When first considering breast augmentation surgery, few patients stop to think about the long-term effects of the surgery and the future maintenance that may be required to keep the ‘look’ they are trying to achieve. Many patients have their surgery in their young adult years before the damages of gravity and pregnancy take their toll. Usually, at that point an implant alone can give a beautiful result. As they continue to age and go through further life experiences (like weight gain and loss, or engorgement with pregnancy and breast feeding) the skin tone and proportion of the breast can change. Typically the skin stretches and the tissue atrophies and droops leaving a saggy, deflated breast. The implant volume will still be the same, but the tissue itself suffers, and the only way to get back to a perky appearance is to have a breast lift. A lift takes away the extra skin and reshapes the tissue to get rid of the drooping. If this happens 10 years or later after the initial augmentation, most plastic surgeons would recommend exchanging the implant since the average implant lifespan is between 10-15 years. If you require a lift earlier than that it makes perfect sense to leave the implant alone and just reshape the tissue envelope. One exception would be if you desire to change size or type of implant, then the two can easily be combined saving you an extra trip to the operating room.
Most patients who have their augmentation early can realistically expect to have 3 or 4 surgeries over the years, but there is no requirement that you have to exchange them at a certain time. Occasionally, implants will last much longer than the average. If that is the case there is no need to preventatively change them out. Also, realize that having an implant in that has ruptured is not going to make you sick. With saline you will see a size difference. With silicone you typically see a gradual buildup of scar tissue that can change the shape or feel of the breast, but it will not physically make you ill. If you have had implants in the past and they are getting older it is a good idea to visit with your plastic surgeon for a checkup so you can come up with a long-term plan.