Defining Double Capsules: A Clinical and Histological Study

Slyke, Aaron C. Van; Roller, Janine M.; Alaghehbandan, Reza; Carr, Nicholas

doi:10.1093/asj/sjab045

Cited by 5 publications

(2 citation statements)

References 21 publications

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“…Although double capsules have been reported in some patients before, 9,[14][15][16] this is the first known case of a patient with EDS with two independent implant capsules surrounding a single textured silicone implant. It seems likely that the two capsules resulted from the shearing of a single capsule at some point in the past, probably due to the COL5A genetic defect present in this patient's type I EDS.…”

Section: Discussionmentioning

confidence: 99%

Two Independent Capsules Surrounding a Single Textured Implant in Ehlers-Danlos Syndrome

Padmanabhan¹,

Liu²,

Sivaraj³

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Summary: Textured breast implants are associated with prolonged inflammation leading to increased risk for complications such as the development of anaplastic large cell lymphoma. The underlying molecular mechanisms that drive increased inflammation toward textured implants (compared with smooth implants) remain poorly understood. Here, we present the first known case of a patient with Ehlers-Danlos syndrome (EDS) who developed two independent fibrotic capsules around a single textured silicone implant. The patient was found to have one internal capsule tightly adherent to the implant and a second external capsule that was attached to the surrounding tissue. We observed that the internal implant-adherent capsule was composed of a highly aligned and dense collagen network, completely atypical for EDS and indicative of a high mechanical stress environment. In contrast, the external nonadherent capsule, which primarily interacted with the smooth surface of the internal capsule, displayed disorganized collagen fibers with no discernible alignment, classic for EDS. Remarkably, we found that the internal capsule displayed high activation of monocyte chemoattractant protein-1, a mechanoresponsive inflammatory mediator that was not elevated in the disorganized external capsule. Taken together, these findings demonstrate that the tight adhesion between the textured implant surface and the internal capsule creates a high mechanical stress environment, which is responsible for the increased local inflammation observed in the internal capsule. This unique case demonstrates that mechanical stress is able to override genetic defects locally in collagen organization and directly connects the textured surface of implants to prolonged inflammation.

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Section: Discussionmentioning

confidence: 99%

Two Independent Capsules Surrounding a Single Textured Implant in Ehlers-Danlos Syndrome

Padmanabhan¹,

Liu²,

Sivaraj³

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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“…A small study of Biocell-associated DCs has recently shown the inner lamina to range between a thin layer of nascent capsule and an identifiable organised one. Histological analysis revealed hypocellular fibrosis with synovial metaplasia and provided a clinicopathological correlation between DCs and failed tissue adherence [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

The Double Capsule Phenomenon in a Case Series and its Relationship with the Macro-Textured Breast Implant

Berry

Stanek

2022

Aesth Plast Surg

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Background Silicone breast augmentation remains one of the most common aesthetic surgery procedures, and 2022 marks the 60th anniversary of the first case. Recent studies suggest a link between double capsule (DC) formation and macro-textured devices. Methods Between 2010 and 2015, 268 aesthetic patients underwent bilateral mammary prosthesis exchange for indications including PIP exchange, adverse capsular contracture and ultrasonographic evidence of rupture. All surgery, in the form of implant exchange and capsulectomy, was undertaken by the senior author using standard techniques. A retrospective review was undertaken, and data analysed with descriptive statistics and Fisher’s exact and Mann–Whitney U tests. Results Of 268 patients identified, 40 (14.9%) showed some degree of capsular duplication and bilateral involvement was marginally more common (52.5%). Two macroscopic patterns of duplication were observed: complete and subtotal . Complete DCs correlated with a clinical triad of extreme firmness, mobility and minimal-to-no pain. Whilst a wide range of manufacturers was represented, macro-textured devices were associated with the highest DC prevalence (58.3% vs. 5.6%) (Fisher’s exact test p < 0.00001). Patients with DC had been implanted for less than half the time, median 52 versus. 120 months ( p = 0.0003) of those without. Discussion An elevated prevalence of duplicate capsules in macro-textured prostheses is reconfirmed in addition to a novel symptom constellation that may assist with clinical diagnosis. Our study reinforces the aetiopathogenic influence of the elastomer in DC formation and reports DC for the first time in non-macrotextured implants. Single-surgeon cohort of 268 consecutive patients with 532 implants Statistically significant association of macro-textured devices with DC Statistically significant reduced duration of implantation of macro-textured devices First report of DC in non-macro-textured devices Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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