Do You Have to Remove the Shell After a Saline Implant Deflates?

If your saline implant has deflated, either because you had it drained or because it simply broke, you're left with an empty shell sitting in the pocket. So the question comes up: do you actually have to take it out?

You can do anything you want. Nobody is going to force you into surgery. But I always recommend removing the implant shell, and here's my reasoning.

The simplest version of my objection:

An intact implant is a medical device doing a job. A collapsed shell isn't doing anything, it's just material left behind. If I can remove it for you, I'd like to.

Any foreign body carries potential for infection and problems. That's true of implants generally, and it doesn't stop being true once the implant has failed.

I want to be measured here: infection is not horribly common in this situation. I'm not trying to frighten anyone. But it's a non-zero risk you're carrying for no benefit, since the deflated shell isn't providing shape or volume anymore. (For context on what infections look like when they do happen, see how we diagnose and treat implant infections.)

This is the problem I actually see most often, and it's the one patients don't anticipate.

An empty shell doesn't lie flat. It folds. And when it folds, patients get a weird little point or area that distorts the shape of the chest.

It's not subtle to the person living with it. You can often feel a firm edge or corner where the collapsed material has bunched up, and it can be visible depending on your tissue.

This is the one that pushes it from "recommended" to "please do this."

If you're very thin, a folded shell can actually erode through the skin. The shell creates a firm point, that point presses outward against tissue with little padding over it, and over time it can work its way through.

That turns a simple elective removal into a wound problem with an exposed implant, which is a substantially harder situation to manage than just taking the shell out in the first place.

• You're not required to remove a deflated saline shell. It's your body and your call.
• But I always recommend it, because you're carrying a damaged foreign object that provides no benefit.
• It carries a small but real infection risk, and any retained foreign body can cause problems.
• The most common issue I see is the shell folding, creating a point or area that distorts the chest.
• In thin patients, that folded point can erode through the skin, which is far worse to deal with than a planned removal.

If you've had a saline deflation, talk to your surgeon about taking the shell out, and about whether you want to replace the implant or remove them permanently while you're at it. It's usually a straightforward operation, and it's a lot easier to do on your schedule than after a complication forces the issue.