Breast implants enhance the size and shape of the breasts, adding volume to breasts that are naturally small or restoring volume lost after weight loss, pregnancy, or breastfeeding. Implants can also correct asymmetry in the breasts, creating a more balanced look. Women can turn to implants after a mastectomy to restore a natural appearance and boost confidence.
Like any surgery, breast augmentation has its benefits and risks. One of these risks is implant failure, such as a ruptured implant. Implant failure can occur after a bad boob job or due to something unexpected that happens after an otherwise great surgery.
Implant failure doesn’t have to happen to you. Here’s what you need to know about how to detect problems, prevent them, and what your options are if an implant does fail.
Breast implants vary in size, shape, and material. Different types of implants have different lifespans. They can also have different signs and symptoms when there is an issue with the implant.
Materials: Saline and Silicone
As of 2006, the FDA has approved both saline and silicone implants for breast augmentation in women. Saline implants are approved for women over the age of 18 for cosmetic reasons and silicone implants are approved for women over the age of 22. Both types can be used in women of any age for breast reconstruction.
There are several notable differences between saline and silicone implants. Silicone is often the material of choice, as the implants feel softer and more natural. One type of silicone implant, the gummy bear implant, has a thicker gel material inside them, meaning they hold their shape even if the shell of the implant breaks.
Saline implants can be filled after insertion by the plastic surgeon, meaning it’s possible for the surgeon to make a smaller incision during the surgery. The implants are then filled with a sterile saltwater solution. If a saline implant breaks, the body harmlessly absorbs the saltwater.
Shape: Round and Tear-Drop
Modern implants come in a selection of shapes, including round and tear-drop. Round implants typically provide the most projection. If the implant turns or shifts position, it won’t cause a deformity in the breast.
Tear-drop implants are supposed to provide a better initial shape to the breast, but in reality, there is little visible difference between a round implant and a tear-drop-shaped implant, once they are placed inside the chest. Tear-drop implants have a tendency to shift, changing the shape of the breast.
Texture: Smooth or Textured
The exterior of an implant can either be smooth or textured. As of 2019, certain types of textured implants are no longer recommended for use by the FDA, due to a link between these implants and a type of cancer called Breast Implant-Associated Anaplastic Large Cell Lymphoma.
Smooth implants tend to look and feel natural, as they will move with the body. Depending on the amount of natural breast tissue a person has, smooth implants can sometimes be visible beneath the skin, which is a fairly common cosmetic issue.
Breast implants are measured in volume, usually in cubic centimeters. Size options range from 100 cubic centimeters to 1,000 cubic centimeters. For many women, the sweet spot seems to be in the range of 300 to 500 cubic centimeters.
Implant volume isn’t the only factor that affects the size of the breasts after surgery. A woman’s frame and the size of her existing breasts also play a role. An identical pair of 300 cc implants can look dramatically different on two different women.
What Happens During Breast Implant Placement
The best way to prevent breast implant failure is by ensuring the proper placement of the implants during the initial surgery. Implant malpositioning is one major cause of implant failure, as are other poor surgical techniques.
During breast augmentation, a plastic surgeon will place the implants above or beneath the chest muscle. The submuscular position is often the most aesthetically pleasing, particularly when a patient doesn’t have a lot of natural breast tissue. Submuscular placement usually is less likely to result in deformity or cause wrinkling of the skin.
At the start of the surgery, the plastic surgeon makes an incision, typically in the crease just beneath the breasts. Working through the incision, they will make a pocket in the breasts for the implant. After creating the pocket, the surgeon will place the implant in the breast.
If a patient chooses saline implants, they will be filled after placement. Silicone implants are pre-filled. Once the implants are in position, the surgeon will close up the incisions.
Breast Implant Failure Reasons
Some reasons for breast implant failure have to do with the initial surgery but others are related to outside factors. There are several possible reasons for failed implants, including:
- Implant aging or wear and tear: Implants aren’t lifetime devices and can wear out as they get older. The older the implants are, the higher the risk of failure.
- Excessive force on the implant: If the implant gets hit with a lot of force, such as during a car accident or when a person gets tackled playing a sport, there is a chance of rupture.
- Needlestick: During a biopsy or other procedure, there’s a chance that a needle will poke the implant, making a hole that leads to a leak. In some cases, the rupture can occur due to a needle stick that occurs during the initial surgery.
- Constrictive scar tissue (capsular contracture): Scar tissue naturally forms around the implants after surgery. If the tissue tightens around the implant too much, however, it can cause deformity and failure.
For the most part, damage to an implant is more likely to occur rather than wear-and-tear on the implant itself. Both silicone and saline implants can fail, but how they fail and the signs of failure vary.
Silicone Breast Implant Failure
Generally speaking, older silicone implants are more likely to rupture or fail than newer ones. Newer silicone implants are made from a more advanced cohesive gel that’s less likely to leak than older versions.
