SUBJECTIVE AND OBJECTIVE ASSESSMENT OF CAPSULAR CONTRACTURE - RESULTSOBTAINED WITH TEXTURED SILICONE IMPLANTS AND HISTOLOGICAL CORRELATION

Contraction of the fibrous capsule around an implant after prosthetic breast surgery is a serious complication, which can adversely effect t he outcome and spoil the overall result. Textured silicone implants ar e reported to have reduced rates of capsular contraction, but their ex act mechanism, especially at the interface, remains unclear. Over a pe riod of 2 1/2 years, 94 textured silicone implants were used in augmen tation mammoplasty. A follow-up examination was possible in 74 cases. The clinical assessment of results was based on Baker's classification . In addition to the subjective assessment of breast firmness, objecti ve measurements (mamma compliance) were obtained. The average follow-u p period was 55.6 weeks. 79.7% of augmented breasts were classified as Baker I, 16.2% as Baker II, 4.1% as Baker III and 0% Baker IV. In com parison to previous results reported in the literature, the incidence of capsular contracture obtained with textured implants was significan tly lower. All Baker III cases were replacements of the original impla nt following advanced capsular contraction. The compliance measurement s were found to correlate well with Baker's classification. Sixty-one of 72 cases of augmented breasts showed compliance values similar to n ormal breasts, which ranged between 0.64 and 3.7 cm at D20n. This meas urement proves that 82.4% of the augmented breasts are as soft as norm al breasts. A partial comparison between our clinical data and histolo gical examination was possible. Firm adhesion of the capsule to the su rface of the implant was characteristic of those breasts which showed no capsular contracture, while in breasts showing advanced capsular co ntraction, implant and capsule were separated by a liquid film. The us e of surface textured silicone implants has led to a significantly dec reased rate of capsular contraction without having to employ steroids. Close contact between implant and capsule seems to be the most import ant factor for reduced capsular contraction.