How do you know when a silicone implant needs to be replaced?

I am considering silicone implants but am a bit concerned about leakage. I know they have a limited lifespan and will likely need to be replaced after 15-20 years, but how would one know there is an issue with an implant? My understanding is that it is often hard to tell that a silicone implant has ruptured... what happens to the leaked silicone? Where does it go in the body and what impact does this have? Are elective MRI's the only way to determine that there is a problem? Thank you!

Doctor Answers 8

Regular MRI Tests Detect Implant Issues

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Thank you for your question. It is an issue I discuss with all my patients who choose silicone implants. The silicone gel implants we use today don't actually leak. By that, I mean the gel filling the implant remains in place even if the external structure cracks or ruptures. Still, it is a legitimate concern to wonder how you will know if the silicone shell fails. That is why it's important, especially after a number of years, to have regularly scheduled MRI tests, which can determine if the shell remains intact. So, to answer your question, yes, an MRI is the only sure way to detect a problem.


Portland Plastic Surgeon

Firmness

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When there is a silent rupture of a silicone implant, the most common sign is firmness. Ultrasound can be used to determine if there is a rupture, and your doctor can perform this exam in the office if they have the proper machine. MRIs are the gold standard and they can be performed every 2 years after surgery if you listen to the FDA.

How do you know when a silicone implant needs to be replaced?

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Since modern silicone implants don't leak, they are a highly cohesive gel, leaking is not a problem, but their shells do fail at some point. Currently an MRI is the only way short of physically looking at the implant, but the MRI test is far from perfect. BTW, chemists will tell you that a woman who wears lipstick has a measurable level of silicone in her blood and every time a doctor sticks a needle into you, you are being injected with silicone. It is inert. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 29 reviews

Leaking implants

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That is an excellent question. Although modern silicone gel implants have breakage rates that are just a few percent in 10 years, certainly after that this rate will go up. It's sometimes difficult to find this on physical exam or see it on a standard mammogram. MRI is the definitive test to look for a ruptured implant. I have now used office-based ultrasound for four years on hundreds of patients that were part of implant studies that necessitated an MRI on asymptomatic patients at certain intervals. We were able to diagnose both rupture or the absence of rupture 100% of the time comparing our findings to that of the MRI done later the same day. I think that in a few years office-based ultrasound for surveillance of breast implants will become the standard. If these modern implants do break, because the silicone gel is so sticky, thick this gel will usually remain attached to the gel from where it came. Silicone gel that extrudes from a broken implant shell is most always contained inside the capsule. In the past, when it was thought that early capsular contracture could be treated with a hard squeeze of the breast capsule, this probably pushed the more runny silicone of that era of breast implant into the breast tissue and possibly then migrating into the lymph nodes. It is now been definitively shown by multiple studies that ruptured silicone gel implants do not lead to any collagen vascular diseases. I recommend you discuss these issues with a board-certified plastic surgeon in your region and get their opinions as well. Good luck with your anticipated surgery.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 58 reviews

When Does a Silicone Implant Need to be Replaced?

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It is not accurate to say that implants, of any type, have a certain "lifespan". Implants have a leak "rate" which is obtained from long term studies (up to 10 years or longer). The leak rates are around 1% per year and are slightly lower for silicone gel implants. So if you have had an implant for 10 years, then you will have around a 10% chance of the implant leaking in that time period, and there will be about a 20% chance of your implant leaking if it has been in for 20 years. What we don't know at this time is if the leak rate dramatically rises after a certain number of years. Right now there is no evidence to suggest that the newest generation of silicone gel implants have dramatically increased rate of leaking or rupture at say twenty years, so there is not a defined "lifespan" and therefore they do not necessarily need to be replaced after 20 years.

It is true that an implant can leak (or more accurately the implant shell ruptures) and there are no visible external changes, and the patient is unaware that the implant has leaked. On the other hand there is often some change in the shape or position of the implant or the patient may develop capsular contracture. These could be a warning sign that the implant has leaked. It is terribly misleading to say that modern implants don't leak. It is a demonstrated fact that the new generation of highly cohesive silicone gel implants do have a very low but real incidence of rupture or failure of the implant shell. The difference with the new generation implants is that the gel inside is cohesive, which means that it tends to hold together and therefore is less likely to "leak" outside of the implant shell. But that does not mean that your body does not come in contact with the silicone gel. It means that the gel does grossly spill outside the implant and into the pocket around the implant.

The rupture or leaking of a silicone gel implant can often be seen on mammogram or ultrasound, but these tests are not the most accurate or sensitive at determining if your implant has ruptured. MRI is considered to be the most accurate test to determine if your implant has ruptured but it is not 100% accurate. There can be both false negatives and false positives. A false negative is when the test does not show that there is a rupture, but in fact your implant has ruptured. A false positive is when the test indicates that the implant has ruptured but in fact there is nothing wrong with the implant. The problem then is that the patient could potentially undergo an unnecessary operation to replace an implant that an MRI indicates is leaking, when in fact the is no leak.

The take home message here is that the new generation of highly cohesive silicone gel implants have very low rupture or "leak" rates, and that if the implant shell does rupture or fail, the gel will tend to hold together and not spill outside of implant into the surrounding tissue.

Implants don't have to be replaced

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if everything is good (appearances, softness, etc) unless the implant if broken... and even then, its not an emergency because the gel is cohesive and will stick together rather than break up into drops and particles.  With the scar tissue that forms in everyone around implants, this blob of gel should not infiltrate your adjacent tissues or spread around.  My patients are told they do not have to have MRI's unless they feel something is amiss OR before the 10 year anniversary when the warranty benefits change.  So ruptured gel implants should have no real impact on you or your body but if they are known to be broken, they should be changed out.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

How to tell if a silicone implant has ruptured

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Yes, at this time, the only way you can tell if a silicone implant has ruptured is by an MRI x-ray. The implant manufacturers and the FDA currently recommend that you get an MRI three years after your initial surgery and then every 2 years thereafter. Insurance may or may not cover this test. You could check with your company in advance. Good luck to you.

Ted Eisenberg, DO, FACOS
Philadelphia Plastic Surgeon
4.9 out of 5 stars 85 reviews

Ruptured silicone implant

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Great question.  This is a common concern and Q before deciding to have silicone implants.  Given the "scare" of ruptured silicone implants and cancer, many people are still afraid of silicone implants, depsite the fact that all studies have shown that they are safe.  As for detecting rupture, MRI or ultrasound (US) can detect the rupture.  If there is a a rupture silicone implant, the newer silicone technology ensures that the silicone essentially stays in place despite a rupture or leak.  Furthermore, when any implant is placed in the body, a natural capsule or pocket of scar tissue is formed around the breast and the silicone is trapped within this capsule, preventing it from "leaking" into the surrounsing breast tissue.

You should have a consultation with a local board-certified plastic surgeon to directly address all of your concerns.

Hope this helps!

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.