Guidelines for Replacing “Old” Breast Implants

Serving Chattanooga, Tennessee

Many patients are uncertain or have misinformation regarding the timing and necessity of replacing implants from the 60’s, 70’s or 80’s.  To clear up any confusion, the following information will outline the evolution of breast implants and give patients guidelines for replacement.

Silicone breast implants were invented in the 1960’s, but really reached the height of their popularity in the 70’s and 80’s.  These old implants were not very reliable.  They had a problem with micro-leaking, meaning that the liquid silicone inside the implant passed through the implant’s outer shell.  This leaking created the biggest problem with the old implants; that is, capsular contracture.  A capsular contracture can turn a soft natural-appearing implant into the shape and feel of a soft ball on a woman’s chest.  The rates at which this occurred were as high as 30%.  This necessitated a contracture release, which was either performed in a closed or open manner.  With a closed contracture release, the doctor physically crushed the implant between his palm and the woman’s chest.  Not much fun!  The capsule would pop and the implant would be soft again for some period of time.

In addition, the old implants had high rupture rates.  Ruptured implants were removed and replaced.  Sometimes, silicone escaped from the implant and had to be cleared from the surrounding breast tissue.  A storm of false information then grew from all of these problems, and silicone breast implants were blamed for a host of medical problems.  None of these medical problems were ever scientifically proven, however, the misinformation led to the removal of silicone implants from the non-experimental market in the 1990’s.

Research and development continued on the use of silicone for breast implants.  In the interim, though, salt water implants came into use.  Saline breast implants enjoyed a 95% efficacy rate.  This means that 95% of women who have them are happy with them.  But even saline implants were not ideal.  They do not have much trouble with contracture, but they can appear unnatural, especially in an implant reconstruction of the breast.  They can develop folds which can be felt or sometimes seen.  Most of all, they deflate.  The deflation rates are low at approximately 4% at ten years.  But, after ten years, the rates begin to climb.

The research for a breast implant that had a natural appearance and texture, a low contracture rate, and was deflation proof paid off.  Modern cohesive gel silicone breast implants emerged in the mid 1990’s as experimental devices.  Last year, the FDA (pleased with the results of extensive testing and review) released them for general use.

Here are my guidelines.   If you have old silicone implants from the 70’s and 80’s which are hard on your chest or you have been told by your doctor that your mammogram has found a rupture of your old implant, you should replace them with modern implants.  If your saline implant is unnatural in appearance, or there are folds in the implant that are of an aesthetic concern to you, you should replace them with modern silicone implants.  If your saline implant has deflated, you should consider a modern silicone implant.

Obviously, if you have had an augmentation or reconstruction with modern silicone or saline implants and you are happy with your appearance, it would be inappropriate for a surgeon to prescribe an implant change.  As always,  routine mammograms and physical exam should continue in all breasts.  Breast imaging saves lives.  For more information on breast implants, visit our website at