1
|
Mao Y, Hou X, Fu S, Luan J. Transcriptomic and machine learning analyses identify hub genes of metabolism and host immune response that are associated with the progression of breast capsular contracture. Genes Dis 2024; 11:101087. [PMID: 38292203 PMCID: PMC10825289 DOI: 10.1016/j.gendis.2023.101087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/03/2023] [Accepted: 08/16/2023] [Indexed: 02/01/2024] Open
Abstract
Capsular contracture is a prevalent and severe complication that affects the postoperative outcomes of patients who receive silicone breast implants. At present, prosthesis replacement is the major treatment for capsular contracture after both breast augmentation procedures and breast reconstruction following breast cancer surgery. However, the mechanism(s) underlying breast capsular contracture remains unclear. This study aimed to identify the biological features of breast capsular contracture and reveal the potential underlying mechanism using RNA sequencing. Sample tissues from 12 female patients (15 breast capsules) were divided into low capsular contracture (LCC) and high capsular contracture (HCC) groups based on the Baker grades. Subsequently, 41 lipid metabolism-related genes were identified through enrichment analysis, and three of these genes were identified as candidate genes by SVM-RFE and LASSO algorithms. We then compared the proportions of the 22 types of immune cells between the LCC and HCC groups using a CIBERSORT analysis and explored the correlation between the candidate hub features and immune cells. Notably, PRKAR2B was positively correlated with the differentially clustered immune cells, which were M1 macrophages and follicular helper T cells (area under the ROC = 0.786). In addition, the expression of PRKAR2B at the mRNA or protein level was lower in the HCC group than in the LCC group. Potential molecular mechanisms were identified based on the expression levels in the high and low PRKAR2B groups. Our findings indicate that PRKAR2B is a novel diagnostic biomarker for breast capsular contracture and might also influence the grade and progression of capsular contracture.
Collapse
Affiliation(s)
- Yukun Mao
- Breast Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100144, China
| | - Xueying Hou
- Breast Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100144, China
| | - Su Fu
- Breast Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100144, China
| | - Jie Luan
- Breast Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100144, China
| |
Collapse
|
2
|
Ivanova E, Fayzullin A, Minaev N, Dolganova I, Serejnikova N, Gafarova E, Tokarev M, Minaeva E, Aleksandrova P, Reshetov I, Timashev P, Shekhter A. Surface Topography of PLA Implants Defines the Outcome of Foreign Body Reaction: An In Vivo Study. Polymers (Basel) 2023; 15:4119. [PMID: 37896364 PMCID: PMC10610271 DOI: 10.3390/polym15204119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/19/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023] Open
Abstract
The formation of a dense fibrous capsule around the foreign body and its contracture is the most common complication of biomaterial implantation. The aim of our research is to find out how the surface of the implant influences the inflammatory and fibrotic reactions in the surrounding tissues. We made three types of implants with a remote surface topography formed of polylactide granules with different diameters: large (100-200 µm), medium (56-100 µm) and small (1-56 µm). We placed these implants in skin pockets in the ears of six chinchilla rabbits. We explanted the implants on the 7th, 14th, 30th and 60th days and performed optical coherence tomography, and histological, immunohistochemical and morphometric studies. We examined 72 samples and compared the composition of immune cell infiltration, vascularization, the thickness of the peri-implant tissues, the severity of fibrotic processes and α-SMA expression in myofibroblasts. We analyzed the scattering coefficient of tissue layers on OCT scans. We found that implants made from large granules induced a milder inflammatory process and slower formation of a connective tissue capsule around the foreign body. Our results prove the importance of assessing the surface texture in order to avoid the formation of capsular contracture after implantation.
Collapse
Affiliation(s)
- Elena Ivanova
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), 8-2 Trubetskaya St., Moscow 119991, Russia; (E.I.); (A.F.); (N.S.); (E.G.); (M.T.); (P.T.)
- B.V. Petrovsky Russian Research Center of Surgery, 2 Abrikosovskiy Lane, Moscow 119991, Russia
| | - Alexey Fayzullin
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), 8-2 Trubetskaya St., Moscow 119991, Russia; (E.I.); (A.F.); (N.S.); (E.G.); (M.T.); (P.T.)
| | - Nikita Minaev
- Institute of Photon Technologies of FSRC “Crystallography and Photonics” RAS, Troitsk, Moscow 108840, Russia; (N.M.); (E.M.)
| | - Irina Dolganova
- Osipyan Institute of Solid State Physics of the Russian Academy of Sciences, 2 Osipyan St., Chernogolovka 142432, Russia;
| | - Natalia Serejnikova
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), 8-2 Trubetskaya St., Moscow 119991, Russia; (E.I.); (A.F.); (N.S.); (E.G.); (M.T.); (P.T.)
| | - Elvira Gafarova
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), 8-2 Trubetskaya St., Moscow 119991, Russia; (E.I.); (A.F.); (N.S.); (E.G.); (M.T.); (P.T.)
| | - Mark Tokarev
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), 8-2 Trubetskaya St., Moscow 119991, Russia; (E.I.); (A.F.); (N.S.); (E.G.); (M.T.); (P.T.)
| | - Ekaterina Minaeva
- Institute of Photon Technologies of FSRC “Crystallography and Photonics” RAS, Troitsk, Moscow 108840, Russia; (N.M.); (E.M.)
| | - Polina Aleksandrova
- Prokhorov General Physics Institute of the Russian Academy of Sciences, 38 Vavilova St., Moscow 119991, Russia;
| | - Igor Reshetov
- L.L. Levshin Institute of Cluster Oncology, Sechenov First Moscow State Medical University (Sechenov University), 8-2 Trubetskaya St., Moscow 119991, Russia;
| | - Peter Timashev
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), 8-2 Trubetskaya St., Moscow 119991, Russia; (E.I.); (A.F.); (N.S.); (E.G.); (M.T.); (P.T.)
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, Sechenov First Moscow State Medical University (Sechenov University), 8-2 Trubetskaya St., Moscow 119991, Russia
| | - Anatoly Shekhter
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), 8-2 Trubetskaya St., Moscow 119991, Russia; (E.I.); (A.F.); (N.S.); (E.G.); (M.T.); (P.T.)
| |
Collapse
|
3
|
Diehm YF, Thomé J, Will P, Kotsougiani-Fischer D, Haug VF, Siegwart LC, Kneser U, Fischer S. Stem Cell-Enriched Hybrid Breast Reconstruction Reduces Risk for Capsular Contracture in a Hybrid Breast Model. Plast Reconstr Surg 2023; 152:572-580. [PMID: 36735813 DOI: 10.1097/prs.0000000000010260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hybrid breast reconstruction (HBR) combines silicone implants with fat grafting to improve implant coverage, treating local tissue deficiencies and leading to a more natural breast appearance. Recent data also indicated less capsular contracture after HBR. The authors developed a novel technique and animal model of cell-assisted (CA) HBR to illuminate its effects on capsular contracture. METHODS Animals received silicone implants in a dorsal submuscular pocket. Although animals of the HBR group received fat grafting around the implant without stem cell enrichment, rats of the CA-HBR1 and the CA-HBR2 groups received stem cell-enriched fat grafting with 2 × 10 6 and 4 × 10 6 adipose-derived stem cells immediately after implant insertion. On day 60, animals underwent sonography and elastography imaging and were euthanized, and outcome analysis was performed by means of histology, immunohistochemistry, chemical collagen quantification, and gene expression analysis. RESULTS With this novel technique, long-term survival of adipose-derived stem cells within the implant pocket was demonstrated after 60 days after implant insertion. CA-HBR led to significantly reduced thickness and collagen density of capsular contractures. In addition, CA-HBR resulted in reduced fibrotic responses with less occurrence of collagen type I and transforming growth factor-β in capsule tissue. Moreover, the addition of stem cells suppressed fibrotic and inflammatory responses on a genetic level with significant underexpression of collagen type I and transforming growth factor-β1. CONCLUSIONS With this new technique and animal model, the authors observed a preventive effect on capsular contracture substantiating the basis of clinical outcomes of HBR. The authors propose that the addition of stem cells to HBR might booster its beneficial results. CLINICAL RELEVANCE STATEMENT Stem cell-enriched fat grafting around silicone implants may reduce the risk for capsular contracture after silicone breast implantation. While fat grafting alone already shows beneficial effects, the addition of stem cells to the fat graft can potentiate this effect.
Collapse
Affiliation(s)
- Yannick F Diehm
- From the Department of Hand, Plastic, and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen; University of Heidelberg
| | - Julia Thomé
- From the Department of Hand, Plastic, and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen; University of Heidelberg
| | - Patrick Will
- From the Department of Hand, Plastic, and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen; University of Heidelberg
| | - Dimitra Kotsougiani-Fischer
- From the Department of Hand, Plastic, and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen; University of Heidelberg
- Private Practice for Plastic and Aesthetic Surgery, Aesthetikon Mannheim and Heidelberg
| | - Valentin F Haug
- From the Department of Hand, Plastic, and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen; University of Heidelberg
| | - Laura C Siegwart
- From the Department of Hand, Plastic, and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen; University of Heidelberg
| | - Ulrich Kneser
- From the Department of Hand, Plastic, and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen; University of Heidelberg
| | - Sebastian Fischer
- From the Department of Hand, Plastic, and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen; University of Heidelberg
- Private Practice for Plastic and Aesthetic Surgery, Aesthetikon Mannheim and Heidelberg
| |
Collapse
|
4
|
Chau Nguyen TT, Shin CM, Lee SJ, Koh ES, Kwon HH, Park H, Kim DH, Choi CH, Oh SH, Kim DW, Yang SY. Ultrathin Nanostructured Films of Hyaluronic Acid and Functionalized β-Cyclodextrin Polymer Suppress Bacterial Infection and Capsular Formation of Medical Silicone Implants. Biomacromolecules 2022; 23:4547-4561. [PMID: 36130109 PMCID: PMC9667880 DOI: 10.1021/acs.biomac.2c00687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/08/2022] [Indexed: 11/29/2022]
Abstract
A type of ultrathin films has been developed for suppressing capsule formation induced by medical silicone implants and hence reducing the inflammation response to such formation and the differentiation to myofibroblasts. The films were each fabricated from hyaluronic acid (HA) and modified β-cyclodextrin (Mod-β-CyD) polymer which was synthesized with a cyclodextrin with partially substituted quaternary amine. Ultrathin films comprising HA and Mod-β-CyD or poly(allylamine hydrochloride) (PAH) were fabricated by using a layer-by-layer dipping method. The electrostatic interactions produced from the functional groups of Mod-β-CyD and HA influenced the surface morphology, wettability, and bio-functional activity of the film. Notably, medical silicone implants coated with PAH/HA and Mod-β-CyD multilayers under a low pH condition exhibited excellent biocompatibility and antibiofilm and anti-inflammation properties. Implantation of these nanoscale film-coated silicones showed a reduced capsular thickness as well as reduced TGFβ-SMAD signaling, myofibroblast differentiation, biofilm formation, and inflammatory response levels. We expect our novel coating system to be considered a strong candidate for use in various medical implant applications in order to decrease implant-induced capsule formation.
