Question 1

When should breast implants be replaced?

Accepted Answer

A saline implant is obvious when it requires replacement, as any leak will result in the breast losing volume.  Silicone gel implants (the only silicone-filled implants available since 1999) are not obvious when the shell tears, as the silicone gel remains within the fibrous pocket (capsule) made by your body and volume is preserved.  About 20 % of gel implants are found to have a hole at 5 years, MRI over-diagnoses implant holes about 20% of the time, and the presence of a torn implant causes no medical problems in the vast majority of patients. Implant manufacturers will pay for a replacement implant if tear is found (or suspected on MRI).  Our advice is to be grateful if your implants are causing you no problems, and leave them alone.  If you have hardening, swelling, or mass appearing in an implanted breast, or an illness that defies all explanation, see your plastic surgeon to discuss whether implant replacement is a good idea for you.

Question 2

Where do breast implants go?

Accepted Answer

In patients with enough padding (2 cm pinch is general rule), it is preferable to put the implant over muscle. Implants put under muscle are actually only under muscle across the top of the implant, which hides the upper edge of the implant in thin people, but has the negatives of dynamic deformity (breasts get deformed when you contract your pectoral muscle) and the implants tend to sit a little too lateral (not close enough to the center) in some patients.

Question 3

What breast implants are safe?

Accepted Answer

It is safest to live with small breasts (or no breast if following mastectomy).  If you can accept tiny risks of dissatisfaction (about 95% of patients are happy with their decision to get implants), several types of implants are approved for use by the FDA. Saline-filled implants, round smooth silicone gel implants, and structured silicone implants should be considered safest, and textured implants should be avoided unless there is a significant advantage to their use in your case.

Question 4

Which breast implants cause cancer?

Accepted Answer

Textured implants have been associated with a very rare cancer (anaplastic large cell lymphoma), with ALCL occurring in about 1/3000 patients with textured implants.  Whether the implant is causing the cancer is not clear- perhaps the more aggressive healing process around a textured implant is the cause.  Whatever the case, use of a textured implant should be considered only if use of a smooth implant will not be successful.

Question 5

Which breast implants are more expensive?

Accepted Answer

The structured saline-filled implants are most expensive, followed by silicone gel and then saline-filled implants.  The differences in cost are not significant, and the additional effort involved in handling a saline implant (smaller incisions, testing and filling the implant) will generally result in total surgery fees comparable to the use of silicone gel implants.  The choice of implant should not be based on the relative cost of the implant ($500-$1000 each).

Question 6

Why do breast implants need to be replaced?

Accepted Answer

If you experience swelling or a mass or painful hardening in an implanted breast, you should be seen by a plastic surgeon to discuss management of your implant.  If an MRI or ultrasound suggests a torn implant, this presents an opportunity for implant replacement in which the manufacturers warranty would cover the implant cost, even if you are just replacing for cosmetic purposes.  A torn cohesive gel implant that is not causing any symptoms does not require replacement.  Textured implants have caused some concern as 1/3000 patients may develop a cancer termed ALCL, but if this disease is treated (implant removal and capsulectomy) when early signs (swelling or breast mass) appear, it is curable.  If you do not have swelling or mass formation, there is no need to have a textured implant removed, and most women have had excellent experience with these implants.

Question 7

Why do breast implants hurt?

Accepted Answer

The miracle of surgery is that tissues (including nerves) can be cut/burned/stretched, and that generally any pain experienced after the surgery is gone within a few weeks.  Breast implants that develop capsular contracture (a hard wall of fibrous tissue and sometimes calcium) can cause pain because the presence of this hard mass puts pressure on the surrounding tissues.  By analogy, a stone in your shoe is not the source of the pain, but when it pushes on the surrounding tissues it causes pain. Another cause of pain can be due to damage to a major sensory nerve to the breast.  If you have an areola/nipple that stays numb even months after surgery, this suggests your primary nerve to the breast was damaged and it may be a source of pain if/when it ‘wakes up’.

Question 8

Why do breast implants have to be replaced?

Accepted Answer

A saline implant is obvious when it requires replacement, as any leak will result in the breast losing volume.  Silicone gel implants (the only silicone-filled implants available since 1999) are not obvious when the shell tears, as the silicone gel remains within the fibrous pocket (capsule) made by your body and volume is preserved.  About 20 % of gel implants are found to have a hole at 5 years, MRI over-diagnoses implant holes about 20% of the time (false-positive), and the presence of a torn implant causes no medical problems in the vast majority of patients. Implant manufacturers will pay for a replacement implant if a tear is found (or suspected on MRI).  Our advice is to be grateful if your implants are causing you no problems, and leave them alone.  If you have hardening, swelling, or mass appearing in an implanted breast, or an illness that defies all explanation, see your plastic surgeon to discuss whether implant replacement is a good idea for you.

Breast Implant

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