Stromal-cellular remodeling of breast tissue after silicone implant damage

Abstract

One of the current vectors of modern reconstructive and cosmetic surgery is augmentation mammoplasty - an operation to enlarge the mammary glands. The breast implant is well tolerated by the body, as the immunogenicity of its material is extremely low. At the same time, the silicone gel of the implant is a foreign object and the surrounding breast tissues give a stereotypical response in the form of growth of the connective tissue stroma with the formation of a capsule around the implant and the appearance of focal cellular infiltrates. Modern breast implants, unlike implants of previous decades, are more sophisticated in their structure, and the level of protection against damage is much higher. A complication associated with the long-term use (up to 20 years) of implants, where low-quality silicone or industrial silicone was used as a filler, is the penetration of low-molecular-weight particles of the implant through its shell to the surrounding tissues with the subsequent formation of silicone granules. In the vast majority, such changes develop after mechanical traumatization of the implant. The purpose of the study is to establish the morphological criteria of the reaction of breast tissue after silicone implant damage. The material for research was histological micropreparations of breast tissue from the archive of the "Grace Clinic" (Kyiv), with the mutual consent of patients who applied for repeated mammoplasty. The duration of the implants in the breast gland was from 6 to 20 years. The age range of the women was from 36 to 53 years. On preparations stained with hematoxylin and eosin, tissue biopsies of the glands of 9 patients with a diagnosis of deformation of silicone implants and violation of the integrity of their wall were presented. The micropreparations were visualized using a UlabXSP-137TLED light microscope at various magnifications and photographed with an XCAM 1080P camera. The study of histological preparations of soft tissues of the breast glands, from which silicone implants were removed, established changes in stromal-cellular elements, namely: decorated fibrous structures accumulated in the form of dense capsules with elements of local contractures; from the side of cellular elements, the most demonstrative were cellular infiltrates, which included macrophages, lymphocytes, and plasma cells, which indicated a high probability of a chronic inflammatory process. A large number of giant multinucleated cells of foreign bodies were present in practically all examined sections, which indicated the impossibility of macrophages to complete phagocytosis with lysis of the phagocytosed material, which by its chemical composition is the silicone of the implant. All the described phenomena can be interpreted as a natural reaction of the tissues to the implant, the contents of which got into the soft tissues of the breast. Thus, the presence of numerous giant multinucleated cells of foreign bodies, dense capsules with elements of local contractures, and a significant predominance of macrophages, lymphocytes, and plasma cells in cellular infiltrates over other cellular elements can be considered a morphological criterion for the reaction of breast tissue to silicone implant damage.