Timing of Replacement of Saline / Silicone Implants
Written by: Stuart A. Linder, M.D., F.A.C.S.
Beverly Hills, Board Certified Plastic Surgeon
is tremendous controversy over the specific timing of replacement of
implant. A true myth on the internet and in the world is that implants
must be replaced after 10 years. This is absolutely ludicrous and ridiculous.
This has nothing to do with changing oil in a car every 3,000 miles.
Implants do not need to be replaced after 10 years unless the patient
has specific indications. The following are a few of the more prevalent
indications for implant replacement:
- Ruptured implant. Saline implant upon rupturing clinically will
be obvious and the implant will completely deflate. We see these patients
often from around the United States who have more or their surgeon is
no longer in practice. These implants should be removed as soon as possible,
as by the scar tissue around the implant contracture will increase and
cause collapse of the pocket. Ruptured silicone implants can be detected
most likely by an MRI if the implant is found to be ruptured. Again,
these should be replaced as soon as possible.
- Capsular contracture or significant scar tissue contracture, Baker
IV. There is controversy as to the etiology of scar tissue encapsulation
of a silicone and/or saline implant. Many theories are that there is a micro
contamination of staphylococcus aureus or epidermis. With this micro
contamination of the pocket, the implant should be replaced in the
majority of patients. When performing capsulectomies, this may help
to reduce recurrent scar tissue contracture. Again, this is extremely
controversial and is certainly up to debate.
- Rejection of an implant, silicone
or saline. Implants are made of dimethylsiloxane. The shell of
the implants and the silicone gelatinous material is dimethylsiloxane.
I personally believe rejection of an implant is extraordinarily rare
and it is hard to determine whether it is truly a rejection or simply
a contaminated implant which requires removal. In any case, if a woman
has been shown to have an autoimmune disease such as rheumatoid arthritis
or systemic lupus erythematosus and their symptoms do not abate, the
rheumatologist or immunologist may decide with the Board Certified
Plastic Surgeon that the silicone implants may be removed, which once
again, may help the patients to relieve some of their symptoms, although
this may be placebo at best.
In conclusion, the timing of replacement of implants is not set by
a specific clock nor a specific set time. There is no 10-year rule.
Patients do present to my office with the thought "I've had implants
for 18 years, I must get them replaced immediately." Well, this
again is only the case if the patients are clinically having symptoms
of scar tissue, pain or a rupture of the implant via clinical diagnosis,
saline or an MRI diagnosis for silicone gel implants.
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