Breast implants - How long do they last? When should you replace them?

Great question Pamela.  As you can see from the many responses there's an overall consensus about the stability and durability of both the saline and gel implants.  Anything man/woman/machine made has a potential for failure, since nothing in our body remains stable for very long.

The implant replacement issue was very prevalent during the early years of breast augmentation and before the newer 'models' were redesigned after the 10 yr moratorium by the FDA.  Back then we had thin walled incompletely polymerized gel implants, sometimes enclosed in another implant of saline (the double lumen implant) and both had the problem of capsular contracture.  Since we didn't know what was causing the contracture, we assumed it was silicone, and the implant was often removed with the capsule.  Those were the years when multiple types of synthetics were used and multiple surfaces applied to the implants including Dacron patches to keep them from 'moving around' - a concept borrowed from hip replacement prosthesis - not exactly applicable to breast 'natural' function.

Today, with the advent of endoscopic breast augmentations and thicker implant shells, cohesive (better polymerized) gels the intrinsic problems contributed by the implant are much less.  A recent disclosure that cotton (one of the most reactive of substances within the body) may be the main culprit in capsular contracture has led many of us to dispense with using any cotton gauze within the wounds, to dry any fluid drainage or use as dissecting tool (as we were taught in years past) and the capsular contracture issue is much less (from 20% to less than 0.5%) than it used to be, and implants are not removed as often.

I am starting to see patients that have had submuscular implants with several muscle induced deformities come to the realization that a submammary gel implant can give them a more natural cleavage with less 'folding' 'creasing or rippling' and enhance the overall breast texture than it ever was with saline, especially if the implant pocket was small to begin with, so I'm removing saline implants and replacing them with gels and improving the patient's overall satisfaction with their breasts.

I suspect that when the current trend of submuscular placements begins its reversal as it did 20 yrs ago when we had to use the pectoralis muscle in breast reconstruction and became disillussioned with the abnormal movement and lack of cleavage, we will see more women ask for cleavage and texture, bounce and giggle than they had in the past.  The best way to achieve that will be with submammary gels and a resurgence of primary gel augmentations will occur.  Time will tell.

Ultimately it's the woman who has grown accustomed to her implants as her own breasts that will decide what happens.  The body image incorporation is so strong as to produce the same emotional effect as a mastectomy when an implant deflates.  The idea of 'having to go through that again' will ultimately determine the decision to reach for the non-deflatable gels and get on with their lives.

I hope this helps.

Dr."C"

The average lifespan of implants manufactured in the US is 10-15 years, and the most common reasons they would need to be replaced are because they rupture, or because of capsular contracture (firmness and shrinkage of the connective tissue surrounding the implant) which may or may not cause discomfort and/or distortion of the breast.

If you are having problems- whether that be dissatisfaction with the changes in appearance of the breasts, pain, or loss of volume, I would consult your Board Certified Plastic Surgeon for an opinion. You may not necessarily need to consider surgery for new implants, but it is best to keep in mind that, while our modern implants are much better than those of the past, they remain man-made devices that should be expected to eventually fail and need to be replaced. In most cases, this replacement of the implants and an aesthetically pleasing result is most simple and likely if the problem is addressed early in the process (especially if your implants are silicone filled).

Good luck- I hope that helps.

Both major US breast implant manufactures have a lifetime warranty on their implant, as well as a 10 year warranty on the replacement cost, if they deflate.

Therefore, your implants are good forever, but statistically, according to the FDA, most women tend to change their implants (not beacuse of the implants) within 18-20 years.

Given the signs and symptoms described in this question, along with the amount of time the implants have been in place I recommend a prompt evaluation by a board-certified Plastic Surgeon experienced in the use of implants in breast surgery. While general statements about the lifespan of implants generally hold true the specific circumstances referenced here require investigation, independent of how long the implants have been in place.

There is no absolute date from surgery that breast implants need to exchanged. That is saline and silicone. Peace of mind is a different issue. Saline breast implants do not seem to cause much concern and when they fail you will know it. All of the fluid will go out and the breast will be smaller. Sometimes this is a one day event others will note a progressive diminition in volume over a few days to weeks.

Silicone gel is a differnet device and raises alot more concern and anxiety. To alleviate concerns 15 years is very reasonable with the current quality of new gel devices. Those not wanting unnecessary surgery and MRI may be of some value.

