Breast Implant Checks: How Often, Which Scan and When to See a Surgeon

Breast implants are not designed to last a lifetime, and the two problems that most often lead to further surgery, rupture and capsular contracture, become more likely the longer implants are in place. Some changes are obvious. Others, particularly a silent rupture of a silicone implant, cause no symptoms at all. That is why women with implants ask how often they should have them checked, what a check involves and whether they need a scan.

This guide explains the current advice on checking breast implants in the UK and US, how to check your breasts at home when you have implants, the signs that something may be wrong, and what ultrasound, MRI and mammography can and cannot tell you. If you are still choosing implants, our guide to the types of breast implants covers fill, shape and surface, and our guide to how long breast implants last explains why no implant should be thought of as permanent. For a specific worry about a leak, our guide to breast implant rupture covers causes, symptoms and treatment in detail.

Do Breast Implants Need to Be Checked?

Yes, and silicone implants in particular. Every implant has a silicone outer shell that slowly weakens with age. When a saline implant fails, the salt water leaks out and is absorbed, so the breast visibly deflates within days and you know about it. When a silicone implant fails, the gel usually stays inside the scar capsule your body forms around the implant, so the breast can look and feel exactly the same. This is known as a silent rupture, and the only reliable way to find one is a scan.

Modern implants are considerably more durable than older ones. An MRI study of form-stable cohesive gel implants found ruptures in 1.7% of implants a median of eight years after surgery (Aesthetic Plastic Surgery, 2009), compared with 26% of implants in a Danish study of older-generation devices placed between 1973 and 1997 (Plastic and Reconstructive Surgery, 2001). In both, the risk rose with the age of the implant.

Rupture is only one reason to keep an eye on your implants. A check also looks for capsular contracture, changes in implant position, fluid around the implant and changes in the breast tissue itself. Our guide to common breast implant problems sets out each of these and how they are treated.

How Often Should Breast Implants Be Checked?

There is no single schedule that applies everywhere. The advice depends on the type of implant, how long it has been in place and which country’s guidance you follow.

In the first year after surgery

Your surgeon will review you during your recovery to check healing, implant position and symmetry. These early reviews are about recovery rather than long-term monitoring, but they give you a baseline: a clear sense of how your implants look and feel once they have settled, which makes later changes easier to spot.

The FDA recommendation for silicone implants

The US Food and Drug Administration recommends that women with silicone gel implants have a first ultrasound or MRI five to six years after surgery, even if they have no symptoms, and then a scan every two to three years. If you have symptoms at any stage, or an ultrasound result is unclear, it recommends an MRI (FDA, 2020). The same schedule is set out in a review written for family doctors (American Family Physician, 2021). Saline implants have no scanning recommendation, because a saline rupture is obvious without one.

The UK position

The UK has no national programme that scans implants routinely. The NHS Breast Screening Programme advises women with specific concerns about implant integrity, or about the feel or appearance of their implants, to see their GP (NHS Breast Screening Programme). In practice, that leaves the timing to you and your surgeon.

Our advice is to know what is normal for your breasts and check them monthly; to see a surgeon promptly if anything changes; and to have your implants reviewed by a surgeon once they are around ten years old, even if nothing feels different. The review may or may not lead to a scan. What it gives you is an informed decision about whether your implants need attention, rather than an assumption either way.

How Do You Check Your Breasts If You Have Implants?

Checking your breasts with implants is much the same as without them. The aim is to know what is normal for you, so that a change stands out. Once a month is enough; if you still have periods, the week after your period is best, when breasts are least tender.

1. Look. Stand in front of a mirror with your arms by your sides, then raised above your head, then with your hands pressed on your hips. Look for any change in size, shape or position of either breast, new rippling, dimpling or puckering of the skin, redness, or a change in either nipple.
2. Feel. Using the flat pads of your fingers, press gently in small circles over the whole breast, working from the collarbone to the bra line and from the breastbone to the armpit. Include the armpit itself.
3. Feel lying down. Repeat with one arm behind your head, which spreads the breast tissue more evenly over the implant.
4. Learn your implant. It is normal to feel the edge of an implant, particularly at the side or underneath, and some women can feel a fold or ripple in one place. What matters is whether that changes.

A self-check cannot detect a silent rupture, and it does not replace breast cancer screening. A new lump, nipple discharge, skin dimpling or a change in the shape of the nipple should be checked by your GP first, as you would without implants.

How Do I Tell If Something Is Wrong With My Breast Implant?

