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01-12-2021 | Silicone | Review

Histological Analyses of Capsular Contracture and Associated Risk Factors: A Systematic Review

Authors: Andreas Larsen, Louise E. Rasmussen, Leonia F. Rasmussen, Tim K. Weltz, Mathilde N. Hemmingsen, Steen S. Poulsen, Jens C. B. Jacobsen, Peter Vester-Glowinski, Mikkel Herly

Published in: Aesthetic Plastic Surgery | Issue 6/2021

Abstract

Background

Capsular contracture is a severe complication to breast surgery with implants. Previous studies suggest multiple risk factors are associated with capsular contracture, but the etiology is still unknown. We performed a literature review to investigate existing studies on histological analyses of breast implant capsules and how clinical risk factors impact the capsule morphology.

Methods

The literature search was conducted in PubMed. Studies that performed histological analyses of breast implant capsules were included. Animal studies or studies with a study population of less than five patients were excluded.

Results

Fifty-two studies were included. The histological analyses showed that the breast implant capsules were organized in multiple layers with an inner layer of synovial-like metaplasia which was reported to diminish in capsules with capsular contracture. The remaining layers of the capsule mostly consisted of collagen. The alignment of the collagen fibers differed between contracted and non-contracted capsules, and capsules with higher Baker grade were generally thickest and contained more tissue inflammation. Studies investigating capsules affected by radiotherapy found a more pronounced inflammatory response and the capsules were generally thicker and fibrotic compared with nonirradiated capsules.

Conclusions

The included studies offer valuable insights into the histological changes caused by capsular contracture and their relation to clinical risk factors. Further studies with larger sample sizes and more strict inclusion criteria are needed to further investigate implant capsules and the role of the synovial-like metaplasia for the development of capsular contracture.

Level of Evidence III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com/00266.

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Title: Histological Analyses of Capsular Contracture and Associated Risk Factors: A Systematic Review
Authors: Andreas Larsen
Louise E. Rasmussen
Leonia F. Rasmussen
Tim K. Weltz
Mathilde N. Hemmingsen
Steen S. Poulsen
Jens C. B. Jacobsen
Peter Vester-Glowinski
Mikkel Herly
Publication date: 01-12-2021
Publisher: Springer US
Keywords: Silicone
Radiotherapy
Published in: Aesthetic Plastic Surgery / Issue 6/2021
Print ISSN: 0364-216X
Electronic ISSN: 1432-5241
DOI: https://doi.org/10.1007/s00266-021-02473-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Histological Analyses of Capsular Contracture and Associated Risk Factors: A Systematic Review

Abstract

Background

Methods

Results

Conclusions

Level of Evidence III

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Level of Evidence III

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