Collapse
Affiliation(s)
- Thi Thuy Chau Nguyen
- Department
of Polymer Science and Engineering, Graduate
School of Chungnam National University, 99 Daehak-Ro, Yuseong-gu, Daejeon 34134, Republic
of Korea
| | - Chung Min Shin
- Department
of Plastic Surgery, Chungnam National University
School of Medicine, 266 Munhwa-Ro, Chung-Gu, Daejeon 35015, Republic of Korea
| | - Su Jin Lee
- Department
of Polymer Science and Engineering, Graduate
School of Chungnam National University, 99 Daehak-Ro, Yuseong-gu, Daejeon 34134, Republic
of Korea
| | - Eun Seo Koh
- Department
of Polymer Science and Engineering, Graduate
School of Chungnam National University, 99 Daehak-Ro, Yuseong-gu, Daejeon 34134, Republic
of Korea
| | - Hyeok Hee Kwon
- Department
of Medical Science, Chungnam National University
School of Medicine, 266
Munhwa-Ro, Chung-Gu, Daejeon 35015, Republic of Korea
| | - Hyewon Park
- Department
of Medical Science, Chungnam National University
School of Medicine, 266
Munhwa-Ro, Chung-Gu, Daejeon 35015, Republic of Korea
| | - Dong Ho Kim
- Department
of Microbiology, Chungnam National University
School of Medicine, 266
Munhwa-Ro, Chung-Gu, Daejeon 35015, Republic of Korea
- Department
of Medical Science, Chungnam National University
School of Medicine, 266
Munhwa-Ro, Chung-Gu, Daejeon 35015, Republic of Korea
| | - Chul Hee Choi
- Department
of Microbiology, Chungnam National University
School of Medicine, 266
Munhwa-Ro, Chung-Gu, Daejeon 35015, Republic of Korea
- Department
of Medical Science, Chungnam National University
School of Medicine, 266
Munhwa-Ro, Chung-Gu, Daejeon 35015, Republic of Korea
| | - Sang-Ha Oh
- Department
of Plastic Surgery, Chungnam National University
School of Medicine, 266 Munhwa-Ro, Chung-Gu, Daejeon 35015, Republic of Korea
| | - Dong Woon Kim
- Department
of Anatomy and Cell Biology, Chungnam National
University School of Medicine, 266 Munhwa-Ro, Chung-Gu, Daejeon 35015, Republic of Korea
| | - Sung Yun Yang
- Department
of Polymer Science and Engineering, Graduate
School of Chungnam National University, 99 Daehak-Ro, Yuseong-gu, Daejeon 34134, Republic
of Korea
| |
Collapse
|
5
|
Discussion on "In Vivo and In Vitro Fibroblasts' Behavior and Capsular Formation in Correlation with Smooth and Textured Silicone Surfaces by Shuqing Huang, Qiong Zhu, Qiong Zhu, Yiming Zhang, Zeyuan Lei, Xin Zhou, Dongli Fan". Aesthetic Plast Surg 2022; 46:1178-1179. [PMID: 35286412 DOI: 10.1007/s00266-022-02830-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 11/01/2022]
|
6
|
Papaconstantinou A, Koletsa T, Demiri E, Tzorakoleftheraki SE, Gasteratos K, Pavlidis L, Dionyssiou D, Spyropoulou GA. Investigation of Autologous Fat Transfer in Capsule Formation around Silicone Implants in a Rat Model. Plast Reconstr Surg 2022; 149:881-887. [PMID: 35139050 DOI: 10.1097/prs.0000000000008923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In this experimental study, the authors investigated whether fat placement in the pocket during implant insertion affects capsule formation. METHODS Twenty albino Wistar rats, 400 g each, were used. The rats were divided into two groups, A and B, of 10 rats each. At the dorsum of each rat, four pockets (2 × 2 cm each) were dissected, two left and two right of the midline. In each pocket, a 1 × 1 × 1.5-cm silicone implant was inserted. In the two left pockets, only silicone implants were placed (control). In the two right pockets, 0.4 ml of fat was injected around the implant. Animals in group A were killed 2 months postoperatively, and those in group B were killed 4 months postoperatively. The implants were dissected with the capsule and sent for histopathologic examination. RESULTS The data of the fat transfer group was compared with control in groups A and B. Capsule thickness, neovascularization, myofibroblast layer thickness, and mast cell population demonstrated no statistically significant difference in either group A (p = 0.385, p = 0.862, p = 0.874, and p = 0.210, respectively) or group B (p = 0.338, p = 1.000, p = 0.288, and p = 0.344, respectively). Inflammation was statistically significantly less (p = 0.07) at 4 months (group B) in the fat transfer group compared to the control group. Likewise, cellularity was statistically significantly less (p = 0.019) at 4 months for the fat transfer group compared with the control group. CONCLUSION Fat injection in the pocket during implant placement may reduce inflammation and cellularity of capsules and predispose to faster capsule maturation. CLINICAL RELEVANCE STATEMENT PLEASE PROVIDE 1- TO 2-SENTENCE STATEMENT.
Collapse
Affiliation(s)
- Anthony Papaconstantinou
- From the Departments of Plastic Surgery and Pathology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki
| | - Triantafyllia Koletsa
- From the Departments of Plastic Surgery and Pathology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki
| | - Efterpi Demiri
- From the Departments of Plastic Surgery and Pathology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki
| | - Sofia-Eleni Tzorakoleftheraki
- From the Departments of Plastic Surgery and Pathology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki
| | - Kostantinos Gasteratos
- From the Departments of Plastic Surgery and Pathology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki
| | - Leonidas Pavlidis
- From the Departments of Plastic Surgery and Pathology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki
| | - Dimitrios Dionyssiou
- From the Departments of Plastic Surgery and Pathology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki
| | - Georgia-Alexandra Spyropoulou
- From the Departments of Plastic Surgery and Pathology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki
| |
Collapse
|
7
|
Berger R, Ribas Filho JM, Malafaia O, Nassif PAN, Silva EN, Silva ABDD, Takejima M, Souza MAD, Paula PHD, Montemor Netto MR, Noronha LD. Histological evaluation of capsules formed by texturized silicone implants with and without polyester mesh coverage (Parietex®). A study on female rats. Acta Cir Bras 2021; 36:e360505. [PMID: 34133505 PMCID: PMC8205442 DOI: 10.1590/acb360505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 04/13/2021] [Indexed: 11/22/2022] Open
Abstract
Purpose To evaluate capsules formed by microtextured silicone implants with and
without Parietex® mesh coverage histologically. Methods Sixty Wistar rats were divided in two groups (meshed and unmeshed). Each
group was, then, divided into two subgroups for evaluation at 30 and 90
days. Capsules were analyzed based on hematoxylin and eosin (HE) and
picrosirius staining. Results The number of fibroblasts, neutrophils and macrophages was similar among all
subgroups. There was a higher lymphocyte reaction in the 30-day meshed group
(p = 0.003). Giant cell reaction, granulation tissue and neoangiogenesis
were similar among the subgroups. Synovial metaplasia was milder at 90-day
in the unmeshed (p = 0.002) and meshed group (p < 0.001). Capsular
thickness was significantly greater in the meshed samples (30-day p <
0.001 and 90-day p < 0.001). There was a similar amount of collagen types
I and III in both groups. Conclusions The mesh-covered implants produced capsules similar to the microtextured ones
when analyzing inflammatory variables. Synovial metaplasia was milder at 90
than at 30 days, and the capsular thickness was significantly greater in the
meshed group. A similar amount of collagen types I and III was observed. Due
to these characteristics, the mesh coverage did not seem to significantly
affect the local inflammatory activity.
Collapse
Affiliation(s)
- Ralf Berger
- Mackenzie Evangelical School of Medicine, Brazil
| | | | | | | | | | | | | | | | | | - Mário Rodrigues Montemor Netto
- Universidade Federal do Paraná, Brazil; Universidade Estadual de Ponta Grossa, Brazil; Santa Casa de Misericórdia, Brazil
| | | |
Collapse
|
8
|
Tallroth L, Brorson H, Mobargha N, Velander P, Klasson S, Becker M. Breast softness in patients randomised to postmastectomy breast reconstruction with an expander prosthesis or DIEP flap. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-021-01835-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Abstract
Background
Objectively measured breast softness in reconstructed breasts and its relation to patients’ subjective satisfaction with breast softness has not yet been investigated. The aim of this study was to evaluate breast softness in patients 1 year following delayed breast reconstruction with an expander prosthesis (EP) or deep inferior epigastric perforator (DIEP) flap, using objective and subjective methods.
