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We live in an age of unparalleled access to information. At the touch of a button, we can access anything and everything from real-time events across the globe to academic papers on any number of topics. As a Plastic Surgeon, this is mostly fantastic. Patients can now come to me already armed with some basic knowledge about the aesthetic procedures they are interested in, allowing us to maximize our time during a consultation. This age of information can, however, also amplify information at unprecedented speeds, whether that information is true or false. There is one particular, ubiquitous misconception I have heard time and time again from patients during Breast Augmentation consultations. I hear it so much, it seemed a natural and obvious topic to cover in detail in my own blog. Below, I’ll break it all down.
THE RUMOR:
Breast Augmentation consultations are unique in that we have to discuss not only the surgical procedure but also the breast implant devices themselves. There are a lot of numbers to digest– from rupture and capsular contracture rates to how often you should screen your implants. Inevitably during this discussion, patients almost universally purport that breast implants must be exchanged every ten years. Not five, not twenty, but always ten. Oftentimes, they don’t even pose it as a question directed at me but rather state it as a well-known fact. And they aren’t wrong–it is well-known. The problem is, it’s not a fact. How did this falsity even take hold? I’ve wondered that constantly throughout my years of practice. My best guess is that it is misconstrued from the breast implant warranties. The warranty typically lasts ten years, so somehow that morphed into the implants needing to be replaced every ten years. It is only speculation, but what’s more overarchingly important if you are considering or have breast implants is to understand the circumstances in which a patient would need their breast implant replaced.
NEED VERSUS WANT:
To be clear, the number one reason for reoperation in a Breast Augmentation is voluntary size change. There are many scenarios I encounter as a Plastic Surgeon where patients come in seeking to either upgrade or downgrade their implant size. Maybe they’ve outgrown their larger implants and feel they no longer fit their lifestyle. Or maybe, they lost breast volume with weight loss, pregnancy, or breastfeeding and now feel they need a larger implant to recapture their desired breast size. Sometimes it's not the size we are changing but rather the type of implant. Typically, I see this in patients who had saline implants placed during the FDA ban on silicone implants (1990’s era) who now want to switch to silicone implants. The age of the breast implant can be something to consider. For example, if we are planning a breast lift in a patient who has older implants (by “older” I mean usually >15 years), oftentimes they will elect to place new implants at the same time in hopes of improving their outcomes long term and giving them better peace of mind. Regardless, these are all situations where patients choose to replace their implants.
WHEN YOU NEED A REPLACEMENT:
There are two circumstances where a patient will need a breast implant exchange– capsular contracture and implant rupture. The former, capsular contracture, is a phenomenon that occurs when the body begins to thicken the already existing layer of scar tissue that naturally forms around a breast implant. Why would the body do that? Well, the answer is complicated and not totally understood. The most common reason to trigger a capsular contracture is a crack in the implant. Basically, you get a crack in your implant, your body recognizes the crack, and it triggers a hyper-inflammatory response that results in a thickened scar. However, there are other reasons hypothesized to cause a contracture such as biofilm and surgical plane, but a deep dive into those is best served for its own exclusive blog post.
The latter reason for needing an implant replacement is an implant rupture. Now, this term is not nearly as dramatic as it sounds and is actually akin to what was described above– simply developing a crack in the shell of the implant. Why would this happen? Generally, there are two reasons for this occurrence. First, your breast implant bends and moves with your body over time. This constant movement and bending subjects the shell of the implant to general wear and tear. The areas of the implant that see the most stress are most likely to develop cracks. That is why the longer you have the implants, the more likely they are to rupture. The second reason for implant rupture is due to a manufacturer defect (or implant ‘flaw’). While this sounds scary, this is something we see with all manufactured products and is often the impetus for offering a warranty. Bottom line, sometimes you just get a lemon.
NOT LIFETIME DEVICES:
What’s really important to keep in mind when you are considering a Breast Augmentation is that breast implants, whether silicone or saline, are not lifetime devices. Just like a car or a laptop, they will inevitably have an expiration date for one reason or another. Especially in my younger patients, setting realistic expectations is critical. Odds are, at some point in your life, you will either need or want an additional surgery. This brings up two CRITICAL points. First, your relationship with your Plastic Surgeon should be looked at as a long-term one where you can seek appropriate follow up and screening. Second, keep your records! Surgeons and patients move, retire, etc. Surgeons and implant companies are only required to keep patient records for a set amount of time before they get destroyed, and the details of your surgery and your breast implants are a key component when planning any subsequent surgeries. Keep your records and upload them to your digital drive, take a picture of your implant card and save it to the cloud. You will be doing your future self a huge favor!
RECOMMENDATIONS FOR FOLLOW UP:
Despite dispelling the 10 year implant replacement rumor, there is maintenance recommended for silicone breast implants. Due to the risk of a silent rupture (crack in the implant without symptoms), the FDA currently recommends MRI or Ultrasound imaging 5-6 years after having your implant placed and every 2-3 years from there on out. Whether you want to follow these recommendations or not is up to you. Previously, MRI was the only imaging modality recommended and its high out-of-pocket cost kept many patients from following through. Currently, we are seeing a rise in the use of ultrasound technology to examine breast implants, which can occur at much lower friction points to patients (cost, scheduling, availability, time, etc).
CONCLUSION:
No, you do not have to have your breast implants replaced every ten years. Yes, you will most
likely have something done with your implants throughout the course of your life. Implants are not lifetime devices, so it’s important to approach your relationship with your Plastic Surgeon as a long-term one. Having someone you know and trust and who knows the details of your surgical history are key to keeping you safe, healthy, and maintaining your surgical results.
If you would like to schedule a consultation with Seattle-based Plastic Surgeon Dr. Megan Dreveskracht, call 206-860-5582 or click on the link below.
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