When thinking about getting breast implants, there are many things to consider. First of all: the pain. Let’s be honest, going into a surgery of such magnitude definitely does some wear and tear on the body. As with any surgery, there are the risks of complications both during and after the procedure, and did I mention the pain aspect? Yes, there will be pain, and not just from one round of breast implants, but maybe even others to follow.

The thing with breast implants is that they don’t come with a lifetime guarantee, and the longer you have them the more likely you are to have to deal with complications because of them. When you get breast implants, you’re signing up for a lifelong commitment to maintenance of your implants. What this also means is that you will, most definitely, have to get a replacement set at one point in your life, either because there’s a medical issue or because it’s just time to cash them in for a new, updated pair.

According to the FDA, 20% of women will have to have their implants removed within eight to ten years of receiving them. It’s at this point that the patient needs to decide if they want to keep them out and avoid another round of replacements in the future, or sign up for it again. And while you may be over your breast implant phase and ready to go au naturel, the problem is that once the skin has been stretched from implants, skipping the replacements can lead to “major cosmetic deformity,” that in some cases may even require reconstructive surgery.

Basically, when you sign up for implants, you’re pretty much signing up for life, and replacements, whether it be because of complications or simply because it’s time, aren’t a walk in the park.

“I had my first set at 19 in 1981,” a breast implant patient, who wishes to remain anonymous, told YouBeauty, “Then the silicone scar happened so I had saline ones put in in 1995… I fell out of a handstand teaching yoga last spring and landed on the left side of my chest. I thought I ruptured it, but after the ultra sound found out the pop sound [I heard] was calcification ripping off scar tissue. I’m in the program for the gummy bear ones and have been fearfully taking pain meds while I wait for surgery.”

Despite the responsibility and problems that can come with getting breast implants, considering how far medicine has come in breast implant safety, it’s a good time to get them done. Contrary to what we saw in the ’80s, women are having fewer and fewer issues with their implants and with new regulations as to what sort of materials can be used, it’s a far safer time to go under the knife for breast augmentation. Restrictions have tightened up so much on cosmetic surgery that the owner of French company Poly Implant Prothese, who used industrial-grade silicone in their implants instead of medical-grade on an estimated 300,000 women in 65 countries, is in jail for fraud.

YouBeauty talked to plastic surgeon Dr. Vikisha Fripp about what women need to know about breast implant replacement. From how long they can last to the signs that you’ve had them in too long, here’s what Dr. Fripp had to say:

Typically, implants should be replaced every 10 years. When it comes to getting replacements, 10 years seems to be the typical amount of time, but that’s not always the case. “I’ve had patients with implants that were over 20 years old, while others needed to be exchanged after five years,” says Fripp. “It depends on the woman’s body.”

Here’s why replacements are necessary:

Breast implants have a shelf life. Nothing lasts forever and as with everything in life, over time things start to break down. As Fripp explains, breast implants are not supposed to last forever, and when you’re going in for your initial surgery this is something to keep in mind. “Implants, like every other prosthetic device, have a lifespan. They are composed of man-made materials and while they are tested and proven to be incredibly durable and reliable, they are not promoted as permanent products.”

Women’s bodies change. It doesn’t take a rocket scientist to realize that gravity can do a number on the human body. With these changes to the outside comes the need for changes on the inside, too. As skin begins to lose its elasticity there may come a need for a replacement that will fit an aging woman’s body better.

There are risks if you don’t get your replacements on a regular basis. The biggest risks that come with not keeping up breast implant maintenance is that the implant will fall or rupture. Although a ruptured implant these days will not wreck havoc the way it would have in the ’80s, it’s still something with which to be concerned.

According to Fripp, “Saline implant rupture is noticeable and the size of the breast will decrease in size. Gel implant rupture may not be as noticeable as the implant will retain its volume, however, the shape may be slightly altered. With the current gel implants, rupture will not cause the gel to leak outside of the implant shell. Another risk is the development of a capsular contracture, which is the formation of an internal scar around the implant. With both gel and saline implants, the appearance of the breasts will change as the contracture worsens, but a contracture alone does not necessitate removal. When the contracture is accompanied by pain and distorts the breasts then an exchange of implants and a capsulotomy (to release the capsule) is performed.” There is also the risk of infection and, along with distortion in appearance, a “fold or ridge” may be noticeable on the outside of the breast.

Breast implants have come a long way, but that doesn’t mean you can go into the surgery haphazardly without regard to what can happen down the road. As Fripp said, they are not meant to be a permanent situation and upkeep is just part of having them. If you’re not willing to keep them in tip-top condition by doing everything you have to do on your end, then maybe you need to think about just getting a padded bra instead. Padded bras, like breast implants, have also come a long way, and no one will be the wiser… until you take off your bra, of course.