title: Clinical and morphological conditions in capsular contracture formed around silicone breast implants.
abstract: BACKGROUND
  A study was performed to investigate histological changes in capsules formed around silicone breast implants and their correlation with the clinical classification of capsular contracture defined by the Baker score. For histological classification, the authors used the classification introduced by Wilflingseder, which identifies four grades of contracture.
  
  
  METHODS
  The study included 24 female patients (average age, 40 +/- 12 years) with capsular contracture after bilateral cosmetic breast augmentation with smooth silicone gel implants (Mentor, Santa Barbara, Calif.). The Baker score was determined preoperatively for each patient. Samples of capsular tissue were obtained from all patients for histologic and immunohistochemical analyses. Capsular thickness, age of the collagen fibers, presence of synovia-like metaplasia on the inner surface of the capsule, number of histiocytes, giant cells, and other inflammatory cells, amount of silicone, foreign body granulomas, and capsule calcification were evaluated.
  
  
  RESULTS
  There was a positive correlation between capsular thickness (p < 0.05) and Baker score. Silicone-containing deposits were found in all four histological capsule types. A trend toward greater capsular thickness was documented in patients with severe inflammatory reaction. These patients also had more clinical symptoms. Greater capsular thickness was associated with a higher number of silicone particles and silicone-loaded macrophages in the peri-implant capsule.
  
  
  CONCLUSIONS
  The authors demonstrated a positive correlation (p < 0.05) between the clinical classification (Baker score I to IV) and the histological classification introduced by Wilflingseder (Wilflingseder score I to IV). An exact histological classification is needed to describe precisely the morphological changes in capsular contracture.
authors.affiliation: Regensburg, Germany From the Department of Plastic Surgery, University Hospital Regensburg.
authors.forename: Lukas
authors.initials: L
authors.lastname: Prantl
authors.forename: Stephan
authors.initials: S
authors.lastname: Schreml
authors.forename: Stefan
authors.initials: S
authors.lastname: Fichtner-Feigl
authors.forename: Nina
authors.initials: N
authors.lastname: Pöppl
authors.forename: Marita
authors.initials: M
authors.lastname: Eisenmann-Klein
authors.forename: Hartmut
authors.initials: H
authors.lastname: Schwarze
authors.forename: Bernd
authors.initials: B
authors.lastname: Füchtmeier
mesh_terms: D000328:Adult; D019928:Breast Implantation / Q000009:adverse effects* / Q000379:methods; D018427:Breast Implants / Q000009:adverse effects*; D015331:Cohort Studies; D003286:Contracture / Q000145:classification / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D015745:Granuloma, Foreign-Body / Q000145:classification* / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D008422:Materials Testing; D008875:Middle Aged; D010147:Pain Measurement; D011336:Probability; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D012307:Risk Factors; D020034:Silicone Gels / Q000009:adverse effects; D018709:Statistics, Nonparametric
chemical_list: D020034:Silicone Gels