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Defining Double Capsules: A Clinical and Histological Study.

Aaron C Van Slyke1, Janine M Roller1, Reza Alaghehbandan2

  • 1Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.

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|March 3, 2021
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Summary

Macrotextured breast implants can form double capsules, which are linked to tissue nonadherence. This study defines double capsules as a spectrum of inner capsule formation and correlates them with implant adherence.

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Area of Science:

  • Plastic Surgery
  • Biomaterials Science
  • Pathology

Background:

  • Macrotextured breast implants are associated with double capsules, but definitions and presentations vary.
  • The existence of different degrees of double capsule formation is not well-established.

Purpose of the Study:

  • To define double capsules associated with macrotextured breast implants.
  • To investigate the correlation between double-capsule type and the degree of tissue adherence.

Main Methods:

  • Retrospective analysis of 22 Biocell implants from 11 patients undergoing explantation.
  • Intraoperative assessment of double capsules and tissue adherence.
  • Histological examination of capsular specimens and descriptive statistical analysis.

Main Results:

  • All areas of implant nonadherence were associated with double-capsule formation.
  • Double capsules presented as partial or complete, with varying inner layer architecture.
  • Histology revealed hypocellular fibrous capsules with chronic inflammation and synovial metaplasia; spaces/cracks were more common in partially adherent capsules.

Conclusions:

  • This study establishes a clinical and pathological correlation between double capsules and failed tissue adherence.
  • Double capsules represent a spectrum of inner capsule formation, from nascent to mature tissue.