Why would capsular contracture suddenly appear after 24 years?

We do not know why patients get capsular contracture. Development of a capsular contracture 24 years after breast augmentation might be due to failure of the prosthesis and shorter chain silicone gel in the pocket. There are other possibilities as well but in short no one really knows.

Congratulations on a nice long run with your implants!  No one knows exactly why one person develops a capsular contracture while others don't.  With that said, it is likely that if you are developing a capsular contracture, it is due to a rupture.  At this point, I would go see a board certified plastic surgeon for an exam for an accurate assessment and go from there.  Should you decide to replace them, you would most likely need a capsulectomy with implant exchange.  I would also expect a nice result with hopefully another 15-20 years or longer lifespan from the device. ac

While I'm sorry to hear that you are having issues with your implants, I'm pleased that you got a great 24 years out of them!  If you are rather suddenly having hardening of one of your implants, it is quite likely that this is due to rupture.  While we don't really know for certain what causes contracture, a ruptured implant is certainly high on the list of likely causes in your situation.I agree with you and recommend a bilateral revision in which the old implants are removed along with any problematic scar tissue.  The odds are very good that you will have an excellent outcome, but if you get another 24 years out of your next set of implants you will certainly be one lucky patient.  I recommend following FDA guidelines and getting periodic MRI evaluations of your new silicone implants to make sure they remain in great shape.

Statistically speaking, if you have 24 year-old silicone implants you have a >90% chance of having a leak in one or both of them.  Sometimes this can lead to a sudden appearance of a capsular contracture.  You need to see a Board Certified Plastic Surgeon.  If you have the records from your original surgery that tells the size and type of implant that you have, this would be very helpful.  If the implants are leaking, there could be a warranty that would pay for the cost of the new implants.  However, no warranty will cover any of the other costs of surgery 24 years later.  Some insurance plans will also pay to have them removed if they are ruptured silicone implants, but no insurance will pay to have them replaced.

Capsular contracture has about a 1% per year incidence. It is impossible to determine why you have noticed this after 24 years. Usually, capsular contracture goes through stages or a process of progressive worsening, so there may have been some mild capsular contracture going on for a while without you necessarily noticing it too much. There is much that is still unknown about the etiology of capsular contracture. There is some relationship to bacteria and inflammation, but exactly why any particular patient develops a contracture is practically impossible to determine. Your plastic surgeon will have several treatment options available to you depending upon your exam.