Serologic and Histologic Findings in Capsule Contracture Patients with Silicone Gel Implants
Local and systemic reactions of the body to silicone gel implants are still under discussion and are the subject of intensive research to improve biocompatibility. The incidence of capsular contracture varies in the literature from less than 1% up to 74%.
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Serologic and Histologic Findings in Capsule Contracture Patients with Silicone Gel Implants Lukas Prantl
77.1 Introduction Since 1962 when the first silicone implants were developed in the United States, they have been widely used for reconstruction after breast amputation to correct breast malformations, dysplasia, and aplasia and for aesthetic breast augmentation. Local and systemic reactions of the body to implants are still under discussion and are the subject of intensive research to improve biocompatibility [1–3]. To decrease the rate of local complications caused by implants, such as progressive shrinking of the capsule (so-called capsular contracture) and penetration of silicone gel (so-called gel bleed) through the intact implant shell, silicone implants have undergone further development. The incidence of capsular contracture varies in the literature from less than 1% up to 74% [4, 5]. The high variability of the stated capsular contracture rate by various authors depends on many factors. An objective assessment of the degree of capsular contracture is difficult. The severity is mainly assessed by the purely clinical classification according to Baker [6]. This palpation method is largely dependent on the experience and sensitivity of the clinician. Often the studies are hardly comparable because different implant types of different implant generations were used. In addition, every implant company uses its own production process and its own editing. This demonstrates the importance of an study in which the mentioned variables (implant-specific factors) in addition to the individual factors are kept very small.
sive gel [4, 5, 7]. Histologic investigations of the capsular tissue are generally not comparable in previous studies because uniform histologic criteria are absent in the classification of the degree of capsular contracture. Such a classification was described by Wilflingseder and colleagues in 1983 [8], but this soon fell into oblivion. On the basis of morphological investigations of implant capsules in support of the work of Wilflingseder and colleagues, the author set up a histologic classification of capsular contracture that correlates with clinical findings. It takes the pathogenetic mechanism into consideration and serves as a basis for further studies (Fig. 77.1) [7]. Histologically, the fibrous capsule shows a threelayer composition: 1. The internal layer abutting the silicone surface appears to be single-layered or multilayered containing macrophages and fibroblasts. In some cases, a pseudoepithelial cellular layer at the implant/capsule interface (synovia-like metaplasia) is found. 2. The middle layer consists of loosely arranged connective tissue including the internal vascular supply. 3. The outer layer is formed by dense connective tissue with the external vascular supply (Fig. 77.2a,b,c).
Semiquantitative analysis of samples of capsular tissue with regard to silicone content and the cellular inflammatory reaction was performed according to the above mentioned classification patter
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