1. Implants too old: The lifespan of a breast implant is generally thought to be about 10 to 12 years. However, age of an implant alone is not necessarily a reason to remove them. Especially with respect to saline implants, if a patient is not having any issues with the implant, it is likely safe to leave the implant alone. Conversely, silicone gel implants may require imaging once they reach a certain age. This is best done with an MRI, which has the best detail and the most sensitivity for detecting damage to the outer shell. If a silicone implant is noted to be damaged, then breast implant exchange is indicated.
2. Implants ruptured or leaking: Breast implants are mechanical devices and will develop “wear and tear” over time. When a breast implant sustains an injury to its shell (i.e.a tear) it will begin to leak its contents. With respect to saline implants, the saline will leak out slowly and be absorbed by the capsule and into the blood stream. Silicone implants can leak as well. However, silicone implants (in particular the new cohesive gel silicone implants) will tend to maintain their shape, even when the shell is compromised. When an implant leak leads to a change in shape of the breast, this is known as symptomatic rupture. When an implant leak is undetectable to the eye or on physical examination, this is known as silent rupture.
3. Want an implant size change: Some women have breast implants that they are very happy with; they just simply would like a size change. For most patients that fall into this category, they have grown familiar with their size and would prefer to exchange them for a bigger size. For the minority of women who desire a smaller size, they may choose to “downsize” their implants.
4. Want to change from saline to silicone breast implants: Both saline and silicone are great choices when it comes to breast augmentation. However many patients were implanted with saline implants prior to silicone implants becoming approved by the FDA in 2006 for cosmetic use. Therefore, there is a large subset of women who want to switch to silicone simply for the advantage of having breast implants that feel more natural.
5. Capsular Contracture: Breast implants are mechanical devices. Following implantation, the body forms a capsule around the breast in order to “wall off” the implant as a foreign body. Rarely, people will have an overwhelming inflammatory reaction within the breast capsule that causes it to tighten around the implant. When severe, this may require removal of the breast capsule along with removal and replacement of the involved implant.