In this case above, she should be evaluated by a well trained, board certified plastic surgeon.

1- Durability of breast implants - Saline implants will last a very long time. About 5% will leak in the first ten years and then the number of leakages will increase significantly. A leakage is not dangerous but the loss of volume can be embarrassing.
Silicone implants can be divided into generations. The pre-FDA approval variety and the newer FDA approved cohesive gel implants. The earlier variety have a higher rate of capsule contracture and were known to have the silicone shell disintegrate over time. The disintegration of the shell left free floating gel in the breast pocket and this gel on rare occasions would enter the local breast tissue to cause nodule formation. The Cohesive gel implants are not subject to the shell disintegration problem. Thus, any break of the implant is not subject to these concerns.
2-Redness under the breast - Intertrigo is a redness that forms under the breast as they sag,especially during hot weather. This can be relieved with a good fitting bra or by medication. Of course, it is imperative to see your doctor first.
3- Air bubbles- this can be the interpretation of the calcified capsule as it bends and folds, air around the implant (unlikely after 14 years) or sign of an infection. In any case, see your trusted plastic surgeon for a true evaluation.

You should return to your plastic surgeon to have the rash under the breast properly evaluated. The rash could be heat related, but it is not possible to determine this without an evaluation.

Typically, we tell our patients that a breast implant is not a permanent device. Some will eventually fail. With a saline implant there is no question if it is leaking, the breast will gradually decrease in size. Eventually, over a 3 - 6 week period all fo the saline will leak out. This is not a health risk and the implant will simply need to be replaced.

I had a patient a few years ago who had a saline filled implant inserted in 1973. Unfortunately, the implant was placed above the muscle and she developed a severe capsular contracture but the implants were intact. These implants had been in place for over 33 years.

With the new style gel implants a rupture can be more difficult to diagnose and may require a MRI scan.

Hello, When you ask this question, the answer really depends upon the type of implant you have had placed. A rash under the breast is especially worrisome. When the implants are silicone gel implants, it might mean that the implant has ruptured and the gel is affecting the tissues including the skin.

Your mention of "air pockets" makes me think you likely have saline implants. The rash indicates a reaction, so I would get this evaluated by your plastic surgeon ASAP.

When saline filled implants rupture, the process is more noticeable as the breast loses size rapidly. The body absorbs the saline and there is usually less of a worry from a "reaction" standpoint. Saline implants when they last (they may rupture more readily) can last 10-15 years.

Newer generation silicone gel implants (Cohesive Gel) may last longer. We don’t have much data on the longevity of Cohesive gel implants as they are newer. I have posted a Youtube video showing some silicone gel scar capsules I removed for a woman with really old silicone gel implants for your information.

Best Regards,

John Di Saia MD

Patients who see their doctors annually have their implants in an average of 10-15 years. However, that doesn't mean they need to be replaced during that interval; many patients have their implants even longer and are problem-free. However when problems such as the ones described here come up, it is imperative to see your doctor to have an examination.

 Regarding your rash - i would definitely see your surgeon as soon as possible.

In regards to when to replace them, I share the same opinion as a lot of the others on this forum - if there is no problem with your breasts and they look fine, there really is nothing to do. Now if you have a change in shape, increased pain, develop hardness or lumps, change in volume, these are reasons to consider doing something or exchanging them.

Any time there is a new finding, certainly "air pockets" and a rash, you should see your plastic surgeon.

You didnt mention whether you have salin or silicone gel implants. Typically when saline implants fail

there is an obvious change in shape and volume of the breast. Mnay times when gel implants fail, the gel i  contained in the natural capsule around the device and there may be no outward noticeable change.  Most often failed gel implants csue no local problems and are "asymptomatic" and noticed on routine mammography.

After a thorought history and exam by your plastic surgeon, he or she may decide to get an MRI to more fully assess the integrity of the implant.

If you have developed "a rash and air pockets" you need to be seen by a plastic surgeon. There is one local "cosmetic surgeon" who recommends that his patients have implants replaced every 10 years. This notion seems ridiculous to every "plastic surgeon" who I have spoken to about this subject. If the implant is not causing you a problem, there is no reason to change it. Hardness of the implant, desire for change in size, and known leakages are good reasons to have implant exchanges but otherwise you are subjecting yourself to surgery (with some level of risk) for no good reason. Leave well enough alone unless you are having a problem. In your case or "rash and air pockets" you need to be evaluated by a plastic surgeon.

