Is it safe to remove implants from 1975?

Question

My mother (who is 78 years old and has almost no natural breast tissue) has had multiple ruptures (due to mammograms) of her liquid silicone implants from 1975, but the Toronto surgeon who implanted them originally told her it's too risky to remove them, that the liquid silicone would just spread further. She has very bad capsular contracture but, amazingly, feels ok otherwise. What do you suggest?

Jules Feledy, Jr., MD · Answer

A breast implant develops a fibrotic capsule with time that holds the implant in position. This is a normal process. The older implants were made of a polymer shell containing a liquid silicone oil, as opposed to the cohesive gel (gummy bear/non liquid) that are now available. Over time the polymer shell weakened and the oil leaked out of the implant. The first step is leakage into the area inside the capsule - Intracapsular (IC) rupture. Over time, the silicone extrudes through the capsule and becomes Extracapsular (EC) rupture. This can be asymptomatic or can become noticeable as palpable lumps or irregularities around the implant; contractures, muscle firmness, skin discoloration, infection, etc. It may affect breast screening for breast cancers. There has been no evidence that silicone from a ruptured implant causes cancer, autoimmune diseases or systemic problems. It is great that your mother feels OK. There is no medical urgency. In the last 20 years I have seen several of these cases. If the women are medically stable, I prefer to remove the implants, silicone, and surrounding tissue and leave a small drain. This is outpatient surgery. The women have done well and there has been a sense of release of pain from the contracture and weight. Respectfully, Jules A Feledy, Jr, MD American Board of Plastic Surgery, American Society of Plastic Surgery

Donald R. Revis Jr, MD · Answer

Good evening,
That would be ridiculous for a surgeon to tell a patient not to have their implants removed. Remove the capsules, implants, and any residual silicone- that is the correct way forward!

Daniel Barrett, MD · Answer

Dear FairWanderer,
it is hard to tell for sure without an examination. Generally speaking, it is possible to remove ruptured implants together with capsule. If you are considering a surgery, I would suggest you to 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

Vasileios Vasilakis, MD, FACS · Answer

Thank you for the question. Provided that your mother is in good health, removing the implants and at least part of the capsule should be possible and safe, including the evacuation of all the silicone material. I hope this helps. Vasileios Vasilakis, MD. Double board-certified, fellowship-trained plastic surgeon, Houston. TX.

Connie Hiers, MD, FACS · Answer

I would suggest that she see another plastic surgeon who will remove the capsules with the ruptured gel implants. It is possible, that all of the gel may not be able to be removed if the capsules have torn and leaked gel. She will need a medical clearance for elective surgery.

Aleksandr Shteynberg, MD · Answer

Hello FairWanderer.
Old generations of silicone implants had a very liquid silicone which does easily spread during implant removal if the capsule ruptures. I have removed and replaced old implants, it takes more time and requires more skills to maintain capsule integrity during dissection for as long as possible. If some silicone spills out, it needs to be meticulously washed out. In my mind, there may be significant risks from anesthesia due to your mother's age and I would consider performing surgery under sedation with local anesthesia if it is true. 
Best.
A. Shteynberg, M.D., F.A.C.S.Diplomate, American Board of Plastic SurgeryNew York, NY.

Stephen Brown, MD, FRCSC · Answer

If you mom has no symptoms related to her implants then I would not recommend any surgery. Having the implants left in place doesn't put her at risk. If she is bothered by pain or firmness and her general health is good enough to have an anesthetic with minimal risk, then I would recommend removal of the implants. I would suggest that she have an ultrasound or MRI to see if there is spread of any silicone beyond the implant capsule. If there is, it might make any surgery more difficult.

Is it safe to remove implants from 1975?

Answers (7)

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