Baker-IV capsular contracture is correlated with an increased amount of silicone material: an intra-patient study.

Abstract

ince its introduction, the use of silicone breast implants for reconstructive and cosmetic purposes has increased significantly; thus, breast implant surgery is one of the most frequently performed procedures by plastic surgeons worldwide. 1,2 Simultaneously, extensive research efforts and lively discussions on their safety and complications continue. [3][4][5][6][7][8][9][10][11][12] Although most of the recent attention is focused on breast implant-associated anaplastic large cell lymphoma 13 and breast implant illness, 14 the most common complications are still related to the capsule surrounding the implant. Capsule formation is a normal foreign Background: Breast implant surgery is one of the most frequently performed procedures by plastic surgeons worldwide. However, the relationship between silicone leakage and the most common complication, capsular contracture, is far from understood. This study aimed to compare Baker grade I with Baker grade IV capsules regarding their silicone content in an intradonor setting, using two previously validated imaging techniques. Methods: Twenty-two donor-matched capsules from 11 patients experiencing unilateral complaints were included after bilateral explantation surgery. All capsules were examined using both stimulated Raman scattering (SRS) imaging and staining with modified oil red O (MORO). Evaluation was done visually for qualitative and semiquantitative assessment and automated for quantitative analysis. Results: Using both SRS and MORO techniques, silicone was found in more Baker grade IV capsules (eight of 11 and 11 of 11, respectively) than in Baker grade I capsules (three of 11 and five of 11, respectively). Baker grade IV capsules also showed significantly more silicone content compared with the Baker grade I capsules. This was true for semiquantitative assessment for both SRS and MORO techniques (P = 0.019 and P = 0.006, respectively), whereas quantitative analysis proved to be significant for MORO alone (P = 0.026 versus P = 0.248 for SRS, respectively). Conclusions: In this study, a significant correlation between capsule silicone content and capsular contracture is shown. An extensive and continued foreign body response to silicone particles is likely to be responsible. Considering the widespread use of silicone breast implants, these results affect many women worldwide and warrant a more focused research effort.

Discussion: Baker Grade IV Capsular Contracture Is Correlated with an Increased Amount of Silicone Material: An Intrapatient Study

“…This article strongly supports the conclusion that extravasation of silicone from an implant into the surrounding capsule is highly associated with CC through the facilitation of an innate immune response and foreign-body reaction. 1 The authors’ findings thoroughly expand on their prior research, which both supports our current understanding of CC and foreign-body reaction and helps to contextualize it as a very specific disease process outside of other known risk factors. 4,7,8 Ultimately, this work shows that a need to improve breast implant safety persists, in part by improving breast implant technology through further innovation.…”

“…I n this article, de Bakker et al identify increased silicone extravasation in the capsules of Baker grade IV capsular contracture (CC) compared with Baker grade I CC. 1 This group has a longstanding history of investigating CC, and this article expands on their prior findings, 2,3 with an elegant study showing significant correlation between high-grade CC and increased silicone extravasation.…”

“…As the authors acknowledge, many factors contribute to the diagnosis of CC, including “reconstructive surgery after breast cancer, irradiation of the breast, subglandular implant placement, postoperative hematoma, and a smooth implant surface.” 1 These investigators limit the scope of their study to silicone-filled implants in a subpectoral plane devoid of radiation therapy and limited to patients desiring bilateral explanation in the context of unilateral disease. In our view, this homogeneous patient population enables the authors to significantly reduce interpatient and disease-process variability, strengthening the relevance of their findings.…”