The double capsules in macro-textured breast implants

Biomaterials. 2015 Oct;67:65-72. doi: 10.1016/j.biomaterials.2015.06.010. Epub 2015 Jun 23.


Breast implants are amongst the most widely used types of permanent implants in modern medicine and have both aesthetic and reconstructive applications with excellent biocompatibility. The double capsule is a complication associated with textured prostheses that leads to implant displacement; however, its etiology has yet to be elucidated. In this study, 10 double capsules were sampled from breast expander implants for in-depth analysis; histologically, the inner capsular layer demonstrated highly organized collagen in sheets with delamination of fibers. At the prosthesis interface (PI) where the implant shell contacts the inner capsular layer, scanning electron microscopy (SEM) revealed a thin layer which mirrored the three-dimensional characteristics of the implant texture; the external surface of the inner capsular layer facing the intercapsular space (ICS) was flat. SEM examination of the inner capsule layer revealed both a large bacterial presence as well as biofilm deposition at the PI; a significantly lower quantity of bacteria and biofilm were found at the ICS interface. These findings suggest that the double capsule phenomenon's etiopathogenesis is of mechanical origin. Delamination of the periprosthetic capsule leads to the creation of the ICS; the maintained separation of the 2 layers subsequently alters the biostability of the macro-textured breast implant.

Keywords: Bacteria; Biofilm; Biostability; Scanning electron microscopy (SEM); Silicone breast implant; Silicone macrotexturation.

MeSH terms

  • Biofilms
  • Breast Implants* / microbiology
  • Breast Neoplasms / pathology
  • Breast Neoplasms / surgery
  • Capsules
  • Colony Count, Microbial
  • Female
  • Humans
  • Image Processing, Computer-Assisted*
  • Microscopy, Electron, Scanning
  • Middle Aged


  • Capsules