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Adverse Capsular Contracture, pp. 47-85 $100.00
Authors:  M. G. Berry, Department of Human Pathology, University Hospital of Messina, Via Consolare Valeria, 1, Messina, Italy
Silicone prosthesis-based breast augmentation has shown year-on-year increases in popularity in both the USA and UK[1,2], but as surgical and implant technologies improve, adverse capsular contracture (ACC) has become a key determinant of outcome. ACC is the term given to the abnormal soft tissue reaction to a foreign body leading to constrictive fibrosis.
Constrictive fibrosis refers to the poorly understood phenomenon by which the capsule that normally envelops an implant shrinks in size. As the capsule is peripherally attached to the surrounding soft tissues and encloses a compressible fluid or gel, this capsular reduction results in concentric and/or irregular distortion of the implant. In turn, this produces signs and/or symptoms that require further surgical intervention.
The formation of a capsule around any foreign material entering the body is a normal response of the organism and is not per se pathological in nature. Its purpose is to wall off the foreign material from the rest of the body blocking any possible interaction of the exogenous material with body fluids or active immune cells triggering unwanted inflammatory or cell-mediated immune reactions.
Numerous clinical studies have been published over the years trying to elucidate the mechanism or at least to understand the natural history of this common side effect of breast implantation but, as we shall see, even this simple task has proved elusive in some key respects. Part of the difficulty is attributable to the heterogeneity of prostheses that have been available over the years with respect to both shell and content composition.
Breast implants have undergone an evolution spanning several decades, 

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Adverse Capsular Contracture, pp. 47-85