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Logo for Marquis Plastic Surgery, Coral Gables, Miami, West Palm Beach, Florida.

What’s Wrong with My Breast Implant?

“What’s wrong with my breast implant?”

“Why is my breast implant suddenly hard?”

“Why didn’t my breast implant drop?”

“Why is my breast implant suddenly riding high?”

If you find yourself asking any of these questions, two common causes are: 1) capsular contracture and 2) implant rupture.

Breast implant stock image for Dr. Arthur E. Desrosiers, Marquis Plastic Surgery, Miami, Coral Gables, Florida.

What is a Capsular Contracture?

A capsule of natural scar tissue forms around all implants placed inside the body – whether a breast implant or a knee implant. In most cases, this capsule remains soft and does not cause issues. However, in some instances, the capsule tightens and hardens, leading to capsular contracture. The severity of capsular contracture is graded using the Baker scale:

  • Baker Grade 1: The breast is soft and feels normal
  • Baker Grade 2: The breast is slightly firm but looks normal
  • Baker Grade 3: The breast is firm and looks abnormal
  • Baker Grade 4: The breast is hard, painful, and looks abnormal

Assuming the implant was properly placed, Baker Grade 3 to 4 capsular contraction is a common cause of the implant “riding high” or not dropping.

Why certain people have a propensity for developing capsular contraction remains a topic of research. However, capsular contraction has been associated with:

  • Implant Rupture: Leakage from a ruptured implant can irritate surrounding tissues, leading to inflammation and tightening of the capsule around the implant.
  • Autoimmune Responses: Some individuals may have a strong immune reaction to the implant material, triggering excessive capsule formation.
  • Innate Scar Response: Certain people naturally form thick scar tissue, such as keloids. Individuals with a history of keloid formation may be at higher risk of capsular contracture.
  • Biofilm or Infection: The presence of bacteria or a biofilm on the implant surface can lead to chronic inflammation, which contributes to capsular tightening.
  • Hematoma or Seroma: Blood or fluid accumulation around the implant can irritate tissues and increase the risk of contracture.
  • Powdered Glove Dust: Residual powder from surgical gloves can act as a foreign substance, triggering inflammation.
  • Hormonal Changes: Significant hormonal fluctuations, such as those during pregnancy, may influence the capsule’s development and thickness.

How do you Treat a Capsular Contracture?

There are surgical and non-surgical options.

Non-Surgical Capsular Contracture Treatments

There are two treatments that may help fully or partially alleviate capsular contracture.

Aspen Ultrasound Therapy: This treatment employs sound waves to break down hardened scar tissue, potentially alleviating the severity of capsular contracture. To our knowledge, Aspen After Surgery in Coral Springs, Florida, is the only center offering this therapy. I have referred patients, including those with late-stage capsular contracture, to Aspen, and the results have been remarkable. Check out Aspen’s website for their before and after.

Singulair:  Singulair (montelukast) is a medicine that has been explored as a potential treatment for capsular contracture.

A study published in the Aesthetic Surgery Journal in 2010 investigated the effects of Singulair on capsular contracture. The preliminary findings indicated that Singulair may improve capsular contracture, particularly in cases classified as mild (Baker score < III). The study concluded that Singulair is well-tolerated with minimal side effects and can be administered to patients after breast implant surgery to improve capsular contracture.

Non-surgical treatment options may not work for everyone.

Surgical Treatment for Capsular Contraction

In some cases, surgery may be necessary to try and address a Capsular Contraction. Here are some common surgical options:

Implant Removal with Capsulectomy: This involves removing the implant and the hardened capsule of scar tissue.

Plane Change: There’s some evidence that placing the new implant in a different plant – e.g., if it was below the muscle, placing the new implant subfascial – can reduce (but not eliminate) the risk of future capsular contracture.

Implant Rupture?

An implant rupture occurs when the outer shell of a breast implant develops a tear or hole.

Saline Rupture

If you have saline implants, the rupture will be readily apparent. The saline will simply be absorbed by the body over time. Apart from a “deflated” appearance, a ruptured saline implant is unlikely to cause other physical problems.

Silicone Rupture

Silicone ruptures require prompt treatment by your surgeon. For silicone implants, there are two types of ruptures: intracapsular rupture and extracapsular rupture.

Silicone Intracapsular Rupture

An intracapsular rupture happens when a tear occurs in the implant shell. If you have silicone implants, the silicone gel remains contained within the fibrous capsule that the body naturally forms around implants. Because the leakage is confined, this type of rupture may not cause noticeable symptoms right away. However, over time, the gel can cause changes to the capsule, such as thickening or inflammation.

Key Features:

  • Leakage remains contained within the capsule.
  • Often asymptomatic and detected via imaging, such as MRI or ultrasound.
  • May require monitoring or surgery to remove the implant and clean the capsule.

Silicone Extracapsular Rupture

An extracapsular rupture occurs when the silicone gel escapes beyond the fibrous capsule and spreads into the surrounding breast tissue. This type of rupture is more likely to cause noticeable symptoms, such as swelling, lumps, or changes in breast shape. Silicone outside the capsule can trigger inflammation or granulomas (small lumps of tissue caused by a reaction to the silicone).

Key Features:

  • Silicone leaks beyond the fibrous capsule into the breast tissue.
  • Can cause pain, swelling, or visible changes in the breast.
  • More likely to require immediate surgical intervention to remove the implant and any leaked material.

If you suspect a silicone implant rupture, consult with your healthcare provider promptly. Imaging tests, like MRI or ultrasound, can help diagnose the rupture type and guide appropriate treatment. Early detection and management are essential for maintaining your health and cosmetic outcomes.

Takeaways

If you suspect something is wrong with your breast implant, don’t panic. While complications like ruptures and capsular contracture can be alarming, they are manageable with the right care. Start by consulting a qualified plastic surgeon to evaluate your symptoms and discuss the best course of action, whether that’s non-surgical treatment or surgery.

Your peace of mind and health are worth prioritizing.

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