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Double capsules related to dynamic malrotation of breast implants: a causal link?
Short reports and correspondence
Double capsules related to dynamic malrotation of breast implants: a causal link? We read with interest the short report by Pandya and Dickinson and Cross’s subsequent letter on double capsules that were recently published in the journal.1,2 Double capsules have also been reported in association with oil-based implants.3 We have recently seen a series of three patients that presented with breast deformity related to rotation of previously implanted prostheses. All three patients had uneventful insertion of implants with no immediate complications. The initial results were satisfactory but deformity was later noted. When the implants were exchanged it was noted that a double capsule was present (Fig. 1). All affected implants had rotated around both the vertical ðxÞ axis and the horizontal ðyÞ axis. There
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was minimal fluid present. All three patients recalled episodes of minor trauma prior to developing the deformity. Two patients had anatomical implants and one patient an implant expander. Beake describes a risk rate of 14% for malrotation of anatomical implants, many of whom related the problem to an episode of trauma,4 which corresponds with our experience. This may support the theory of Pandya and Dickinson that the double capsule is caused by the shearing of the implant complex form the breast tissue during movement. The occurrences of double capsules and the malrotation of anatomical implants have both been reported but not simultaneously. We propose that the implants initially integrate well but following minor trauma the interface between cavity and implant is disrupted. A new capsule then forms around the first producing a very low friction interface between the two and rotation of the implant may then occur.
References 1. Cross P. Double capsule or capsule within a capsule: is there a difference? Br J Plast Surg 2003;56(1):76. 2. Pandya ANDM. Capsule within a capsule: an unusual entity. Br J Plast Surg 2002;55(5):455—6. 3. Colville J, McLean N. True double capsules in oil based (Trilcent) breast implants. Br J Plast Surg;55(3):270—1. 4. Beake J. Breast deformity caused by anatomical or teardrop implant rotation. Plast Reconstr Surg 2002;109(7):2555—67.
Figure 1 Double capsule. A capsule is visible around the implant and adjacent to this is the specimen from a total capsulectomy from the same breast.
Paolo Matteucci, Le Roux Fourie Department of Plastic Surgery, Pinderfields General Hospital, Aberford Road, Wakefield, UK doi:10.1016/j.bjps.2003.11.022
Double capsules related to dynamic malrotation of breast implants: a causal link? We read with interest the short report by Pandya and Dickinson and Cross’s subsequent letter on double capsules that were recently published in the journal.1,2 Double capsules have also been reported in association with oil-based implants.3 We have recently seen a series of three patients that presented with breast deformity related to rotation of previously implanted prostheses. All three patients had uneventful insertion of implants with no immediate complications. The initial results were satisfactory but deformity was later noted. When the implants were exchanged it was noted that a double capsule was present (Fig. 1). All affected implants had rotated around both the vertical ðxÞ axis and the horizontal ðyÞ axis. There
289
was minimal fluid present. All three patients recalled episodes of minor trauma prior to developing the deformity. Two patients had anatomical implants and one patient an implant expander. Beake describes a risk rate of 14% for malrotation of anatomical implants, many of whom related the problem to an episode of trauma,4 which corresponds with our experience. This may support the theory of Pandya and Dickinson that the double capsule is caused by the shearing of the implant complex form the breast tissue during movement. The occurrences of double capsules and the malrotation of anatomical implants have both been reported but not simultaneously. We propose that the implants initially integrate well but following minor trauma the interface between cavity and implant is disrupted. A new capsule then forms around the first producing a very low friction interface between the two and rotation of the implant may then occur.
References 1. Cross P. Double capsule or capsule within a capsule: is there a difference? Br J Plast Surg 2003;56(1):76. 2. Pandya ANDM. Capsule within a capsule: an unusual entity. Br J Plast Surg 2002;55(5):455—6. 3. Colville J, McLean N. True double capsules in oil based (Trilcent) breast implants. Br J Plast Surg;55(3):270—1. 4. Beake J. Breast deformity caused by anatomical or teardrop implant rotation. Plast Reconstr Surg 2002;109(7):2555—67.
Figure 1 Double capsule. A capsule is visible around the implant and adjacent to this is the specimen from a total capsulectomy from the same breast.
Paolo Matteucci, Le Roux Fourie Department of Plastic Surgery, Pinderfields General Hospital, Aberford Road, Wakefield, UK doi:10.1016/j.bjps.2003.11.022