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When is it necessary to change breast implants and why?

As an aesthetic surgeon, my patients often ask this important and valid question, and it is essential to understand the reasons why it may be necessary to replace your breast implants.

In this article, I explain the most common reasons why breast implants must be changed, as well as the examinations and procedures necessary for regular monitoring.

When is it necessary to change breast implants?

A priori, breast implants must only be replaced if there are any complications or specific problems. However, the implants do not last forever and can deteriorate and wear over time. Furthermore, you should consider replacing your implants earlier if you have any problems such as an implant rupture, capsular contracture or other complications, even if these cases are relatively rare.

If it is just a case of replacing the implants when there is no rupture and the shape and volume of the breasts are satisfactory, the procedure can be carried out under local anesthesia. However, in the event of a complication such as leaking silicone or a capsular contracture, a general anesthetic is essential and the procedure to change the implants will be longer and more complicated.

In theory, it is recommended to replace the implants every 10 to 15 years even if there are no issues.


What examinations are necessary for monitoring breast implants?

It is essential to regularly monitor breast implants to detect any potential problems at an early stage.

Firstly, clinical check-ups by a doctor are necessary for all women, with or without implants, as the incidence of breast cancer is 1 in 8 women, all women included. In the case of breast augmentation, I see patients regularly throughout the first year after the operation then after 1 year, 2 years, 5 years, and 10 years.

There is no systematic follow-up examination and radiological monitoring must be that of any woman of the same age (mammography and ultrasound at least every 2 years from the age of 40) and it is recommended to undergo an MRI 10 years post-op. Women with breast implants must also be attentive to changes in the shape, size or texture of their breasts.


Change of implants in the event of complications, including capsular contracture

The most common late complications – even if they are rare – linked to breast implants are the rupture of the implant with leakage of silicone (detected during a radiological examination) or a capsular contracture (the breast hardens and changes shape).

If you have one of these symptoms, you should consider replacing your implants, but there is no urgency. Implants filled with saline can slowly deflate, which gives enough time to plan the replacement, or they can deflate very rapidly, even overnight. Conversely, silicone implants can have silent ruptures and must be carefully monitored.

Once again, these cases are very rare. The majority of implants used today are round with a smooth or nanotextured surface and are filled with cohesive silicone gel. This cohesive gel is not liquid and thus has the advantage of not diffusing in the event of rupture or wear of the shell.


When the patient wishes to change the size or shape

Some women who have had a breast augmentation wish to change the size or shape of their breasts at a later stage.

Because your breasts have changed after a pregnancy or breastfeeding or simply because your morphology has changed (changes in build with the menopause for example) or because your tastes have changed, you may consider replacing your implants. In this case, a consultation will be necessary and I will help you find the best solution in terms of your aesthetic objectives.


What does a breast implant replacement procedure entail?

The replacement of breast implants is a surgical procedure that can be carried out under local anesthesia in the case of just a « simple » replacement. However, it is carried out under general anesthesia when the procedure is more complex (capsular contracture, change in breast shape, reshaping). In the case of a complicated change, the duration of the procedure is longer than a « traditional » placement.

The procedure can be carried out through an incision under the breast (inframammary approach), or around the areola (areolar approach). The incision will depend on the preference of the patient, as well as the current condition of the implants and the operating procedure. In the case of a complication such as a capsular contracture, it is necessary to perform a capsulectomy, which involves removing the entire capsule (a sort of shell) that has formed around the implant.

The surgeon removes the old implants and then replaces them with new ones.


What happens after the operation?

After breast implant replacement surgery, you will feel some discomfort and pain for a few days but no pain in the case of a standard replacement. You should wear a compression bra for 4 to 6 weeks to help minimize edema (swelling) and hold the implants in place. You should also avoid intense physical activities for four weeks to allow your body to heal properly. Your surgeon will give you specific instructions regarding postoperative care.


Is it possible to remove the implants and not replace them?

Yes, it is possible to remove breast implants without replacing them. This is known as breast explant surgery. Women can choose to have their implants removed for various reasons such as complications linked to the implants or just because they wish to recover a more natural appearance.

Removal of the implants can be performed in the same way as the breast augmentation procedure by removing the implant through an incision under the breast or around the areola.


What will the breasts be like after removing implants?

After removing the implants, the breasts may seem flabby and look less firm than before with the implants. The amount of sagging will depend on several factors such as age, the quantity of natural breast tissue, how long the implants were in place, and above all the quality (elasticity) of the skin. In some cases, it may be necessary to combine breast explant surgery with a mastopexy (breast lift) to restore a firmer, younger appearance.


In summary

The replacement of breast implants is not essential unless there are complications or specific problems. However, it is recommended to replace the implants every 10 to 15 years even if there are no problems.

Regular follow-up examinations such as a mammography, breast ultrasound, or MRI are essential to detect any potential problems early.

If you observe any change in the appearance or feeling of your breasts, if you encounter any problems such as the rupture of an implant or a capsular contracture, you should consider replacing your implants sooner.

If you are considering explant surgery, we will discuss your options together to determine the best way forward.

Finally, some women decide to undergo breast augmentation without implants using breast lipofilling. This technique has the advantage of not requiring the insertion of a foreign body but only allows an increase of one cup size in one session.

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