“I had my breast implants put in 28 years ago. My gynecologist thinks they look fine. My question is, when should they be replaced?” –Judith M., Newport Beach, CA
This is a very good question, Judith. I’m glad you asked because it’s one that we hear every week at our practice!
I’ll start with some brief background. The first silicone breast implants were inserted in the mid 1960s. By the mid-1970s, when I began doing surgery, breast implant procedures had become mainstream. During these early years, I don’t recall much discussion with manufacturers, other physicians, or even patients regarding the longevity of such implants. The assumption was that they would last forever and never need to be replaced! But boy, were we all naïve at that time!
Knowing what we know now, hip joints, knee joints, heart valves and pacemakers all wear out and eventually need to be replaced.
The reason that most patients who have received a hip, knee, heart valve or pacemaker don’t require a replacement, is that such implants are frequently placed in older patients who don’t live long enough for the implant to wear out or malfunction. But anyone in their 20s who receives an artificial knee, hip, heart valve or pacemaker surely knows that someday these implants will have to be replaced.
Now we know that all breast implants will rupture eventually if the patient lives long enough. This raises two important questions that need to be addressed:
1) Does a ruptured implant cause a patient any harm?
2) What is the expected duration of a breast implant and when should it be replaced?
In the early 1990s, breast implants came under scrutiny after numerous reports outlined that older breast implants were frequently found to be ruptured by mammography or during secondary surgical procedures. At the same time, a few reports surfaced questioning whether the presence of silicone led to an increased incidence of autoimmune diseases such as lupus and arthritis.
Gel implants were removed from the market by the FDA until further studies could be conducted. Hundreds of scientific studies were carried out, some retrospective, looking at the history of previously performed cases. Others were prospective, studying patients after new implants were inserted in carefully monitored situations. These prospective studies were set up by the major implant manufacturers in the United States, under the auspices of the FDA, and all data was presented to the FDA. I was chosen to be one of the investigators in these studies and was able to have access to silicone implants during the years that they were not available to non-investigators.
After carefully studying all the data from these studies and other studies worldwide, the FDA concluded that silicone implants do not increase the incidence of any other diseases.
We now know that all breast implants, whether gel or saline filled, will rupture eventually but the important thing to know is that with current implants and early detection, there is little likelihood of harm to the patient following a rupture of either saline or gel filled implants.
In November of 2006, silicone gel implants were approved by the FDA for breast augmentation in the United States. These are now the most common type of implant used in our practice. Judith, you mentioned that you were seeing a gynecologist, which is a good thing! Whether or not a person has breast implants, it is highly recommended that each female examine herself monthly for breast lumps and undergo mammography as suggested by your personal physician.
All women, whether or not they are contemplating breast surgery, are encouraged to obtain a baseline mammogram at age 35 (or even sooner if recommended by your gynecologist due to family history of breast cancer) and a yearly mammogram or MRI past the age of 40. In conjunction with your mammogram and gynecological examination, PAP smears should also be performed.
In addition, we strongly believe that any patient who has had any type of implant inserted should see a surgeon of that same specialty as the one who inserted the implant. Do this on an annual basis! For example, if you’ve had a knee implant, please see an orthopedic surgeon every year. Likewise, if a woman has had a breast implant procedure, she should see a plastic surgeon annually.
Annual visits are recommended for a few reasons. First of all, even though family practitioners or gynecologists may know more than a lay person about knees, heart valves, pacemakers or breast implants, they do not have the in-depth knowledge possessed by a surgeon of inserting specialty. As plastic surgeons, we learn about breast implants every year from our own experience, by attending scientific meetings and from reading plastic surgery journals. Such specialized knowledge is paramount for a thorough, annual breast exam.
Secondly, we occasionally learn in a medical meeting or through an FDA notification of a problem with a product or medication. If we have been seeing a patient who had breast implants inserted many years ago on an annual basis, there is a high likelihood that a letter, email or phone call will get us in touch with the affected patient. On the other hand, if someone has not seen us for many years, there is a high probability that the person has moved, married or divorced and can no longer be reached at the last known address.
Similarly, many patients who had implants inserted many years ago can no longer remember the name of the surgeon who inserted them, which year it was, or what type of implant was used.
How long will breast implants last? This question is a little more difficult to answer. I will start by telling you what happens when an implant gets inserted and why an implant eventually ruptures.
It is normal for a body to make a thin layer of scar tissue around every foreign device that is inserted, be it a chin implant, a knee joint, a breast implant or a pacemaker. If you were to look inside the pocket around a breast implant, you’d see a thin layer of scar tissue, the so-called “capsule.” From the inside, it appears smooth, soft, whitish and looks like the inside of a plastic bag. An implant is basically a loose, floppy bag that has folds in it. Normal movement inside the pocket can cause the shell to fail anywhere along a fold.
After the implants have been in place a long time–say, over 15 years–the body may begin to deposit calcium in this scar tissue around the implant. These calcium deposits grow in size and begin protruding into the pocket housing the implant, just like stalactites and stalagmites grow into an underground cave. Once this occurs, very frequently with implants that have been in place for 20 or more years, the roughened calcium deposits cause the implant shell to rupture. We strongly recommend replacing all implants that have been in place for 20 years.
Another, purely aesthetic reason that old implants should be replaced is that we rarely see a breast more than 20 years after implantation that still looks great or feels normal. As the pocket contracts and begins to calcify, the breast frequently becomes firm, sometimes uncomfortable, and often looks distorted. This is another reason to replace old breast implants.
While insurance companies, rightfully so, do not cover the cost of implant insertions for cosmetic reasons, most (PPOs, not HMOs) will cover at least a portion of the expenses involved in removing old, contracted, ruptured implants. Yet one reason breast implant surgery is so popular is because there is a high patient satisfaction from such procedures.
The important thing to take away from this discussion is that implants are safe and rarely lead to problems if inserted properly and replaced before the 20-year mark. If you have any specific questions about cosmetic procedures, your best bet would be to see a qualified plastic surgeon to review your options.