title: Pathologic Findings in Primary Capsulectomy Specimens: Analysis of 2531 Patients.
abstract: BACKGROUND
  After breast augmentation, additional operations are often needed for revision or explantation. Although the surgeon may elect to leave the capsule in situ during these procedures, excised capsule tissue may be examined histopathologically for cancer cells.
  
  
  OBJECTIVE
  The authors assessed pathologic findings from breast implant capsules submitted for histopathologic examination and evaluated whether it is oncologically safe to leave capsule tissue in situ.
  
  
  METHODS
  The authors searched PALGA, the nationwide histopathology and cytopathology data network and registry in the Netherlands, for primary capsulectomy specimens excised between 2003 and 2012. The authors applied a sensitive search strategy with low specificity that included female and breast as the sex and anatomic location keywords, and wildcards were used to detect different spellings. Cases were excluded if previous examinations showed compatibility with a history of breast cancer, prophylactic mastectomy, or prophylactic oophorectomy. The pathologic reports were manually reviewed for relevance, and each case's diagnosis was registered. A total of 6803 reports were available, representing 4948 patients; 2574 reports from 2531 patients were included in this study. The median age of patients was 51.2 ± 12.0 years (range, 15-88 years).
  
  
  RESULTS
  Invasive carcinoma was detected in 4 patients (0.16%). Four patients (0.16%) had ductal carcinoma in situ, and 1 patient (0.04%) had lobular carcinoma in situ. Metaplasia was noted in 51 patients (2.0%), calcifications in 375 (14.6%), and silicone in 701 (27.2%).
  
  
  CONCLUSIONS
  The incidence of occult invasive or in situ carcinoma in capsulectomy specimens of patients with no previous breast pathology is low. Therefore, it appears oncologically safe to leave capsule tissue in situ.
  
  
  METHODS
  3.
authors.affiliation: Dr Lapid is a plastic surgeon and Dr Noels was a medical student in the Department of Plastic, Reconstructive and Hand Surgery o.lapid@amc.nl.
authors.forename: Oren
authors.initials: O
authors.lastname: Lapid
authors.affiliation: Dr Lapid is a plastic surgeon and Dr Noels was a medical student in the Department of Plastic, Reconstructive and Hand Surgery.
authors.forename: Eline C
authors.initials: EC
authors.lastname: Noels
authors.affiliation: Dr Meijer is a pathologist in the Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Sybren L
authors.initials: SL
authors.lastname: Meijer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001940:Breast / Q000473:pathology / Q000601:surgery*; D000071960:Breast Carcinoma In Situ / Q000473:pathology*; D019928:Breast Implantation / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000473:pathology*; D002277:Carcinoma / Q000473:pathology*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology*; D005260:Female; D006801:Humans; D057910:Implant Capsular Contracture / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D008679:Metaplasia; D008875:Middle Aged; D009426:Netherlands; D010781:Photography; D012042:Registries; D016896:Treatment Outcome; D055815:Young Adult
keywords: PALGA; augmentation; breast neoplasms; capsule; capsulectomy; foreign body; implant; implant capsular contracture; mammaplasty; oncology; pathology; rupture; silicone