Methods
Seventy-three patients were randomised to breast reconstruction with an EP or DIEP flap between 2012 and 2018. Of these, 69 completed objective evaluation at a mean of 25 (standard deviation, SD 9.4) months following breast reconstruction. Objective evaluation included measurements of breast volume, jugulum-nipple distance, clavicular-submammary fold distance, ptosis and Baker scale grading. Breast softness was assessed with applanation tonometry. Subjective evaluation was performed using the BREAST-Q questionnaire.
Results
Objectively, DIEP flaps were significantly softer than EP breast reconstructions. Non-operated contralateral breasts were significantly softer compared with reconstructed breasts. In the subjective evaluation, the median score on the question (labelled 1.h) “How satisfied or dissatisfied have you been with the softness of your reconstructed breast (s)?” was higher in the DIEP flap group corresponding to greater satisfaction in this group. A fair correlation was found between the applanation tonometry and the patient-reported satisfaction with the reconstructed breast’s softness (rs = 0.37).
Conclusions
In terms of breast softness, breast reconstructions with DIEP flaps result in more satisfied patients. Concerning applanation tonometry as an objective tool for softness assessment, future studies on interobserver agreement are warranted.
Level of evidence: Level I, therapeutic study
Collapse
|
9
|
Pontes GH, Carneiro Filho FSM, Vargas Guerrero LA, Lipinski LC, de Noronha L, Silva EN, Serra-Guimarães F. Reduced Remodeling Biomarkers Tissue Expression in Nanotextured Compared With Polyurethane Implants Capsules: A Study in Rats. Aesthet Surg J 2021; 41:NP664-NP683. [PMID: 33232440 DOI: 10.1093/asj/sjaa315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND In the biological response to biomaterials, the implant shell plays a key role in immune and inflammatory reactions. We hypothesized that the capsules formed around nanotextured implants exhibit an immunohistochemical behavior different to those formed around polyurethane implants. OBJECTIVES The aim of this study was to evaluate through immunohistochemistry markers the capsules formed around nanotextured and polyurethane implants. METHODS Sixty albino female Wistar rats were divided into 2 groups (nanotextured and polyurethane), with 30 animals in each group. A mini silicone implant was inserted on the back of the animals. After a predetermined period, the animals were killed, and the capsules formed around the implants were studied. The capsules in the 30-, 60-, and 90-day subgroups were analyzed via immunohistochemistry to detect markers for fibroblast α smooth muscle actin (α-SMA), transforming growth factor β (TGF-β), cluster of differentiation 34 (CD34), and CD68, via picrosirius staining to determine the density of type I and III collagen fibers and via hematoxylin and eosin staining to assess capsule thickness. A Wilcoxon-Mann-Whitney test was used to compare the groups, and a Kruskal-Wallis test was used to compare the subgroups. RESULTS Lower α-SMA, TGF-β, CD34 and CD68 immunoexpression was observed in the nanotextured 30- and 60-day subgroups than in the corresponding polyurethane subgroups. In the 90-day subgroup, more pronounced α-SMA and CD34 immunoexpression was observed in the nanotextured group; however, TGF-β and CD68 immunoexpression remained lower. The nanotextured implants showed reduced capsular thickness and greater formation of type I collagen in all the analyzed subgroups. CONCLUSIONS Nanotextured implants led to reduced immune and inflammatory reactions compared with polyurethane implants according to all analyzed variables.
Collapse
Affiliation(s)
- Gisela Hobson Pontes
- Postgraduate Program in Physiopathology and Surgical Sciences, State University of Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | | | | | | | - Lucia de Noronha
- Anatomical Pathology, Pontifical Catholic University of Paraná (PUC-PR), Curitiba-PR, Brazil
| | | | - Fernando Serra-Guimarães
- Postgraduate Program in Physiopathology and Surgical Sciences, State University of Rio de Janeiro (UERJ)
| |
Collapse
|
10
|
Shin CM, Cho S, Kim DH, Ha Y, Shin HJ, Shin N, Kim DW, Choi CH, Cho WK, Oh SH. Zwitterionic polydopamine coatings suppress silicone implant-induced capsule formation. Biomater Sci 2021; 9:3425-3432. [PMID: 33949402 DOI: 10.1039/d0bm02215b] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A synthetic zwitterionic dopamine derivative (ZW-DOPA) containing both catechol and amine groups was recently shown to exhibit excellent antifouling activity on marine surfaces. Here, we have extended these analyses to investigate the effects of ZW-DOPA coating on silicone implants. Successful formation of ZW-DOPA coatings on silicone implants was confirmed based on a combination of decreased static water contact angles on silicone implants, evidence of new peaks at 400.2 (N 1s), 232.2 (S 2s), and 168.0 (S 2p) eV, and increased quantitative atomic composition of C 1s with a concurrent decrease of Si 2p. Anti-biofilm formation assays revealed that ZW-DOPA coating prevented biofilm formation on silicone at a non-lethal concentration (0.5 mg mL-1). Capsule formation was also significantly inhibited by ZW-DOPA coating in vivo and the differentiation of fibroblasts into myofibroblasts was significantly suppressed. Together, these data suggest that silicone implants coated with ZW-DOPA may prevent capsular contracture after insertion when used in breast surgery.
Collapse
Affiliation(s)
- Chung Min Shin
- Department of Plastic and Reconstructive Surgery, Chungnam National University College of Medicine, Daejeon 35015, Republic of Korea.
| | - Soojeong Cho
- Department of Chemistry, Chungnam National University, Daejeon 34134, Republic of Korea.
| | - Dong Ho Kim
- Department of Medical Science, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea and Department of Microbiology, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea
| | - Yooseok Ha
- Department of Plastic and Reconstructive Surgery, Chungnam National University College of Medicine, Daejeon 35015, Republic of Korea.
| | - Hyo Jung Shin
- Department of Medical Science, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea and Department of Anatomy and Cell Biology, Brain Research Institute, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea
| | - Nara Shin
- Department of Medical Science, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea and Department of Anatomy and Cell Biology, Brain Research Institute, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea
| | - Dong Woon Kim
- Department of Medical Science, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea and Department of Anatomy and Cell Biology, Brain Research Institute, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea
| | - Chul Hee Choi
- Department of Medical Science, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea and Department of Microbiology, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea
| | - Woo Kyung Cho
- Department of Chemistry, Chungnam National University, Daejeon 34134, Republic of Korea.
| | - Sang-Ha Oh
- Department of Plastic and Reconstructive Surgery, Chungnam National University College of Medicine, Daejeon 35015, Republic of Korea.
| |
Collapse
|
11
|
The State of the Art about Etiopathogenetic Models on Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL): A Narrative Review. J Clin Med 2021; 10:jcm10102082. [PMID: 34066230 PMCID: PMC8151182 DOI: 10.3390/jcm10102082] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Breast-implant-associated anaplastic large cell lymphoma is a rare malignancy linked to texturized breast implants. Although many researchers focus on its etiopathogenesis, this topic is affected by a lack of evidence. Materials and Methods: A literature review about BIA-ALCL was made. Results and conclusions: Although the incidence is reported between 1:355–1:30,000, there is great attention to BIA-ALCL. The incidence is uncertain due to many reasons. It may well be lower, due to inclusion in multiple databases as pointed out by the FDA and undiagnosed cases. The role of chronic inflammation, bacterial contamination, and mechanical forces was discussed. Clarification is needed to understand the mechanisms underlying the progression of alterations and mutations for BIA-ALCL; new molecular analysis and pathogenetic models should be investigated.
Collapse
|
12
|
Ham J, Kim Y, An T, Kang S, Ha C, Wufue M, Kim Y, Jeon B, Kim S, Kim J, Choi TH, Seo JH, Kim DW, Park JU, Lee Y. Covalently Grafted 2-Methacryloyloxyethyl Phosphorylcholine Networks Inhibit Fibrous Capsule Formation around Silicone Breast Implants in a Porcine Model. ACS APPLIED MATERIALS & INTERFACES 2020; 12:30198-30212. [PMID: 32574031 DOI: 10.1021/acsami.0c07629] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The surface of human silicone breast implants is covalently grafted at a high density with a 2-methacryloyloxyethyl phosphorylcholine (MPC)-based polymer. Addition of cross-linkers is essential for enhancing the density and mechanical durability of the MPC graft. The MPC graft strongly inhibits not only adsorption but also the conformational deformation of fibrinogen, resulting in the exposure of a buried amino acid sequence, γ377-395, which is recognized by inflammatory cells. Furthermore, the numbers of adhered macrophages and the amounts of released cytokines (MIP-1α, MIP-1β, IL-8, TNFα, IL-1α, IL-1β, and IL-10) are dramatically decreased when the MPC network is introduced at a high density on the silicone surface (cross-linked PMPC-silicone). We insert the MPC-grafted human silicone breast implants into Yorkshire pigs to analyze the in vivo effect of the MPC graft on the capsular formation around the implants. After 6 month implantation, marked reductions of inflammatory cell recruitment, inflammatory-related proteins (TGF-β and myeloperoxidase), a myoblast marker (α-smooth muscle actin), vascularity-related factors (blood vessels and VEGF), and, most importantly, capsular thickness are observed on the cross-linked PMPC-silicone. We propose a mechanism of the MPC grafting effect on fibrous capsular formation around silicone implants on the basis of the in vitro and in vivo results.