Intracapsular vs. Extracapsular Rupture
Two types of implant failure are possible when a silicone implant ruptures. The first is intracapsular rupture. When an intracapsular rupture occurs, the silicone gel leaks out from the implant but remains in the capsule, the scar tissue that surrounds the implant.
If the silicone leaks out from the capsule, spreading to other areas of the body, an extracapsular rupture has occurred. Extracapsular rupture can cause scar tissue to develop or can cause irritation in other tissues. It’s usually not associated with illness or other health issues, however.
Silicone Breast Implant Failure Symptoms
If you have silicone implants that have ruptured, you might not have symptoms. A rupture that occurs without symptoms is called a silent rupture. Often, intracapsular ruptures are examples of silent ruptures.
It’s also possible that you will have symptoms after an implant ruptures. Whether a rupture is intracapsular or extracapsular, some possible signs include pain in the breasts, lumps, or hardening of the breast tissue. Depending on the type of failure, the implant might also change shape, causing the breasts to change shape, too.
Silicone Breast Implant Failure Rate
The likelihood of silicone implant failure increases the longer a woman has had her implants. One study found that the failure rate was 6% per year for each of the first five years. At five years, about 30% of implants had failed.
After 10 years, the failure rate was 50%. After 17 years, the rate was 70%.
It’s important to remember that failure rates are just numbers. It’s possible for women to have the same implants for several decades without any problems. With that said, breast implants are not lifetime devices and may need to be replaced at some point.
Detecting Silicone Breast Implant Failure
Although a ruptured silicone implant can cause symptoms that alert you to the issue, a silent rupture can go unnoticed. If you’ve experienced something that you think could have damaged your implants, you can ask your doctor to perform imaging on your breasts to get a better look.
An ultrasound or MRI will take a picture of the breasts and implants. A doctor can examine the imaging to see if the implant ruptured and check for silicone gel in the capsule or elsewhere in the body.
Even if you have avoided accidents that could have damaged your implants, it might still be a good idea to schedule imaging every few years to monitor the status of your silicone implants. Imaging three years after your initial surgery, then every two years after that, is ideal.
Saline Breast Implant Failure
While a silicone implant can fail silently, escaping notice, a saline implant rupture often causes much more dramatic changes and is generally easier to spot.
Saline Breast Implant Failure Symptoms
When a saline breast implant fails, the saltwater inside of the implant leaks out. Depending on how quickly the liquid leaks out, the implant can seem to deflate before your very eyes. If the leak is slow, you might notice that the affected breast becomes smaller and smaller over time.
Saltwater is a harmless substance and the human body contains it naturally. When the saline solution in an implant leaks out, the body eventually reabsorbs the saline, without the risk of complications or harm.
Saline Breast Implant Failure Rate
Like silicone implants, saline implants are more likely to fail the older they are. One study found a failure rate between 3% and 5% when saline implants were three years old. In 10-year-old implants, the failure rate was between 7% and 10%.
The average age of the patient when the failure occurred was just over 48, suggesting that most women with saline implants will want to replace their implants at least once during their lifetime.
Detecting Saline Breast Implant Failure
The most common sign that a saline implant has failed is a change in the shape or size of the affected breast. The breast will lose volume, either right away or over the course of several days. As it loses volume, it might also begin to look deformed.
Other Breast Implant Concerns
Although implant rupture is a common reason for implant failure, it’s not the only problem that can occur. Several other complications can occur after breast augmentation that affect the shape of the breast and typically require implant removal or replacement.
The formation of scar tissue is natural and expected after breast augmentation. The capsule of fibrous tissue that forms around the implant holds it in place. Capsule formation is also the body’s way of keeping the implant separate from the rest of the body, as a type of defense mechanism.
Problems can occur when the capsule hardens and starts to tighten around the implant. The tightening can be painful and can deform the breast. Depending on the severity of the capsular contracture, removing the implants and the scar tissue might be necessary.
Wrinkling of the Skin
Some implants can make the skin around the breasts look rippled or wrinkled. Saline implants are more likely to cause rippling than silicone. The placement of the implant and the amount of breast tissue a person has naturally can also contribute to wrinkling.
While wrinkling doesn’t cause implant failure, it does affect the aesthetics of your breasts and can be a reason to consider implant exchange.
Bottoming Out of the Implants
Over time, the position of the implants in the breasts can change, making the breasts themselves look droopy. One example of this shift in position is “bottoming out.”
If the implants aren’t properly supported by the pocket in the breasts, the effects of gravity can push them down so much of the implant ends up beneath the nipple. Replacing the implants or reinforcing the breast tissue can help correct bottoming out.
What Is Your Risk for Implant Rupture or Failure?
The risk of implant failure, including rupture, is relatively low for most patients, even if the implants themselves wear out with time. Working with your surgeon to monitor your implants with imaging will help you detect any issues early on.