Like any device in medicine or, in fact, life for that matter, breast implants can fail after a period of time. This may be in the form of a rupture of the outer shell of the implant, causing the saline or silicone to leak out.

With saline breast implants, the saline is absorbed by your body without a problem, and your affected breast becomes “deflated” or smaller again.

With silicone gel implants, however, your body does not absorb the leaking silicone in the same way, and therefore there may not be any outward signs of any problem. Because of this, the FDA has recommended that patients who have silicone breast implants are checked with magnetic resonance imaging (MRI) periodically to make sure that there are no problems with their implants.

In the case of rupture of either a saline or silicone breast implant, replacement is indicated and can be easily performed by your plastic surgeon. Recently I've been made aware of some TV personalities recommending that implants be removed and exchanged after 14 years, regardless of whether or not they are causing problems. I have, in fact, had a woman who had her implants intact for 25 years, crying in my office because the surgeon on TV had said they had to come out- though they looked and felt great!

I do not feel that implants should be removed unless they are causing some kind of problem- rupture, contracture, reactions, etc. I do not perform routine removal and replacement of intact implants that are not problematic.

That being said, I do recommend medical evaluation of silicone implants to make sure that there are no occult leaks, and this is best done with involvement of a plastic surgeon and radiologist who can recommend at least ultrasound evaluation if not MRI.

You need to be examined by a competent and experienced plastic surgeon. Whether or not an implant needs to be replaced is independent of your symptoms. Generally speaking, implants do not have to be replaced unless they are not functioning in the way that they were intended. If we are talking only about leakage, saline implants will demonstrate leakage by a decrease in size or shape. Silicone implants may not change the breast size, shape or consistency, thus the "silent" leak.

Rash and discoloration may indicate leakage of silicone implants or thinning of the overlying soft tissue with either saline or silicone implants but without leakage. Both may indicate a need for re-operation. It is the fact the we know that implants may not last a lifetime and can leak that requires your situation be given serious examination. 

While breast implants do have the possibility of lasting a lifetime, the implant manufacturers do not consider them 'lifetime devices' as the possibility exists that over time the outer shell will fail.  Saline breast implant failure is quite obvious when it occurs, for when a saline implant leaks, the saline solution is quickly absorbed by the body and the 'deflated' side immediately looks smaller than the intact side.
 
Several large studies have shown saline implant deflation rates of around 1% at 1 year and 3% at 3 years.  If this rate of saline implant failure holds true over time, one can expect that 1 out of 10 (10%) patients can expect a deflation in the first 10 years following augmentation.  My own experience with saline implant deflation has been less than that: in 6 years of practice in North Carolina I have had only one patient (out of more than 300 patients with 600 saline breast implants) return with a deflation.  It is certainly possible that some patients who moved out of the area experienced deflation and did not return to this practice for implant replacement, however we have asked the implant manufacturer to notify us in the event that this happens and thus far we have received no report of additional saline implant failures.

Silicone gel implant failure is a somewhat different issue, as implant rupture can not be detected by looking at or feeling the augmented breast.  The gel material is inert and is not absorbed by the body, so the appearance and feel of the implant does not change following rupture of the outer shell.  In order to detect a gel implant rupture, a radiologic study, such as an MRI, is required.  For that reason, the FDA has recommended that women receiving the recently approved cohesive gel implants obtain breast implant MRI scans at intervals following augmentation.

One study including over 500 patients has shown a gel implant rupture rate of 0.5% at 3 years among those patients who had had a postoperative MRI scan, so the failure rate for the new cohesive gel implants appears to be no greater than what we have seen with saline implants, and may in fact be somewhat lower.
 
It is worth noting that the material which is used to manufacture the outer shell of saline and silicone gel breast implants is the same, so varying failure rates between the two types of implants probably has to do with differences in the way that the substance that fills them affects the outer shell.  I think that it is also important to stress that if a woman's breast implants have not deflated (saline) or ruptured (silicone gel), there is no need to remove and replace either kind of implant merely because a certain amount of time has passed since the augmentation surgery. 

In most cases your breast implants will last many years.

