From the Guidelines
Saline implants with extensive bilateral capsular calcification typically require surgical intervention for definitive management, and I strongly recommend complete removal of the implants and calcified capsules (capsulectomy) by a board-certified plastic surgeon experienced in complex breast implant cases. This condition occurs when calcium deposits form within the scar tissue capsule surrounding breast implants, leading to hardening, pain, distortion, and sometimes implant rupture. Prior to surgery, diagnostic imaging such as mammography, ultrasound, or MRI should be performed to assess the extent of calcification and implant integrity, as suggested by the guidelines for the pathologic diagnosis of breast implant-associated anaplastic large-cell lymphoma 1.
During surgery, the surgeon will likely need to remove both the implants and the calcified capsules, with options for replacement with new implants or complete removal without replacement (explantation) depending on your preferences and tissue quality. The processing of capsulectomy specimens is crucial, and the approach proposed by Lyapichev et al 1 can be followed, which includes analyzing the gross and microscopic features to assess both the distribution of residual disease and presence of invasion.
The preparation and sectioning of the specimen should be done carefully, as described in the guidelines 1, to ensure that all necessary tissue is submitted for histologic evaluation. Recovery typically requires 1-2 weeks of limited activity, with compression garments worn for several weeks. Capsular calcification develops due to chronic inflammation, implant leakage, or as a response to foreign material, and is more common in older implants or those with previous complications like capsular contracture.
It is essential to note that the clinical evaluation of patients with breast implants and symptoms, such as effusion or seroma, should be thorough, and the diagnosis of BIA-ALCL should be considered, as outlined in the guidelines 1. The use of ultrasound-guided aspiration (fine-needle aspiration) of the effusion is essential to obtaining an accurate diagnosis of BIA-ALCL, and the staining of specimens with specific antibodies, such as CD30, can help confirm the diagnosis 1.
In summary, the management of saline implants with extensive bilateral capsular calcification requires a comprehensive approach, including diagnostic imaging, surgical intervention, and careful processing of capsulectomy specimens, to ensure the best possible outcome for the patient. Key considerations include:
- Complete removal of implants and calcified capsules
- Diagnostic imaging to assess extent of calcification and implant integrity
- Careful processing of capsulectomy specimens
- Consideration of replacement with new implants or explantation
- Recovery and follow-up care to ensure optimal outcomes.
From the Research
Saline Implants with Extensive Bilateral Capsular Calcification
- Extensive bilateral capsular calcification is a rare but clinically important complication of breast implant use, including saline-filled implants 2, 3, 4.
- The pathogenesis of capsular calcification is not fully understood, but it is believed to be related to the presence of molecular silicone and/or Dacron patches in the pericapsular environment 2.
- Calcification properties of saline-filled breast implants differ from those of silicone gel-filled implants, with calcification occurring primarily on the implant surface and capsular calcification observed only microscopically 3.
- The incidence of capsular calcification is related to the generation of the implant, with first-generation implants more likely to calcify due to the presence of Dacron patches 4.
- Capsular calcification can mask calcifications of the breast due to carcinoma and exacerbate symptoms of capsular contracture, making removal of the calcified capsules and replacement of the implants in the submuscular position a recommended treatment option 2.
Treatment Options
- Surgical treatment, including capsulectomy or capsulotomy, is the standard management for capsular contracture, but is associated with a significant rate of recurrence 5.
- Non-surgical treatment options, such as overfilling a Spectrum™ adjustable saline implant, have shown promise in treating capsular contracture, but require further investigation 6.
- Medical treatment using leukotriene receptor antagonists, acellular dermal matrices, botox, and neopocket formation have also been reported to reduce severity and prevent capsular contracture, but are associated with varying degrees of success 5.
Risk Factors
- Risk factors for capsular contracture include the use of smooth implants, subglandular placement, use of silicone-filled implants, and previous radiotherapy to the breast 5.
- Textured implants, submuscular placement, and polyurethane-coated implants are associated with a lower incidence of capsular contracture 5.