There is a widespread misconception that breast implants need to be replaced every 10 years. Is that true? No! Unless there is a problem with an implant, it does not need to be exchanged. Neither the FDA, implant manufacturers, nor the national organizations of plastic surgeons recommend this as a routine policy.

What kinds of problems merit implant replacement? The first category of problems consists of “Must Replace” problems. A leaking implant fits into this category. An implant is not like a tire – if it leaks, it cannot be repaired. Lifetime warranty plans for leaking implants are offered by all of the implant manufacturers that offer implants in the U.S. The Mentor Corporation has a lifetime warranty that offers replacement of both implants. If the leak occurs within 10 years of insertion, there is also coverage of the replacement surgery up to a certain dollar amount.

How does a patient know that her implant is leaking? In the case of a saline-filled implant, the typical scenario is a rapid loss of size of the breast, usually occurring within 24 hours. Occasionally the leak is slower, but the breast will still decrease in size. With the current generation of silicone-filled implants, the breast size may not change at all since the scar tissue that surrounds the implant holds the silicone within it and does not allow leakage. In addition, the silicone gel is very cohesive and “sticks” together, further keeping the silicone gel inside the scar tissue. For that reason an MRI is recommended every few years to check on the status of the implant if a silicone-filled implant is in place. The truth, however, is that MRI’s are not 100% accurate when it comes to diagnosing leaking implants. I have operated on a number of women because their MRI’s claimed that their implants were leaking, only to find an intact implant. On the other hand, an MRI is currently the best test available.

What about other reasons for which implants are removed but which are not “Must Replace” situations?

• Treatment of scar tissue contracture around an implant frequently includes removal of the implant as part of the treatment of the contracture. The most popular theory as to why the scar tissue that surrounds every implant will in certain cases begin to contract and produce painful, distorted implants is that there is a small amount of bacteria present around the implant that is stimulating the contracture. According to this theory, the removal of the scar tissue alone does not remove the bacteria completely since they bind to the implant surface. The implant must be replaced with a new one to eliminate the bacteria from the scar tissue pocket and cure the contracture. On the other hand, a patient who develops a mild degree of contracture shortly after surgery is frequently successfully treated with a surgical release of the scar tissue only, saving the patient the expense of a new implant.

• The patient wants a new implant, either for reasons of size or shape. If the implant is a saline filled implant, saline can frequently be added or subtracted to adjust the size slightly. This is helpful if there is a slight degree of asymmetry of the breasts after saline-filled implant augmentation. A significant (1/2 cup size larger or smaller) change, however, is not usually possible because underfilled or overfilled implants tend to wrinkle, be too firm, and even leak in some cases. The size of a silicone implant cannot be changed, as can the saline implants.

Should you have any further questions, please contact my office.

George Sanders, M.D.