Breast implants are not lifetime devices. These medical devices have a limited lifespan, and the risk of complications causing pain or discomfort increases significantly over time. Pain that begins or intensifies long after the surgical site has healed signals a change in the implant or the surrounding tissue. These late-onset issues require professional medical evaluation to determine the specific cause and the appropriate course of action.
Capsular Contracture: The Most Common Cause of Late Pain
The body forms a protective layer of scar tissue, known as the capsule, around any foreign object, including a breast implant. Capsular contracture occurs when this capsule tightens and hardens, squeezing the implant and causing localized pain, firmness, and a change in breast shape. This mechanical problem can develop gradually, sometimes years after surgery, and is the most frequent long-term complication of breast augmentation.
The severity is classified using the Baker Grading System, which ranges from Grade I to Grade IV. Grade I is a soft, natural-feeling breast, while Grade II involves slight firmness that is palpable but not visible. Pain and noticeable distortion begin in Grade III, where the breast feels firm and appears abnormal. Grade IV is the most severe form, marked by a hard, painful, and significantly misshapen breast, often requiring surgical intervention.
The excessive tightening is thought to involve factors like subclinical infection, low-grade chronic inflammation, or silicone gel “bleed” into the surrounding tissue. This localized mechanical pressure focuses solely on the reaction of the scar tissue. Surgical treatment often involves removing the implant along with the constricting capsule, a procedure known as capsulectomy.
Structural Failure: Rupture, Leakage, and Displacement
Pain developing years later may result from the implant losing structural integrity or shifting position. All implants wear out over time, and the risk of rupture increases significantly after the first decade post-surgery. The presentation of this failure depends on the implant filler material.
For saline-filled implants, rupture is obvious because the saltwater solution is harmlessly absorbed, causing rapid and noticeable deflation. The sudden loss of volume is the primary symptom, though the deflated shell can cause discomfort. Silicone gel implants present a unique challenge because a tear can result in a “silent rupture.”
The cohesive gel often remains contained within the fibrous capsule, making the rupture undetectable by physical examination. Symptoms can be subtle, including a gradual change in shape, increased firmness, or localized pain. The FDA recommends routine imaging screening for all silicone implant recipients because a contained rupture may not be immediately obvious.
Implant displacement is another source of late-onset discomfort, occurring when the device shifts from the surgical pocket. This movement can be caused by capsular contracture pressure, trauma, or the effects of gravity and physical activity. Displacement often leads to asymmetry, which causes chronic pain as the implant presses against surrounding tissue or chest wall structures.
Addressing Broader Symptoms and Breast Implant Illness (BII)
Beyond localized physical complications, many long-term recipients report systemic, whole-body symptoms referred to as Breast Implant Illness (BII). This collection of health issues is distinct from mechanical problems because the symptoms are non-localized and affect multiple systems. Common symptoms include chronic fatigue, persistent joint pain, unexplained muscle aches, and cognitive issues described as “brain fog.” Other reported issues involve skin rashes, hair loss, and symptoms mimicking autoimmune disorders.
BII is currently a clinical diagnosis based on the patient’s self-reported symptoms and the exclusion of other known diseases. There is no single, universally accepted biological marker or diagnostic test. Symptoms can appear immediately following surgery or years later, and they do not correlate with the type or manufacturer of the implant. The medical community is actively researching the causes, which may involve the body’s inflammatory or immune response to the implant materials.
In a separate category, a very rare cancer called Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) has been linked to implants, particularly those with textured surfaces. BIA-ALCL is an immune system disorder that develops in the fluid or scar capsule surrounding the implant, not in the breast tissue itself. Any sudden swelling, mass, or fluid accumulation around an implant requires immediate medical evaluation.
Diagnosis and Treatment Options
A thorough evaluation by a plastic surgeon is the first step for anyone experiencing new pain or systemic symptoms years after implant placement. The diagnostic process begins with a detailed physical examination and medical history. Imaging tests determine the structural integrity and position of the implants.
For silicone implants, the FDA recommends screening for silent rupture, even without symptoms, using magnetic resonance imaging (MRI) or ultrasound. The first screening should occur five to six years after surgery and be repeated every two to three years thereafter. Ultrasound is often used as a less expensive initial screening tool, with MRI reserved for inconclusive cases or when rupture is suspected.
The definitive treatment for nearly all long-term implant-related complications, including severe capsular contracture, rupture, and BII symptoms, is explantation. This surgical procedure involves removing the breast implant and, in most cases, the complete removal of the surrounding scar tissue capsule, known as a total capsulectomy. Following explantation, the patient may choose a replacement implant, undergo a breast lift, or remain without implants.