Discussion on capsules over time

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I asked Dr. Kolb this question:

" Dr. Kolb, is there any evidence that capsules resolve on their own,

or are absorbed over time? "

Here is her reply:

" If there is any silicone in the capsule, such as with gel or

textured implants, I do not think they dissolve over time. If is

probable that smooth capsules can dissolve over time, but I do not

know for sure that they do. The complication rate if capsules are

not removed is higher than if they are removed. Kolb M.D. "

I had asked Dr. Melmed for evidence of the capsules being absorbed

over time. This was Dr. Melmed's reply:

" Reoperation shows the capsule to be basically shrivveled down to a

tiny bit of scar tissue almost unidentifyable. "

So, it appears that there is some debate on this.

Here is a study that would seem to support removal of the capsule as

much as possible:

Author: Hardt, N. S.; Yu, L.; LaTorre, G.; Steinbach, B.

Address: Dept. Pathology, University of Florida College of Medicine,

Gainesville, FL.

Source: Plastic and Reconstructive Surgery Journal, Feb., 1995,

95:2, 364-71

Abstract: Citing evidence that breast implant-related capsules

resolve

uneventfully, surgeons have elected to leave the capsules in place

when

implants are removed because capsulectomy adds both morbidity and

expense to

the procedure. However, recent clinical and histopathologic evidence

suggests

that uneventful resolution is not always the case, and several

potential

problems may arise from retained capsules after removal of the

implant.

Retained implant capsules may result in a spiculated mass suspicious

for

carcinoma, dense calcifications that obscure neighboring breast

tissue on

subsequent imaging studies, and cystic masses due to persistent

serous

effusion, expansile hematoma, or encapsulated silicone filled cysts.

Furthermore, retained capsules are a reservoir of implant-related

foreign

material in the case of silicone gel-filled implants and textured

implants

promoting tissue ingrowth. To avoid complications from retained

capsules,

total capsulectomy or postoperative surveillance should be offered to

patients.

And this link where the above study is found has further evidence,

including Dr. Blais's article on long term risk factors of retained

capsules.

Excerpt:

" In summary, a capsule with a dense fibro-collagenous wall behaves

as a

bioreactor. Worse yet, it is fitted with a semi-permeable wall that

may

periodically open to release its content to the breast. The

probability of

finding the space colonized with atypical microorganisms is elevated

and the

control of infective processes by classic pharmacologic approaches is

difficult if not impossible. "

http://runningrace.freeyellow.com/explantation/en_bloc.html