Collapse
Affiliation(s)
- Jiyeon Ham
- Department of Chemistry, College of Natural Sciences, Seoul National University, Gwanak-ro 1, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Youngmin Kim
- Interdisciplinary Program in Stem Cell Biology, College of Medicine, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
- Department of Plastic and Reconstructive Surgery, Institute of Human-Environment Interface Biology, College of Medicine, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Taeyang An
- Department of Chemistry, College of Natural Sciences, Seoul National University, Gwanak-ro 1, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Sunah Kang
- Department of Chemistry, College of Natural Sciences, Seoul National University, Gwanak-ro 1, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Cheolmin Ha
- Department of Plastic and Reconstructive Surgery, Institute of Human-Environment Interface Biology, College of Medicine, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Maierdanjiang Wufue
- Department of Plastic and Reconstructive Surgery, Institute of Human-Environment Interface Biology, College of Medicine, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Yumin Kim
- Department of Chemistry, College of Natural Sciences, Seoul National University, Gwanak-ro 1, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Byoungjun Jeon
- Interdisciplinary Program in Bioengineering, College of Engineering, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Seulah Kim
- Department of Chemistry, College of Natural Sciences, Seoul National University, Gwanak-ro 1, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Jungah Kim
- Department of Chemistry, College of Natural Sciences, Seoul National University, Gwanak-ro 1, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Tae Hyun Choi
- Department of Plastic and Reconstructive Surgery, Institute of Human-Environment Interface Biology, College of Medicine, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Ji-Hun Seo
- Department of Materials Science and Engineering, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Dae Woo Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul National University Boramae Medical Center, 5 Gil 20, Boramae-ro, Dongjak-gu, Seoul 07061, Republic of Korea
| | - Ji-Ung Park
- Department of Plastic and Reconstructive Surgery, Seoul National University Boramae Hospital, 5 Gil 20, Boramae-ro, Dongjak-gu, Seoul 07061, Republic of Korea
| | - Yan Lee
- Department of Chemistry, College of Natural Sciences, Seoul National University, Gwanak-ro 1, Gwanak-gu, Seoul 08826, Republic of Korea
| |
Collapse
|
13
|
A multi-center, retrospective, preliminary observational study to assess the safety of BellaGel® after augmentation mammaplasty. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-020-01626-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Abstract
Background
BellaGel® is the only cohesive silicone gel-filled breast implant from a Korean manufacturer, and it was first developed in 2005. It was approved by the CE in 2008, thus becoming the first Asian breast implant available in the EU. We conducted this study to assess the safety of BellaGel® in patients receiving augmentation mammaplasty.
Methods
We evaluated a consecutive series of 239 patients (478 breasts) who received esthetic augmentation mammaplasty using the BellaGel® (round smooth, round textured, round nanotextured, and anatomical textured types of implant) (HansBiomed Co. Ltd., Seoul, Korea) at three clinics in Korea (JW Plastic Surgery Center, BS The Body Plastic Surgery Clinic and Grace Plastic Surgery Clinic) during a period from December 1, 2015 to January 31, 2018.
Results
A total of 239 patients with a mean age of 33.1 ± 8.5 years old were followed up during a mean period of 399.58 ± 232.71 days, where there were no cases of capsular contracture in our clinical series of the patients. Other complications include one case (0.4%) of seroma, three cases (1.3%) of hematoma, and one case (0.4%) of infection. Moreover, there were no significant differences in the cumulative incidences of complications between the four types of the BellaGel® (χ2 = 2.322, df = 3, P = 0.508). Furthermore, the cumulative Kaplan-Meier survival rate was estimated at 0.979 (95% CI 0.961–0.997).
Conclusions
Our results indicate that the BellaGel® is such a safe breast implant that surgeons might consider using it for esthetic augmentation mammaplasty.
Level of evidence: Level III, risk/prognostic study.
Collapse
|
14
|
Kang S, Kim J, Kim S, Wufuer M, Park S, Kim Y, Choi D, Jin X, Kim Y, Huang Y, Jeon B, Choi TH, Park JU, Lee Y. Efficient reduction of fibrous capsule formation around silicone breast implants densely grafted with 2-methacryloyloxyethyl phosphorylcholine (MPC) polymers by heat-induced polymerization. Biomater Sci 2020; 8:1580-1591. [DOI: 10.1039/c9bm01802f] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This article presents the efficacy of heat-induced MPC-grafting against excessive fibrous capsule formation and related inflammation in tissues surrounding silicone breast implants inserted in a pig model.
Collapse
|
15
|
Zingaretti N, Galvano F, Vittorini P, De Francesco F, Almesberger D, Riccio M, Vaienti L, Parodi PC. Smooth Prosthesis: Our Experience and Current State of Art in the Use of Smooth Sub-muscular Silicone Gel Breast Implants. Aesthetic Plast Surg 2019; 43:1454-1466. [PMID: 31342127 DOI: 10.1007/s00266-019-01464-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The objective of this clinical review is to provide an overview of the use of silicone gel-filled breast implants placed in the sub-muscular position, with a focus on complication rates reported for both smooth and textured implants. Furthermore, our experience in this field is also reviewed. METHODS MEDLINE, EMBASE, Web of Science, Scopus, the Cochrane Central and Google Scholar databases were reviewed to identify the literature related to smooth breast implants. Each article was reviewed by two independent reviewers to ensure all relevant publications were identified. The literature search identified 98 applicable articles. Of these, just a few articles were found to have a therapeutic level of evidence. The reference lists in each relevant paper were screened manually to include relevant papers not found through the initial search. RESULTS Eight articles report the risk of capsular contracture when the breast implants were placed in the sub-muscular position. Six of these articles report a similar rate of capsular contracture in smooth and textured implants. Local complications such as wrinkling, late seroma and double capsules were found to be associated with the use of textured breast implants (4 articles). All articles concerning BIA-ALCL reported a total absence occurring in smooth breast implants. All cases have been associated with textured mammary prostheses. CONCLUSION With our expertise in the field and the results of this up-to-date literature review, it can be concluded that there are no significant advantages of using one type of implant surface over the other when placed in the sub-pectoral position. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Collapse
|
16
|
The Collagenase of the Bacterium Clostridium histolyticum in the Treatment of Irradiation-Induced Capsular Contracture. Aesthetic Plast Surg 2019; 43:836-844. [PMID: 30456640 DOI: 10.1007/s00266-018-1267-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/04/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Irradiation therapy is an important pillar in the treatment of breast cancer. However, it can trigger capsular fibrosis, the most significant complication of implant-based breast reconstruction. As collagen is the main component of fibrotic capsules, the collagenase of the bacterium Clostridium histolyticum poses a potential treatment option for this pathological condition. METHODS Thirty-six rats received miniature silicone implants on their backs. On day 1, the implant sites of two groups were irradiated with 10 Gy. On day 120, one irradiated group received collagenase injections into the implant pockets (n = 12). Non-irradiated (n = 12) and irradiated capsules (n = 12) were injected with plain solvent solution serving as controls. Data were analyzed by means of in vivo imaging, histology, immunohistochemistry and gene expression analysis. RESULTS Compared with both controls, the injection of collagenase led to significantly thinner capsules. This was verified by in vivo imaging and histology. Although irradiation provoked alterations in capsule collagen structure and vessel wall thickness, the application of collagenase resulted in a significant reduction of collagen density. This was accompanied by an up-regulation of VEGF-A gene expression. Of note, hematoma formation inside the implant pocket occurred in two cases after collagenase injection. CONCLUSIONS The collagenase of the bacterium Clostridium histolyticum is effective in degrading irradiation-induced capsular fibrosis around silicone implants. Hematoma formation occurred most likely because of irradiation-induced alterations in vessel wall architecture and capsule vascularization. Further studies need to be performed to address the clinical safety of this novel treatment option.
Collapse
|
17
|
Silva EN, Ribas-Filho JM, Tabushi FI, Silva MAP, Siqueira EBD, de Noronha L, da Silva ABD, Lipinski LC, Guth I, Vosgerau LM. Smooth Muscle Alpha Actin Immunoexpression (α-Sma) and CD-117 Antibody (C-Kit) in Capsules Formed by Polyurethane Foam-Coated Silicone Implants and with Textured Surface: A Study on Rats. Aesthetic Plast Surg 2019; 43:233-242. [PMID: 30276460 DOI: 10.1007/s00266-018-1238-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/09/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND One of the undesirable complications that might occur after breast augmentation with silicone implants is capsular contracture. In its etiology, the relations between mast cells and myofibroblasts play an important role in collagen synthesis. Mast cells are able to activate fibroblasts into myofibroblasts, through paracrine secretions, inducing collagen production. The objectives of this study were to analyze the myofibroblast concentration through the α-SMA immunomarker and evaluate the intensity of mast cell expression against the C-Kit immunomarker. MATERIAL AND METHOD Sixty-four Wistar rats were used, divided into two groups (polyurethane foam and textured surface) with 32 animals in each. The animals received silicone implants on the back, below the panniculus carnosus, and after the determined period, they were killed and the capsules formed around the implants were studied. The capsules were analyzed employing the immunohistochemical technique, with the α-SMA and C-Kit immunomarkers in subgroups of 30, 50, 70 and 90 days. RESULTS The myofibroblast concentration was higher in the polyurethane group when compared to the textured group (30 days p = 0.105; 50 days p = 0.247; 70 days p = 0.014 and 90 days p = 0.536). The intensity of mast cell expression was more pronounced in the polyurethane group when compared to the textured group (30 days p = 0.798; 50 days p = 0.537; 70 days p = 0.094 and 90 days p = 0.536). CONCLUSIONS Polyurethane-coated implants induced higher concentrations of myofibroblasts and higher expression of mast cells, when compared to the textured surface implants. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
- Eduardo Nascimento Silva
- Evangelical Faculty of Medicine of Paraná (FEPAR), Evangelical University Hospital of Curitiba (HUEC) and Institute for Medical Research (IPEM), Curitiba, PR, Brazil.
