title: Polyurethane-coated breast implants revisited: a 30-year follow-up.
abstract: BACKGROUND
  Polyurethane coating of breast implants has been shown to reduce capsular contracture in short-term follow-up studies. This 30-year study is the longest examination of the use of polyurethane-coated implants and their correlation with capsular contracture.
  
  
  METHODS
  This study evaluates the senior surgeon's (F.D.P.) experience with the use of polyurethane-coated implants in aesthetic breast augmentation in 382 patients over 30 years. Follow-up evaluations were conducted for six months after surgery. After the six-month follow-up period, 76 patients returned for reoperation. The gross findings, histology, and associated capsular contracture were noted at the time of explantation.
  
  
  RESULTS
  No patient during the six-month follow-up period demonstrated capsular contracture. For those who underwent reoperation for capsular contracture, Baker II/III contractures were noted nine to 10 years after surgery and Baker IV contractures were noted 12 to 21 years after surgery. None of the explanted implants had macroscopic evidence of polyurethane, which was only found during the first five years after surgery. The microscopic presence of polyurethane was noted in all capsules up to 30 years after the original operation.
  
  
  CONCLUSIONS
  An inverse correlation was found between the amount of polyurethane coating on the implant and the occurrence of capsular contracture. Increasingly severe capsular contracture was associated with a decreased amount of polyurethane coating on the surface of the implants. No contracture occurred in patients whose implants showed incomplete biodegradation of polyurethane, as indicated by the visible presence of polyurethane coating. We recommend research to find a non-toxic, non-biodegradable synthetic material as an alternative to polyurethane.
authors: Department of Surgery, Division of Plastic Surgery, University of Hawai'i, John A. Burns School of Medicine, Honolulu, HI, USA.
authors: Nikki
authors: N
authors: Castel
authors: Department of Surgery, Division of Plastic Surgery, University of Hawai'i, John A. Burns School of Medicine, Honolulu, HI, USA.
authors: Taylor
authors: T
authors: Soon-Sutton
authors: Department of Surgery, Division of Plastic Surgery, University of Hawai'i, John A. Burns School of Medicine, Honolulu, HI, USA.
authors: Peter
authors: P
authors: Deptula
authors: Department of Surgery, Division of Plastic Surgery, University of Hawai'i, John A. Burns School of Medicine, Honolulu, HI, USA.
authors: Anna
authors: A
authors: Flaherty
authors: Department of Surgery, Division of Plastic Surgery, University of Hawai'i, John A. Burns School of Medicine, Honolulu, HI, USA.
authors: Fereydoun Don
authors: FD
authors: Parsa
keywords: Breast implants; Implant capsular contracture; Polyurethanes