Most implant problems develop slowly and are not emergencies, but they should be assessed rather than watched indefinitely. The signs that warrant a consultation are:

• A change in the size or shape of one breast, including flattening, a new asymmetry or a breast that looks rounder or higher than before.
• Hardening or tightness, often with the implant sitting higher, which is the typical pattern of capsular contracture.
• Pain, tenderness or a burning sensation that is new or persistent.
• Lumps in the breast or armpit, which can occasionally be silicone that has escaped the capsule and collected in lymph nodes.
• Swelling that appears a year or more after surgery, usually on one side. Late fluid around an implant needs prompt assessment, because it is the most common way BIA-ALCL, a rare lymphoma linked to textured implants, first shows itself. In a large US cohort, cases were diagnosed a median of about ten years after surgery (Annals of Surgery, 2020).
• An implant that has moved, dropped too low or, with a teardrop implant, rotated. Our guides to how to tell if an implant has moved and bottoming out explain what to look for.
• New visible rippling or wrinkling, covered in our guide to breast implant rippling.

Redness, heat and swelling with a fever, particularly after an injury or an infection elsewhere, need same-day medical attention. Some women also describe symptoms such as fatigue, joint pain and poor concentration that they attribute to their implants; our guide to breast implant illness explains what is and is not known about it.

What Is a Silent Rupture?

A silent rupture is a tear or hole in the shell of a silicone implant that causes no symptoms. In an intracapsular rupture, the gel stays within the scar capsule around the implant, so the breast keeps its shape. In an extracapsular rupture, gel has passed through the capsule into the surrounding tissue, where it can form small firm lumps; in the Danish study, 22% of ruptures were extracapsular (Plastic and Reconstructive Surgery, 2001).

Modern cohesive gel is thicker and more cohesive than the gel in older implants, so it tends to stay where it is even when the shell is damaged. A silent rupture is therefore not usually urgent. It is still a reason to plan treatment, because a ruptured implant can go on to cause capsular contracture, shape change or gel migration, and because surgery is simpler before those develop.

What Happens at a Breast Implant Check?

At Centre for Surgery, the first step is a consultation with a plastic surgeon rather than a scan on its own. The consultation covers:

1. Your history. When and where you had surgery, which implants were used, any operations since, pregnancies and breastfeeding, symptoms and when they started, and your family history of breast cancer. Bring your implant card or any surgical records you have.
2. An examination. Your surgeon assesses the shape, symmetry and position of your breasts, the softness of each implant and its capsule, the skin, and the lymph nodes in your armpits.
3. A decision about imaging. If a scan would change what happens next, your surgeon will refer you for an ultrasound or MRI and explain which one and why. If the examination is reassuring and your implants are relatively new, you may not need a scan at all.
4. A plan. Once any results are back, your surgeon talks you through them and sets out the options, including simply keeping an eye on things.

Starting with an examination matters. A meta-analysis of MRI for silicone implant rupture concluded that MRI is best used to confirm a suspected problem, because in women without symptoms, where most implants are intact, a positive result is more likely to be a false alarm (Annals of Plastic Surgery, 2001). An examination first means the right scan is done for the right reason, and results are interpreted by the person who would treat you.

Ultrasound or MRI: Which Scan Is Best for Breast Implants?

Both scans can show whether a silicone implant has ruptured. They suit different situations.

Ultrasound is quick, uses no radiation and needs no injection. It shows the implant shell, fluid around the implant, the capsule and the lymph nodes in the armpit, which makes it useful for investigating swelling and lumps as well as rupture. Its accuracy depends on the experience of the person scanning, and it sees the back of an implant less clearly, particularly when the implant sits under the muscle. In a study comparing scans with what surgeons found at operation, ultrasound was 72% accurate at detecting rupture, but a normal ultrasound was right 85% of the time, which means a clearly normal scan can often make an MRI unnecessary (Plastic and Reconstructive Surgery, 2014).

MRI is the most accurate way to detect rupture. The same study found it 94% accurate, and a study of women whose implants were removed after MRI found a sensitivity and specificity of 93% each (European Radiology, 2014). An MRI for implant integrity uses silicone-specific sequences and does not usually need a contrast injection. It takes longer, costs more and is not suitable for everyone, for example some people with pacemakers or severe claustrophobia.

In practice, ultrasound is usually the first scan, and MRI is used when symptoms suggest a rupture, when ultrasound is unclear, or when the precise state of the implants will shape an operation.

Can a Mammogram Tell If an Implant Has Ruptured?

Not reliably. Mammography is designed to detect breast cancer, not to assess implants. It can sometimes show silicone that has escaped beyond the capsule, but it does not show a rupture contained within the capsule.

If you have implants, you are still invited for NHS breast screening in the usual way, which in England means every three years between the ages of 50 and 71. Let the screening service know about your implants before your appointment. Screening women with implants is carried out by a registered radiographer, using the Eklund technique, which gently moves the implant back so that more of the breast tissue can be seen (NHS Breast Screening Programme). Implants can still hide a small amount of tissue, so continuing to check your own breasts matters. If you are worried that an implant has ruptured, the screening programme’s advice is to see your GP rather than attend screening.

What If You Had Surgery Abroad or Don’t Know What Implants You Have?

