title: Breast-implant texturing associated with delamination of capsular layers: A histological analysis of the double capsule phenomenon.
abstract: BACKGROUND
  Macro-texturing of breast implants was developed with the double goal of improving implant stabilization within the breast cavity and decreasing the rate of capsular contractures. However, recent evidence suggests that double capsular formation, a potentially worrisome phenomenon associated with late seromas and biofilms, occurs with preponderance in macro-textured implants. Our objective was to analyze histologically different regions of double capsules to determine if they are more prone to mechanical movements.
  
  
  METHODS
  A prospective analysis including patients undergoing second-stage expander to definitive breast-implant reconstruction post-mastectomy was conducted after intraoperative identification of the double capsule phenomenon. Two samples were collected from each capsules around the implant, located centrally and laterally. The specimens were sent for histological analysis by the institution's pathologist.
  
  
  RESULTS
  In total, 10 patients were identified intraoperatively with partial double capsule phenomenon. Among samples retrieved from the lateral aspect of the breast implant, all were associated with delamination and fractures in the collagen matrix of the double capsules. This phenomenon was not observed in any sample from the dome of the breast.
  
  
  CONCLUSIONS
  Breast-implant macro-texturing plays an important role on delamination of capsules on lateral portions of the breast, which may have an etiologic role in double capsule formation. Manufacturing implants with macro-texturing on one side and smooth surface on the other could diminish mechanical shear forces responsible for these findings.
authors.affiliation: Division of plastic surgery, department of surgery, CHUM Montreal university health center, 1650, Sherbrooke East, Montreal, Quebec, H2L 4M1, Canada.
authors.forename: J I
authors.initials: JI
authors.lastname: Efanov
authors.affiliation: Division of plastic and maxillo-facial surgery, CHU Grenoble Alpes, avenue Maquis-du-Grésivaudan, 38700 La-Tronche, France.
authors.forename: J P
authors.initials: JP
authors.lastname: Giot
authors.affiliation: Division of plastic, reconstructive and aesthetic surgery, hôpital Saint-Roch, CHU de Nice, 5, rue Pierre-Dévoluy, 06000 Nice, France.
authors.forename: J
authors.initials: J
authors.lastname: Fernandez
authors.affiliation: Division of plastic surgery, department of surgery, CHUM Montreal university health center, 1650, Sherbrooke East, Montreal, Quebec, H2L 4M1, Canada. Electronic address: michel.alain.danino@umontreal.ca.
authors.forename: M A
authors.initials: MA
authors.lastname: Danino
mesh_terms: D018427:Breast Implants / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000601:surgery; D002214:Capsules; D015169:Colony Count, Microbial; D005260:Female; D006801:Humans; D064169:Intermediate Back Muscles / Q000601:surgery; D016462:Mammaplasty / Q000379:methods; D008408:Mastectomy / Q000379:methods; D011446:Prospective Studies; D011474:Prosthesis Design; D049291:Seroma / Q000209:etiology* / Q000601:surgery; D064171:Superficial Back Muscles / Q000601:surgery; D013524:Surgical Flaps; D016896:Treatment Outcome
chemical_list: D002214:Capsules
keywords: Capsule double; Delamination; Double capsule; Délamination; Fracture; Implant mammaire en silicone; Implant texturing; Macrotexturation du silicone; Silicone breast implant; Silicone macrotexturation; Texturation d’implant