CAPSULE – SCAR TISSUE REMOVAL
Patients present for capsular contracture, severe, every week in my Beverly Hills and Las Vegas practice. What exactly is the capsule that forms around an implant? Any time a prosthetic device is placed in the body, i.e., hydraulic shunts into the brain, heart valves, aortic valves, mitral valves, prosthetic hips or any other form of internal foreign material, the body creates a capsule within one month. The composition of a capsule includes collagen, blood vessels, and fibroblast. Scar tissue formation around internal appliances and implantable devices is common and usual. A capsule will form a internal protective cover on any foreign object, including a splinter in the finger. When a capsule becomes thickened due to increase in collagen or myofibroblastic contraction, hardening can occur, leading to capsular contracture of the breast. Baker I classification is soft, Baker II is palpable, Baker III is palpable and hard, Baker IV is palpable, hard and distortion and coldness to the breast occurs.
The photograph shows portions of capsule removed during a recent capsulectomy. Notice the thickness of the capsule. The capsule can vary in color, from yellow to whitish, pure white. This is associated with silicone calcifications. It can also be associated with protein within the capsule and can be an important indicator of an acute versus chronic rupture of the silicone implant. Capsules can present with hardening and calcifications and plaque formation called silicone granulomata which may be associated with a ruptured silicone implant after a long period of time. Capsule tissue should always be sent to Pathology for diagnostic purposes in order to determine malignancy. Malignancy can occur within a capsule. Patients especially with seromas within the breast or chronic seromas should be tested, the fluid, for lymphoblastic cancer. It is important to realize that capsules are normal. They do form and will form in any antigen, including a breast implant. What becomes pathological is when it becomes thick, hard and contracts which may again lead to severe disfigurement and pain.