title: The double capsules in macro-textured breast implants.
abstract: Breast implants are amongst the most widely used types of permanent implants in modern medicine and have both aesthetic and reconstructive applications with excellent biocompatibility. The double capsule is a complication associated with textured prostheses that leads to implant displacement; however, its etiology has yet to be elucidated. In this study, 10 double capsules were sampled from breast expander implants for in-depth analysis; histologically, the inner capsular layer demonstrated highly organized collagen in sheets with delamination of fibers. At the prosthesis interface (PI) where the implant shell contacts the inner capsular layer, scanning electron microscopy (SEM) revealed a thin layer which mirrored the three-dimensional characteristics of the implant texture; the external surface of the inner capsular layer facing the intercapsular space (ICS) was flat. SEM examination of the inner capsule layer revealed both a large bacterial presence as well as biofilm deposition at the PI; a significantly lower quantity of bacteria and biofilm were found at the ICS interface. These findings suggest that the double capsule phenomenon's etiopathogenesis is of mechanical origin. Delamination of the periprosthetic capsule leads to the creation of the ICS; the maintained separation of the 2 layers subsequently alters the biostability of the macro-textured breast implant.
authors.affiliation: Division of Plastic Surgery, Department of Surgery, CHUM Montreal University Health Center, 1650 Sherbrooke East, Montréal, Québec H2L 4M1, Canada. Electronic address: jp@giot.net.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Giot
authors.affiliation: Division of Plastic Surgery, Department of Surgery, CHUM Montreal University Health Center, 1650 Sherbrooke East, Montréal, Québec H2L 4M1, Canada. Electronic address: laurence.paek@gmail.com.
authors.forename: Laurence S
authors.initials: LS
authors.lastname: Paek
authors.affiliation: Division of Plastic Surgery, Department of Surgery, CHUM Montreal University Health Center, 1650 Sherbrooke East, Montréal, Québec H2L 4M1, Canada. Electronic address: nizardnathanael@gmail.com.
authors.forename: Nathanael
authors.initials: N
authors.lastname: Nizard
authors.affiliation: Division of Plastic Surgery, Department of Surgery, CHUM Montreal University Health Center, 1650 Sherbrooke East, Montréal, Québec H2L 4M1, Canada. Electronic address: mostafa.el-diwany@umontreal.ca.
authors.forename: Mostafa
authors.initials: M
authors.lastname: El-Diwany
authors.affiliation: Institute for Research in Immunology and Cancer, Université de Montréal, C.P. 6128 succursale Centre-ville, Montréal, Québec H3C 3J7, Canada. Electronic address: louis.gaboury@umontreal.ca.
authors.forename: Louis A
authors.initials: LA
authors.lastname: Gaboury
authors.affiliation: Institute of Biomedical Engineering, Department of Chemical Engineering, Ecole Polytechnique de Montréal, P.O. Box 6079, Station Centre-Ville, Montreal, Québec H3C 3A7, Canada. Electronic address: Monica.nelea@polymtl.ca.
authors.forename: Monica
authors.initials: M
authors.lastname: Nelea
authors.affiliation: Division of Plastic Surgery, Department of Surgery, CHUM Montreal University Health Center, 1650 Sherbrooke East, Montréal, Québec H2L 4M1, Canada. Electronic address: joseph.boumerhi@gmail.com.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Bou-Merhi
authors.affiliation: Division of Plastic Surgery, Department of Surgery, CHUM Montreal University Health Center, 1650 Sherbrooke East, Montréal, Québec H2L 4M1, Canada. Electronic address: patrick.harris.chum@ssss.gouv.qc.ca.
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Harris
authors.affiliation: Division of Plastic Surgery, Department of Surgery, CHUM Montreal University Health Center, 1650 Sherbrooke East, Montréal, Québec H2L 4M1, Canada. Electronic address: daninoalain@gmail.com.
authors.forename: Michel A
authors.initials: MA
authors.lastname: Danino
mesh_terms: D018441:Biofilms; D018427:Breast Implants / Q000382:microbiology; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery; D002214:Capsules; D015169:Colony Count, Microbial; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged
chemical_list: D002214:Capsules
keywords: Bacteria; Biofilm; Biostability; Scanning electron microscopy (SEM); Silicone breast implant; Silicone macrotexturation