Saline breast implants consist of a silicone shell filled with a sterile, saltwater solution, making them a common option for breast augmentation. Although designed to be durable, these medical devices are not permanent fixtures in the body. Like any manufactured device, they are subject to wear, tear, and eventual failure. Therefore, replacement is a likely event during a person’s lifetime.
Expected Lifespan and Replacement Timelines
The expected lifespan for a saline breast implant is generally between 10 and 20 years, though this is not a guaranteed expiration date. While many women keep their original implants longer, up to 20% require removal or replacement within 8 to 10 years of the initial surgery due to complications or elective changes.
The Food and Drug Administration (FDA) and plastic surgeons advise patients that replacement or removal will eventually be necessary. Revision surgery is often needed due to device failure, personal preference (such as changing size), or addressing changes in breast tissue due to aging. Even intact implants may prompt a preventative exchange procedure due to the increasing risk of complications over time.
The Mechanisms of Implant Failure
Saline implants fail when the silicone shell’s integrity is compromised, allowing the sterile solution to leak out. Normal movement and internal stresses weaken the implant envelope over time. The most common failure point is a tear in the shell, often caused by friction from the implant folding or wrinkling within the breast pocket.
Less frequent causes of failure include a defect in the valve mechanism used during filling, which can lead to a slow leak. Significant external trauma, such as a severe accident, can also cause the shell to rupture.
Another common reason for early replacement is capsular contracture, where internal scar tissue forms a tight, hard capsule around the implant. This scar tissue can cause pain and distortion, or exert pressure that weakens the implant shell, necessitating surgical removal. Placing an under-filled saline implant also contributes to premature failure by increasing the risk of folds and creases forming on the shell.
Recognizing and Responding to Deflation
Saline implant failure is typically obvious because the saltwater solution immediately leaks out, causing the implant to deflate. Since the saline is harmlessly absorbed by the body, the event is not considered a medical emergency. However, the cosmetic change is immediate and noticeable, appearing as a sudden loss of breast volume.
Signs of failure include a sudden or gradual change in the breast’s size or shape, causing noticeable asymmetry. The affected breast loses firmness, often feeling soft due to the loss of internal pressure. If the deflation is slow, such as with a valve leak, the change may take weeks or months to become apparent.
Upon noticing any significant change in symmetry or volume, the patient should promptly contact their plastic surgeon for an evaluation. While imaging like a mammogram or ultrasound can confirm deflation, visual and palpable changes are usually sufficient for diagnosis. Addressing deflation quickly is important, as a contracted scar capsule can complicate the eventual revision surgery.
Revision and Replacement Procedures
Once deflation or another complication is confirmed, a revision procedure is necessary. The surgery typically involves removing the compromised implant shell and any surrounding scar tissue, a process called a capsulectomy. The patient then chooses between replacing the implant or pursuing explantation (removal without replacement).
If replacement is chosen, the surgeon inserts a new implant, which may be saline or a switch to silicone gel. This procedure allows for concurrent changes, such as adjusting implant size, altering pocket placement, or performing a breast lift. The complexity of the revision depends on the degree of scar tissue contraction and the need for other procedures.
Recovery for a straightforward replacement is often quicker than the initial augmentation, with most patients resuming routine activities within one to two weeks. If the breast pocket has significantly contracted, a more extensive operation may be needed to release the scar tissue before placing the new implant. Surgeons commonly replace both implants, even if only one has failed, to ensure long-term symmetry.