- Plastic Surgery and Anatomy, State University of Ponta Grossa (UEPG), Avenida Doutor Francisco Búrzio, 991, 84010-200, Ponta Grossa, PR, Brazil.
| | - Jurandir Marcondes Ribas-Filho
- Evangelical Faculty of Medicine of Paraná (FEPAR), Evangelical University Hospital of Curitiba (HUEC) and Institute for Medical Research (IPEM), Curitiba, PR, Brazil
| | - Fernando Issamu Tabushi
- Evangelical Faculty of Medicine of Paraná (FEPAR), Evangelical University Hospital of Curitiba (HUEC) and Institute for Medical Research (IPEM), Curitiba, PR, Brazil
| | | | - Elisa Beatriz Dalledone Siqueira
- Evangelical Faculty of Medicine of Paraná (FEPAR), Evangelical University Hospital of Curitiba (HUEC) and Institute for Medical Research (IPEM), Curitiba, PR, Brazil
| | - Lucia de Noronha
- Anatomical Pathology, Pontifical Catholic University of Paraná (PUC-PR), Curitiba, PR, Brazil
| | - Alfredo Benjamim Duarte da Silva
- Plastic Surgery and Anatomy, State University of Ponta Grossa (UEPG), Avenida Doutor Francisco Búrzio, 991, 84010-200, Ponta Grossa, PR, Brazil
- Operative Technique, Federal University of Paraná (UFPR), Curitiba, PR, Brazil
| | | | - Isabelle Guth
- Evangelical Faculty of Medicine of Paraná (FEPAR), Evangelical University Hospital of Curitiba (HUEC) and Institute for Medical Research (IPEM), Curitiba, PR, Brazil
| | - Larissa Maria Vosgerau
- Evangelical Faculty of Medicine of Paraná (FEPAR), Evangelical University Hospital of Curitiba (HUEC) and Institute for Medical Research (IPEM), Curitiba, PR, Brazil
| |
Collapse
|
18
|
Atlan M, Nuti G, Wang H, Decker S, Perry T. Breast implant surface texture impacts host tissue response. J Mech Behav Biomed Mater 2018; 88:377-385. [DOI: 10.1016/j.jmbbm.2018.08.035] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/15/2018] [Accepted: 08/26/2018] [Indexed: 12/20/2022]
|
19
|
Jeon BS, Shin BH, Huh BK, Kim BH, Kim SN, Ji HB, Lee SH, Kang SI, Shim JH, Kang SM, Lee JC, Lee KS, Heo CY, Choy YB. Silicone implants capable of the local, controlled delivery of triamcinolone for the prevention of fibrosis with minimized drug side effects. J IND ENG CHEM 2018. [DOI: 10.1016/j.jiec.2018.02.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
20
|
The Role of Periostin in Capsule Formation on Silicone Implants. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3167037. [PMID: 29854742 PMCID: PMC5944282 DOI: 10.1155/2018/3167037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/09/2018] [Accepted: 03/27/2018] [Indexed: 01/08/2023]
Abstract
Although silicone implants are widely used in breast and other reconstructive surgeries, the limited biocompatibility of these materials leads to severe complications, including capsular contracture. Here, we aimed to clarify the relationship between periostin and the process of capsule formation after in vivo implantation. Seven-week-old wild-type (WT) C57BL/6 mice and periostin-deficient mice were used. Round silicone implants were inserted into a subcutaneous pocket on the dorsum of the mice. After 8 weeks, the fibrous capsule around the implant was harvested and histologically examined to estimate capsular thickness and the number of inflammatory cells. Additionally, immunohistochemical analysis (periostin, α-SMA, and collagen type I) and western blotting (CTGF, TGF-β, VEGF, and MPO) were performed for a more detailed analysis of capsule formation. The capsules in periostin-knockout mice (PN-KO) were significantly thinner than those in WT mice. PN-KO mice showed significantly lower numbers of inflammatory cells than WT mice. Fibrous tissue formation markers (α-SMA, periostin, collagen type I, and CTGF) were significantly reduced in PN-KO mice. We also confirmed that inflammatory reaction and angiogenesis indicators (TGF-β, MPO, and VEGF) had lower expression in PN-KO mice. Inhibition of periostin could be important for suppressing capsule formation on silicone implants after in vivo implantation.
Collapse
|
21
|
Current Approaches Including Novel Nano/Microtechniques to Reduce Silicone Implant-Induced Contracture with Adverse Immune Responses. Int J Mol Sci 2018; 19:ijms19041171. [PMID: 29649133 PMCID: PMC5979366 DOI: 10.3390/ijms19041171] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 03/28/2018] [Accepted: 04/10/2018] [Indexed: 12/29/2022] Open
Abstract
Capsular contracture, which is the pathologic development of fibrous capsules around implants, is a major complication of reconstructive and aesthetic breast surgeries. Capsular contracture can cause implant failure with breast hardening, deformity, and severe pain. The exact mechanisms underlying this complication remain unclear. In addition, anaplastic large cell lymphoma is now widely recognized as a very rare disease associated with breast implants. Foreign body reactions are an inevitable common denominator of capsular contracture. A number of studies have focused on the associated immune responses and their regulation. The present article provides an overview of the currently available techniques, including novel nano/microtechniques, to reduce silicone implant-induced contracture and associated foreign body responses.
Collapse
|
22
|
Silva EN, Ribas-Filho JM, Czeczko NG, Pachnicki JPA, Netto MRM, Lipinski LC, Noronha LD, Colman J, Zeni JO, Carvalho CAD. Histological evaluation of capsules formed by silicon implants coated with polyurethane foam and with a textured surface in rats. Acta Cir Bras 2017; 31:774-782. [PMID: 28076500 DOI: 10.1590/s0102-865020160120000001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 11/14/2016] [Indexed: 11/22/2022] Open
Abstract
PURPOSE: To assess the capsules formed by silicone implants coated with polyurethane foam and with a textured surface. METHODS: Sixty-four Wistar albinus rats were divided into two groups of 32 each using polyurethane foam and textured surface. The capsules around the implants were analyzed for 30, 50, 70 and 90 days. Were analyzed the following parameters: foreign body reaction, granulation tissue, presence of myofibroblasts, neoangiogenesis, presence of synovial metaplasia, capsular thickness, total area and collagen percentage of type I and III, in capsules formed around silicone implants in both groups. RESULTS: The foreign body reaction was only present in the four polyurethane subgroups. The formation of granulation tissue and the presence of myofibroblasts were higher in the four polyurethane subgroups. Regarding to neoangiogenesis and synovial metaplasia, there was no statistical difference between the groups. Polyurethane group presented (all subgroups) a greater capsule thickness, a smaller total area and collagen percentage of type I and a higher percentage area of type III, with statistical difference. CONCLUSION: The use of polyurethane-coated implants should be stimulated by the long-term results in a more stable capsule and a lower incidence of capsular contracture, despite developing a more intense and delayed inflammatory reaction in relation to implants with textured surface.
Collapse
Affiliation(s)
- Eduardo Nascimento Silva
- Fellow Master degree, Postgraduate Program in Principles of Surgery, Faculdade Evangélica do Paraná (FEPAR), Evangelic University Hospital (HUEC) and Institute for Medical Research (IPEM), Curitiba-PR, Brazil. Assistant Professor, General Surgery, Universidade Estadual de Ponta Grossa (UEPG), PR, Brazil. Conception, design, intellectual and scientific content of the study; technical procedures; statistical analysis
| | - Jurandir Marcondes Ribas-Filho
- Associate Professor, Postgraduate Program in Principles of Surgery, FEPAR, Evangelic University Hospital (HUEC) and Institute for Medical Research (IPEM), Curitiba-PR, Brazil. Scientific and intellectual content of the study, interpretation of data, critical revision, final approval
| | - Nicolau Gregori Czeczko
- Associate Professor, Postgraduate Program in Principles of Surgery, FEPAR, Evangelic University Hospital (HUEC) and Institute for Medical Research (IPEM), Curitiba-PR, Brazil. Scientific and intellectual content of the study, interpretation of data, critical revision
| | - Jan Pawel Andrade Pachnicki
- Fellow PhD degree, Postgraduate Program in Principles of Surgery, FEPAR, Evangelic University Hospital (HUEC) and Institute for Medical Research (IPEM), Curitiba-PR, Brazil. Conception, design, intellectual and scientific content of the study
| | - Mário Rodrigues Montemor Netto
- MSc, Clinical Surgery, Universidade Federal do Paraná (UFPR), Curitiba-PR, Brazil. Assistant Professor, Anatomical Pathology, UEPG, Ponta Grossa-PR. Head, Department of Anatomical Pathology, Santa Casa de Misericórdia, Ponta Grossa-PR, Brazil. Scientific and intellectual content of the study, interpretation of data, critical revision
| | - Leandro Cavalcante Lipinski
- DVM, Assistant Professor, Faculty of Medicine, UEPG, Ponta Grossa-PR, Brazil. Scientific and intellectual content of the study, interpretation of data, critical revision
| | - Lucia de Noronha
- PhD, School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba-PR, Brazil. Interpretation of data, histopathological examinations
| | - Joelmir Colman
- MD, Faculty of Medicine, UEPG, Ponta Grossa-PR, Brazil. Acquisition of data, technical procedures, manuscript preparation
| | - João Otavio Zeni
- Graduate student, FEPAR, Evangelic University Hospital (HUEC) and Institute for Medical Research (IPEM), Curitiba-PR, Brazil. Acquisition of data, technical procedures
| | - Caroline Aragão de Carvalho
- Graduate student, FEPAR, Evangelic University Hospital (HUEC) and Institute for Medical Research (IPEM), Curitiba-PR, Brazil. Acquisition of data, technical procedures
| |
Collapse
|
23
|
Effect of Botulinum Toxin Type A on TGF-β/Smad Pathway Signaling: Implications for Silicone-Induced Capsule Formation. Plast Reconstr Surg 2017; 138:821e-829e. [PMID: 27391832 DOI: 10.1097/prs.0000000000002625] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND One of the most serious complications of breast surgery using implants is capsular contracture. Several preventive treatments have been introduced; however, the mechanism of capsule formation has not been resolved completely. The authors previously identified negative effects of botulinum toxin type A on capsule formation, expression of transforming growth factor (TGF)-β1, and differentiation of fibroblasts into myofibroblasts. Thus, the authors investigated how to prevent capsule formation by using botulinum toxin type A, particularly by means of TGF-β1 signaling, in human fibroblasts. METHODS In vitro, cultured human fibroblasts were treated with TGF-β1 and/or botulinum toxin type A. Expression of collagen, matrix metalloproteinase, and Smad was examined by Western blotting. The activation of matrix metalloproteinase was observed by gelatin zymography. In vivo, the effect of botulinum toxin type A on the phosphorylation of Smad2 in silicone-induced capsule formation was evaluated by immunocytochemistry. RESULTS In vitro, the phosphorylation of Smad2 was inhibited by botulinum toxin type A treatment. The expression levels of collagen types 1 and 3 were inhibited by botulinum toxin type A treatment, whereas those of matrix metalloproteinase-2 and matrix metalloproteinase-9 were enhanced. Gelatin zymography experiments confirmed enhanced matrix metalloproteinase-2 activity in collagen degradation. In vivo, botulinum toxin type A treatment reduced capsule thickness and Smad2 phosphorylation in silicone-induced capsules. CONCLUSION This study suggests that botulinum toxin type A plays an important role in the inhibition of capsule formation through the TGF-β/Smad signaling pathway. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
Collapse
|
24
|
Zhan W, Lu F. Activated macrophages as key mediators of capsule formation on adipose constructs in tissue engineering chamber models. Cell Biol Int 2017; 41:354-360. [DOI: 10.1002/cbin.10731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 01/15/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Weiqing Zhan
- Department of Plastic and Cosmetic Surgery; Nanfang Hospital, Southern Medical University, Guang Zhou; Guang Dong People's Republic of China
- O'Brien Institute Department; St Vincent's Institute of Medical Research; Victoria Australia
| | - Feng Lu
- Department of Plastic and Cosmetic Surgery; Nanfang Hospital, Southern Medical University, Guang Zhou; Guang Dong People's Republic of China
| |
Collapse
|
25
|
Hartmann H, Krastev R. Biofunctionalization of surfaces using polyelectrolyte multilayers. ACTA ACUST UNITED AC 2017. [DOI: 10.1515/bnm-2016-0015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractBiomaterials play a central role in modern strategies in regenerative medicine and tissue engineering to restore the structure and function of damaged or dysfunctional tissue and to direct cellular behavior. Both biologically derived and synthetic materials have been extensively explored in this context. However, most materials when implanted into living tissue initiate a host response. Modern implant design therefore aims to improve implant integration while avoiding chronic inflammation and foreign body reactions, and thus loss of the intended implant function. Directing these processes requires an in-depth understanding of the immunological processes that take place at the interface between biomaterials and the host tissue. The physicochemical properties of biomaterial surfaces (charge, charge density, hydrophilicity, functional molecular domains, etc.) are decisive, as are their stiffness, roughness and topography. This review outlines specific strategies, using polyelectrolyte multilayers to modulate the interactions between biomaterial surfaces and biological systems. The described coatings have the potential to control the adhesion of proteins, bacteria and mammalian cells. They can be used to decrease the risk of bacterial infections occurring after implantation and to achieve better contact between biological tissue and implants. In summary, these results are important for further development and modification of surfaces from different medical implants.
