What Happens If Breast Implants Aren’t Replaced?

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What Happens If Breast Implants Aren’t Replaced?

If you have had a breast augmentation, or are considering breast augmentation surgery, you've probably heard that you will need to get your implants replaced at some point. And you may be wondering why that is and what happens if you don't replace breast implants? 

Let’s look at why and how you might replace your breast implants.

Why Must You Replace Breast Implants?

  • Leakage/Tearing: A common reason to replace breast implants is that they have torn, ruptured or leaked. By design, breast implants are made to look and feel natural, soft, and flexible. But because their shells flex, they will eventually crack. This is true of both saline and silicone gel implants. A torn implant will leak and need to be replaced.
  • Capsular Contracture: Capsular contracture is an increasingly rare complication of breast implants. It is a buildup of scar tissue around the implant that can squeeze down on it, changing the shape of the breast. It usually makes the breast look and feel unnaturally hard. The main treatment for capsular contracture is surgical removal of the excess scar tissue, but often the implants must be changed as well.
  • Textured Implants: Since the 1980s, breast implants have been available with shells that are either smooth or have a slight rough texture. There are pros and cons for each of these. It’s important to know that some textured breast implants may be associated with a higher risk of a rare lymphoma called ALCL. Though this risk is still extremely low and ALCL is almost always curable, you might want to consider switching certain textured implants to smooth ones.
  • Appearance: The most common reason for women to change their breast implants is simply to change the appearance of their breasts. In some cases, this is because the original surgery didn’t create the look that they truly wanted. In other cases, time, aging, and pregnancy have altered your breasts so that the original implants no longer match your present anatomy or goals. A desire to make your breasts larger, smaller, higher, lower, closer or further apart, more or less rounded are all potential reasons to consider changing your breast implants.

What Happens if You Don’t Replace Leaking Breast Implants?

Before we discuss what might happen if you ignore leaking breast implants, let’s eliminate what won’t happen:

  • You don’t get breast cancer: There is no data linking breast implants, intact or ruptured, saline or silicone gel, to breast cancer. There is a link between textured breast implants and a rare lymphoma that can occur in the capsule around breast implants (ALCL). But ALCL is not in the breast itself, is extremely rare, is highly curable, and has nothing to do with implant leakage. And you eliminate this low risk by choosing the smooth surface implants that are far more commonly used in the U.S.
  • You don’t get autoimmune diseases: In the early 1990s, a number of women who had silicone gel implants developed autoimmune disease. At the time, there was no recommendation to replace your implants regularly or do regular scans. It became a concern that the cause of these diseases was the women's ruptured silicone gel implants. The implants were then recalled and studied in very large clinical trials. In these trials, women were divided into two groups: those with implants and those without. They examined the rates of disease among the two groups and found that women with silicone gel implants, ruptured or otherwise, did not get any diseases at a faster rate than women without. So, silicone gel implants were brought back into the market in 2006. The studies have since continued and there has been no data to change the initial conclusion. Silicone gel implants, intact or ruptured, do not cause autoimmune diseases.
  • You don’t get other illnesses: You may have come across the term “breast implant associated illness”. In some instances, women have complained of symptoms including chronic fatigue, headaches, muscle pain, and joint aches. These symptoms have been studied in much the same way as the autoimmune diseases were studied. The conclusion again was that the rate of these symptoms appear to be the same in women who have implants, intact or otherwise, as in women who do not have implants. So, there was no evidence to suggest that breast implants cause these symptoms.

So if you ignore your leaking breast implants, you won’t get sick and that’s clearly good news. But there are other problems that can develop. They may not be as serious but they would be better to avoid. Let’s look at them:

  • Change in appearance: Changes in appearance with a ruptured silicone gel implant are more difficult to detect than saline, but you might be able to detect that your breasts are smaller, or have changed in shape. This is why regular scans are recommended. Saline ruptures are much more obvious in that your breast will deflate.
  • Change in feel: A leaking saline implant will feel dramatically softer and smaller. Often, women can also feel folds in the deflated shell as well. A leaking silicone gel implant may continue to feel normal. This is because the gel continues to stick to itself and may not move very much. This is why regular scans are recommended.
  • Capsular contracture: The buildup of scar tissue in the capsule in which your implant is placed can occur early on after your initial augmentation, or can build up over time and is very common. It is only when the scar tissue thickens or tightens that it can become a problem as this can distort the shape of your implant. Although it is quite rare, there are cases in which the leakage of an implant has caused capsular contracture.
  • Discomfort: When a breast implant leaks, some women will have discomfort or even pain. This is usually caused by the shell itself folding or contracting once the saline filling has leaked out. It is rarer for silicone gel implants leaking to cause discomfort as they don’t commonly fold if they are losing filling.
  • Gel migration: This is when the gel of your implants leaks outside of the pocket in which your implant lies. This is extremely rare in modern implants because the gel used is cohesive, meaning it sticks to itself so even if your implant has torn, the gel is likely to remain attached to itself within your breast implant pocket. However, in very rare cases, the gel can migrate to your breast tissue and, even less commonly, to the lymph nodes in your armpit. In the breast tissue, this can cause nodules or hardness. Lymph nodes can become swollen which is an indication that something is not right.
  • Pocket Shrinkage: A leaking implant will take up less space in the implant pocket as it shrinks, and your pocket will therefore also shrink. This is more common with saline implants than gel, as the gel tends not to leave the pocket. With a ruptured saline implant, once the fluid has leaked out all that is left in the pocket is the shell and the pocket will then begin to shrink around it. This won’t necessarily cause problems immediately but will mean that during your breast revision surgery to replace your ruptured implants, more work will need to be done on the pocket to create symmetry between the two breasts. So, to avoid this it is better to replace your ruptured implant relatively quickly.

What happens if breast implants are removed but not replaced?

Some women with breast implants - leaking or intact - prefer to remove their implants and not replace them. In our experience, these women are always very concerned about what their breasts are going to look like after the removal. They imagine that they will be left with two empty bags of skin on their chest. This would obviously be unattractive and not what they want.

The good news is that's not the case. When you remove implants and leave them out, we’ve that the results almost always surprise on the upside, meaning that the breasts look dramatically better than expected. With every passing week, they heal and improve and, most often, require no further procedures to correct their appearance.

Based on this experience, we have no qualms about removing breast implants for whatever reason, and leaving them out. And we rarely recommend doing anything additional along with the removal procedure. That means we don’t recommend (and most women don’t ultimately need) a breast lift or fat injections.

If you no longer want breast implants, the best idea is to remove the implants and let everything heal because, most commonly, nothing else will need to be done. And if you do end up needing a breast lift, fat injections, or other procedures, they can be done more accurately - and with better long-term results - if you let your breasts recover fully from the removal first.

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