I see women sometimes with (usually) older silicone implants and rock. hard. breasts. This is called capsular contracture, which we rate on a scale of I (soft, pliable) to IV (rock hard, tight, calcified). But what causes the rock hard capsule after breast augmentation? Is it predictable? We know capsular contracture is related to biofilm and breast implant leakage.
This study looks at the causation of thickened capsules, specifically the silicone content. This was in the December 2023 Plastic & Reconstructive Surgery Journal, “Baker Grade IV Capsular Contracture Is Correlated with an Increased Amount of Silicone Material: An Intrapatient Study.”
Study:
- 22 donor matched capsules from 11 patients with unilateral complaints after bilateral explant surgery (so they were essentially their own control group- one breast was hard with a IV capsule, one side was soft with a I capsule)
- All capsules were examined using stimulated Raman Scattering imaging and staining with modified oil red O. Evaluations was done visually for qualitative and semiquantitative assessment.
- Baker grade IV capsules showed significantly more silicone content compared to grade I capsules.
- Interesting tidbits from the study: Average age of implants was 156 months, but the age did not have a significant influence on the amount of silicone found in the capsules.
- Capsules obtained from saline implants had comparable of higher capsular contracture rates compared to full silicone implants- in saline implants only the shell of the implant is silicone.
- Even the Grade I capsules had silicone in them. Just a smaller amount.
They postulate that “an extensive and continued foreign body response to silicone particles is likely to be responsible.”
My thoughts?
Capsular contracture is not a simple thing. We know it is multifactorial: biofilm, genetics, silicone bleed, and more. This study was small, but interesting.
They suggest in this study that implant shells deteriorate over time. They generally recommend breast revision surgery around 10-15 years out. I used to say, “not broke, don’t fix” as to when to replace implants, but I am starting to see my own patients 17 years out, 19 years out, with leaking implants. So I think that 10-15 year number may be better.
The real question is do you take out the capsule? If it is a thick capsule, you for sure do. But if it is thin, do you? Is there a difference in silicone bleed between older implants and newer ones (for sure I would think yes). Is there a difference between brands? The cohesiveness of the gel? (there are now multiple different levels of gel cohesiveness which gives a firmer look and feel).
Interesting stuff. Will keep you updated.