Ultrastructural anatomy of contracted capsules around textured implants inaugmented breasts

The development of a capsule around an implant is part of the physiological response to a foreign body. Capsular contracture is the most specific and frustrating complication of augmentation mammaplasty, and a lot of studies have been devoted to it. The aim of the current study is to examine the fin e architecture of the contracted capsule around textured implants in humans . Eight capsules from augmented and contracted breasts with gel-filled, tex tured-surface silicone implants were studied after standard preparation for light and scanning electron microscopy, and after partial digestion in sod ium hydroxide. Two capsules from contracted breasts around smooth implants and two noncontracted capsules around textured implants were prepared and s tudied in the same fashion as controls, A multilayer structure of the contr acted capsule was seen, and the architecture of the various layers is descr ibed. The inner surface presents irregular craterlike depressions. The arra ngement of collagen fibers varies in capsule layers. The effect of a textur ed-surface implant on the mechanism of capsule contraction based on the obs erved capsular architecture is that only part of the capsule is effective m echanically in producing a contracting force. A thin vascular layer was ide ntified near the inner surface in contracted capsules around textured impla nts, and the authors' think that this layer is probably the key structure i n the histological development and growth of the capsule.