Does an Implant Always Have to Be Removed if There is Calcification?

Question

Larry S. Nichter, MD, MS, FACS · Answer

Heterotopic Calcification refers to calcium present at an abnormal site such as around your breast implant in the capsule. Calcification means calcium (an egg shell is mostly calcium for example) not bone in which calcium is but one ingredient. Heterotopic calcification is not an unusual finding in implants over 15 or more years. It can be found with saline or silicone implants thought in my experience more common with silicone implants that have ruptured or the older ones that have "silicone bleed" - that is the implant membrane is intact but there is still some sticky silicone on the outer shell. It is not related with any disease process and cannot harm you though can feel uncomfortable as part of a capsular contracture, makes your implant feel hard, and your breast can be distorted by its presence. If the radiologist feels certain it does not look like a malignancy, that your implant has not ruptured and its presence does not obscure reading mammograms then you theoretically can leave it alone. However my recommendation would be to remove it as it is an abnormal process that makes your breast feel hard and causes distortion

Donovan Rosas, MD · Answer

Calcification of the capsule can occur with time. This is not an emergency which needs to be addressed. It is often seen in conjunction with a capsular contracture which can be uncomfortable necessitating capsular removal and implant exchange.This sort of calcification is different from the calcifications which may be identified on mammogram and are a hallmark for malignancy. As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Jed H. Horowitz, MD, FACS · Answer

One of the most common problems is breast capsular #contracture or the development of thickening, and contracture of the capsule that exists around the breast implants. Severe capsule contracture probably occurs in less than 15% of augmentation patients. Every woman has a breast capsule around their implant and this is a normal phenomenon. The capsule itself could be as thin as Saran Wrap but may also become calcified and thickened. As it thickens and shrinks, the patient may develop a feeling a firmness of the breasts and in its worst situation, the breast may become painful and abnormal in appearance, achieving a very round, hard, and uneven appearance. There may be distortion and possible breakage and leakage of an older implant, but may also include a newer #implant. Nicotine users, such as smokers, have up to a 30x increased risk of #capsular contracture.Saline implants may deflate spontaneously. When the patient has significant #symptoms, complete or partial leakage of their saline implant, or concerns regarding silicone leakage, it is recommended that the implant is removed and exchanged. Frequently, this is performed on both sides depending upon the age of the implant. Capsulotomy or opening of the capsule may be required or frequently capsulectomy, which is removal of the scarred capsule, is r#ecommended to ensure adequate pocket dimensions.New implants may then be placed in the same existing position or may undergo a change of #placement frequently from submammary to subpectoral position and, on occasion, the other way around.

Richard J. Bruneteau, MD · Answer

The vast majority of
calcified capsular contractures are associated with silicone implant bleed or
ruptured silicone implants. Under these
circumstances, it’s probably reasonable to change implants and remove the
capsule with its calcifications.It’s important to realize that health problems have not
been associated with calcified capsules.For this reason, it’s not an absolute necessity that they be
removed.Unfortunately, they may obscure
the detection of breast cancer during mammography.In addition, they can adversely impact the
patient’s aesthetic result.Calcified
capsules are often associated with breast pain, breast distortion, and breast
hardening.Although calcified capsules don’t have to be removed, in
most cases it’s appropriate to perform an implant exchange with bilateral
capsulectomy procedures.Under these
circumstances, the clinical results are excellent and levels of patient
satisfaction are high.If you have calcified capsular contractures, it’s
important to consult a board certified plastic surgeon.This surgeon can evaluate your capsular
contractures and formulate a treatment plan that not only addresses your
anatomic findings but achieves your aesthetic goals as well.

Jeffrey E. Schreiber, MD, FACS · Answer

As long as an MRI and mammogram shows no evidence of rupture or malignancy, then you'll probably be okay leaving in the implants.  Make sure you're cleared by an oncologic breast surgeon as well.

Tom J. Pousti, MD · Answer

Breast implants associated with calcification do not necessarily have to be removed.  Each patient's situation should be evaluated individually/specifically. For example, if a patient has a strong  family history of  breast cancer,  then removal of the breast implants/ calcifications may be indicated to avoid  radiographic confusion  and/or delay of diagnosis of breast cancer.

	If patients with calcification choose to have the breast implants left in place however close radiologic  follow-up will be important.  For example, any change in the nature of the calcifications may require  further evaluation  and/or biopsy.

	I hope this helps.

Peter E. Johnson, MD · Answer

When the silicone gel bleeds and leaks onto the capsule, irritation and inflammation causes the capsule to calcify, a sure sign that the implants is no longer intact and suffers an intracapsular leak. Both implants and capsules should be removed to prevent further capsular contracture.

	Best of luck,

	peterejohnsonmd

Steven Wallach, MD · Answer

If your implants are okay and there is no suspicious radiologic findings with the calcifications and they are considered benign, then they probably do not have to come out.

Michael C. Edwards, MD, FACS · Answer

As has been mentioned, the location of the calcification is the more important consideration. If you have older implants and there is calcification around the capsule that is not concerning to the radiologist for malignancy, there is no rush to have surgery. If this is the case though it is often associated with firmness of the capsule making your breast(s) harder. It would be prudent to have these implant and associated capsules removed and replaced with new implants in the near future. If the calcifications are in the breast tissue you will need to discuss these results with your doctor who ordered the exam for you.

	I hope this helps

	Dr Edwards

Peter A. Aldea, MD · Answer

Calcifications are not seen with the breast implants but may be seen in advanced cases of severe scarring of the scar capsule normally found around breast implants. In some women, especially old silicone gel implants which have leaked, the body reacted in a very exaggerated fashion forming very thick dense scar tissue with calcifications which in some cases resemble oyster shells.

	Calcification is NOT an automatic reason to remove the breast implants UNLESS the IDENTITY of the calcification cannot be established and they could be thereby hiding a malignancy. Modern MRI techniques can read a lot of breast which were hard to be inspected years ago but the test runs over 2,000 dollars. It is therefore up to you and your surgeon to decide what would be best.

	Dr. Peter Aldea