Collapse
|
26
|
VIEIRA VILBERTOJ, D'ACAMPORA ARMANDO, NEVES FERNANDAS, MENDES PAULOR, VASCONCELLOS ZULMARADE, NEVES RODRIGOD, FIGUEIREDO CLAUDIAP. Capsular Contracture In Silicone Breast Implants: Insights From Rat Models. AN ACAD BRAS CIENC 2016; 88:1459-70. [DOI: 10.1590/0001-3765201620150874] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 02/04/2016] [Indexed: 01/19/2023] Open
|
27
|
Di Liddo R, Valente S, Taurone S, Zwergel C, Marrocco B, Turchetta R, Conconi MT, Scarpa C, Bertalot T, Schrenk S, Mai A, Artico M. Histone deacetylase inhibitors restore IL-10 expression in lipopolysaccharide-induced cell inflammation and reduce IL-1β and IL-6 production in breast silicone implant in C57BL/6J wild-type murine model. Autoimmunity 2016; 49:155-165. [PMID: 26789595 DOI: 10.3109/08916934.2015.1134510] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 12/16/2015] [Indexed: 12/29/2022]
Abstract
Among epigenetic enzymes, histone deacetylases (HDACs) are responsible for regulating the expression of an extensive array of genes by reversible deacetylation of nuclear histones as well as a large number of non-histone proteins. Initially proposed for cancer therapy, recently the interest for HDAC inhibitors (HDACi) as orally active, safe, and anti-inflammatory agents is rising due to their ability in reducing the severity of inflammatory and autoimmune diseases. In particular, selective HDAC3, HDAC6, and HDAC8 inhibitors have been described to downregulate the expression of pro-inflammatory cytokines (TNF-α, TGF-β, IL-1β, and IL-6). Herein, using KB31, C2C12, and 3T3-J2 cell lines, we demonstrated that, under lipopolysaccharide-induced in vitro inflammation, HDAC3/6/8 inhibitor MC2625 and HDAC6-selective inhibitor MC2780 were effective at a concentration of 30 ng/mL to downregulate mRNA expression of pro-inflammatory cytokines (IL-1β and IL-6) and to promote the transcription of IL-10 gene, without affecting the cell viability. Afterwards, we investigated by immunohistochemistry the activity of MC2625 and MC2780 at a concentration of 60 ng/kg animal weight to regulate silicone-triggered immune response in C57BL/6J female mice. Our findings evidenced the ability of such inhibitors to reduce host inflammation in silicone implants promoting a thickness reduction of peri-implant fibrous capsule, upregulating IL-10 expression, and reducing the production of both IL-1β and IL-6. These results underline the potential application of MC2625 and MC2780 in inflammation-related diseases.
Collapse
Affiliation(s)
- Rosa Di Liddo
- Dipartimento Scienze del Farmaco, Università di Padova, Padova, Italy
| | - Sergio Valente
- Dipartimento di Chimica e Tecnologie del Farmaco, Sapienza Università di Roma, Roma, Italy
| | - Samanta Taurone
- Dipartimento Organi di Senso, Sapienza Università di Roma, Roma, Italy
| | - Clemens Zwergel
- Dipartimento di Chimica e Tecnologie del Farmaco, Sapienza Università di Roma, Roma, Italy
| | - Biagina Marrocco
- Dipartimento di Chimica e Tecnologie del Farmaco, Sapienza Università di Roma, Roma, Italy
| | - Rosaria Turchetta
- Dipartimento Organi di Senso, Sapienza Università di Roma, Roma, Italy
| | | | - Carlotta Scarpa
- Dipartimento di Neuroscienze, Clinica di Chirurgia Plastica, Università di Padova, Padova, Italy, and
| | - Thomas Bertalot
- Dipartimento Scienze del Farmaco, Università di Padova, Padova, Italy
| | - Sandra Schrenk
- Dipartimento Scienze del Farmaco, Università di Padova, Padova, Italy
| | - Antonello Mai
- Dipartimento di Chimica e Tecnologie del Farmaco, Sapienza Università di Roma, Roma, Italy
- Istituto Pasteur - Fondazione Cenci Bolognetti, Sapienza Università di Roma, Roma, Italy
| | - Marco Artico
- Dipartimento Organi di Senso, Sapienza Università di Roma, Roma, Italy
| |
Collapse
|
28
|
The Collagenase of the Bacterium Clostridium histolyticum for the Treatment of Capsular Fibrosis after Silicone Implants. Plast Reconstr Surg 2016; 136:981-989. [PMID: 26171751 DOI: 10.1097/prs.0000000000001698] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The main part of the fibrotic capsule in capsular contracture is collagen. The collagenase of the bacterium Clostridium histolyticum is U.S. Food and Drug Administration approved for the treatment of Dupuytren contracture and might be capable of dissolving the fibrotic capsule surrounding silicone implants. METHODS One hundred twenty days after insertion of miniature silicone implants the authors performed in vitro studies (n = 14) for optimum dosage-finding and subsequent in vivo studies (n = 36) to evaluate application method and efficiency. Data analysis involved histologic measurements of capsule thickness and collagen density; 7-T magnetic resonance imaging-based in vivo imaging; and polymerase chain reaction analysis of inflammatory, profibrotic, and antifibrotic markers. RESULTS Compared with the control group, each dosage showed significantly thinner capsules after in vitro incubation. Skin digestion occurred in 0, 1 (7 percent), and 11 cases (80 percent) after incubation with 0.3, 0.9, and 1.8 mg/ml, respectively. In vivo application showed a dosage-dependent decrease in capsule formation, which was more prominent in lower capsule parts, seen by magnetic resonance imaging. In vivo skin perforation was seen in two (17 percent) and six cases (50 percent) after injection of 0.3 mg/ml and 0.9 mg/ml, respectively. Profibrotic and inflammatory markers were significantly up-regulated 10 days after collagenase injection. CONCLUSIONS The collagenase of C. histolyticum is capable of dissolving the fibrotic capsule surrounding silicone implants. Skin perforation occurred most likely because of mechanical irritation after complete digestion of the capsule. Further studies are required to pave the way for safe clinical application.
Collapse
|
29
|
Negating Tissue Contracture Improves Volume Maintenance and Longevity of In Vivo Engineered Tissues. Plast Reconstr Surg 2015; 136:453e-460e. [PMID: 26397264 DOI: 10.1097/prs.0000000000001623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Engineering large, complex tissues in vivo requires robust vascularization to optimize survival, growth, and function. Previously, the authors used a "chamber" model that promotes intense angiogenesis in vivo as a platform for functional three-dimensional muscle and renal engineering. A silicone membrane used to define the structure and to contain the constructs is successful in the short term. However, over time, generated tissues contract and decrease in size in a manner similar to capsular contracture seen around many commonly used surgical implants. The authors hypothesized that modification of the chamber structure or internal surface would promote tissue adherence and maintain construct volume. METHODS Three chamber configurations were tested against volume maintenance. Previously studied, smooth silicone surfaces were compared to chambers modified for improved tissue adherence, with multiple transmembrane perforations or lined with a commercially available textured surface. Tissues were allowed to mature long term in a rat model, before analysis. RESULTS On explantation, average tissue masses were 49, 102, and 122 mg; average volumes were 74, 158 and 176 μl; and average cross-sectional areas were 1.6, 6.7, and 8.7 mm for the smooth, perforated, and textured groups, respectively. Both perforated and textured designs demonstrated significantly greater measures than the smooth-surfaced constructs in all respects. CONCLUSIONS By modifying the design of chambers supporting vascularized, three-dimensional, in vivo tissue engineering constructs, generated tissue mass, volume, and area can be maintained over a long time course. Successful progress in the scale-up of construct size should follow, leading to improved potential for development of increasingly complex engineered tissues.
