Baker-IV capsular contracture is correlated with an increased amount of silicone material: an intra-patient study

BACKGROUND: Breast implant surgery is one of the most frequently performed procedures by plastic surgeons worldwide. However, the relationship between silicone leakage and the most common complication, capsular contracture, is far from understood. This study aimed to compare Baker-I with Baker-IV capsules regarding their silicone content in an intra-donor setting, using two previously validated imaging techniques.METHODS: Twenty-two donor-matched capsules from eleven patients experiencing unilateral complaints were included after bilateral explantation surgery. All capsules were examined using both Stimulated Raman Scattering (SRS) imaging and staining with Modified Oil Red O (MORO). Evaluation was done visually for qualitative and semi-quantitative assessment and automated for quantitative analysis.RESULTS: Using both SRS and MORO techniques, silicone was found in more Baker-IV capsules (8/11 and 11/11, respectively) than in Baker-I capsules (3/11 and 5/11, respectively). Baker-IV capsules also showed significantly more silicone content compared to the Baker-I capsules. This was true for semi-quantitative assessment for both SRS and MORO techniques (p=0.019 and p=0.006, respectively), while quantitative analysis proved to be significant for MORO alone (p=0.026 vs. p=0.248 for SRS).CONCLUSIONS: In this study, a significant correlation between capsule silicone content and capsular contracture is shown. An extensive and continued foreign body response to silicone particles is likely to be responsible. Considering the widespread use of silicone breast implants these results affect many women worldwide and warrant a more focused research effort.