Considering Explantation: 12-Year Old Silicone Breast Implants May Be Leaking.

A: We don't give medical advice, but we can tell you what we have learned from speaking to many experts and reading the research that has been done on this topic.

Research suggests that a broken breast implant should be removed as soon as possible if it is leaking, or if you have an old implant that you suspect is leaking.

The big question for most women is whether to replace their removed implant.
Some surgeons discourage patients from removing their implants without replacing them, because they believe that silicone is safe and because they are concerned that the patient will be very unhappy with their appearance after the implant is removed. The breast tissue stretches from the implant, and if the surgeon is not skilled in explantation without replacement, the breast is unlikely to be as attractive as it was before the implant surgery. If the surgeon is not skilled at removing ruptured implants, the silicone can spill into healthy breast tissue, which then may need to be removed as part of the surgery. However, after implants are removed by a board-certified surgeon who is very experienced at removing broken gel implants, many women are pleased with the way their breasts look and feel.

In the only health study of removed implants, doctors found that 97% of women with pain and other rheumatologic symptoms felt better after their implants were removed and not replaced. Many symptoms lessened or disappeared over the next few months. In contrast, 96% of the women who did not have their implants removed became even more ill (see reference below).

The only study of the health of women with leaking silicone gel implants, conducted by scientists at the FDA, found that women with leaking implants were more likely to report fibromyalgia and several other painful and debilitating diseases, compared to women whose implants were not broken, or whose implants were broken but not leaking.

Whether or not you decide to replace your implants, the plastic surgeon that performed the original surgery is not necessarily the best choice for removing the implant. Removal can be much more complicated and expensive than the original surgery, especially if a silicone gel implant has broken. Results can be excellent or disastrous. Some plastic surgeons are very experienced at removal and are especially skilled at getting the best possible cosmetic result. The surgeon you choose should be board certified and should be willing to show you pictures of many patients' post-explantation results, or better still, offer to have former patients talk to you. Find out if they were happy with their doctor and with their results.

Most experts believe that removing the implants "en bloc" is very important. En bloc means that the entire implant and the scar tissue capsule surrounding it are all removed together. This helps remove any silicone that may have leaked from a broken gel implant, and also helps remove silicone or other chemicals that may have leaked from the silicone outer envelope. If you have two old implants, it makes sense to remove both at the same time.

You may find the following website helpful, because it includes stories of women who had very good experiences with explantation without replacement: www.explantation.com.

Only you can make this decision. If your illness is affecting your quality of life, that will probably help you decide.

Aziz NM, Vasey FB, Leaverton PE, et al. Comparison of clinical status among women retaining or removing gel breast implants. Presented at the annual meeting of the American College of Epidemiology, 1998.