The breast implants used for augmentation 30 years ago were made from a 1st generation silicone gel that has a very liquid consistency. After being in your body for 30 years, the silicone shell that holds the implant together has a high chance of being worn down or ruptured. Many times, the implant capsule or scar tissue layer around the implant can contain a ruptured silicone implant, but the rupture and free silicone can lead to capsular contracture - or tightening and hardening of that scar tissue layer. This makes the breast feel hard and sometimes painful. Capsular contracture around a ruptured silicone implant is not dangerous, but you may want to treat it. Sometimes the silicone can leak out of the capsule and migrate into your breast tissue, which is not dangerous to your health (won't cause cancer or any diseases), but it will make an operation to remove the silicone more damaging to your breast. If the silicone is contained within the capsule, then it can be more easily removed. There is a possibility that your implant is not ruptured and that you just have capsular contracture, but I would be suspicious of rupture. The way this is treated is with a total capsulectomy - removal of the implant along with the capsule. It is your choice to replace the implant with a new one, leave the implants out and do a lift, or fat graft instead. If you are going to replace the implant with a new one, I would recommend doing both sides - since the other one is likely to cause you problems soon.