I had silicone breast implants inserted 4 years ago, and they have always been just fine, but now they are getting hard. I am worried that something is leaking.
Hard Breast Implants
Doctor Answers (15)
Hard Breast Implants Indicate Capsular Contracture
Thank you for your question.
Breast Implants that become hard usually indicate Capsular Contracture or scar tissue around the implants. This is not an indication of leakage.
See your doctor for an exam. There is normally a small amount of silicone leakage around all silicone gel implants but this is not harmful.
A rupture of the implant typically follows trauma of some kind and results in a change of the shape of the implant. An MRI is used to diagnose a rupture.
The causes of Capsular Contracture are not fully understood. However low grade bacterial infection or excessive bleeding during the placement of the implants are both believed to contribute.
All gel implants leak to an extent.
Silicone implants all leak to some extent and a patient's body can respond to this silicone gel sometimes by depositing scar tissue and/ or calcium crystals. This is thought to occur less with the more modern cohesive gel implants, but we really do not know the bottom line here yet as they have not been in use all that long. At four years, you are a bit early, but reaction to silicone gel is still possible. I would get in to see your surgeon and consider an MRI and/or operation to sort this out.
Gradually Harder? - A Capsule Summary
Patients may develop a progressive hardening of the breasts during the months and years following breast augmentation. This is called Capsular Contracture or Encapsulation. The cause of this condition is not clearly known, and the presentation is variable; some patients may develop it in only one breast, other patients in both breasts, and some patients never have the problem; it may appear very soon after augmentation, or many years later.
Generally, the implant does not need to be leaking in order for there to be encapsulation; most often, the implants are found to be intact when surgery is performed to relieve the capsular contracture, depending largely upon the age of the implants.
When severe, Capsular Contracture can distort the appearance of the breasts, and can be painful. Many patients "live with the problem" for as long as they can, until that point when the less-attractive appearance and pain makes that impossible. At that point, the usual recommendation is to completely remove the capsule ("Capsulectomy") to as great an extent as is safe and possible, and to replace the implants. MRI or other examinations are only useful to determine whether the implant is ruptured or not, and do not change the recommendation to perform the capsulectomy procedure.
I always counsel my patients before surgery that Breast Augmentation is usually not a "one-time" procedure, and that it is very likely that over the patient's lifetime, they will require additional procedures. Capsular Contracture is one such problem that may occur after any Breast Augmentation procedure, and it will necessitate additional surgery at additional expense to the patient. Nevertheless, most patients have many years of satisfaction with their results following Breast Augmentation.
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It sounds like capsular contracture
It is sometimes the case that implants will develop a hard scar around them causing a distorted look, a harder feel, and even pain on some occasions. All patients with implants form a "capsule" around the implant as this is a natural reaction by the body to something foreign. But in a "capsular contracture," this scar tissue becomes harder than normal.
You should be evaluated by your plastic surgeon who can tell you on physical exam if this is happening. The status of your implants, whether intact or ruptured, will likely require an MRI.
Surgery is the only way to address the capsular contracture problem if you have it, so if that is necessary, there isn't much benefit in taking on the out-of-pocket expense of an MRI.
Get evaluated by your plastic surgeon - It may be capsular contracture
Silicone or saline breast implants can develop a condition called capsular contracture (where excess scar tissue forms around the implant) shortly after surgery or in years to come.
The only way to determine what is causing your condition is the evaluation by your surgeon, and possibly an MRI to determine the condition of your implants.
When you had your implant surgery, the process of informed consent should have included specific language about the changes you may experience over time, such as the hardening, and that implants are not lifetime devices that may have to be replaced.
In addition, if your implants were strictly for breast enhancement purposes, you should have been advised that insurance will not cover the cost of evaluation or of replacement.
It is recommended that an implant that is leaking or disrupted be replaced. However, the vast number of valid scientific studies have shown that even if an implant is leaking, that there is no causal relationship between the leaking silicone material and any disease process.
Signs of Capsular Contracture
Thank you for your question. Capsular Contracture is one of the main risks of breast augmentation. Classic signs are:
1. hardness/tightness of the implant
2. change in implant position (typically migrates towards the collarbone)
3. increased pain and stiffness on the associated side.
Based on your description, you should see a board certified plastic surgeon for evaluation of capsular contracture. If present, I would recommend a capsulectomy (removal of scar tissue) and implant exchange.
Factors to consider:
1. If your implants are above your muscle, you may want to consider switching to underneath the muscle, which lessens the risk of capsular contracture.
2. If your implants are above the muscle and you desire to keep them there, you may benefit from the use of a textured implant.
Web reference: http://www.drpaulgill.com
Hard Breast Implants
I do not know if there is leakage. It can be diagnosed with some degree of accuracy using an MRI. But the hardness of your implants makes me think that you have a capsular contracture. This means that you need to have your capsule removed and your implants replaced. The old implants have a biofilm with bacteria that cannot be remove d from the implant. Please see your Plastic Surgeon for evaluation.
Hard Breast Implants
Implants that become hard and sometimes distorted or painful have capsular contractures. There are four grades of contractures depending upon the hardness and appearance. The cause of capsular contractures is unknown but current thinking favors a bacterial etiology at the time of insertion. There are some ways to try to avoid this problem. Covering the nipple areolar complex with betadine and cleaning the incision with betadine frequently are some of the ways to try to avoid this problem. Once the problem has occurred, if significant, then the capsules are best removed by surgical excision.
Web reference: http://www.drvitenas.com/breast-augmentation.html
Encapsulation of breast implants
Firming of an implant or both breasts can be caused from encapsulation. Encapsulation, also known as capsular contracture, is scar tissue formed around the implants. Depending on the severity and complexity of the case, you may require revisionary surgery to remove the capsule. If it is painful or you notice any distortions, I would suggest consulting with your plastic surgeon or a board certified plastic surgeon to discuss the best option for you as soon as possible.
Unfortunately, the risk of reoccurence may exist if you replace the implants. To prevent it from reoccuring, make sure to aggressively massage the implants.
Web reference: http://www.poustiplasticsurgery.com
Silicone breast implants are getting hard.
This is most likely due to capsular contracture around the implant. This can happen at any time after the surgery, even several years. Sometimes, a leaking silicone implant will induce capsular contracture. However, if both breasts are firm, it is unlikely that both implants are leaking. If your surgeon is concerned about leaking, he/she will consider ordering an MRI to evaluate the implants for leaking . Hope this helps.
Tracy M. Pfeifer, MD, MS
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.
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