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What should I do if my saline implant deflates? Should I deflate my intact implant?

Wouldn’t it be great if breast implants could last forever, and we did one surgery and never had to think about it again. Wishful thinking I’m afraid for both silicone and saline implants are not invincible, and they have a rate of rupture or deflation over time. For this discussion let’s focus on saline implant deflation. In general, saline implants deflate around 10% to 12% of the time at ten years. This is not a straight line progression for 3 to 4 % may deflate in the first 3 years, and the deflation rate at 20 years is likely 30 % or more. Exact data can be tough to determine for implant construction changes over time, and many people choose to have breast lifts or change to silicone implants without having deflated so exact numbers are impossible to come by. Of course if your implant has deflated then it’s 100% for you at that point in time whether 5 years or 15 years after your surgery. 
One upside of saline implants is that if the implants does break and deflate you know it. The result is not subtle for that breast will shrink in size, get softer, and likely hang a bit looser than the other breast. Also when implants deflate it is common to feel the irregularities and folds in the implants once it is mostly empty of the saline. Sometimes the empty implant even feels like it is pocking you and feels very different than when full and intact. The saline in your implant is regular IV fluid, and your body absorbs the slat water over time and you just pee it out like you would an IV solution. Most implant deflations are a small pin hole that may have occurred from a small edge fold in the implant that made it rub against itself over the years and a hole occurred. Those deflations with a true hole in the implant deflate in a couple weeks, it’s fairly rapid and obvious. A less frequent type of deflation occurs at the valve which is the part of the implant used to fill it with saline at the time of surgery. These valve leaks can lead to partial deflations, or changes in the breast size that take many weeks to occur.
So once you and your surgeon know your implant on one side has deflated what should you do? Most patients plan on replacing their implants, possibly with saline again or silicone, but depending on how the breast have changed over time a breast lift may also be appropriate with or without new implants. Also decisions about going larger or smaller need to be discussed. It is often wise to strongly consider deflating the intact implant before considering revision surgery. This may be especially important if you don’t know the exact fill volumes your surgeon put in the implants. Many patients at initial surgery were asymmetric and the surgeon put 25 or 40 cc’s more on one side or the other, and now with a deflation we can’t tell how naturally asymmetric you are. Hopefully the original surgeon gave you an implant card with the exact fill volumes placed in each implant, but those cards are often misplaced. Also over time the implants may have stretched the natural breast tissue differently on one side, or if your weight has changed with time that change may have changed the breasts differently. Another reason to deflate the intact implant is that the weight of the full implant changes the natural hydration and tissue volume of that breast. The weight of the implant pushes some swelling out of that breast and once deflated the volume of the deflated breast can change up to 20%. Twenty percent is a significant amount and if we don’t deflate the other breast we may be way off getting things symmetric.
Deflating an intact implant is a very simple and safe in- office procedure. A little local anesthesia and a surgeon can deflate the intact implant over a couple minutes so the whole process may be 15 or 20 minutes in the office. In my practice I have patients wait at least one month and often a bit longer before doing the revision so we gave the breast time to relax back to a normal baseline. If you have a unilateral deflation, especially if it’s been a few months before you sought out surgical advice, strongly consider deflation of the intact implant to assist you in making the best decisions for the next surgery. I hope this helped clarify why your surgeon might suggest deflation of your intact saline implant.
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