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 20
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.
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.
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.
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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.
Potentially Capsular Contracture
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.
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
Hard Breast Implants?
An increase in hardness should be evaluated
Possible capsular contracture
Capsular Contracture Following Breast Augmentation Surgery
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.
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.
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.