Breast Expander-Implant Capsules: Correlation Between the Type of Expander Texturation (Biocell or Siltex ) , the Timing of First Expansion and the Capsular Characteristics

Purpose: is there an optimal expansion schedule for each breast expander?

 The efficacy of breast prosthesis texturing is still a debated question. However it has been established that the type of texture will determine the type of capsular reaction. The timing of breast expander filling is also subject to variations .   We analyzed two usual schedules of filling for the two most popular breast expander texture in North America: Biocell (Allergan), and Siltex (Mentor). An observation at the electron microscopic level of the capsular reaction was achieved. Cellularity relief and biofilm presence in breast implant capsules were analyzed around 2 type of expander with 2 filling schedule. 

Methods:

We prospectively included 60 breast cancer patients for a total of 60 expanders. Four groups were constituted considering the delay between implantation of the expander, first filling and the expander texture .  Group 1: Biocell first filling before day 15 ; G2: Biocell first filling after 6 weeks ;G3: Siltex first filling before day 15 ; G4: Siltex  first filling after 6 weeks .1 cm² periprosthetic capsule specimens were sampled during expander to permanent implant exchange. All samples were analyzed under SEM using High Vacuum (HiVac) modes and  Energy dispersive X-ray (EDX) studies. Observations were charted in order to tally and objectivise three parameters: texture/cellularity /presence of biofilm   

Results:

All groups were constituted of 15 samples from 15 patients. 

Group 1: Biocell first filling before day 15 : very low level of  texture , low cellularity and 52% of  biofilm . EDX microanalysis allows detection of silicium in the capsular tissue

G2: Biocell first filling after 6 weeks: high level of texture, high cellularity with 45% of echinocytes (red blood cells with a modified cellular membrane), no biofilm.

G3: Siltex first filling before day 15: very low level of texture, low cellularity and 22% of biofilm.

G4: Siltex  first filling after 6 weeks: very low level of texture, low cellularity and 25% of biofilm .

Conclusions:

There is probably an optimal inflation scheme for each type of breast expander in order to reduce the presence of biofilm and obtain the full potential of the material. For deep texture Biocell implant we believe there is a major interest waiting 6 weeks before the first filling.