Procedures

Why Are Breast Implants Replaced?  

Breast implants have been used as a method for breast augmentation for 50 years. Breast implants all consist of a silicone outer shell with either a smooth or a textured surface. The implants are filled either with silicone rubber or with a salt water solution. Breast implants are known not to last a lifetime. This means that they will require replacement at some stage. 

Chief Medical Officer's Warning

The Chief Medical Officer recently published a fact sheet about silicone gel-filled breast implants in which he warned that:

 “All silicone gel-filled breast implants are considered high risk medical devices”.

 This is because:

  • They have a limited lifespan, with the risk of rupture increasing with time.  MRI studies show that 40% of silicone breast implants have ruptured by 8 years but we have seen some silicone implants rupture after as little as 1-2 years.
  • A rupture may be present without any clinical signs or symptoms.  This means that the implant may have ruptured with the silicone spreading to lymph nodes and other parts of your body without you being aware of the problem.
  • There is a link between textured breast implants (especially those with a macro texture) and a condition known as Anaplastic Large Cell Lymphoma (ALCL).  This is an indolent cancer of the capsule surrounding the breast implant.  It presents with swelling of the breast due to fluid accumulation and requires radical treatment including total excision of the capsule surrounding the implant.  Thus far we have had 64 cases in Australia but given the large numbers of macro textured implants that have been inserted in Australia, this number is likely to increase in the future. 

Problems With Implants

Other problems associated with breast implants include rippling where the implant is visible or palpable just beneath the skin. The implants can also be displaced causing an asymmetry with one implant sitting too high or too low. Implants can become hard due to capsule contracture which is a thick wall of scar tissue developing around the soft breast implant. Implants can erode through the skin causing ulceration which will require implant removal. 

Often women simply regret having had implants and feel that they have reached a stage in life when they are no longer required. Unfortunately, many women have implants that are just too large and they tire of the "fake" or stylised look with the increased upper pole fullness caused by the implants.

In addition some women complain of what is known as Breast Implant Illness. This refers to a vague group of symptoms such as tiredness, skin rashes, muscle and joint pains etc. that are often likened to a rheumatoid or autoimmune type of illness. Indeed some patients develop rheumatoid arthritis following silicone breast implants.  Although the existence of this condition is denied by the manufacturers of breast implants who state that there is no evidence linking breast implants to these illnesses, nevertheless many women report an increased sense of wellbeing following removal of their silicone implants.

Your Options

Do nothing

When implants are removed, your options are to leave them out and not request a replacement.  Unfortunately implants (especially those that have been in for a long time) cause secondary changes to the surrounding tissues such as indentation of the rib cage and thinning of the surrounding breast tissue. In addition, the skin may have stretched giving the breasts a deflated and saggy appearance.

Replace your old breast implants with new implants 

This gives the opportunity to increase or decrease the size, to correct any asymmetries and to relocate the implants into better positions (e.g. placing them behind the muscle, where they are less visible and where they will produce a more natural result). We usually recommend using a smooth-walled, round, saline-filled implant placed behind the muscle, as this gives you the safest and most natural and long lasting augmentation. Even if the saline implant leaks, it is only salt water which is harmlessly absorbed by the tissues. The implant can then easily be replaced. Fortunately deflation of a saline implant is extremely rare and much less likely than leakage of a silicone-gel filled implant.

Replace your implants with your own fat

For many women, this is the ideal option following removal of their breast implants.  The fat can be harvested from the hips, thighs or abdomen (thereby providing a welcome size reduction in these areas) or from deep in the hips and thighs (if no obvious excess fat is present).  Following purification, the fat is grafted not into the old space left by the implant but into the breast tissue itself.  The fat is grafted selectively into the cleavage and upper pole in order to enhance these areas.  Even though the total volume of fat grafted may be less than the volume of the old implants, the breasts often have a better appearance and a far softer more natural look. In the United States this procedure is referred to as SIEF which stands for Simultaneous Implant Explant and Fat Grafting.

*All surgical procedures carry risk and you should discuss these risks with your surgeon prior to consenting to any operation.

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