The 411 on Silicone Breast Implants

By C. Andrew Salzberg, MD, New York Group for Plastic Surgery

There’s been much discussion surrounding use and safety of silicone breast implants over the years, and the information can certainly be confusing! Are they safe? Do they rupture and how can you tell? Do they increase your risk for autoimmune diseases? Do they need to be replaced at some point? So many questions, and the answers aren't always straightforward.

I’d like to provide some information that can help women feel more confident in the decisions they make when having breast surgery involving the use of implants, whether cosmetic or reconstructive.

Much of the confusion over silicone implant safety stems from when FDA ordered them taken off the market in 1992 and required additional research by unbiased experts to make sure that leaking silicone implants were not causing autoimmune disorders like lupus, scleroderma, fibromyalgia or rheumatoid arthritis. (Breast cancer patients were still allowed to receive silicone implants for post-mastectomy reconstructive surgery and research protocols.) After 14 years of research, the experts concluded there was no causative relationship between ruptured implants and these autoimmune disorders, and use of silicone implants for breast reconstruction and cosmetic purposes was re-instated by FDA in 2006.

Silicone implants are overall very safe, and in fact have been improved since returning to the market. The outside shell is more stable and less likely to rupture, and the internal silicone is in a more stable form. “Memory gel” implants, as well as “form stable”(also known as “gummy bear”) implants, offer silicone that is more cohesive and less viscous i.e., it will not "run out” of the implant even in the unlikely case of a rupture. 

As far as breast cancer screening, radiologists are very accustomed to reading mammograms for women with implants. An additional view of a breast may be requested, but surveillance for breast cancer should generally not be a problem.

Silicone implants are unlikely to rupture. The manufacturers state that it’s reasonable to expect to replace implants within 10—12 years, but as long as they remain soft, don't change shape, become hard or cause any discomfort, we leave them alone. In fact, we have lots of patients at our practice that have had the same implants for 20+ years before needing them replaced. Activities of daily living — even your kids or dogs jumping up on you! — won't rupture implants.

How do you tell if an implant is ruptured and needs to be replaced? Some women are made aware via their yearly mammogram. We counsel patients on their options and they decide if they want the implants replaced. If the breasts are soft and the patient is not having any symptoms, they do not have to replace their implants, though some choose to do so if they’ve had the implants for a while or desire a change in shape or size.

Another scenario is a patient who has had implants for 10+ years and notices that one breast feels slightly firmer and may sit a little higher than the other. This is an indication that the implant may have ruptured and her body is reacting by tightening the tissue around the implant. If necessary the implants can be replaced in a simple outpatient procedure. There is no reason to have a yearly MRI or any routine testing on implants, but see your surgeon yearly for a checkup.

It’s important to have any of your concerns properly addressed by your plastic surgeon when deciding on the use of an implant in breast surgery, but hopefully this gives you some background knowledge and a foundation from which to focus your questions and discussion.

Dr. C. Andrew Salzberg, a board certified plastic and reconstructive surgeon, is Associate Professor at NY Medical College and Chief of Plastic Surgery at Westchester Medical Center and St. John's Riverside Hospital at Dobbs Ferry Pavilion. He also operates at the Institute for Aesthetic and Reconstructive Surgery within the Hudson Valley Hospital Center and at The Mt. Sinai Hospital Center in New York City. He is a partner with the New York Group for Plastic Surgery. http://www.nygplasticsurgery.com