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

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

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).

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.

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.

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.