Question: Do all implants leak?
Answer: There are various types of breast implants that we use in reconstruction. There is also saline implants that are commonly used in augmentation and sometimes still used in reconstruction. So it's important to separate which type of implant you're talking about when you talk about whether implants leak.
The literature states that all saline implants have a natural deflation rate -- that means they just lose a little of their fluid, either through evaporation or some other means -- of probably 1 percent or so per year. So at 10 years or so, a patient has lost about 10 percent of their volume in their saline implant.
Saline implants can also actively leak. They can lose volume through their port. They can actually become damaged through severe trauma, just like any other type of foreign material can. So yes, saline implants, to some degree, all naturally deflate a little, and if they have any kind of injury or port problem, they actually will leak much faster. Probably once or twice a year in a reconstruction practice, we'll have to take a patient with a saline implant back because it's totally deflated.
As for silicone gel, there is a certain percentage of those that will leak as well; we don't know the exact number -- the number has been clouded to some degree with the various problems that silicone underwent in the early 90's. And when I say the issue has been clouded, it's because many people came in to have their silicone implants removed, and many of them were found to be ruptured; but we don't have a really good control measure to know exactly what percentage of silicone does leak or rupture.
Overall, silicone does not have a natural deflation rate -- like saline implants do -- but just like any foreign material, it can go bad, and it can eventually have a break of the outer capsule and lead to leakage of the silicone into the scar capsule that's left behind. But I would say, in general, we can't say that all implants necessarily leak. Again, saline slightly deflates, and silicone it really depends on the integrity of the silicon shell.