D19. Silicone Breast Implant Rupture is Associated With a Higher Risk of Capsular Contracture: An Intra-patient Study of 96 Patients With Unilateral Implant Rupture

PURPOSE: To investigate the association between silicone breast implant rupture and capsular contracture. METHODS: In this intra-patient study, we included patients scheduled for bilateral implant replacement who had a unilateral implant rupture. We analyzed the association between implant rupture and preoperatively diagnosed capsular contracture (Baker III and IV). We used a histopathological scoring system to exclude potentially misclassified cases of capsular contracture in a sensitivity analysis. Biopsies of the breast implant capsule from all included breasts were examined histologically to quantify silicone and to assess histological changes. RESULTS: A total of 96 patients with a ruptured implant and a contralateral intact implant were included. Capsular contracture was significantly more prevalent in the breasts with implant rupture (50/96, 52%) than in the breasts with intact implants (22/96, 23%; p<0.001). This was verified in the sensitivity analysis which excluded 28 patients with potential misclassifications (p<0.001). Implant rupture was associated with significantly more silicone in the breast implant capsule than intact implants (1.97 mL vs. 0.11 mL, p<0.001). Implant rupture was also associated with a significantly greater capsule thickness (p<0.001), higher degrees of lymphocyte infiltration (p=0.002), and presence of foreign body giant cells (p<0.001) in the breast implant capsule compared with intact implants. CONCLUSION: Silicone breast implant rupture leads to increased silicone deposition in the breast implant capsule and is associated with a higher risk of capsular contracture. These findings suggest that exchanging breast implants before implant rupture may reduce the risk of capsular contracture.