Finding a new lump or texture change in a breast with an implant is concerning. A breast lump is a distinct, palpable mass or area of hardening that differs from the surrounding tissue. This change could involve the native breast tissue, the implant, or the scar capsule that forms around the implant. While any new finding requires prompt medical attention, many changes are related to benign implant complications. This article reviews the potential causes, immediate steps, and medical evaluations used for diagnosis.
Understanding the Potential Causes
The palpable change could be related to the implant, the surrounding scar tissue, or the breast tissue itself. One frequent implant-related cause is capsular contracture, which occurs when the scar tissue capsule around the implant hardens and tightens. This contraction squeezes the implant, causing the breast to feel abnormally firm or hard, sometimes with a palpable ridge or lumpiness. This condition can distort the breast’s shape or cause pain.
Another possibility is an implant rupture, which can present as a lump even without immediate deflation, particularly with silicone gel implants. Silicone gel is cohesive, meaning it tends to stay within the scar capsule when the shell tears (intracapsular rupture). However, silicone can sometimes migrate outside the capsule, forming a palpable cluster of gel, often called a siliconoma. A saline implant rupture usually causes rapid deflation, but the deflated shell can fold over itself, creating a palpable ripple or lump.
Lumps can also arise from standard breast pathology, independent of the implant. Common benign masses include cysts, which are fluid-filled sacs that can fluctuate with the menstrual cycle. Fibroadenomas are another type of benign solid mass. A seroma, a collection of fluid around the implant, can also feel like a lumpy area or cause generalized swelling, sometimes requiring drainage.
While rare, malignancies must be considered, including standard breast cancer and Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). BIA-ALCL is an immune system cancer that forms in the fluid or mass around the implant, most often associated with textured implants. A lump or mass in the breast or armpit is a less common symptom of BIA-ALCL, which typically presents years after implant placement.
Immediate Steps to Take
The most important step upon finding a new lump is to seek professional medical evaluation promptly. Contact the plastic surgeon who performed your augmentation or your primary care physician to schedule an examination.
Before your appointment, gather all available information about your implants. This includes the date of surgery, implant type (saline or silicone), manufacturer, and size. Also, note when you first noticed the lump, its exact location, and any associated symptoms like pain, redness, swelling, or changes in breast shape.
Medical Evaluation and Testing
Your medical evaluation begins with a thorough physical examination by your doctor, who will assess the size, texture, and mobility of the lump. The physician will also check for signs of capsular contracture, such as firmness or distortion of the breast. This initial assessment helps differentiate between a solid mass, a fluid collection, or an implant-related issue.
The next step almost always involves specialized imaging. Ultrasound is typically the first-line modality for evaluating a breast lump with an implant, as it distinguishes between a solid mass and a fluid-filled cyst or seroma. Ultrasound is also used to assess the integrity of the implant shell and look for signs of silicone rupture. Mammography requires specialized implant displacement views to visualize the maximum amount of native breast tissue. Magnetic Resonance Imaging (MRI) is the most accurate method for assessing silicone implant integrity and is the gold standard for detecting a “silent rupture.”
If imaging reveals a suspicious solid mass or significant fluid collection, a biopsy or aspiration may be necessary for a definitive diagnosis. Fluid from a seroma can be drained and sent for testing, particularly for BIA-ALCL cells (checking for the CD30 protein). A core needle biopsy analyzes the cells of a solid mass to determine if it is benign, such as a fibroadenoma, or malignant.
Treatment Options Based on Diagnosis
Treatment depends entirely on the final diagnosis confirmed by evaluation and testing. For a simple cyst or small seroma, observation may be sufficient, or the fluid may be drained via needle aspiration to relieve symptoms. If the seroma is recurrent or large, it may suggest an underlying issue requiring further investigation.
If the lump is due to capsular contracture, the definitive treatment is usually surgical. This involves removing the scar capsule (capsulectomy), often performed with the removal or replacement of the implant. The surgeon may also change the implant’s position to potentially reduce the risk of recurrence.
For a confirmed implant rupture, the recommended treatment is removal of the compromised implant and all surrounding silicone gel and capsule material, followed by replacement if desired. If a siliconoma is present, the surgeon will attempt to remove the localized clumps of silicone that have migrated into the breast tissue.
If the biopsy confirms a benign solid mass, such as a fibroadenoma, treatment may be observation with regular follow-up imaging, or surgical excision if the mass is large or growing. In the rare event of a malignancy, such as BIA-ALCL or breast cancer, the patient will be referred to an oncology specialist. Treatment for BIA-ALCL involves complete removal of the implant and the entire surrounding capsule (total capsulectomy), which is curative in most cases.