You don’t notice the grass growing, but you know that it does. You don’t notice the paint on your walls fading, but you see it when you take down a picture after many years. Women with old silicone gel breast implants often don’t notice the changes in their breasts that have occurred over the years because they happened so slowly. They forget what is ‘normal.’
Silicone Implant Moratorium
The vast majority of the silicone gel breast implants that were inserted before the FDA moratorium on silicone implants in 1991 were produced by Dow Corning. These implants were termed ‘low bleed’ implants which meant that the silicone inside of the implant slowly oozed out of the implant shell. This occurred because the shell of the implant was very thin and the gel inside of the implant was much more like a liquid than the current silicone implants.
As a result of this silicone bleed, the scar tissue around the implant reacted to the silicone causing it to become harder and/or compress the implant; this is known as a capsular contracture. Unfortunately, most of these implants were usually placed on top of the chest wall muscle, which also contributes to the incidence of capsular contracture. As the capsules often developed slowly, many women don’t realize that their breasts gradually became harder and less natural. They forgot how soft and natural they used to feel.
These implants can be removed, along with the scar tissue if necessary, and replaced with more modern silicone implants which have both a thicker shell and a thicker (more cohesive) gel which has dramatically reduced the risk of silicone leaking out of the implant and, as a result, the incidence of capsular contracture. In these situations, it may also be advisable to reposition the implant under the muscle to create a more natural look and to further reduce the risk of another capsular contracture.
In cases where the skin has stretched out resulting in sagging of the breasts, it may also be necessary to perform a breast lift (mastopexy). In some cases, this can be done at the same time as removing the old implants and in others, it is necessary to perform that surgery at another time. This depends on the position of the implants and how much tissue the surgeon has to work with. You must quit smoking in order to have a breast lift.
It is likely that the vast majority of breast implants that were inserted in the 70’s, 80’s and early 90’s have ruptured. It may be difficult to tell by exam because the volume of the breast does not change, as the silicone remains trapped in the scar capsule around the implant. In these situations, it is advisable to have the implant material and scar tissue removed; replacing the implant if desired with a newer implant and potentially perform other procedures at the same time to improve shape and symmetry.