Over 300,000 breast augmentations with implants are performed each year in the United States by thousands of board-certified plastic surgeons. Breast augmentation is safe and generally considered to be a one-time procedure. However, there are a small number of patients that have their implants replaced. This can be voluntary (e.g. the patient wants a larger size) or medically necessary (e.g. the implant has ruptured).

Women considering breast implants should not worry about having to replace their implants as long as they have their procedure done by a board-certified, experienced surgeon. If you already have breast implants and are wondering if you need a replacement, read on for more information.

There are four main reasons a woman might need or choose to replace her implants:

1. To switch implant types or size. Some women undergo a second breast surgery in order to reduce or increase volume, to switch the type of implant they have from saline or silicone to the other, or both. A desire to add more volume to the breasts is the most common reason women replace their implants.
2. The implant has ruptured. In these cases the implant must be replaced or at least removed.
3. Capsular contracture. The capsule is the natural, living tissue that forms around a breast implant over time. When capsular contracture occurs, the capsule shrinks and compresses the implant, changing its shape.
4. To correct changes to a breast implant. A small number of implants may migrate from the original placement site, causing malposition, symmastia, and asymmetry.

Changing Implant Sizes and Types

Some women are unhappy with their choice of implant or decide that they would like to add even more volume to their breasts. The old implant can be removed and a new one set in its place.

Sometimes when women are already undergoing a breast implant revision—whether it’s to change implant sizes or for a different reason—they will switch implant types, usually from saline to silicone. There can be a number of benefits to making this switch. Silicone implants:

• Often look more natural
• Are less likely to ripple or change shape
• Are less likely to need to be replaced in the future

If a woman isn’t entirely happy with the results of her breast augmentation, she will often try the opposite type of implant in a breast revision, especially if she is already having her implants replaced for another reason.

More About Ruptured Implants

Although the risk of a leak or rupture is very low, if you suspect that you have a ruptured breast implant, you should visit your surgeon immediately.

Saline implants. These implants have a silicone outer shell that is filled with saline solution to the desired level. Saline implants are slightly more likely to rupture, but in the event that a rupture does happen, the solution is safely reabsorbed by the body. There is no risk posed by the rupture, and it is usually immediately noticeable.

Silicone implants. While silicone implants are less likely to rupture, the long-term risks associated with it are unknown. Silicone leaks from the implant slowly, so it may not be apparent that a rupture has occurred for some time. In many cases, the capsule surrounding the implant will contain the leaked silicone and it can be removed from the body. If it leaks from the capsule as well, the silicone can migrate to other parts of the body.

An MRI can reveal whether a silicone implant rupture has occurred, and some breast implant patients make this a part of their routine physical exams in order to detect a rupture sooner.

More About Capsular Contracture

Capsular contracture occurs when the capsule that naturally forms around a breast implant begins to shrink, compressing the implant. The breast can become hard, round, and uncomfortable.

The compression causes the implant to take the shape that will have the least amount of surface area, which is a round ball. Since capsular contracture is usually isolated to one side, it will make a woman’s breasts look unnaturally asymmetrical.

Women who experience capsular contracture will need to have the implant removed and replaced as soon as possible, ideally before it begins to cause discomfort.

Repositioning an Implant

An implant may need to be repositioned if it has migrated from the original site or merged with the other implant in a rare condition called symmastia. Symmastia can occur when a surgeon places the implants too close together in an effort to create more cleavage. A qualified, board-certified plastic surgeon will prevent a condition like symmastia from occurring, as well as any malposition of an original implant that would require replacement.

When rippling occurs with a saline implant, a surgeon may correct the problem by placing a new implant below the breast muscle instead of above it, or by switching to silicone implants in both breasts.