Collapse
|
30
|
Capsular Contracture after Breast Augmentation: An Update for Clinical Practice. Arch Plast Surg 2015; 42:532-43. [PMID: 26430623 PMCID: PMC4579163 DOI: 10.5999/aps.2015.42.5.532] [Citation(s) in RCA: 187] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 04/09/2015] [Accepted: 04/13/2015] [Indexed: 01/17/2023] Open
Abstract
Capsular contracture is the most common complication following implant based breast surgery and is one of the most common reasons for reoperation. Therefore, it is important to try and understand why this happens, and what can be done to reduce its incidence. A literature search using the MEDLINE database was conducted including search terms 'capsular contracture breast augmentation', 'capsular contracture pathogenesis', 'capsular contracture incidence', and 'capsular contracture management', which yielded 82 results which met inclusion criteria. Capsular contracture is caused by an excessive fibrotic reaction to a foreign body (the implant) and has an overall incidence of 10.6%. Risk factors that were identified included the use of smooth (vs. textured) implants, a subglandular (vs. submuscular) placement, use of a silicone (vs. saline) filled implant and previous radiotherapy to the breast. The standard management of capsular contracture is surgical via a capsulectomy or capsulotomy. Medical treatment using the off-label leukotriene receptor antagonist Zafirlukast has been reported to reduce severity and help prevent capsular contracture from forming, as has the use of acellular dermal matrices, botox and neopocket formation. However, nearly all therapeutic approaches are associated with a significant rate of recurrence. Capsular contracture is a multifactorial fibrotic process the precise cause of which is still unknown. The incidence of contracture developing is lower with the use of textured implants, submuscular placement and the use of polyurethane coated implants. Symptomatic capsular contracture is usually managed surgically, however recent research has focussed on preventing capsular contracture from occurring, or treating it with autologous fat transfer.
Collapse
|
31
|
Fischer S, Hirche C, Reichenberger MA, Kiefer J, Diehm Y, Mukundan S, Alhefzi M, Bueno EM, Kneser U, Pomahac B. Silicone Implants with Smooth Surfaces Induce Thinner but Denser Fibrotic Capsules Compared to Those with Textured Surfaces in a Rodent Model. PLoS One 2015; 10:e0132131. [PMID: 26151888 PMCID: PMC4495016 DOI: 10.1371/journal.pone.0132131] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 06/10/2015] [Indexed: 12/05/2022] Open
Abstract
Purpose Capsular contracture is the most frequent long-term complication after implant-based breast reconstruction or augmentation. The aim of this study was to evaluate the impact of implant surface properties on fibrotic capsule formation in an animal model. Materials and Methods Twenty-four rats received 1 scaled down silicone implant each; 12 of the rats received implants with textured surfaces, and the other 12 received implants with smooth surfaces. After 60 and 120 days, rats in each group underwent 7-Tesla Magnetic Resonance Imaging (MRI) and high-resolution ultrasound (HR-US), and specimens of the capsules were acquired and used to measure capsule thickness through histology, collagen density through picro sirius red staining, and analyses of expression of pro-fibrotic and inflammatory genes (Collagen1-4, TGFb1, TGFb3, Smad3, IL4, IL10, IL13, CD68) through qRT-PCR. Furthermore, MRI data were processed to obtain capsule volume and implant surface area. Results On day 60, histology and HR-US showed that fibrotic capsules were significantly thicker in the textured implant group with respect to the smooth implant group (p<0.05). However, this difference did not persist on day 120 (p=0.56). Capsule thickness decreased significantly over the study period in both smooth and textured implant groups (p<0.05). Thickness measurements were substantiated by MRI analysis and volumes changed accordingly. Implant surface area did not vary between study dates, but it was different between implant types. On day 60, the density of collagen in the fibrotic capsules was significantly lower in the textured implant group with respect to the smooth group (p<0.05), but again this difference did not persist on day 120 (p=0.67). Collagen 1 and CD68 were respectively over- and under expressed in the textured implant group on day 60. Significant differences in the expression of other genes were not observed. Conclusion Silicone implants with textured surfaces led to temporarily thicker but less dense fibrotic capsules compared with smooth surfaces. 7-Tesla MRI and HR-US are capable for non-invasive in-vivo assessment of capsular fibrosis in an animal model and can provide unique insights into the fibrotic process by 3D reconstruction and surface area measurement.
Collapse
Affiliation(s)
- Sebastian Fischer
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America; Department of Hand-, Plastic and Reconstructive Surgery, BG Clinic Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Christoph Hirche
- Department of Hand-, Plastic and Reconstructive Surgery, BG Clinic Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Matthias A Reichenberger
- Ethianum, Clinic for Plastic and Reconstructive Surgery, Aesthetic and Preventive Medicine at Heidelberg University Hospital, Heidelberg, Germany
| | - Jurij Kiefer
- Department of Hand-, Plastic and Reconstructive Surgery, BG Clinic Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Yannick Diehm
- Department of Hand-, Plastic and Reconstructive Surgery, BG Clinic Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Srinivasan Mukundan
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Muayyad Alhefzi
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ericka M Bueno
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ulrich Kneser
- Department of Hand-, Plastic and Reconstructive Surgery, BG Clinic Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Bohdan Pomahac
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| |
Collapse
|
32
|
Abstract
Clinicians and investigators have been implanting biomedical devices into patients and experimental animals for centuries. There is a characteristic complex inflammatory response to the presence of the biomedical device with diverse cell signaling, followed by migration of fibroblasts to the implant surface and the eventual walling off of the implant in a collagen capsule. If the device is to interact with the surrounding tissues, the collagen envelope will eventually incapacitate the device or myofibroblasts can cause capsular contracture with resulting distortion, migration, or firmness. This review analyzes the various tactics used in the past to modify or control capsule formation with suggestions for future investigative approaches.
Collapse
|
33
|
Farhadieh RD, Farhadi J. Breast augmentation. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
34
|
Roça GB, Graf R, da Silva Freitas R, Salles G, Francisco JC, Noronha L, Maluf I. Autologous Fat Grafting for Treatment of Breast Implant Capsular Contracture: A Study in Pigs. Aesthet Surg J 2014; 34:769-75. [PMID: 24963064 DOI: 10.1177/1090820x14533184] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Capsular contracture (CC) is a common complication after breast augmentation. Autologous fat grafting may be effective for restoring tissue vascularization and function. OBJECTIVE The authors evaluated the efficacy of autologous fat grafting in a porcine model as a treatment for CC after breast augmentation. METHODS This prospective study was performed in 20 female 30-day-old pigs. Each animal was implanted with three 30-cc textured silicone implants (stage 1 of the experiment). Group A served as the untreated control group. To induce CC, 2 mL of autologous fibrin glue was applied to the pericapsular space in group B and C animals at implantation. Three months after implantation (stage 2), the CCs of all groups were assessed by Baker classification and applanation tonometry (AT). Liposuction was performed in group B to harvest fat for these animals. Three months after group B underwent fat grafting, all 3 groups were reevaluated. Reassessments included Baker classification, AT, histologic analysis, and tensiometry (stage 3). RESULTS The deposition of mature and immature collagen was similar for the 3 groups. The amount of fat remaining around the implanted capsules did not differ significantly between the groups. At stage 3, group B exhibited significantly larger tonometry areas than did group C. The CCs in groups B and C were significantly thicker than those of group A, but the difference between groups B and C was not significant. Capsule rupture forces did not differ significantly between groups A and B but were significantly higher in group C compared with the other groups. CONCLUSIONS Results in this animal model indicate that pericapsular lipoinjection may be a promising treatment for CC in humans.
Collapse
Affiliation(s)
| | - Ruth Graf
- Dr Graf is Professor, Dr Freitas is Professor and Head of Unit, and Mr Maluf is a resident in the Plastic Surgery Unit, Federal University of Paraná, Brazil
| | - Renato da Silva Freitas
- Dr Graf is Professor, Dr Freitas is Professor and Head of Unit, and Mr Maluf is a resident in the Plastic Surgery Unit, Federal University of Paraná, Brazil
| | - Guataçara Salles
- Drs Salles, Francisco, and Noronha are Professors at Pontifical Catholic University of Paraná, Brazil
| | - Julio Cesar Francisco
- Drs Salles, Francisco, and Noronha are Professors at Pontifical Catholic University of Paraná, Brazil
| | - Lucia Noronha
- Drs Salles, Francisco, and Noronha are Professors at Pontifical Catholic University of Paraná, Brazil
| | - Ivan Maluf
- Dr Graf is Professor, Dr Freitas is Professor and Head of Unit, and Mr Maluf is a resident in the Plastic Surgery Unit, Federal University of Paraná, Brazil
| |
Collapse
|
35
|
Persichetti P, Segreto F, Pendolino AL, Del Buono R, Marangi GF. Breast implant capsule flaps and grafts: a review of the literature. Aesthetic Plast Surg 2014; 38:540-8. [PMID: 24764105 DOI: 10.1007/s00266-014-0308-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 03/18/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND A breast implant capsule forms as a physiological response to the foreign material. Over the past decades, authors started to consider the breast implant capsule as a new source of tissue, thus describing several capsular flaps and grafts. The aim of this article is to provide an overview of the applications and indications for the use of capsular tissue flaps and grafts in reconstructive and aesthetic surgery. METHODS A review of the literature on breast implant capsule grafts and flaps was conducted. The reported surgical techniques were described and compared for indications and complications. The studies were evaluated and compared for number of patients and follow-up. RESULTS The search yielded a total of 21 citations. Patient population was reported in 11 studies for capsular flaps and 2 articles for capsular grafts. Between 1997 and 2012, a total of 74 patients underwent surgery with the use of capsular tissue. Among these, 60 patients had a capsular flap (81 %) and 14 (19 %) had a capsular graft. Complications were experienced in 5 patients (6.7 %). CONCLUSIONS Capsular flaps and grafts are indicated mainly to address breast implant-related problems. The breast implant capsule represents a versatile and reliable source of tissue for both aesthetic and reconstructive surgery. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266.
