Breast Implant Rupture is Strongly Associated with Capsular Contracture: An Intrapatient Study

Capsular contracture is a common complication following breast augmentation and reconstruction with implants. Implant rupture is suspected to cause capsular contracture, but the evidence remains limited. This intrapatient study included consecutive patients with one ruptured and one intact implant who underwent bilateral implant exchange following breast augmentation. The primary outcome was the association between capsular contracture (Baker III-IV) and implant rupture. Secondary outcomes included comparisons of silicone content and histopathological characteristics of the breast implant capsule in the breast with a ruptured implant and the contralateral intact implant. Among 105 patients with unilateral implant rupture, capsular contracture was observed in 53 of 105 (50%) breasts with ruptured implants, versus 25 of 105 (24%) breasts with intact implants (OR=4.5, P<0.001). This association was entirely driven by low-cohesive implants (OR=7.5, P<0.001 and OR=23.0, P<0.001 in the sensitivity analysis) whereas no association was observed among the 13 patients with highly cohesive implants. Capsules surrounding ruptured implants contained significantly more silicone (median 1.97 mL vs. 0.11 mL; P<0.001), were thicker (median 926 µm vs. 526 µm; P<0.001), and showed increased lymphocyte- (P=0.002) and multinucleated giant cell infiltration (P<0.001) compared with capsules around intact implants. The study shows that implant rupture is an important risk factor for capsular contracture, likely mediated by silicone leakage causing inflammation and fibrosis. These findings emphasize the importance of preventing implant rupture, which can be achieved by using implants with a lower rupture rate, or by proactively exchanging implants before the risk of rupture increases.