The longer you have implants, the greater the risk of complications. Plastic surgeons often say that, as a general guideline, you should expect, at some point, your implants to be removed and replaced.
Implants Don’t Last Forever?
Implants are not lifetime devices, and both saline and silicone implants can rupture and leak. If you have a saline implant, you will notice a gradual deflation. The body can absorb the saltwater leaking from the implant, and over a few days to weeks, you will see your implant get smaller. If you have silicone implants, their shape may change; however, often there is no change at all. Often, the only way to detect a leak in a silicone implant is with an MRI. If you choose silicone implants, you will be scheduled for periodic MRIs to ensure that your implants are still intact. Implant rupture rates, regardless of whether they are saline or silicone, are approximately 1% per year; this means your implant can rupture at any time after placement. Most implants will need to be replaced every 15-20 years.
What is Explant Surgery
This procedure permanently removes silicone or saline breast implants and may also remove some or all of the scar tissue that has formed around the implant(s).
Explant surgery is different from implant exchange surgery, which replaces old implants with new ones. Women who have implant reconstruction may need to have their implants replaced after about 10–15 years, but sometimes implants last longer.
The risks of explant surgery include:
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- Seroma, a buildup of fluid under the skin
- Hematoma, a pooling of blood under the skin
- Wound healing issues if you’ve had radiation to the area in the past
- Collapsed lung (this is rare) if the scar tissue capsule was stuck to the chest wall
Breast Implant Ruptures
If you notice any abnormal changes in your breasts or implants, you need to see a healthcare provider right away.
The U.S. Food and Drug Administration (FDA) recommends that people with silicone-filled implants undergo routine ultrasound or MRI screening to detect silent rupture. Screening for silent rupture should start five to six years after the implant is placed and then every two to three years afterward. Getting health insurance to cover these imaging tests can be challenging. Your plastic surgeon may be able to help you work with your health insurance company to get approved coverage for silent rupture screening in advance.
Ruptured silicone-filled implants have greater health risks than ruptured saline-filled implants and should be removed. When silicone gel leaks past the scar tissue capsule around the ruptured implant, plastic surgeons try to remove as much of it as they can.
A breast implant exchange or removal may be a good option for you if you experience:
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- Poor healing and scarring
- Dissatisfaction with implant size, shape, type, or placement
- Capsular contracture (hardened scar tissue)
- Implant rupture
- Implant leakage
- Implant displacement
Insurance Coverage
The Women’s Health and Cancer Rights Act (WHCRA) includes protection for individuals who elect breast reconstruction in connection with a mastectomy. WHCRA requires group health plans and health insurance issues that provide coverage for medical and surgical benefits for mastectomies, also to cover certain post-mastectomy benefits, including reconstructive surgery and treatment of complications (such as lymphedema).
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- For more information on the Women’s Health and Cancer Rights Act
- It is always good to check with your individual health insurance carrier for definitive information regarding your coverage.
The Procedure
Performed under general anesthesia, implant replacement involves removing the old implants and, if needed, adjusting the breast pocket or selecting new implants that best suit your desired look. Some patients also choose to combine their procedure with a breast lift to improve breast contour and firmness.
Surgical Pain
Pain from implant replacement surgery is highly variable and ranges from minimal to severe. It is worse in the first few days after surgery, but then it rapidly improves. It is impossible to predict a person’s expected pain. If you have done well with surgery in the past, you will likely be fine after this surgery. By the end of the first week, most people’s pain is controlled by plain Tylenol or Motrin.
Breast Implant Removal and Replacement Recovery
Wear your surgical bra: If your surgeon has asked you to wear one after your procedure, it is essential to follow their instructions. This will protect the surgical site and reduce swelling.
Stay hydrated: Drinking plenty of water during recovery after explant surgery will help reduce swelling and prevent fluid retention around your incisions.
Eat a balanced diet: Eating nutrient-rich foods and protein will support healing and recovery after breast implant removal. Avoiding high-salt foods will help prevent swelling.
Rest: Rest is crucial during recovery from breast implant removal. Ensure you have organized support from friends and family so you can get the downtime you need.
Strenuous activity or exercise: You should avoid all strenuous activity and exercise for at least six weeks after Breast Implant Removal or Replacement. This includes bending, lifting, and carrying heavy weights. This prevents strain on your incisions.
Driving: You cannot drive for at least seven days following surgery. Check with your insurance company for the exact details of your policy.
Baths: Although a soothing bath may seem appealing during your Breast Implant Removal and Replacement recovery, it is essential not to submerge your incisions and dressings in water. Take showers instead and keep the area clean and dry.
Sun Exposure: Exposing your incisions while they are healing to excessive UV from the sun or sunbeds may cause your scars to become darker. Protect your incisions by covering them with clothing and wearing sunscreen.
Work after Surgery
This, of course, depends on the kind of work you do. Most people go back to work after 1-2 weeks. Sedentary jobs, such as computer work or phone work, can begin even sooner. If you have a strenuous job that involves a lot of lifting or physical activity, you may have to wait 6 weeks before you are ready to return to work.
Travel
Traveling after surgery (air travel, long-distance car trips, train rides, etc.) should not be done before you have had your first postoperative visit. Typically, this occurs 7-10 days after surgery. Patients at high risk of developing a blood clot should not travel until instructed by their surgeon. Short car trips of 60 minutes or less can be done before the first visit. A good rule of thumb is that when you are off the more potent pain medication and can get up without assistance, you are ready to go for a short drive. You should not drive the car yourself until your surgeon gives you clearance.
Nipple reconstruction is a surgical procedure designed to restore the appearance and, to some extent, the sensation of the nipple after mastectomy or other breast procedures. This procedure is often a crucial part of the overall breast reconstruction process, helping women regain a sense of body image and confidence. Your surgeon will consult with you on nipple replacement surgery with your explant assessment.
Nipple prosthetics
Another option for women who might not want further surgery or tattooing is nipple prosthetics, which are made of silicone or other materials and look and feel like real nipples. They can be attached to the chest and then taken off when you choose
SUMMARY
Breast implants don’t have a specific expiration date, but they don’t last a lifetime. It’s normal for people who have breast implant reconstruction to have one or more surgeries because of a complication or to improve how their breasts look and feel.
For personal or medical reasons, you may wish to have your breast implants exchanged for a different type or size or removed permanently. Older implants are often replaced with more natural-feeling implants. Breast implant exchange may also be performed to remove and replace older implants that have become displaced, encapsulated, ruptured, or leaked. A breast lift sometimes follows.
The Women’s Health and Cancer Rights Act (WHCRA) includes protection for individuals who elect breast reconstruction in connection with a mastectomy.
Restoring the nipple(s) contributes significantly to wholeness and femininity after breast surgery. The emotional impact of breast cancer and its treatment can be profound, and nipple reconstruction can be an essential step in the healing process.
References
Breastcancer.org
Brigham and Women’s Hospital
Cadogan Clinic
Canadian Cancer Society
Cleveland Clinic
Dr. Juliana Hansen – Breast Implant Exchange (Video)
Kryger Institute of Plastic Surgery
Living Beyond Breast Cancer
UCSF Helen Diller Family Comprehensive Cancer Center