Any breast implant can leak, and the incidence of leaking is slightly under 1% per year. That means that in 25 years, you may have a 25% risk of one of your breast implants leaking and needing to be replaced. There is no rigid schedule for implant replacement, and they never need to be replaced as long as they are intact.

If a saline implant leaks, the breast gradually becomes smaller as the saline gets absorbed, and then you realize immediately that your breast implant is leaking. With silicone implants, on the other hand, you don't necessarily know if the silicone implant is leaking because the silicone is very highly cohesive and it all stays inside the implant pocket in your breast. Therefore, patients who have silicone implants need to have an MRI of the breasts every three years to make sure that the silicone implants are intact.

But the important point to make is that silicone does not cause any disease or medical problem and that, therefore, a leaking silicone breast implant is not a threat to your health. It is only a local mechanical problem that is corrected by replacing the implant.

Implants can be replaced for elective reasons such as a desire to change from saline to silicone or a request for a larger size. The medical indications for removing implants are rupture of the implant or capsular contracture.

Years ago many surgeons told patients to change their implants every ten years because the predominant implants at the time were siicone and there were no reliabel studies to determine implant rupture.

Today we have reliable studies with MRI and we have better quality implants. As long as the implants are intact and you are pleased with them you do not need to replace them.

Your comments about a painful rash and "feeling air pockets" is concerning to me. On rare occasion the pressure of the implants on the breast skin can lead to skin loss and exposure of the implant. This requires immediate medical attention.

There is also a type ofbreast cancer which presents as a rash involving the breast skin. It is called inflammatory breast cancer and this also requires immmediate attention.

I am not trying to scare you as this may simply be a rash but I encourage you to see your plastic surgeon as soon as possible

I wish you all the best.

Breast implants do not need to be changed unless they have ruptured. A typical implant will last over 10yrs.

With saline-filled implants the diagnosis is easier. The saline that leaks out of the implant is reabsorbed by your body, then the implant will deflate and your breast size will return to its pre-augmentation size. The saline is safe. At that point you will need to consult with your plastic surgeon to discuss replacement surgery.

With silicone gel-filled implants, the diagnosis of a rupture will often require an MRI to confirm. As always, regular follow-ups with your surgeon are necessary to not only answer all your questions but to have an exam to ensure your implants are intact.

Breast implants do not have an expiration date and can last well over ten years. The key is to have regular testing and evaluation to ensure that the breast implants do not have leakages. If there is a leakage, you should contact a board certified plastic surgeon to determine the best course of action.

If there is no problem and you still enjoy the size, shape and projection of the implants, then you should not expend the time, money, and emotional resources to replace the breast implants.

Frequently, patients come in armed with the thought that every 10 years they need a new set of implants. This is simply an urban myth. If there are no problems with the implants, and if you are happy with the size, appearance and feel, then leave them alone.

I have personally seen patients with 35-year-old saline implants who never had an exchange and never had a problem.

As to the rash and feel of air pockets, these issues should be evaluated by a surgeon certified by the American Board of Plastic Surgery who can best determine if they are in some way related to your implants or something else.

Pamela,

The first issue for you is to find out what is causing the rash and pain under your left breast. Is it possible that this is from your implant? Pretty unlikely, but certainly, a remote possibility. Do you have saline or silicone implants? The air pockets you feel could possibly be the wrinkles and ripples of the implant shell - much easier to feel with saline implants especially if there is little tissue covering over the implant.

Now, should you go and swap out your implants just because time has passed? Not so much. If your implants aren't causing problems and aren't deflated, there is no need to assume the extra cost, risks of surgery, risks of anesthesia, risks of capsular contracture, and discomfort. Who knows, your implants may last 20-30 years. Why pay the price in dollars, risk, and pain if you don't need to? With the saline implant you will see your breast get smaller and smaller over 48-72 hours. Often this is associated with a feeling of nausea and dizziness. If you have gel implants, you should be monitoring them as the FDA recommends: An MRI 3 years after your implants were placed, and then every two years as long as you have them. Your MRI reports will let you know if your implant has been compromised and needs to be replaced.

Good luck!

There is a myth out there that implants have to be replaced every 10 years. In general, if there is no problem with the implants or breasts, you should leave well enough alone.

If there are associated problems, such as a rash or abnormal-feeling implants, you should be evaluated by a Board Certified Plastic Surgeon to determine if replacing the implants is appropriate.