SIGNIFICANCE OF HISTOPATHOLOGICAL PARAMETERS IN FEMALE PATIENTS AFTER PLACEMENT OF BREAST IMPLANTS
Abstract
Introduction: Mammoplasty is a surgical procedure of placement of breast implants for aestetic reasons or because of breast reconstruction after mastectomy after cancer. As the implant represents a foreign body, there is an inflammatory reaction and complications (most often capsule contractures, most rarely anaplastic large cell lymphoma), with different histopathological presentations (synovial metaplasia, chronic inflammation, dystrophic calcifications, granulomas around a foreign body type). Clinically, these complications are presented as tumor-like changes.
Aim: Aim of the paper is to show the most significant histopathological parameters, age of the patients at the time of the complications, period that passed from the placement of the implant to the onset of complications and the existence of previous cancer.
Material and methods: This study included patients with breast implants in the period of January 2019 to December 2023. Evaluating data from medical records, we performed a retrospective study, which included: age of the patient at the time of complications, reasons for performing mammoplasty, period that passed from mammoplasty to the appearance of complications. Archived material was used (paraffin molds and histopathological material stained with the hematoxylin-eosin method, as well as immunochistochemical stainings). Descriptive statistics methods (Fishers exact probability test) were used for data analysis.
Results: Average age of the patients was 50.1 years, and the period that passed from the placement of the implant to the appearence of complications was 16.7 years. The breast cancer previously had 22%. Most common histopathological parameters were synovial metaplasia (100%) followed by chronic inflammation (76%), foreign material (52%) and granuloma around a foreign body (32%). The breast surgery was performed for cosmetic reasons in 88% of the patients.
Conclusion: This study proved that the patients were older and that more time passed before complications occurred than was shown in literature. Large percent of patients had the procedure only because of cosmetic reasons.
References
2. Guimier E, Carson L, David B, Lambert JM, Heery E, Malcolm K.R. Pharmacological Approaches for the Prevention of Breast Implant Capsular Contracture, School of Pharmacy, Queen’s University Belfast. 2022; 280:129-150
3. Bo Choi S, Kim J, Kim D, Park J, Lee Y, Park K, et al. Augmentation Mammoplasty Using Polyacrylamide Hydrogel Injection Can Mimic Breast Cancer After 20 Years: A Case Report. Journal of Breast Disease. 2022; 10(2):77-81
4. Larsen A, Timmermann AM, Kring M, et al. A Histological Assessment Tool for Breast Implant Capsules Validated in 480 Patients with and Without Capsular Contracture. Aesthetic Plast Surg. Published online June 7, 2024. doi:10.1007/s00266-024-04128-5
5. Leung KM, Yeoh G, Chan KW. Breast pathology in complications associated with polyacrylamide hydrogel (PAAG) mammoplasty. Hong Kong Med J. 2007; 13:137-140
6. Gorgy A, Barone N, Nepon H, et al. Implant-based breast surgery and capsular formation: when, how and why?-a narrative review. Ann Transl Med. 2023;11(11):385. doi:10.21037/atm-23-131
7. Van Diest PJ, Beekman WH, Hage JJ. Pathology of silicone leakage from breast implants. J Clin Pathol. 1998;51(7):493-497. doi:10.1136/jcp.51.7.493
8. Fowler MR, Nathan CO, Abreo F. Synovial metaplasia, a specialized form of repair. Arch Pathol Lab Med. 2002;126(6):727-730. doi:10.5858/2002-126-0727-SMASFO
9. Coussens LM, Werb Z. Inflammation and cancer. Nature. 2002;420(6917):860-867. doi:10.1038/nature01322
10. Yeoh G, Russell P, Jenkins E. Spectrum of histological changes reactive to prosthetic breast implants: a clinopathological study of 84 patients. Pathology. 1996;28(3):232-235. doi:10.1080/00313029600169044
11. Del Rosario AD, Bui HX, Petrocine S, et al. True synovial metaplasia of breast implant capsules: a light and electron microscopic study. Ultrastruct Pathol. 1995;19(2):83-93. doi:10.3109/0191312950901460
12. Siggelkow W, Faridi A, Spiritus K, Klinge U, Rath W, Klosterhalfen B. Histological analysis of silicone breast implant capsules and correlation with capsular contracture. Biomaterials. 2003;24(6):1101-1109. doi:10.1016/s0142-9612(02)00429-5
