Breast Implant Maintenance

Summer Hardy (00:01):
Welcome to Park Avenue Plastic Surgery Class, the podcast where we explore controversies and breaking issues in plastic surgery. I'm your co-host, Summer Hardy, a clinical assistant at Bass Plastic Surgery in New York City. I'm excited to be here with Dr. Lawrence Bass, Park Avenue plastic surgeon, educator and technology innovator. The title of today's episode is Implant Maintenance. Okay, Dr. Bass, I maintain my car. I maintain my house. What kind of maintenance do my implants need? Is this a thing?

Dr. Lawrence Bass (00:30):
That's a great question, Summer, and it's a question I get an awful lot from patients. At what point do I need to replace my implants?

Summer Hardy (00:42):
So do the implants need maintenance?

Dr. Lawrence Bass (00:45):
The classic answer to this question is no. You basically run until they break. So there's no official time point when the plastic surgeons or the manufacturer or the FDA says you have to go back in and replace a breast implant. If the implant is performing, then you can continue to leave it in place. We do recommend that you see your plastic surgeon once a year for the implants to be evaluated, but barring any change in the behavior of the implant or any concern raised on imaging like mammography where sometimes they see something suspicious that an implant may be ruptured or somehow not normal, barring any of those kind of findings, you can just live with the implant. Despite this, a lot of surgeons are giving guidance that's different from that. And they're basically saying at some point, whatever your decision making was about getting the implants with the size you picked, the shape you picked, the kind of implant it is, may have changed and the implant is aging and taking out an intact implant is definitely easier than taking out a ruptured implant.

(02:15):
So sometimes it's worthwhile to circle back at some point if it's been quite some time since the implants were placed because you serve a range of needs at once by replacing the implant.

Summer Hardy (02:32):
So if I'm thinking about timing more work on my implants, how do I measure the interval? Every 5,000 miles?

Dr. Lawrence Bass (02:39):
So of course summer, it's not like a car where you can quantitate a certain amount of driving distance and that there's no hard and fast rules. So the basic idea about thinking about whether it's time to replace the implants relates to events that happen with the implants. And the two big late things that happen to implants are capsular contracture, which is the tightening of the membrane around the implant that can distort shape or symmetry or increase the firmness of the implant and deflation or rupture of a saline or silicone gel implant. And sometimes calcification is seen on ultrasound or MRI or some kind of breast imaging. Separate from that, there's the issue of breast implant associated illness, which I'll touch on briefly a little bit later, but that's really a separate subject. And we have other podcast episodes to look at the issue of breast implant associated illness in a little bit more depth.

(03:57):
So events with the implants are one big category as I described. Then events with your breasts because breasts change over time. Pregnancies will change the breast. Aging changes the breast. Weigh change is going to make differences in the breast appearance. And this is largely manifested as differences in size and shape and also the dreaded breast droopiness or in medical terms, breast ptosis. And of course we're losing the war on gravity one day at a time. So if it's been 10 years or 20 years or even 30 years since a breast implant went in, predictably breasts are going to be droopier than they were when the implants were first placed. And this can result in just a not good breast shape. It can result in a mismatch between where the implant lives and where the breast lives so they're not lined up one on top of the other like they were when the implant went in.

(05:01):
And the final thing is sometimes there are changes in aesthetic goals. So you may feel like you want to be smaller or larger than what your breast implants currently are. Or again, you may want to go ahead and do a breast lift. And if you're doing a breast lift surgery and the implants are not young implants, it's reasonable to think about changing them out at that point in time.

Summer Hardy (05:29):
That makes sense. What is the maintenance? We're talking about surgery, right?

Dr. Lawrence Bass (05:33):
In a word, yes. So we're talking about replacing the implants, somehow revising the breast augmentation in terms of the shape of the breast, the size of the breast, some kind of adjustment of that sort. But mostly replacing the implant because then you go from an implant of whatever the current age is, which may be decades, because implants typically last decades, to an implant that's brand new, which gives you new decades until the implant wears out and fails. Of course, we know that breast implants left in long enough will likely eventually fail. This is the legacy of what you sign up for when you get a breast implant. And nowadays we are very clear and it's part of FDA guidance to make patients aware, including signing off on a checklist, that they're aware that the implants are a device which will eventually wear out and need replacement or removal.

(06:40):
So when you sign up for breast augmentation, you're signing up for more surgery anesthesia recovery times somewhere in your future. Separate from that reason, there are the reasons we talked about for returning to the OR for a revision.

