Hard Upper Breast After Silicone Implants

I have had silicone implants for 31 years. Several months ago, my right breast got hard on the top. I had my mammogram, which was normal. I also went for an ultrasound, to be safe, and it showed 3 little cysts. Then went for MRI and the right breast shows folding. Went back now after 6 months and had another mammogram and another ultrasound which are normal. I am nervous because the right breast on top is very hard. I also just found out that they put the silicone implants on top of the muscle. Not sure what to do. Any suggestions?

Doctor Answers 12

See a plastic surgeon experienced in breast surgery

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The very best thing you can do for yourself is to make an appointment with a board certified/eligible plastic surgeon who is experienced in breast surgery. Gather as much of your medical records that you can find. It sounds like you are experiencing scar capsule contraction. You need to have a thorough evaluation by a plastic surgeon in order to develop a reasonable plan that may possibly include revision surgery and new implants. I wish you the very best!

Englewood Plastic Surgeon

You have a capsular contracture

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You should go to an excellent plastic surgeon who has much experience with this. Old gel implants above the muscle had a 34-40+% risk of capsular contracture which squeezes down on the implant and folds it and ruptures it. I have sen this countless times and often the scar tissue is so think and calcified that it looks like a geode rock with gel in the middle.

The treatment is removal of the implants and scar tissue. After that, you can leave it alone, have a lift with no implants, or new implants can be placed above or preferrably below the muscle. All of this can be determined by your doctor.

Breast implants can be very long lasting.

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1) You are a success story with breast implants ! 31 years is a long time.

2) MRI is pretty accurate, and if it does not show leaking implant, there is nothing you must do. But since your right breast is hard, and you are nervous, I would probably recommend replacing the implants.

3) The fact that they are over the muscle is not a problem.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Capsular contracture

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If your implants are hard and they bother you, it sounds like you may have a capuslar contracture which can be treated by removing the capsule and putting your implants under the muscle.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Capsular Contracture means surgery

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With old silicone implants contracture is quite likely. See a good surgeon and go from there. You are looking at removal of the scar capsules and probable implant replacement.

John P. Di Saia, MD
Orange Plastic Surgeon

You are probably experiencing capsular contracture

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From your description, it sounds like you are experiencing capsular contracture. The best advice is to see an experienced plastic surgeon to examine you and to review the options. In post cases, you will need replacement of the implants and excision of the scar tissue. Good luck.

Time to remove the implants

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Hi there-

It sounds like you have developed a tight capsular contracture on your right side.

Because your implants are 31 years old, and we know that the odds of them leaking silicone at this point are very high, and that the risk of this silicone migrating to your lymph nodes increases over time (this will not harm you, but obviously it would be preferable to avoid this if possible), my opinion is that you should seriously consider having these implants removed.

You have many excellent options for achieving your desired breast contour once these are out, but getting these out is important.

Implant removal with capsule excision

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A 31-year-old gel implant with hardening of the breast indicate in my mind an empending rupture (or already ruptured) implant with a high grade capsular contracture. Since a breast mass was rulled out by MRI, the next step will be implant removal with a total capsule removal and replacement. This will take care of the problem.

Hisham Seify, MD, PhD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 19 reviews

Easy suggestion: Schedule a visit with a plastic surgeon

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Krystalclear: In my practice we care for many patients with a story like yours. Most 30+ year-old implants are silicone gel, on top of the muscle. When they develop hardening or distortion, it typically means tight capsular contracture, often with gel leakage. We usually recommend removal of the implants and all the scar tissue. This is a pretty significant procedure, compared to placement of new implants, but needed to produce a good result. Beyond the removal, your options include whether to have new implants, whether to place them under the muscle, whether to have a breast lift (mastopexy), and finally whether to have one or two stages of surgery. This is not unusual. P.S. I assume your treating physician has already made sure you have no breast tumors, etc. If not, that is very important to determine.

Sutton Graham II, MD
Greenville Plastic Surgeon


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You provide a lot of information, but not enough. What would be important to know is the details of the implants -smooth, textured, etc.

Despite the lack of information, it sounds like you should be thinking of a capsulectomy +/- implant exchange. The folding of the implant visualized on MRI (which is the gold standard for evaluating silicone gel implants) presents evidence of rupture. Aside from that, you are getting a hard breast (contracture) that is starting to bother you.

So at your convenience, see your plastic surgeon, and if you could get product information from the original surgeon's office or hospital, that would be helpful, but not essential.

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.