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Breast Implant Complication Review

2011; Lippincott Williams & Wilkins; Volume: 128; Issue: 3 Linguagem: Inglês

10.1097/prs.0b013e3182221513

1529-4242

Howard N. Robinson,

Reconstructive Surgery and Microvascular Techniques

Sir:FigureI enjoyed Dr. Elizabeth Hall-Findlay's excellent article (Plast Reconstr Surg. 2011;127:56–66) concerning double-capsule formation, but I disagree with her explanation of its cause. In 1993, I presented a paper at the American Society for Aesthetic Plastic Surgery meeting in Los Angeles entitled "Double Capsule Formation with Textured Implants." I had performed approximately 100 subglandular breast augmentations with textured gel implants up to the moratorium and noted this phenomenon in two patients. The first patient requested exchange to a smaller size and had moderate spherical contracture on one side. At reoperation, the double-capsule phenomenon was noted on the firm side. The implant was surrounded on 95 percent of its surface by a double capsule, with the 5 percent located retro to the implant. There was only a single capsule on the soft side. The second patient had a complete double encapsulation found at reoperation to treat bilateral spherical contracture. Photomicrographs of the inner capsule clearly showed the irregular collagen surface that was attached to the implant with a smooth surface on its outside. There was a small amount of fluid between the inner capsule and the smooth surface of the outer capsule. The implants were McGhan style 100 gel Biocell implants (McGhan Medical Corp., Santa Barbara, Calif.) that had space for saline to be added to the same lumen that contained the gel. Because the inner capsule was attached tightly like a hook-and-loop fastener, like Dr. Hall-Findlay, I also theorized a mechanical explanation. The double capsule was caused by an activity that caused the initial capsule to shear away from the tissue surface remaining attached to the implant. Fluid normally found in many implant pockets and movement kept it from reattaching until it was gradually and completely stripped away. A new capsule formed around what now amounted to a smooth-surfaced implant and formed a contracture. DISCLOSURE The author has no financial interests in McGhan, Allergan, or Mentor. Howard N. Robinson, M.D. 601 North Flamingo Road, Pembroke Pines, Fla. 33028, [email protected]