From the Guidelines
Breast implants can cause calcified breast lesions, specifically capsular calcifications, which are a common and generally benign finding in patients with breast implants. These calcifications typically form around the implant capsule and develop when calcium deposits form within the capsule tissue, often years after implant placement 1. According to the American College of Radiology, calcifications along the fibrous capsule are thought to arise as a consequence of a chronic inflammatory response and are more frequently encountered in older implants that have been in place for multiple years 1.
Key Points to Consider
- Capsular calcifications correlate with implant age, but calcifications alone do not necessarily imply capsular contracture or implant rupture 1.
- Mammography is useful in detecting extracapsular silicone and can often reveal the high-density free silicone when it escapes the confines of the fibrous capsule and enters the surrounding breast parenchyma 1.
- Radiologists who are experienced in evaluating breasts with implants can usually differentiate between implant-related calcifications and suspicious calcifications that might require further investigation.
- If you have breast implants and are concerned about calcifications, it's recommended to inform your healthcare provider and radiologist about your implants before undergoing breast imaging, as special mammographic techniques may be needed to properly evaluate the breast tissue.
Importance of Proper Evaluation
It's essential to distinguish implant-related calcifications from other types of breast calcifications that could indicate breast cancer. The FDA recommends that patients considering breast implants discuss the risks, considerations for a successful breast implantation, risks of breast implant–associated anaplastic large cell lymphoma (BIA-ALCL), and recommended follow-up with their healthcare provider 1. Regular follow-up with a healthcare provider and radiologist is crucial to monitor the implants and detect any potential complications early on.
From the Research
Breast Implant-Related Calcified Lesions
- Calcification of breast implant capsules is a rare but clinically important complication of augmentation mammoplasty, as reported in a case study from 2.
- The incidence of calcified breast lesions associated with breast implants has been investigated in several studies, with one study finding that 16% of removed implants demonstrated calcified capsules 3.
- The duration of implantation is a significant factor in the development of calcified lesions, with longer implantation times increasing the likelihood of calcification 3, 4.
- The type of implant also plays a role, with thicker, first-generation implants with Dacron patches being more likely to calcify than newer implants 4.
- Calcification can present as discrete calcified plaques on the inner surface of the capsule or as massive heterotopic ossification, and is often associated with capsular contracture and pain 3, 4.
Characteristics of Calcified Lesions
- Calcified lesions associated with breast implants can be characterized by globular aggregates on the surface of the capsule and actual bone formation within the fibrous tissue of the capsule 4.
- Ultrastructural analysis has confirmed the presence of hydroxyapatite crystals in areas of heterotopic bone and globular aggregates 4.
- The distribution, density, mineral nature, crystal phases, and elements within crystals of calcified lesions have been analyzed using electron microscopy, energy-dispersive X-ray spectrometry, and electron diffraction 4.
Clinical Implications
- Calcified lesions associated with breast implants can mask calcifications of the breast due to carcinoma and exacerbate symptoms of capsular contracture 2.
- Removal of calcified capsules and replacement of implants in the submuscular position may be recommended in some cases 2.
- Understanding the physiology of capsular formation and its associated pathologies is crucial for healthcare providers involved in implant-based breast surgery, and efforts should focus on minimizing the risk of capsular contracture and other complications 5.