Background This study investigated the relationships\nbetween histomorphological aspects of breast capsules,\nincluding capsule thickness, collagen fiber alignment, the\npresence of a-smooth muscle actin (a-SMA)ââ?¬â??positive\nmyofibroblasts, and clinical observations of capsular\ncontracture.\nMethods Breast capsule samples were collected at the\ntime of implant removal in patients undergoing breast\nimplant replacement or revision surgery. Capsular contracture\nwas scored preoperatively using the Baker scale.\nHistological analysis included hematoxylin and eosin\nstaining, quantitative analysis of capsule thickness, collagen\nfiber alignment, and immunohistochemical evaluation\nfor a-SMA and CD68.\nResults Forty-nine samples were harvested from 41 patients.\nA large variation in histomorphology was observed\nbetween samples, including differences in cellularity, fiber\ndensity and organization, and overall structure. Baker I\ncapsules were significantly thinner than Baker II, III, and\nIV capsules. Capsule thickness positively correlated with\nimplantation time for all capsules and for contracted capsules\n(Baker III and IV). Contracted capsules had significantly\ngreater collagen fiber alignment and a-SMAââ?¬â??\npositive immunoreactivity than uncontracted capsules\n(Baker I and II). Capsules from textured implants had\nsignificantly less a-SMAââ?¬â??positive immunoreactivity than\ncapsules from smooth implants.\nConclusion The histomorphological diversity observed\nbetween the breast capsules highlights the challenges of\nidentifying mechanistic trends in capsular contracture. Our\nfindings support the role of increasing capsule thickness\nand collagen fiber alignment, and the presence of contractile\nmyofibroblasts in the development of contracture.\nThese changes in capsule structure may be directly related\nto palpation stiffness considered in the Baker score. Approaches\nto disrupt these processes may aid in decreasing\ncapsular contracture rates.\nLevel of Evidence III This journal requires that authors\nassign a level of evidence to each article. For a full description\nof these Evidence-Based Medicine ratings, please\nrefer to the Table of Contents or the online Instructions to\nAuthors www.springer.com/00266.
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