Breast Implants

Definition

Foreign substances employed for breast augmentation; they may produce pathologic lesions

Silicone bag containing saline, silicone gel or silicone liquid
- Fibrous capsule may form around the bag
  - Dense fibrosis with chronic inflammation
  - May exhibit so called synovial metaplasia at interface with bag
  - Does not require leakage of bag contents for formation
  - Silicone as described below may shed from the bag surface and be found in the capsule
- If leakage or rupture occurs, silicone, if present,elicits a histiocytic response
  - Silicone in tissue forms oval refractile globules
    - It is not birefringent
  - If bag contains saline, rupture produces no tissue response
Polyurethane bag containing any of above fillings
- Same potential reactions as above
- Polyurethane in tissue forms refractile triangular bodies
  - It is not birefringent
Direct injection of various substances, including paraffin wax
- Typically forms lipid granulomas
Talc has been associated with capsular contracture
- Talc is birefrengent with a maltese-cross pattern
- Talc was banned on surgical gloves in 1991 in the USA
Polarization may reveal rare birefringent needle-like crystals consistent with silica
- Laser Raman spectroscopy has failed to identify this material as silica
All foreign substances in the breast may migrate to local and occasionally distant draining nodes

Richard L Kempson MD
Robert V Rouse MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342

Original posting:: May 27, 2006