Late unilateral breast enlargement after insertion of silicone gel implants: A histopathological study

Abstract

Late unilateral breast enlargement after the insertion of silicone gel breast implants is a very rare phenomenon. The present study reports five women who presented with this finding over the past 20 years. Three of these patients presented with late unilateral hematomas, which developed nine, 12 and 14 years, respectively, after initial breast augmentation, in the absence of any known trauma. These patients presented for treatment one, four and 12 months, respectively, after their breast enlargements initially appeared. Two of these patients had developed chronic expanding hematomas. Extensive histopathological analyses of the capsules of all three patients provided explanations for the etiologies and progressions of the findings in these patients. In each of the three patients, the etiology of the hematoma was consistent with erosion of a capsular artery. Numerous large vessels were seen within the wall of the capsules. In each case, there was a class IV capsular contracture, which could have increased the friction of the intact implant against the capsule, and there was both old (hemosiderin deposits) and new bleeding into the pocket from the capsules. This supports the concept that numerous episodes of bleeding had occurred in each case. Histopathology also demonstrated the progression of the hematomas. After four weeks, only liquefied hematoma was present, while after four months, there were both liquefied hematoma and blood clotting. The hematoma on the surface of the capsule was becoming organized peripherally, but not centrally. After 12 months, the hematoma was becoming very well organized compared with the hematoma at four months. In one of the two remaining cases, late infection was the cause of the breast enlargement. Histopathology of this capsule showed that the involved capsule was six times as thick as the other side. It also showed edema and infiltration by scattered mononuclear cells, polymorphonuclear cells, and irregular crenated and degenerating nuclei. In the final patient, chronic inflammation appeared to be the cause of the breast enlargement. The histopathology of this capsule was unique. Its inner surface showed re-epithelialization and metaplasia of the ductal epithelium to form stratified squamous epithelium with early surface keratinization. These findings are consistent with synovial metaplasia. Several areas of the fibrous portion of the capsule showed patchy loss of cellular staining with loss of nuclei, indicative of necrosis. This produced a 'washed out' staining appearance. This tissue was paucivascular and fibrotic, and showed areas of fibrinoid necrosis, suggestive of mechanical abrasion and increased pressure.Key Words: Enlargement; Silicone gel breast implants Hypertrophie mammaire unilatérale tardive après la pose d'une prothèse de silicone : examen histopathologique L'hypertrophie mammaire unilatérale tardive après la pose d'une prothèse de silicone est rarissime. Le présent rapport fait état de cinq femmes qui ont connu ce type de complication au cours des 20 dernières a...

Clinical Implications and Management of Non-ALCL Breast Implant Capsular Pathology

“…Capsular epithelialization is rarely reported, with only four reports published in the literature to date. 28–31 The reported presentations include nonspecific unilateral breast enlargement, breast implant extrusion, and contour irregularity with nonspecific fluid on magnetic resonance imaging. 28–31 The cause of capsular epithelialization is unknown; leading hypotheses include ingrowth of epithelial cells from the wound margin, metaplasia of breast duct cells, or surgical seeding of keratinocytes at the time of breast implant placement.…”

“…Capsular assessment by pathologic examination will typically reveal epithelial cells or keratinaceous debris, differentiating capsular epithelialization from other capsular disease. 28–31 Capsulectomy to ensure removal of any residual intracapsular epithelial tissue appropriately treated this condition in case reports.…”

“…Late hematomas in breast implant patients usually present as unilateral swelling of the breast that is more commonly chronic and progressive but can on occasion present acutely. 30,33–36 The exact incidence is unknown, and descriptions of late hematomas are limited to several case reports and small case series. 34,37,38 Many of the published cases have been deemed idiopathic, but some patients report an inciting traumatic event.…”

Late unilateral hematoma after breast augmentation

“…This is very rare and cases are largely anecdotal (4). Early infections are usually caused by endogenous bacteria from the skin or from the milk ducts.…”

“…L ate hematoma after breast implants is a rare phenomenon. Most studies in the literature are in the form of individual case reports (1)(2)(3)(4)(5)(6)(7); no data regarding the actual incidence of this phenomenon exists. It has been reported with smooth and textured silicone gel implants, saline implants and polyurethane-covered silicone gel implants.…”