Summer Hardy (06:59):
Got it. And can implants ever be reused?

Dr. Lawrence Bass (07:03):
So this is controversial. You'll get different answers from different surgeons. Some surgeons always replace the implant with a fresh one if they're operating in the breast for whatever reason. Other surgeons will reuse a young implant and you're more likely to reuse the implant if you want the same size, style and type. And if the implant is only a few months old, but you're back for capsular contracture or the implant is a few years old, say three or four years old, there are definitely surgeons who would say that implant probably can be reused. So the pocket may be getting tailored or something may be getting addressed. But as long as the implant is not damaged during the surgery and appears normal when it's examined and inspected at the surgery, there are some surgeons who will agree with the patient that they'll reuse the implant. Patients have to be aware that the implant always could need replacement.

(08:12):
So if you are planning to reuse an implant, but when you take a look at it during surgery and there's some kind of damage, implant doesn't look normal, then you're going to choose to replace that implant. And so you have to be prepared for the potential for implant replacement no matter what.

Summer Hardy (08:32):
Okay. Time for your takeaways, Dr. Bass. What is the bottom line with breast implants? Maintain them or run until they break?

Dr. Lawrence Bass (08:40):
So patients are 100% in the driver's seat when it comes to this. It's really your decision. For minimal aesthetic issues, what I recommend to patients is it's probably not worth a trip to the OR. So if you have what we call grade one capsular contracture, so there's a little touch of firmness, a little touch of asymmetry. You're going to be back in the OR sooner or later because sooner or later that implant is going to wear out, that's a chance to address the issue at that time. But it's probably not worth going back to the OR for minimal capsular contracture, firmness or asymmetry. Just an example of perfect is the enemy of good. If you have a failed implant or a major capsular contracture, you're almost always back in the OR unless there's some severe medical problems that preclude your going to surgery. If there's a big change in aesthetic goals, you want a different size, you want a different look, you no longer want to worry about implants and you just want them out, or you have health concerns or symptoms that are attributed to the implants, then it's reasonable to go to surgery.

(10:03):
And again, this is a patient-driven decision because it's your decision, you're in the driver's seat and the surgeon will accommodate that. For most patients, if they're in the first 10 years, there's a very low rupture or deflation rate. It runs about 1% a year in the first 10 years, just to put a round number on it. If the implant is older than 10 years, we tend to say the implant's no longer young. So at that time, if your aesthetic goals change, maybe you had a few pregnancies and you want to do a little reworking because the breasts look different, then it might be time for a revision or a replacement. Most important though, remember if the size, shape, or firmness of the breast or the feel of the breast changes, then it's time to see your plastic surgeon right away. The implant may be in trouble, and this could be evaluated properly by the plastic surgeon on a physical exam in the office, possibly an ultrasound or an MRI to make sure that the implant is still intact and that nothing is needed.

(11:20):
Ideally, you see your plastic surgeon once a year to have the implant checked out, but a lot of patients are busy and don't do that. So certainly if anything changes, it's really important to do that rather than just let it go. And of course, always remember to get your mammograms. So patients should get a baseline mammogram between 35 and 40 years, yearly after age 40, and as directed by your doctor, if you have special risk factors like a family history or a genetic test that indicates high risk for breast cancer. And remember when you schedule a mammogram, tell them you have breast implants so that they plan for the necessary extra image that needs to be taken and that can be arranged ahead of time. A lot of patients worry about mammograms and implants because the breast gets compressed during the mammogram, but manufacturers know that the implants are going to need to be compressed.

(12:25):
They know that ladies need to get mammograms. So the implants are tested and designed with the compression forces of the mammogram in mind when they test the implants. They compress and relax and compress and relax the implants on test beds thousands of times for months on end. So an implant that's young, that's intact will not fail with mammography, but sometimes an implant that's at the end of life on its last legs, sometimes the mammogram is the final straw. So occasionally implants do fail with mammograms, but they tend to be implants that are old and we're on the verge of failing one way or another. Overall, it's safe to run implants until they break, but you may get more out of the implants and a better optimized appearance with some maintenance along the way.

Summer Hardy (13:23):
Thank you, Dr. Bass, for answering that often asked question, which so many of us wonder about. Thank you for listening to the Park Avenue Plastic Surgery Class Podcast. Follow us on Apple Podcasts, write a review, and share the show with your friends. Be sure to join us next time to avoid missing all the great content that is coming your way. If you want to contact us with comments or questions, we'd love to hear from you. Send us an email at podcast@drbass.net or DM us on Instagram @drbassnyc.