SILICONE BREAKDOWN AND CAPSULAR SYNOVIAL METAPLASIA IN TEXTURED-WALL SALINE BREAST PROSTHESES

Saline-filled prostheses are currently the only type of prostheses ava ilable for cosmetic use in the United States because of concerns raise d about the possibility of systemic toxicity of silicone-filled artifi cial mammary implants. Although the approved implants are saline-fille d, their potential to release silicone particles from the shells has n ot been systematically evaluated. We performed microscopic examination of the pericapsular tissue of 54 patients with textured-surface impla nts and compared these with 51 patients with smooth-walled implants ov er a 2-year period. The capsules that had formed around virtually all textured-surface implants had silicone fragments present either in ext racellular spaces, in vacuolated histiocytes, or in the form of foreig n-body granulomas in surrounding fibroadipose tissue but not in capsul es associated with smooth-walled implants. In 87 percent of samples of pericapsular tissue from textured saline implants, the contact surfac e displayed exuberant reactive synovial metaplasia, a histologic patte rn not previously described with these devices. Our findings suggest t hat smooth-walled prostheses are associated with less silicone fragmen tation than textured devices in the peri-implant tissue capsules that tend to form around artificial surfaces used for this purpose.