Foreign substances employed for breast augmentation; they may produce pathologic lesions
Diagnostic Criteria
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
Supplemental studies
Immunohistology
The cells associated with pseudo-synovial metaplasia of the implant capsule are CD68 positive
No specific synovial markers are available for testing
Polarization
Substance
Birefringence
Silicone
No
Polyurethane
No
Talc
Yes, maltese-cross
Silica
Yes, needle-like crystals
Differential Diagnosis
Identification of various substances associated with breast implants
Foreign Substance
Tissue Pattern
Birefringence
Silicone
Globules, refractile
No
Polyurethane
Triangular, refractile
No
Talc
Inconspicuous
Yes (maltese cross)
Silica (questionable occurence)
Needle shaped crystals
Yes
Clinical
The question of an association between implants and various disorders including autoimmune disorders has been hotly debated in both scientific and legal settings
Because of the potential for legal action, the gross specimen should be carefully described
Any identifying characters or numbers should be recorded
The specimen should be photographed
We retain the gross specmens indefinitely
Report
Report
The implant should be photographed
Any identifying marks, characters or numbers should be recorded
Because of the potential for legal action, we retain the gross specimens indefinitely
Rosen PP, Oberman HA. Tumors of the Mammary Gland, Atlas of Tumor Pathology, AFIP Third Series, Fascicle 7, 1993
Chandler PJ Jr. Talc and capsular contracture. Ann Plast Surg. 2004 Mar;52(3):288-92.
Pasteris JD, Wopenka B, Freeman JJ, Young VL, Brandon HJ. Analysis of breast implant capsular tissue for crystalline silica and other refractile phases. Plast Reconstr Surg. 1999 Apr;103(4):1273-6.
Abbondanzo SL, Young VL, Wei MQ, Miller FW. Silicone gel-filled breast and testicular implant capsules: a histologic and immunophenotypic study. Mod Pathol. 1999 Jul;12(7):706-13.
Emery JA, Spanier SS, Kasnic G Jr, Hardt NS. The synovial structure of breast-implant-associated bursae. Mod Pathol. 1994 Sep;7(7):728-33.
