What Could Be the Cause of Hardening in Breast After Implants?

Question

I had silicone implants put in in June. It's been about 6 weeks and I have a hardening in my left breast. The area is about 3 inches long and an inch wide. This breast received radiation treatment 6 years ago. I had a mastectomy in August of 2009. Tissue expanders and then the implants. This was my second round with breast cancer. I underwent chemo as well.

Robert Whitfield, MD · Answer

Radiation treatments always make these cases more difficult. Hardening may reflect the scarring around the implant. If this doesn't resolve it can become even more bothersome. If the entire implant becomes firm I usually remove the devices as well as the scar and replace it with your own tissues either in the form of DIEP flaps from the abdomen or somewhere else on the body.

Steven Wallach, MD · Answer

Usually hardening of the breast reconstruction that occurs after impalnt placement is from a capsular contracture. You should have it checked out by your surgeon.

David Greenspun, MD, MSc · Answer

The most common cause of hardening of a breast implant reconstruction is a capsular contracture.

	Data published by the implant manufacturer Mentor in their patient labeling &ldquo;Saline-Filled Breast Implant Surgery: Making an Informed Decision&rdquo; outlines the findings of their study of saline filled implants required by the United States Food and Drug Administration (FDA). The data below have been extracted from the publication, which is available in its entirety on the website of the FDA along with the publications for other approved breast implants.

	IMPLANT RECONSTRUCTION COMPLICATIONS AT 5 YEARS AT 7 YEARS AT 10 YEARS
	Unanticipated Reoperation                                            43%               50%               56%
	Removal of Implant                                                       30%               39%                45%
	Capsular Contracture (Grade III, IV or unknown)          29%               49%                59%
	Implant Deflation                                                           18%               27%                 33%
	Breast Pain                                                                   16%                29%                37%

	Your Rights section of this site. (Adapted from Mentor publication &ldquo;Saline-Filled Breast Implant Surgery: Making an Informed Decision&rdquo; &ndash; available through the FDA)

	WhenRadiation has been part of a woman's treatment the incidence of complications including capsular contracture goes up even higer than what is shown above.

	The Effects of Radiation on Breast Reconstruction

	When radiation is used in the treatment of breast cancer, non-cancerous tissues in the path of the radiation are also affected. Radiation therapy can mean a significant loss of skin elasticity, which can profoundly affect the aesthetic results of breast reconstruction. And because the body&rsquo;s wound-healing mechanisms are altered by exposure to radiation, complications from all types of reconstructive breast surgery occur at a higher rate.

	Radiation is especially problematic for women who undergo implant reconstructions, regardless of whether the radiation is administered before or after the implant is placed. Natural-tissue reconstruction has the benefit of bringing non-radiated, healthy, well-vascularized tissue to the mastectomy site, and this can actually aid in the healing process.

	Because of the potential complications associated with implants, breast reconstruction using natural tissue is generally considered the best method for women who will require or have already had radiation.

	You can compare the safety of DIEP flap surgery, one of themost advanced and sophisticated methods of breast reconstruction, to implant reconstruction by looking at the published data below:

	DIEP FLAP COMPLICATIONS AT 10 YEARS
	Unanticipated Reoperation              5.96%
	Total Flap Failure Approximately     1%

	In general, autologous (your own tissue) offers thebest possibility for sucessful breast reconstruction.

Paul Gill, MD · Answer

I am sorry to hear about your implant problems. It sounds as if you have a capsular contracture. In patients who have had radiation, I find the incidence of capsular contracture to be unacceptably high. I would recommend a form of autologous reconstruction (DIEP/TRAM/LD) to bring in healthy non radiated tissue to your breast mound. I would also recommend removal of the hardened implant capsule and replacement of the implant if a Latissimus Flap is chosen. I wish you a safe and healthy recovery.

Peter A. Aldea, MD · Answer

From your description it sounds like you have been through a lot: Radiation, Mastectomies and Reconstruction with Tissue Expanders followed by silicone breast implants.

	Radiation is a double edge sword; while it helps kill cancer cells it also harms normal breast tissue and its blood vessels. The result of radiation is a hard skin with little vessels which does not stretch well and may break down. Women who had radiation also have a higher rate of scarring around the implants (Capsular Contracture).

	I suggest you see your plastic surgeon who could best advise you on what this hard area may be.

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