How to Prevent Breast Implant Failure
If you are concerned about implant failure, know that there are several things you can do to reduce your risk or prevent implant failure altogether.
The first thing to do is choose your plastic surgeon with care. The American Society of Plastic Surgeons recommends choosing a surgeon who is board-certified by the American Board of Plastic Surgery and performs the surgery in an accredited facility.
Get to know your surgeon before you move forward with breast augmentation. Find out as much about the surgery as possible, including the techniques they will use. Some techniques, such as submuscular placement, can reduce the risk of implant failure or complications such as capsular contracture.
Also, find out how the surgeon will handle the implants. A layer of bacteria, called a biofilm, can form on implants, increasing the risk of capsular contracture. Techniques that reduce the handling of the implants before surgery reduce the formation of the biofilm.
In your daily life, you can take steps to protect your implants. A car accident, particularly one that causes you to slam into a steering wheel or dashboard, can cause an implant to rupture. Wearing a seatbelt every time you are in a car will keep you from being thrown forward in an accident.
If you are going to have a medical procedure performed that will involve a needle near the breasts, let the person know that you have implants, to reduce the chance of them accidentally poking the implants.
What to Do If You Suspect Implant Failure
If you notice a change in the size of your breasts or your breasts feel sore or hard to the touch, implant failure is a possibility. If you suspect that one or both of your implants has failed, your best option is to schedule a consultation with your plastic surgeon.
Your surgeon can perform imaging to assess the condition of the implants and the breasts. Depending on the situation and your preferences, they will recommend implant replacement, implant removal, or taking a “wait and see” approach.
A “wait and see” approach might be appropriate if you have a silent rupture that isn’t causing you symptoms. The issue might never become something to worry about or you might never need to remove or exchange your implants.
Options if There’s a Problem With Your Breast Implants
If you do want to do something about ruptured silicone or saline implants, your options are typically limited to removal or exchange.
The goal of implant removal is to take the existing implants out without replacing them with a new set. You might want to remove your implants entirely if you want to go back to your natural size or if you decided you don’t like having implants.
During implant removal, the plastic surgeon will take out both the implants and the scar tissue that formed around them. Since having implants can change the shape of your breasts or otherwise alter your breast tissue, your surgeon might recommend a breast lift at the same time to restore the perkiness and shape of your breasts.
Like implant removal, implant exchange involves taking out the implants you currently have. During the procedure, the plastic surgeon will then replace the old implants with a new pair.
You can choose a different size of implants during the exchange if you want. You can also go from saline implants to silicone or from silicone to saline, depending on your preference.
Breast implant exchange isn’t just performed to correct damaged implants. You might decide to replace yours if you are no longer happy with their size or material, even if the implants themselves are in good condition.
Breast implants aren’t lifetime devices but they do have a relatively long use life before they need to be replaced. Depending on circumstances, your implants can last for anywhere from a decade to more than 30 years.
Yes, both saline and silicone implants are FDA-approved and considered safe. In the 1990s, there was concern about silicone breast implants causing cancer. The FDA pulled them from the market for a while but approved them again in 2006 after no clear connection was discovered.
According to the FDA, some women report feeling fatigued or experiencing joint pain and memory fog after getting breast implants. Some women report that removing the implants helps to clear up their symptoms. It’s not fully understood whether the implants themselves are contributing to the symptoms or if there are other factors at play, such as autoimmune disorders or menopause.
No, having a ruptured or failed implant does not increase the risk of breast cancer. After extensive study, the FDA has found no connection between approved implants and breast cancer.
Many factors can influence the cost of having breast implants removed. One factor is the type of implants you choose to replace them with. The complexity of the surgery also influences the price. Your plastic surgeon can give you a realistic quote during a consultation.
What are the risks of breast implant surgery?
The risks of breast implant replacement or removal are similar to the risks from other types of cosmetic surgery. Complications are rare, especially when an experienced surgeon is performing the procedure. Possible complications include infection, scarring, asymmetry of the breasts, and a loss of sensation near the nipples.
Will I have new scars after implant removal or exchange?
During implant removal or exchange, the plastic surgeon will usually make an incision in the crease beneath the breasts. The location of the incision means that any scarring will be well concealed by the breasts themselves.
Choosing a Qualified Breast Augmentation Surgeon
Bad boob jobs affect patients’ self-esteem and comfort. Whether you are considering breast augmentation to get implants for the first time or implant exchange, revision, or removal to correct failed implants, the most important decision you’ll make is choosing your surgeon.
Dr. Paul Vitenas is a board-certified plastic surgeon in Houston, Texas who specializes in breast surgery. He’s regularly been named a top doctor and is continually praised for providing natural results in his patients. If you’re concerned about the state of your implants or would like a change, call 281-484-0088 to schedule a consultation with Dr. Vitenas today.