Do Silicone Breast Implants Harden over Time?

Capsular contracture remains the most common reason for women having a revisionary breast surgery.

Even when a surgeon does everything perfectly, employing all we know about avoiding contractures, it can still happen.

It is normal to form a capsule - a thin membrane - around the implant. It should stay thin and pliable. But if there is inflammation around the implant, it can thicken, stiffen, and tighten.

The key is to avoid the inflammation. Many things can cause it, such as trauma at the time of surgery and bacteria. Studies today demonstrate that bacterial contamination may be the most profound avoidable cause of contracture.

Your surgeon should employ a method that minimizes trauma to your tissue, lessening the duration of your mobility and inflammation, thereby allowing you easier motion earlier on. He or she should also give you approriate antibiotics as well as antibiotic irrigation of the implant and pocket during surgery.

And one more thing --your quesiton implied a difference between saline and silicone with regards to capsular contracture. While that may have been true with implants in years gone by, that has not been found to be true with the current generation of silicone implants.

Find a surgeon that is well-versed in the issues of contraction and can explain to you why they believe it occurs and how they avoid it. But be careful of those that say "i never get it!" That's impossible! You want your surgeon to demonstrate both a healthy respect for this problem as well as a thoughtful strategy for how they deal with it.

This is what you are referring to. Capsular contracture happens to some extent in all patients who have implants. There are different grades and what you want is a Grade I. The significant contracture happens in about 7.5% of saline augmentations and about 9% of silicone augmentation. This is some new data from one of the implant companies.

To try to avoid this there are a lot of little things that are done in the operating room and after surgery the patients are instructed to massage vigorously to prevent this.

Hope that helps

It is a very good question to ask. There was a multitude of studies done to find out if there were any saftey issues with silicone implants. None of the studies were able to show any significant association of silicone implants with any particular disease or problem. Thus, silicone implants are considered to be very safe.

One of the complications of breast augmentation, and the one your question alludes to, is something called capsular contracture. Once an implant is inserted into the breast, the body forms a scar around which we call a "capsule." Usually, this stays soft and does not cause any problems. However, in a small percentage of women for unknown reasons, the scar starts to become hard and tight. When this happens, it is called capsular contracture. When it happens, it can cause the breast to feel hard and look distorted. This can happen whether you have saline or silicone implants.

It can be taken care of if it happens. If capsular contracture does occur, the solution is usually to re-operate. The incision used in the first operation can usually be re-used. Then, all of the scar and the implant is removed. I prefer to replace the implant with a brand new one. Once the hard scar is removed, the breast usually remains soft. Rarely, in a small percentage of women, it can happen again.

In summary: Silicone implants are safe. All surgery has its complications. Capsular contracture is one possible complication of breast augmentation. It can happen with both saline and silicone implants. The vast majority of women who get breast augmentation do not get capsular contracture and are very happy and satisfied with their surgery.

Implants themselves do not harden.   The capsule or film around the implant does forming a capsular contracture.   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.
Dr. Gill

Web reference: http://www.drpaulgill.com

All implants harden over time. The percentage for capsular contracture is 1% per year. All implants need to be replaced within 10-15 years.

Hello,

Silicone gel breast implants have advantages and disadvantages relative to saline-filled implants. They tend to feel better at first, but may develop hardening more than the saline filled types over time. When choosing implants, part of your decision will relate to your tolerance for risk over time.

All women who have breast implants will develop a layer of scar around the implant, which has been classified according to its thickness and extent of deformation of the breast from I-IV. Capsular contracture is one of the Holy Grail's of cosmetic Plastic surgery and two recurrent themes have been proposed about its causation. 1) Blood: specifically the iron component is thought to incite an inflammatory cascade, which changes the composition of a capsule, which is thin, filmy and mobile to one which is thick, inelastic and unyielding. This theory is the rationale for limiting patient activity for a certain time after surgery. Additionally, some surgeons place drains in all breast implant cases. Anecdotally, I have seen patients who developed hardening of their breasts (& implants) after sustaining trauma to their chests, either in sports, accidents or assaults.

2) Subclinical Infection: The concept of bacteria triggering an inflammatory response, in which a "foreign body" reaction makes the breast feel firmer and look abnormal.

There has been plenty of controversy over whether silicone gel implants are more prone to getting hard. The current study of women implanted since the moratorium was lifted in November 2006, doesn't seem to support this, however I think we'll have to wait for more data. In summary, the filler substance doesn't change physical properties, rather it's the interface between a woman's own tissue and the implant, which either becomes too hard. Scar isn't always undesirable, because there are some women who develop such thin capsules that even in the presence of a small implant, their tissues are unable to "hold" the implant in position and their results droop in an exaggerated fashion.

Silicone and saline breast implants do not change over time. Our bodies create a "capsule" around all implants since they are foreign substances. These capsules, in some patients, can harden over time, and that is called "capsular contracture." There are different levels of capsular contracture. Some patients never get it, others get a very mild version when you can feel a little firmness but cannot see anything, and yet others can get a more severe version where you can see and feel a very hard capsule that distorts the shape of the breast.

Many factors can contribute to why you get the contracture: infection, bleeding, etc. It can happen in one breast and not the other one. It is poorly understood, but common in about 10-15% of breast implant patients in most studies.

If you have not had a breast augmentation procedure yet, you should make sure to ask your plastic surgeon during your consultation about capsular contracture. If you have already had the procedure, see your surgeon again to go over some treatment options. I am sure you can find someone in San Jose, Meeko. 

All implants are foreign bodies and a capsule will form around the implant, saline or silicone.

Sometimes patients develop capsular contractures (tightening of the capsule); this is the scar that develops around the implant, and this is what makes the implants feel hard.

It is not clear what causes this problem but it occurs in at least 6% of patients to some degree. Sometimes it is painful and sometimes not, most of the time it will cause a deformity of the involved breast, and sometimes it is only on one side.

To correct this problem, surgery is frequently needed.

Implants generally don't get hard however the capsules which form around the implants can get hard.

To give an oversimplified analogy, it is like jeans that shrink around your thighs and make them feel hard.

Capsular contracture is a poorly understood phenomenon.