Do Cohesive Gel Breast Implants Require Replacement After 10 Years?

Question

Had my consult with my PS. He said salines could last a lifetime given there are no problems. He said that cohesive gel silicones would require replacement at 10 years. He did not expand on this. I am wondering why at 10 years? Even if there are no apparent problems with the implant do they require replacement? I am concerned about constant screening with silicones and the safety of the implant should it rupture - and not be known. Do Salines drop more over time? 34A w/good tissue.

Tom J. Pousti, MD · Answer

Thank you for the question.

	Although there is  a lot of mis information (myth) regarding breast implant replacement  the rule of thumb is: &ldquo;if it ain't broke don't fix 'em".

	In other words, if the patient is doing well and has had no problems with her implants (such as leakage, encapsulation, malposition, asymmetry, rippling/palpability, dissatisfaction with size/shape/position etc.)   or her breasts (such as cancer,  trauma, or change in size/shape/position) there is no indication to remove or remove/replace the implants.

	Relevant to this  topic is AVOIDANCE OF COMPLICATIONS  that may necessitate further breast implant surgery (revisionary surgery).  Some suggestions I  am able to offer:

	1. Make sure you are doing the procedure for the right reasons (for yourself)  and that you have realistic expectations.  Be aware that an improvement in the &ldquo;problem area&rdquo; may not translate to an overall improvement in your life   situation.  You are bound to be disappointed with results of the procedure if your motivation for doing the surgery is not internally driven.

	 

	2. Make sure you have your surgery done by a well experienced board-certified PLASTIC SURGEON. You should be aware that there are surgeons, not formally trained in the field of plastic surgery, who will offer to do your breast augmentation surgery. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing  long-term  well-placed breast implants.

	 

	3. COMMUNICATE your goals with your surgeon.  In my practice, the use of photographs of &ldquo;goal&rdquo; pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as &ldquo;natural&rdquo; or &ldquo;C cup&rdquo; or "fake looking" or "top heavy" means different things to different people and therefore prove unhelpful. Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate. I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison. I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible. By the way, the most common regret after this operation, is &ldquo;I wish I was bigger&rdquo;.  

	 

	4. Choose the position (preferably sub muscular) and the type of implant used carefully.  These choices may  determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have.  If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants.  If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result. On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference.  Patients may need an MRI to diagnose a silicone gel rupture.   

	 

	5. Time  your surgery as carefully as possible.  in general, if you can avoid significant weight gain/loss  after the breast surgery you will improve your chances of not needing further surgery.  Pregnancy and breast-feeding will also potentially cause changes in the size/shape/position of the breasts  that may  necessitate further surgery to correct.

	 

	Following these guidelines  may help in reducing the chances the further surgery will be necessary; however, realistically speaking most young ladies undergoing breast augmentation surgery will likely need some type of revisionary surgery during their lifetimes.

	 

	I hope this helps.

William Bruno, MD · Answer

You do not have to replace saline or silicone breast implants at ten years. You only have to replace your implants if you are not happy with the size, if they rupture (saline) or if you develop advanced capsular contracture (scar tissue). Time is not a reason to change breast implants.

	Best wishes,

	Dr.Bruno

George John Alexander, MD, FACS · Answer

Whether you have saline or silicone implants, the only reason another surgery is recommended is if you have a problem.  It could be a disruption of the shell, infection, capsular contraction or for a size change.

	 

	So, either could last a lifetime or only a year.  You may want to schedule another appointment with your chosen plastic surgeon and have your list of questions to review with him.  It is important that you have a good rapport with your physician and are comfortable asking him these questions.

Robert M. Grenley, MD (retired) · Answer

You only need to replace implants if they rupture (that is, assuming you are happy with the results, the size is right, and you do not develop a capsular contracture).  If all is well, the only indication for replacing your implants is a ruptured or deflated implant which can occur with saline or gel. In fact, saline implants tend to deflate a bit more often, though both saline and gel can last 30 years or more...or rupture after 10.  Saline implants let you know when they deflate, you do not have to have a test to check for their integrity.  Though they do not feel as natural, particularly in patients with thinner tissue.  Gel implants tend to feel more natural, but they can rupture over the years and you may or may not be able to tell without doing a test like an MRI. Over the years, some have suggested that you just replace yoru silicone gel implants after 10 years since you can not tell for sure when they will break.  But at 10 years, maybe only 3 or 4 % may have broken (compared with maybe 7% of saline), so you may be paying to repalce implants that are just fine. The FDA determined that ruptured gel implants do not cause any health problem or disease, but it is still best to replace ruptured implants.  Hopefully over time there will be cheaper tests, such as ultrasound, to take the place of the more expensive MRI test to check the integrity of the gel implants.  Yes, saline implants seem to stretch the tissues or cause "drop out" a bit more than the gels, at least in some patients.

Do Cohesive Gel Breast Implants Require Replacement After 10 Years?

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Answer: Do you need to replace implants at 10 years?

Answer: Do you need to replace implants at 10 years?

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Do Cohesive Gel Breast Implants Require Replacement After 10 Years?

Answers (4)

Answer: Do you need to replace implants at 10 years?

Answer: Do you need to replace implants at 10 years?

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Everything you need to know about Breast Implant Revision

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