Do you have silicone breast implants from a long time ago? Are your breasts harder than they used to be? Has a mammogram ever suggested a possible implant leak? Are you unsure how you should be monitoring your old implants?

If you answered “Yes” to any of these questions, you should make an appointment with Dr. Mackenzie in Santa Barbara to discuss your old breast implants. An old leaking breast implant that goes undetected can have serious consequences.

Breast implants do not last forever, and I tell patients that their chance of having additional surgery on their breasts because of their implants is 100%. This is often surprising to the patient. It is apparent that years ago (before I was in practice!) surgeons were not as forthright, or maybe simply didn’t know it themselves, that breast implantation was never going to be a permanent, “set it and forget it” procedure. Perhaps that’s one good thing that came out of the whole moratorium on silicone breast implants in the United States between 1992 and 2006 — a more thorough discussion of breast implants, their pros and cons, and what a woman can expect in the future.

Silicone breast implants today are different than those that were placed many years ago. The silicone inside the implant is a more “form stable” gel, with more consistent and long chain polymers. Thus the silicone within current implants doesn’t have the oily, gooey quality of old implants. A modern implant that develops a hole in its shell deserves to be replaced, but the gel doesn’t “leak” the way old gel did. Some old gel breast implants also “bled”, meaning some of the smaller chain silicone polymers would leak right through the outer shell of the implant. Sometimes I’ll remove an old implant that is “intact” with its shell undamaged, yet there is a pool of silicone around it within the breast capsule.

Capsular Contracture

A hardening breast that has implants is typically developing what is known as a capsular contracture. The normal thin and supple scar capsule around the implant has gotten thick, maybe calcified, and possibly painful as well. This is not normal, and we can fix this! (This may seem obvious, but I have seen many women with implants placed years ago who think this is somehow a normal progression of their breasts and implants with time. No, it’s not!) Gel bleed and/or ruptured implants are often found associated with the capsular contracture, even when nothing is noticed on routine mammograms. Mammograms are fine for looking at breast tissue, but not so good at looking at breast implants. Ultrasound and MRI scans can do a better job at looking at the implants. No study is foolproof, however, and only surgery to remove the old breast implants will reveal whether they are ruptured or not.

If you have an old leaky breast implant, and the silicone stays within the breast capsule, there will probably be no significant issue, whether or not you have a capsular contracture. However, you still should have these implants removed and replaced as soon as possible. Why, you ask? Because although leaked silicone retained within the capsule (intracapsular rupture) is not worrisome per se, if (when) it leaks outside the capsule (extracapsular rupture), problems can arise.

The extracapsular silicone can cause palpable lumps. Lumpiness may be felt under the skin of the chest or within the breast. Silicone can migrate to lymph nodes in the armpit, creating lumps there. As you might imagine, these lumps will raise fears of something more sinister like breast cancer, which will then possibly lead to additional studies or biopsies trying to determine what is causing the lumps. Even if it is determined that these are just lumps of silicone (silicone granulomas), eradicating them is sometimes impossible. Silicone, whether suffused throughout the tissues or as silicone granulomas, is not easily removed, especially when scattered or extensive. In thin women, especially, trying to remove it can create contour defects in the breast and chest. It’s much better to remove and replace your old implants before any of this happens!

Surveillance

Today we follow the current FDA guidelines of recommending MRI scans for women getting breast implants at 3 years and every 2 years thereafter. However, for women with old implants, I usually recommend going straight to removal and replacement.

Indications for mammograms follow the normal indications based on age and risk factors. Some women with hardened breast capsules may not be good candidates for mammograms because their capsules prevent a good study from being obtained. These patients will likely have an MRI in lieu of the mammogram, but this is just another reason to get the old implants replaced and any capsular contracture removed.

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