, Volume 73, Issue 1, pp 107–112 | Cite as

Histological and immunohistochemical characteristics of capsular synovial metaplasias that form around silicone breast implants

  • Martin Boháč
  • Ľuboš Danišovič
  • Ľudovít DanihelSr
  • Jozef FedelešSr
  • Ľudovít DanihelJr
  • Nikoleta Beerová
  • Štefan Polák
  • Ivan VargaEmail author
Original Article


Metaplasia is a reversible phenomenon that usually occurs in response to chronic irritation and/or inflammation. It allows for the substitution of fragile cells with those that are better able to survive under various circumstances. Our study aims to describe the histology of one unusual type of metaplasia results in the formation of a synovial-like membrane typical of joints inside a female patient’s breasts around silicone implants. We analyzed samples from 22 female patients, who underwent delayed-staged breast reconstructions. Attention was paid especially to tissue that was in direct contact with the silicone expander and that was under permanent pressure and friction between the implant and the surrounding tissue. Biopsies of explanted periprosthetic capsules were processed for examination by light microscopy. Immunohistochemical staining (ten different primary antibodies) was performed to examine a variety of cell-specific antigens. At the interface between the tissue capsule and the silicone breast expander, we typically observed a 50–200-μm cellular lining. Thanks to the high cellular density, this cellular layer resembled epithelium. However, there was no basement membrane, and cells were negative for cytokeratin. The cells forming the superficial layer were strongly positive for vimentin and podoplanin and weakly positive for the S100 protein. These cells did not express desmin or smooth muscle actin. Within the most superficial layer (synovial intima), we distinguished two types of cells: phagocytic (CD68-positive) and fibroblast-like synovial cells. We conclude that the cellular lining surrounding silicone breast implants looks like a true synovial membrane resembling a fibrous form of synovium.


Synovial cells Synovial metaplasia Periprosthetic capsule Silicone implants Immunohistochemistry 



The authors thank Mrs. Gabriela Fujerikova, BSc. for assistance during the preparation of histological specimens. The study was supported by VEGA Research Grant No. 1/0271/17 from the Slovak Ministry of Education.

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest.

Ethical approval

The Ethical Committee of the University Hospital Bratislava approved the study (protocol #UHB/006/2015/MB). All patients signed informed consent documents before participating in the study. The clinical study was also registered in the database (NCT02835781).


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Copyright information

© Slovak Academy of Sciences 2018

Authors and Affiliations

  • Martin Boháč
    • 1
  • Ľuboš Danišovič
    • 2
  • Ľudovít DanihelSr
    • 3
  • Jozef FedelešSr
    • 1
  • Ľudovít DanihelJr
    • 4
  • Nikoleta Beerová
    • 5
  • Štefan Polák
    • 5
  • Ivan Varga
    • 5
    Email author
  1. 1.Department of Plastic Surgery, Faculty of MedicineComenius University and University Hospital BratislavaBratislavaSlovakia
  2. 2.Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of MedicineComenius University in BratislavaBratislavaSlovakia
  3. 3.Institute of Pathology, Faculty of MedicineComenius University in BratislavaBratislavaSlovakia
  4. 4.Third Department of Surgery, Faculty of MedicineComenius University and Hospital of The Brothers of Saint John of GodBratislavaSlovakia
  5. 5.Institute of Histology and Embryology, Faculty of MedicineComenius University in BratislavaBratislavaSlovakia

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