Publication:

Histopathological findings in grade IV capsular contracture clinically diagnosed at the Hospital General de México

Background To describe the histopathological findings in capsular tissue obtained from female patients with grade IV capsular contracture (Baker classification) who underwent explantation with capsulectomy at the Hospital General de México.

Methods An observational, retrospective and descriptive study was conducted at the Plastic and Reconstructive Surgery Service of the Hospital General de México "Dr. Eduardo Liceaga." Female patients with breast implants who were clinically diagnosed with grade IV capsular contracture (Baker) between June 2023 and June 2026 were included. All patients underwent explantation with capsulectomy and capsular specimens were sent for histopathological analysis to the hospital's Pathology Department. Pre-surgical variables (age, implant longevity, number of previous exchanges), intraoperative variables (implant integrity, placement plane, type of capsulectomy) and histopathological findings were analyzed. Descriptive statistics were used, with absolute frequencies and percentages for qualitative variables and means and standard deviations for quantitative variables.

Results A total of 50 female patients were included, with a mean age of 49.1±10.1 years (range: 30–70 years). The mean implant longevity was 12.4 years and 86% had no previous implant exchange. The implant was intact in 92% of cases, the retro glandular plane was identified in 78% and total capsulectomy was performed in 88%. Fibrosis was present in 100% of specimens, predominantly moderate (35, 70%) and extensive/marked (11, 22%). Synovial metaplasia was identified in 33 (66%) of cases. Chronic inflammation was present in 35 (70%) of cases, with nonspecific/mild inflammation being the most prevalent subtype (19, 38%), followed by granulomatous foreign body-type inflammation (10, 20%) and xanthomatous inflammation (6, 12%). Dystrophic calcification was found in 8 (16%), stromal hyalinization in 4 (8%), hemorrhage in 3 (6%), bacterial colonies in 1 (2%) and apocrine metaplasia in 2 (4%). Residual mammary parenchymal findings were identified in 7 (14%) of cases. All 50 (100%) specimens were negative for malignancy.

Conclusions The histopathological analysis of periprosthetic capsules in patients with grade IV capsular contracture demonstrates a consistent pattern dominated by fibrosis, present universally and synovial metaplasia, identified in two-thirds of cases. The presence of chronic inflammation in the majority of patients and dystrophic calcification in a relevant subset reflects a sustained foreign body response. No specimen showed evidence of malignancy. These findings provide a histopathological baseline for grade IV capsular contracture in a Mexican tertiary care center.