Firestorm fibrosis: the fast fibrotic phenomenon

Whenever implants are placed within the human body, a fibrous capsule is formed by the host to isolate the implant. If the chemical composition of the implant is inert and stable, the fibrous capsule will be thin and ignored by the body. In some instances, as a reaction of overhealing, however, a rapid fibrosis occurs and a thick contracted capsule forms within a few weeks. We have encountered this in 3 patients who were previous failures of smooth surfaced breast implants, when a new textured silicone implant was placed in the surgical pocket after complete capsulectomy. A thick, fibrotic capsule formed within a few weeks, necessitating re-removal. We treated these patients with aggressive sudden fibrosis with suction drainage and irrigation with methylprednisolone biweekly for 3 weeks. In these 3 consecutive patients, further fibrosis was prevented by this therapy; and all remain soft and asymptomatic after more than 1 year of follow-up. In patients with firestorm fibrosis, aggressive treatment with constant suction drainage and methylprednisolone irrigation warrants further study.