Hardening of Breast Implants

When patients are deciding between saline or silicone breast implants, one of their biggest concerns is how the implants will feel. Patients want a soft, natural feel to their breasts. In many ways, breast implants that feel unnaturally hard may defeat the purpose of having them in the first place. Patients want to enhance their own features, but without breasts that look or feel hard or obviously fake.

However, in some cases, the breast implants may harden over time, requiring a second surgical procedure. Although this may seem to be a difficult problem, the second procedure is relatively straightforward and will generally be all that is needed to restore the breast implants to their natural, softer state.

What Can Cause Hardening of Breast Implants?

Breast implant hardening is also known as capsular contracture. It occurs when the body builds up an excess of scar tissue surrounding the pocket that the cosmetic surgeon has created in order to insert the implants. The scar tissue build up surrounding the pocket and implant is the body’s natural response to a foreign object being implanted in the body; unfortunately, in some cases, this excess scar tissue will tighten around the breast implant, causing hardening and pain. If left unchecked, capsular contracture may lead to implant rupture.

Breast hardening can occur with either silicone or saline implants, most often when the implants are placed subglandularly, or in front of the pectoral chest muscles. Furthermore, capsular contracture can reoccur with the same implant.

The U.S. Food and Drug Administration (FDA), which regulates the manufacturing of breast implants, uses four categories of implant hardening. These are known as Baker Grades:

• Grade I            Breast is normally soft and looks natural
• Grade II            Breast is a little firm but looks normal
• Grade III            Breast is firm and looks abnormal
• Grade IV            Breast is hard, painful, and looks abnormal

Grade I is actually a normal augmented breast. A capsule will form with any breast implant, but contracture does not actually occur until the scar tissue tightens around the capsule and begins to cause hardening of the breast.

Treatment of Capsular Contracture

For mild cases of implant hardening (Baker Grades I and II), some cosmetic surgeons recommend that their patients perform a series of exercises to move the implants around. This is meant to help create a bit more room inside the capsule, thus removing some of the pressure on the implants. Patients should gently rotate their implants in both clockwise and counterclockwise directions several times a day.

For more severe cases of capsular contracture (Baker Grades III and IV), a second surgery is required to cut away some of the excess scar tissue, thereby providing more space for the implant capsule. In many cases, the cosmetic surgeon may be able to go back in through the initial incision, thereby reducing the chance for excessive scarring from the second procedure. If the implant has actually become deformed or ruptured, it will have to be removed. New implants can then be inserted, if the patient wishes.

Although there will be some scar formation around the capsule as part of any breast implant procedure, most will not result in capsular contracture and hardening of the breasts. Fortunately, there are ways to correct the problem.

Contact Jefferson Plastic Surgery to schedule a breast augmentation consultation.