Knowing the make, model and size of your implants makes any assessment easier and tells you whether a manufacturer’s guarantee may apply. The details are on the implant card you should have been given after surgery; if you do not have it, the clinic or hospital where you had surgery should hold the record. Operations in England since 2016 are also recorded on the national Breast and Cosmetic Implant Registry.

If your surgery was abroad and records are hard to obtain, an assessment is still possible. Imaging cannot usually identify the brand, but it can show whether the implants are intact and how they sit. If you had implants placed between about 2001 and 2010 and do not know what they are, it is worth being assessed, because the recalled PIP implants were used in that period. Our guide to breast augmentation in Turkey covers the practical side of aftercare when surgery was done overseas.

What Happens If a Problem Is Found?

The right treatment depends on what the check shows, and not every finding needs an operation.

• Intact implants with a minor change, such as mild rippling or slight softening of the capsule, can often be monitored.
• A confirmed rupture is usually treated by removing the implant and either replacing it or not. Our guides to breast implant replacement, breast implant removal and removal versus replacement explain the choice.
• Capsular contracture is treated by removing some or all of the capsule, usually with a new implant, sometimes in a different position. Where the capsule is removed in one piece with the implant inside, this is an en bloc capsulectomy.
• Late fluid around the implant is sampled and tested before any decision about surgery, because the result determines the right operation.

If a rupture is confirmed, check your implant card. Many manufacturers supply a replacement implant under their guarantee when a rupture is due to a manufacturing defect, though surgical, anaesthetic and hospital fees are not usually covered; our guide to Silimed breast implants explains how the Silimed guarantee works. Our guides to breast implant replacement cost and breast implant removal cost set out what affects the price of further surgery.

Do Breast Implants Need to Be Replaced Every 10 Years?

No. There is no fixed date by which implants must be replaced, and many women keep the same implants for well over ten years without any problem. The ten-year figure comes from older guidance and from the length of some manufacturers’ guarantees, not from a rule that implants fail at that point.

What is true is that the chance of a problem rises with time, which is why a review around the ten-year mark makes sense. Replacement is recommended when there is a problem, such as rupture or capsular contracture, or when you want to change the size or look of your breasts. Our guide to how long breast implants last goes into the evidence.

Frequently Asked Questions About Breast Implant Checks

Getting Your Breast Implants Checked at Centre for Surgery

If your implants are more than ten years old, or something about them has changed, a consultation at Centre for Surgery is the place to start. A consultant plastic surgeon will take your history, examine you, tell you whether a scan is needed and refer you for one if it is, and explain your options if a problem is found. Our plastic surgeons are registered with the General Medical Council, the surgeon who assesses you is the surgeon who operates if you need surgery, and all surgery takes place at our CQC-regulated hospital at 95–97 Baker Street, Marylebone. Call 020 7993 4849 or complete the form below.

References

1. Hölmich LR, Kjøller K, Vejborg I, et al. Prevalence of silicone breast implant rupture among Danish women. Plast Reconstr Surg. 2001;108(4):848–858. doi:10.1097/00006534-200109150-00006
2. Hedén P, Bronz G, Elberg JJ, et al. Long-term safety and effectiveness of style 410 highly cohesive silicone breast implants. Aesthetic Plast Surg. 2009;33(3):430–436. doi:10.1007/s00266-009-9360-x
3. Rietjens M, Villa G, Toesca A, et al. Appropriate use of magnetic resonance imaging and ultrasound to detect early silicone gel breast implant rupture in postmastectomy reconstruction. Plast Reconstr Surg. 2014;134(1):13e–20e. doi:10.1097/PRS.0000000000000291
4. Maijers MC, Niessen FB, Veldhuizen JFH, et al. MRI screening for silicone breast implant rupture: accuracy, inter- and intraobserver variability using explantation results as reference standard. Eur Radiol. 2014;24(6):1167–1175. doi:10.1007/s00330-014-3119-8
5. Cher DJ, Conwell JA, Mandel JS. MRI for detecting silicone breast implant rupture: meta-analysis and implications. Ann Plast Surg. 2001;47(4):367–380. doi:10.1097/00000637-200110000-00002
6. Schrager S, Lyon SM, Poore SO. Breast implants: common questions and answers. Am Fam Physician. 2021;104(5):500–508. PubMed 34783490
7. Nelson JA, Dabic S, Mehrara BJ, et al. Breast implant-associated anaplastic large cell lymphoma incidence: determining an accurate risk. Ann Surg. 2020;272(3):403–409. doi:10.1097/SLA.0000000000004179
8. US Food and Drug Administration. Breast implants – certain labeling recommendations to improve patient communication. Guidance, 2020.
9. NHS England. NHS Breast Screening Programme: screening women with breast implants.
10. NHS England. Breast and Cosmetic Implant Registry.