33-year-old saline implants and mammogram - Are the chances of rupture high for me?

Question

I am 56 yo with 33-year-old, saline implants. I have not had a mammogram in eight years because I am afraid they will rupture. I know that I cannot continue to forego such an important test at my age. My OB/Gyn mentioned MRI instead of traditional mammography. Are the chances of rupture high for me? Is MRI as good as mammography? Or, should the implants be replaced despite not causing me any issues (no contracture, etc)?

Daniel Barrett, MD · Answer

Dear lorntor,

yes, there is a high risk of rupture of 33-year old implants and they should be replaced. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Wayne I. Yamahata, MD · Answer

There is a risk that your implants may rupture during mammography, but the risks do not outweigh the benefits. It is far more important to undergo screening for breast cancer, than to worry about damage to the implants. An MRI is a reasonable option. A prophylactic implant replacement is not indicated or necessary.

Donovan Rosas, MD · Answer

Traditional risk of rupture is quoted at slightly more than 10% at ten years post op. This rate rises at approximately 1% per year. Salines have a slightly higher risk than silicone (potentially as a function of the ease of rupture diagnosis).

With regards to your particular question, your risk of rupture is still less than 50% at 33 years post op. I would not forego mammogram to protect an implant. MRI is a more sensitive test but for this reason it is not used as a screening modality.

There is no need to replace an implant that is not having/causing issues.

As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Ted Eisenberg, DO, FACOS, FAACS · Answer

on average 10 -13%, when possible, the rupture rate of the implants is less than 2%. I recently had a woman who wished to change her size after 27 years and the saline implants seemed brand new, when removed, like the day I put them in. See the link below to read my published article on this topic. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Camille Cash, MD · Answer

Though there is no specified time that implants need to be replaced it is a good idea to visit with a board certified plastic surgeon for an exam just to rule out any obvious concerns.  You can elect to have them replaced at any time.  I encourage you to continue with regular mammograms.  There is an increased risk of rupture due to the age of your implants but it's not worth risking your health over concerns about your implants.

Daniel P. Markmann, MD · Answer

Definitely get your mammogram!  If the implants rupture, get them replaced.  Yes, the older your implants, the greater chance of rupture.   Exchanging implants is usually a very quick and easy surgery.   Most of my patients take one day off and either tylenol or nothing for pain.   It's nothing like the original surgery.  MRI is a great test for cancer detection, but much more expensive than a mammogram.  Therefore, insurance usually will not pay for it unless the mammogram and Ultrasound show something suspicious that needs further workup.     Get your mammogram!

Mats Hagstrom, MD (license on probation) · Answer

Your concerns are real and you’re absolutely right that you should not forgo breast cancer screening.
MRI is a better test for screening breast cancer than mammograms.
For most patient MRIYour concerns are real and you’re absolutely right that you should not forgo breast cancer screening.
MRI is a better test for screening breast cancer then mammograms.
For most patients MRI cost are too high and that’s why it’s not the standard of care.
If your insurance company will pay for MRI screening, then that is an option.
Breast implants, regardless of what’s inside, become fragile with age.
With every year, the implant shell becomes more likely to rupture.
Sometimes minor trauma, such as being bumped or having a mammogram is the triggering factor for the rupture.
 This is highly unlikely during the first decade, but becomes more likely with each year.
At 30 years implants are typically very frail and can easily be ruptured.
Whether the implants should be replaced prophylactically or not depends on a number of variables. Ultimately the decision is yours.
If you for whatever reason are having any other procedure with a plastic surgeon, then that would be the time to replace the implant as well.
My recommendation would be this.
Make sure you have a plastic surgeon that you know, who knows you and is ready to replace the implants if they rupture.
You may as well get everything lined up so you’re ready to go when the time is right.
If your implants rupture, then I recommend not waiting too long before replacing them.
 If you’re implants rupture, then I recommend not waiting too long before replacing them.
This is especially true if you want to maintain the same size. All people form a capsule around implants.
If a saline implant ruptures that capsule slowly begins to shrink.
What this means in reality is that if patients wait a long time before replacing the implants, the capsule will need to be cut on the side with a ruptured implant.
 If the replacement is done soon after implant rupture, the surgeon doesn’t have to do anything with the capsule and can simply swap the implants like replacing the innertube on a bicycle wheel. 
If there’s no other breast work needed, then simply swapping implants as fast and easy with low risk.
There’s minimal recovery.
It may be appropriate to pay less for implant replacement than a full breast augmentation.
You may be able to negotiate a better price, considering the relative simplicity of doing only an implant swap.
For all these reasons, I recommend you get everything lined up in advance.
You can then know where to go and understand pricing and logistics if they implant the ruptures.
You can also choose to replace the implant prophylactically before anything happens.
If it was me, I’d recommend consulting with a few plastic surgeons to do some price comparison and make sure you’re in the hands of the right provider who has sufficient skill and experience that you feel comfortable with.
After that you can either wait until the implant ruptures or move forward and replace the implant when it’s convenient.
What you don’t wanna do is have an implant rupture, wait six months then replace the implants.
At least this is my opinion and different providers may have different suggestions.
If you want to change the size of the implant or do any other breast work then that would be good to know in advance.
If it all possible, you should obtain the information about your current implants in regards to size shape, serial number, etc.
 If you don’t have your implant information, then see if it’s at all possible to obtain a medical records from your procedure, even though it was 30 years ago.
It’s always helpful for a surgeon to know what size and shape implants patients have before doing surgery.
For now, I suggest you get your plastic surgeon lined up, and this may involve consulting with a few different providers.
During in person consultations you’ll be guided to what to do next.
Recognize that plastic surgeons make money by doing surgery so there will be some propensity to recommend moving forward with surgery sooner rather than later, which is not wrong, but you do have the option of waiting if you want.
Best,
Mats Hagstrom MD

33-year-old saline implants and mammogram - Are the chances of rupture high for me?

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