one for waiting a little to save the money for your chosen surgery.

Ruptured Silicone Implants

The FDA recommends that silicone implants that are ruptured
be removed. There is however no imminent health risk associated with ruptured implants.
I am sure that there are many women who have “silent” (unknown) ruptures or
leakage of their silicone implants.

The decision whether to have them replaced is a personal one
entirely. I have taken a number of implants out of women who did not wish to
have them replaced. In many cases the results were quite satisfactory while
others needed a breast lift (mastopexy) to achieve an aesthetic result. If you
choose not to replace the implants immediately, it will probably be about six
months before all the breast tissues have contracted completely so that you can
appreciate what the final appearance will be. Every woman will respond somewhat
differently in this situation so predictions as to the final look cannot be
made.

When searching for a plastic surgeon, seek the consultation
of a plastic surgeon certified by the American Board of Plastic Surgery. They
have a website listing all the certified plastic surgeons. Members of the
American Society of Aesthetic Plastic Surgery will all be board certified in
plastic surgery and have demonstrated an interest and competence in cosmetic
plastic surgery as well.

There are many issues here. What is the risk of ruptured implants?Do they need to be replaced?How will you look if they are removed and not replaced?Can some of the cost be covered by the implant company?Most surgeons feel that it is better to remove broken silicone gel implants, especially if they are causing problems such as pain. However, there are many women with ruptured implants that don't have a problem. If you remove them, then your breasts will look different so you need to consider if you want them replaced. Check your implant paperwork. You may have a clause with covers part of the replacement costs. 

First of all, you definitely need to have them out, whether or not you choose to have new implants. As to what the appearance might be after implant removal alone, there is no way to even have an idea without current photos.