A new Danish study, published in Plastic and Reconstructive Surgery, finds that breast implant rupture is strongly associated with capsular contracture, and that silicone leakage and inflammatory changes may explain the connection.
Researchers from Copenhagen University Hospital and other Danish plastic surgery centres examined patients who had undergone bilateral implant exchange after breast augmentation, where one implant was ruptured and the other was intact. The goal was to compare outcomes within the same patient, reducing variability.
Key findings
Among 105 patients with unilateral implant rupture, 50% (53 of 105) of the breasts with a ruptured implant showed capsular contracture (Baker grade III-IV), compared to 24% (25 of 105) of breasts with intact implants. The odds ratio (OR) was 4.5, with P < 0.001.
The association was driven largely by low-cohesive implants: in these implants, the OR was 7.5 (P < 0.001), and in sensitivity analysis 23.0 (P < 0.001). By contrast, among 13 patients with highly cohesive implants, no statistically significant association was observed.
Histological and silicone findings
The study also compared the capsules around ruptured vs intact implants in the same patients. Among ruptured implants, compared with intact ones:
- Capsules contained significantly more silicone (median 1.97 mL vs. 0.11 mL)
- Capsules were thicker (median 926 µm vs. 526 µm)
- There was increased infiltration by lymphocytes (P = 0.002) and multinucleated giant cells (P < 0.001) in the capsules around ruptured implants.
Conclusions and implications
The authors conclude that implant rupture appears to be a significant risk factor for capsular contracture, likely mediated by silicone leakage causing inflammation and fibrosis.
They emphasise the importance of preventing implant rupture, either by using implants with lower rupture rates, or by proactively exchanging implants before the risk of rupture increases.
You can read more about best practice guidelines for breast implant surgery here, which set standards for patient safety, implant selection, monitoring and patient counselling.
