Serologic and histologic findings in capsule contracture patients with silicone gel implants

Abstract

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%. Histologically, fibrous capsules show a three-layer composition. 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. The middle layer consists of loosely arranged connective tissue that includes the internal vascular supply, and the outer layer is formed by dense connective tissue with the external vascular supply. The author's study showed a positive correlation between the grade of capsular contracture (Baker grades I-IV) and hyaluronan serum concentration. If we can understand the etiopathogenesis of severe capsular fibrosis better, we may be able to reduce the number of patients who require surgical intervention. © 2009 Springer-Verlag.