title: Silicone breakdown and capsular synovial metaplasia in textured-wall saline breast prostheses.
abstract: Saline-filled prostheses are currently the only type of prostheses available for cosmetic use in the United States because of concerns raised about the possibility of systemic toxicity of silicone-filled artificial mammary implants. Although the approved implants are saline-filled, their potential to release silicone particles from the shells has not been systematically evaluated. We performed microscopic examination of the pericapsular tissue of 54 patients with textured-surface implants and compared these with 51 patients with smooth-walled implants over a 2-year period. The capsules that had formed around virtually all textured-surface implants had silicone fragments present either in extracellular spaces, in vacuolated histiocytes, or in the form of foreign-body granulomas in surrounding fibroadipose tissue but not in capsules associated with smooth-walled implants. In 87 percent of samples of pericapsular tissue from textured saline implants, the contact surface displayed exuberant reactive synovial metaplasia, a histologic pattern not previously described with these devices. Our findings suggest that smooth-walled prostheses are associated with less silicone fragmentation than textured devices in the peri-implant tissue capsules that tend to form around artificial surfaces used for this purpose.
authors.affiliation: Department of Surgery, Mount Sinai Medical Center, New York, N.Y.
authors.forename: M
authors.initials: M
authors.lastname: Copeland
authors.forename: M
authors.initials: M
authors.lastname: Choi
authors.forename: I J
authors.initials: IJ
authors.lastname: Bleiweiss
mesh_terms: D001940:Breast / Q000473:pathology*; D001941:Breast Diseases / Q000209:etiology* / Q000473:pathology; D018427:Breast Implants / Q000009:adverse effects*; D004867:Equipment Design; D005260:Female; D015745:Granuloma, Foreign-Body / Q000209:etiology / Q000473:pathology*; D006801:Humans; D016462:Mammaplasty; D012086:Reoperation; D012828:Silicones / Q000009:adverse effects*; D012965:Sodium Chloride
chemical_list: D012828:Silicones; D012965:Sodium Chloride