Q. I would like to know when I should replace my breast implants. I had an augmentation about 10 years ago in another state. I know that I have saline implants but do not know anything else about them. When should I plan to replace these implants?

A. This is a good question and one that I face every day in my practice. Before I answer your question about when to replace a breast implant, let me say that you should make an effort to get as much information as you can about your implants from the doctor who placed them. Most plastic surgeons will keep records for many years. It is always good to know the manufacturer of your implants, the size, the date of placement, and whether the implants are under or on top of the muscle. This information will be of great benefit to the plastic surgeon who may be replacing them in the future. Also, if the implant is leaking, the manufacturer will often provide new implants at no charge.

Now, to your question. What I tell my patients is if you have saline implants, you can simply wait until one of the implants begins to deflate. Deflation is usually fairly slow (not always however), and once you notice that one breast is starting to get smaller than the other, it is time to visit your plastic surgeon. As a general rule, you can expect your saline implants to last about 15-20 years. Replacing them is a surgical procedure that is relatively simple compared to the original augmentation surgery. The surgery typically takes about an hour and you can expect to return to most activities in less than a week. The most common sign that a saline implant is leaking is that one breast no longer fits the bra as it used to because the breast is getting smaller as the implant deflates. The other sign that is sometimes seen in slowly deflating implants is a new onset of rippling on the outside (lateral) portion of the breast. This rippling looks like waviness on the skin. If in doubt, see a plastic surgeon who can help make the diagnosis.

Silicone gel implants have different recommendations than saline. It is now recommended that silicone gel implants be replaced about every 10-14 years. This recommendation is very different than what used to be told to patients, which often was that implants will last forever. This advice is absolutely not true. All implants will eventually fail. There are many women today that have implants that are more than 20-30 years old and likely have leaked. Mammograms are not a very accurate tool to diagnose a leaking silicone implant unless it is obvious. An MRI of the breast is the most accurate diagnostic tool for detecting a leaking implant, however MRI’s are expensive. My recommendation is to save your money on an MRI and plan on replacing the silicone implant electively about every 10-14 years. The goal is to replace the implant before it leaks, not because leaking silicone is dangerous to your health, we do not believe that is the case, but the surgery to replace a leaking implant is more complicated and expensive than replacing a non-leaking implant. There are no definitive physical signs that a silicone gel implant has leaked although sometimes there can be a gradual change in the shape of the breast or new onset of hardness of the breast. Gladly, we are not aware of any diseases that may occur because of a leaking implant.  But still, the recommendation is to remove a broken silicone implant and replace with a new implant, if you want. My recommendation for anyone with older silicone implants is that you visit a board certified plastic surgeon for an evaluation and formulate a plan for taking care of the implants in the future.