When Should You Remove your Breast Implants?

Unless you have a medical emergency related to your breast implants (also called a prosthesis or device in this article,) removing your breast implants is an entirely elective decision. You should however discuss this decision carefully with your Plastic Surgeon and seek his/her advice.

If you are pleased with the appearance of your breasts after augmentation, and you have no medical complication caused by the implants, then there is no reason to remove them.

There is a great deal of confusion about whether stable prostheses have to be removed after 10 years. This is because of the FDA guidelines written a few years ago when they approved the new Silicone Gel Breast Implants. The FDA estimates the “useful life” of these products to be 10 years. Thousands of patients have had similar devices in place for over 40 years and have not had problems. It is important for you to understand that the FDA recommendations were not based on any scientific long-term study as there were no such studies for the new approved devices when these new devices were approved. Thus the FDA recommendations are essentially an estimate of “useful life.”

if you are happy with your result and there is no evidence of rupture or any other problem, I do not recommend removing breast implants unless you no longer wish to have them. Just because they are 10 years old does not mean that you “have” to remove them.

There are situations in which I do recommend removal and, if you desire, exchange to new implants. There are however some serious medical reasons that require removal.

Some of the reasons for removal are listed below:

• Infection-rarely the prosthesis can become infected. I have seen infection once in 30 years and it occurred after a nipple piercing. Infection of an implant can be life threatening and removal is a surgical emergency. Signs of an infection are redness on the skin and fever and if this occurs see your doctor immediately.

• Exposure- if there is a break in the skin and the device is exposed removal is almost always recommended immediately.

• Rupture- if your Silicone Breast Implant ruptures it should be removed according to current guidelines. New ones can be placed back into the breast after removing all possible Silicone. If they are Saline, the device deflates and the saline is reabsorbed by the body safely. However deflation creates an asymmetry and you will most likely want a replacement.

• Capsular contracture-capsular contracture presents as firmness or hardness around the prosthesis. It is caused by scar tissue forming around the device. In severe cases it can cause discomfort. If you are considering re-augmentation, then the surgeon will remove the scar tissue, called a Capsulectomy, so that the new prosthesis will be softer. However, if you have developed capsular contracture there is a 50% chance that it will recur after removal, Capsulectomy and insertion of new prostheses.

• Rippling of Saline Implant-many women are troubled by palpable or visible ripples along the side near the axilla or arm pit. This happens most frequently with Saline prostheses. It is not a medical problem but a cosmetic one. Silicone gel prostheses are less prone to this problem, which is more common in thin women with little glandular tissue.

• Displacement, abnormal position or bottoming out-in some patients the prosthesis can become displaced to the side or sag down on the chest. This is again a cosmetic problem and most women opt revision and replacement.

• Double Bubble-in some cases the device falls below the mammary gland and creates a second “bubble” or fullness below the crease. This is usually repaired and the prostheses replaced.

• Snoopy Deformity-in some cases the prosthesis fails to drop down to a normal position under the mound. This can create a bulge above the nipple which from the side view has the appearance of the cartoon character Snoopy. Revision is usually done.

• You want a larger size.

• You want a smaller size.

• Your breasts have sagged and become smaller after having children, or with age. In most of these cases a breast lift or Mastopexy is done and new prostheses are placed.

• You simply do not want to have them any longer.

How difficult is the removal procedure?

If your breast implants are normal and there are no medical issues then removal is very simple and usually not painful. If you want them out, have them removed. Do not be concerned that you will look deformed or abnormal. You will just look smaller, but if there are no problems with the device such as capsules or rupture, you will look fine.

Capsular contracture or tight scar can require more extensive surgery to remove the scar. Some glandular tissue can be removed in these cases and create visible depressions.

In summary there is no specific time at which your breast implants have to be removed as long as there is no medical reason. Most removals are followed by the insertion of new ones after correction of a cosmetic problem.
If you want or need them removed, don’t worry about how you will look. You will, in most cases, look smaller but normal.

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Dr. Seckel
Boston, Massachusetts
Concord, Massachusetts

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