Dear Alice,

My breast implants were implanted in my body when I was 22 years old. I am now 64 years old and an MRI shows leakage. I am really afraid of having them removed. Am I in danger if I continue with them until I die?

Dear Reader,

Just as other parts of the human body undergo some wear and tear with age, breast implants, too, can rupture or leak over time. There are two types of breast implants — saline and silicone. Although neither type of implant leakage poses serious risks to your health, the U.S. Food and Drug Administration (FDA) does recommend surgery to either remove the implant or replace it to avoid undesirable cosmetic changes or pain associated with the leakage. Speaking with your health care provider about this leakage will help inform what next steps would be best for you to take as you remedy this issue.

Breast implants have been widely available since the 1960s, and the technology has improved with each passing year. However, no matter when you got your implants — decades ago or yesterday — they almost always require some sort of follow-up surgery down the line. In fact, 20 percent of implants need to be removed within the first decade of implantation. Common causes of ruptures include capsular contraction (the tightening or hardening of tissue around the implant), under or overfilling of saline implants, mammograms, damage during surgery, trauma or injury to the breast, or general aging or weakening of the shell that holds the fluid.

What happens after an implant leakage occurs depends on what type of implant you have. With saline implants (implants filled with a salt water solution) you’d probably have noticed the leak immediately, as the implant typically deflates fairly rapidly. Then the saline fluid is simply absorbed by your body (the silicone shell of the implant, however, would need to be surgically removed or replaced). If you have silicone implants (implants filled with a thicker, gel-like fluid), a leak would occur more slowly over time and the fluid would likely get trapped in the “capsule” of fibrous breast tissue around the implant. Silicone leakage can sometimes cause some inflammation of the breast, as well as pain, soreness, lumps, or changes in the shape and firmness of the breast. It’s also possible that you may have no signs or symptoms of a leak — this is known as a silent rupture. Surgical removal of a silicone implant may also help to keep any leaking silicone fluid from traveling to other tissues (like the arm, chest wall, or armpit), where it could be harder to remove.

Now that the leak has been discovered, what’s the risk to your health? There are a lot of misconceptions out there about ruptures, including people who say that a rupture can lead to tissue disease, breast cancer, or reproductive diseases. Rest assured, though: the FDA has found no evidence that any of these health conditions are associated with leaking implants. Nonetheless, the possibility of pain or physical changes to your breasts due to a leak is a good reason to chat with your health care provider about having the implant(s) removed or replaced. It would also be a good idea to check with your health insurance coverage, as these types of procedures aren’t always covered.

Although the prospect of any aesthetic changes to your breasts may be scary, keep in mind that beautiful breasts come in all shapes and sizes. Whether you decide to have the implants removed altogether, replaced, or just monitored for further leakage, staying on top of your breast health is a good idea. You could conduct regular breast self-exams to catch any changes and the FDA recommends getting MRIs every two years to monitor the development or progression of implant leaks (specifically for silicone implants). Also, regular visits with your health care provider may provide another way for you to “nip” any implant issues in the bud.

Alice!

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