Capsular calcification associated with silicone breast implants: incidence, determinants, and characterization

Area of Science:

• Biomaterials Science
• Medical Device Engineering
• Pathology

Background:

• Capsular calcification is a known complication of silicone gel breast implants.
• Previous studies have suggested a link between implant characteristics and calcification, but generation-specific data is limited.

Purpose of the Study:

• To investigate the prevalence and characteristics of capsular calcification in different generations of silicone gel breast implants.
• To identify factors associated with calcification, including implant generation, duration, and integrity.

Main Methods:

• Analysis of 404 silicone gel breast implant capsules explanted between 1981 and 1996.
• Histological and ultrastructural analysis of calcified capsules.
• Comparison of calcification rates across implant generations (first, second, and third).

Main Results:

• Capsular calcification was observed in 15.8% of analyzed implants.
• First-generation implants (1963-1972) with Dacron patches showed 100% calcification, regardless of duration.
• Second-generation implants (1973-1987) showed calcification related to duration and integrity (ruptured implants calcified more).
• Third-generation implants (1987-1991) showed no calcification.
• Calcification presented as globular aggregates and/or heterotopic ossification, both containing hydroxyapatite crystals.

Conclusions:

• First-generation silicone gel breast implants with Dacron patches are significantly more prone to calcification than later generations.
• Implant duration and integrity are key factors in second-generation implant calcification.
• The findings suggest differences in calcification mechanisms between silicone gel and saline implants.