4 years post op breast implants and now they are getting hard. Could something be leaking?

First if there is a change, that should be investigated.  If they were soft and now they are hard, it will likely require some surgery for capsular contracture.  

Thank you for your question.  If your implants are just now becoming hard, it may be indicative of a capsular formation around your implants.  Scar tissue around implants is the bodies natural response to the implant (foreign object) but occasionally this response is heightened and the scar tissue grows and constricts around your implant, commonly referred to as a capsular contracture.  I would recommend following up with a board-certified plastic surgeon for a complete clinical assessment.  It is possible that a physical exam may be all that's necessary but your doctor may send you for a MRI of the bilateral breasts to examine the health of your current implants or diagnosis an implant rupture.  I hope you find this helpful and best of luck!

Please see your surgeon as soon as you can. Hardening of breast implants is often indicative of capsular contracture. This is a complication that should be addressed. Best of luck. 

Unfortunately, you describe
classic capsular contracture of your breast following breast augmentation. It’s
important that you see your plastic surgeon and have a treatment plan
formulated to deal with this problem.

 

         Whenever a foreign
material is placed inside your body, it will generate a reaction from the
surrounding tissue. This typically results in a fibrous capsule that surrounds
the breast implant. When this occurs, following breast augmentation, we call it
a capsular contracture.

 

         All patients have
some capsule formation. Indeed, absence of capsule formation might result in
implants shifting. When capsule formation results in contracture, patients may
experience hardening of the breast, distortion of the breast and breast pain.

 

         Capsule formation
can occur at any time and as time goes on, this may be accompanied by pain and
progressive distortion of the breast. The breast may shift in an upward
direction and develop an abnormal shape.

 

         When capsular
contracture occurs, there are several treatment options. In mild cases, medical
management and massage may be necessary. In severe cases of capsular
contracture, surgery may be necessary. This may require release of the contracture
by performing a capsulotomy, or removal of the capsule by performing a
capsulectomy. Treatment has high satisfaction rates and most patients are
ultimately happy.  

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.

With the new silicone implants, leak detection can be more difficult than in the past. A leak could definitely present with a hardened breast and this should be evaluated with an MRI which will detect this. You should be evaluated by a plastic surgeon who could set you up for this study. You could also simply be developing a capsular contracture without a leak, which also can present as a progressively hardened breast. Either way, your condition may be treatable and responding to the problem in a timely manner will improve your long term result. Hope that helps!

If you are experiencing any of the following symptoms, you should be evaluated by your plastic surgeon. If the diagnosis is made of capsular contracture, depending on its severity, the implants may need to be removed and replaced.
Symptoms:
The implant begins to feel hard
The implant looks smaller, more ball-shaped, or distorted in some other form
The implant is higher on your chest
Pain, tightness, discomfort in your chest
I hope that answers your question regarding your symptoms. It’s great that you’re doing this research. I always say that the best patients are informed patients.
You might also want to research your options for breast implants in case you need to have your current ones replaced. Choosing the right implant is the number one concern among women considering breast augmentation. Did you know, there’s actually a way to select a implant shape, size, and profile that is perfect for you?
A term that I use with my patients for the perfect implant is the “Pony Implant”.
So what do I mean by “perfect”? Well, a Pony Implant has three qualities to it. First, the implant meets your beauty goals. For example, you want to your breasts to look fuller while still appearing natural.
Second, when you chose your Pony Implant, you walk out of your consultation 100% confident that you’ve chosen the right shape and size for you. In other words, you won’t be second guessing your decision, and you won’t be afraid of having gone too big or too small.
And third, after your procedure, you are thrilled with your results, and say, "I’m so happy. This is exactly what I wanted!"
That’s the Pony Implant. And the great news is that there is a simple process to go about finding yours.
This issue of selecting the right implant is so important when it comes to patient satisfaction or dissatisfaction that, again, I really encourage you to learn more about it.
Thank you for reading and best of luck on your journey!

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.
Dr. Gill

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.

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