That is one of the most common questions that a plastic surgeon will hear regarding breast implants. The best answer is that breast implants have no expiration date. Commonly, patients hear that breast implants need replacing after 10 years. However, a better answer equates to the old saying, “If it ain’t broke, don’t fix it.”

Many patients have had their implants for two to three decades and longer without having problems. Originally the gel inside of the implant shell was too liquid, and it often leaked out causing lumps called granulomas. These had to be removed and the implants replaced. For the last 20 years the gel has been thicker and much better. It’s called Memory Gel, and the gel doesn’t leak out even with a tear in the implant shell.

When do they need to be replaced? If a patient has an encapsulation, which is when scar tissue surrounds the implant and makes it look abnormally round and firm, they may request to have them replaced. In such a case, the surrounding scar tissue may need to be removed as much as possible. Some plastic surgeons prefer to simply incise (cut) the scar in many places to allow it to expand. My preference is to excise much of the scar capsule and replace the implant(s) with new ones. When they encapsulate, they come under pressure and often are painful. Unfortunately, usually only one implant encapsulates causing obvious asymmetry of the breasts.

How long do breast implants last? Like everything else, from one’s joints to tires, they do wear out. Many and maybe most patients never know because ruptured implants are usually asymptomatic, causing no problem. These patients may go through life never having the implants exchanged. However, if a mammogram exposed a rupture, the patient may elect to have them replaced at a convenient time, certainly not an emergency.

Other reasons for replacement are to change size, or, as with most everything, sagging has occurred with time. This is a common reason, and occurs more often if the patients had significant breast tissue prior to the implants or if they had very large implants. Another reason is following pregnancy and long-term nursing. Fortunately, all these problems can be corrected with either implant replacement or removal and, if necessary, a breast uplift, called a mastopexy. A mastopexy does create scars which are hidden with a bra or bathing suit. There are several varieties of mastopexies, and a plastic surgeon should give the patient the various options. There should never be “stitch” marks in such scars.

When indicated, a minimally invasive mastopexy can be performed by tightening the breast with the Renuvion. This is a devise that shrinks and tightens skin by applying very intense heat just under the skin through a tiny hole. This requires local anesthesia, or if preferred, general anesthesia.

In conclusion, removing or replacing implants varies according to each individual patient’s needs.

E. Ronald Finger, MD, FACS is a board certified plastic surgeon with offices in Savannah and Bluffton. fingerandassociates.com