Collapse
Affiliation(s)
- Paolo Persichetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico of Rome University, 00128, Rome, Italy
| | | | | | | | | |
Collapse
|
36
|
Lee SD, Yi MH, Kim DW, Lee Y, Choi Y, Oh SH. The effect of botulinum neurotoxin type A on capsule formation around silicone implants: the in vivo and in vitro study. Int Wound J 2014; 13:65-71. [PMID: 24602064 DOI: 10.1111/iwj.12228] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 01/03/2014] [Indexed: 01/05/2023] Open
Abstract
This study confirms that botulinum neurotoxin type A (BoNT-A) decreases capsular contracture and elucidates a possible mechanism. Silicone blocks were implanted subcutaneously in 20 mice. The experimental groups received BoNT-A (1, 2·5 or 5 U) instilled into the subcutaneous pocket. After 30 days, periprosthetic capsules were harvested and evaluated. The effect of BoNT-A on the differentiation of human dermal fibroblasts to myofibroblasts in culture was examined by Western blot analysis. Changes in transforming growth factor-beta1 (TGF-β1) expression in cultured fibroblasts were determined by enzyme-linked immunosorbent assay (ELISA). In in vivo study, the thickness of capsules (P < 0·05) and the number of alpha-smooth muscle actin (α-SMA)(+) cells in capsules (P < 0·05) were significantly decreased in the experimental groups. TGF-β1 was significantly underexpressed in the experimental groups (P < 0·05). In in vitro study, BoNT-A did not significantly affect fibroblast viability. Western blot analysis showed that α-SMA protein levels were significantly decreased in the experimental groups (P < 0·05). Based on ELISA, the amount of TGF-β1 was significantly decreased in the experimental groups (P < 0·05), especially cells treated with a high dose of BoNT-A (P < 0·001). This study confirms that BoNT-A prevents capsular formation around silicone implants, possibly by blocking TGF-β1 signalling and interrupting the differentiation of fibroblasts to myofibroblasts.
Collapse
Affiliation(s)
- Sang D Lee
- Department of Physiology, College of Medicine, Chungnam National University, Daejeon, Korea.,Research Institute for Medical Sciences, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Min-Hee Yi
- Department of Dermatology, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Dong W Kim
- Department of Dermatology, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Young Lee
- Department of Plastic Surgery, Sanggye Piak Hospital, School of Medicine, Inje University, Seoul, Korea
| | - YoungWoong Choi
- Department of Plastic Surgery, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Sang-Ha Oh
- Research Institute for Medical Sciences, College of Medicine, Chungnam National University, Daejeon, Korea.,Department of Anatomy, College of Medicine, Chungnam National University, Daejeon, Korea.,BiO & J Inc., Daejeon, Korea
| |
Collapse
|
37
|
Wagenführ-Júnior J, Ribas Filho JM, Nascimento MMD, Ribas FM, Wanka MV, Godoi ADL. Histopathological reaction over prosthesis surface covered with silicone and polyurethane foam implanted in rats. Acta Cir Bras 2013. [PMID: 23207753 DOI: 10.1590/s0102-86502012001200007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
PURPOSES To evaluate whether polyurethane foam leads more intense foreign-body reaction than silicone foam. To compare the vascularization of the capsules surrounding the foam implants. To investigate if the capsule of polyurethane foam implanted has greater amount of collagen than that of silicone foam. METHODS Sixty-four young male Wistar rats were allocated into two groups: polyurethane foam and silicone foam. Subcutaneous discs were implanted into the dorsum of the animals in both groups. The capsules were assessed 28 days, two months, three months and six months postoperatively. Microscopic analysis with H&E stain was performed to evaluate the acute and chronic inflammatory process, foreign-body reaction and neovascularization. The analysis with picrosirius red was performed using the ImageProPlus software, to measure the number of vessels and collagen types I and III. RESULTS There were no statistical differences between the two groups regarding the acute and chronic inflammatory processes. All rats from the polyurethane group, in all times, exhibited moderate or intense foreign-body reaction, with statistic significant difference (p=0.046) when compared with the silicone group, in which the reaction was either mild or nonexistent at two months. Vascular proliferation was significantly different between the groups at 28 days (p=0.0002), with the polyurethane group displaying greater neovascularization with H&E stain. Similar results were obtained with picrosirius red, which revealed in the polyurethane group a much greater number of vessels than in the silicone group (p=0.001). The collagen area was larger in the polyurethane group, significantly at 28 days (p=0.001) and at two months (p=0.030). CONCLUSIONS Polyurethane foam elicited more intense foreign-body reaction when compared with silicone foam. The number of vessels was higher in the capsules of the polyurethane foam implants 28 days after the operation. The capsule of the polyurethane foam implants showed a greater amount of collagen than that of the silicone foam implants.
Collapse
|
38
|
Analysis of Acellular Dermal Matrix Integration and Revascularization following Tissue Expander Breast Reconstruction in a Clinically Relevant Large-Animal Model. Plast Reconstr Surg 2013; 131:741e-751e. [DOI: 10.1097/prs.0b013e3182865c6d] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
39
|
Jacombs A, Allan J, Hu H, Valente PM, Wessels WLF, Deva AK, Vickery K. Prevention of biofilm-induced capsular contracture with antibiotic-impregnated mesh in a porcine model. Aesthet Surg J 2012; 32:886-91. [PMID: 22942116 DOI: 10.1177/1090820x12455429] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND A growing body of evidence implicates subclinical (biofilm) infection around breast implants as an important cause of capsular contracture (CC). OBJECTIVES The authors use an in vivo porcine model to investigate the potential of antibiotic-impregnated mesh as a prophylactic measure against biofilm formation and CC. METHODS A total of 28 implants (14 untreated controls, 14 treated with antibiotic mesh) were inserted into 5 adult female pigs. All implants and pockets were inoculated with a human clinical strain of Staphylococcus epidermidis. The implants were left in situ for 16 weeks and then analyzed for contracture using both Baker grading and applanation tonometry. The presence of biofilm infection was assessed by subsequent microbiological analysis of implants and capsules. RESULTS One untreated implant had extruded and was excluded from analysis. The tissue surrounding the 13 untreated control implants had Baker Grade III/IV CC, whereas no CC was identified around the 14 antibiotic mesh-treated implants. This difference was highly significant (P < .001). Tonometry findings were consistent with the Baker assessments. Although bacterial biofilm was detected on all implants and capsules, the biofilms on the antibiotic-treated implants and surrounding capsules were generally single-layered or isolated in contrast to the multilayer biofilms found on untreated implants and capsules. CONCLUSIONS Based on the findings from this study of a porcine model, the use of antibiotic-impregnated mesh reduces bacterial access to breast implants at the time of surgical insertion and may subsequently protect against subclinical infection and CC.
Collapse
Affiliation(s)
- Anita Jacombs
- Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
| | | | | | | | | | | | | |
Collapse
|
40
|
Vieira VJ, dʼAcampora AJ, Marcos ABW, Di Giunta G, de Vasconcellos ZAA, Bins-Ely J, dʼEça Neves R, Figueiredo CP. Vascular Endothelial Growth Factor Overexpression Positively Modulates the Characteristics of Periprosthetic Tissue of Polyurethane-Coated Silicone Breast Implant in Rats. Plast Reconstr Surg 2010; 126:1899-1910. [DOI: 10.1097/prs.0b013e3181f446d5] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
41
|
Ng KK, Awad N, Brook MA, Holloway AC, Sheardown H. Local Delivery of Nicotine does not Mitigate Fibrosis but may Lead to Angiogenesis. J Biomater Appl 2010; 26:349-58. [DOI: 10.1177/0885328210372813] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
As with most implanted biomaterials, the wound healing response following implantation of a silicone breast implant leads to the formation of a fibrotic capsule. This can result in capsular contracture, a painful complication that often necessitates the removal of implant. It is well established that nicotine and nicotinic agonists inhibit inflammatory signaling. Based on the link between the inflammatory response and capsule formation, we hypothesized that local delivery of nicotine from the implant may lead to the reduction in inflammation and capsule thickness, which may ultimately reduce the incidence of capsular contracture. Nicotine was loaded into PDMS membranes using a previously established method. The loaded materials were implanted into the submammary pockets between the third and fourth mammary glands of rats. To confirm that the nicotine was acting locally and not systemically, serum cotinine, the primary metabolite of nicotine, was measured by ELISA at 3 days. Thirty days post implantation, the animals were euthanized and the tissue samples were fixed for histological analysis. Blood vessel density was measured immunohistochemically, while the capsule thickness was evaluated microscopically. While the presence of the nicotine metabolite, cotinine, in the serum at the early time points demonstrated that the nicotine was released locally from the devices, there were no significant differences in the capsule thickness between the control and experimental implants. However, the results indicated that there were differences in angiogenesis with the local delivery of nicotine, which may have other implications for the development of biomaterials.
Collapse
Affiliation(s)
- Kenneth K. Ng
- Department of Obstetrics and Gynecology, McMaster University Hamilton Ontario L8S 3Z5, Canada
| | - Neven Awad
- School of Biomedical Engineering, McMaster University Hamilton Ontario L8S 4L7, Canada
| | - Michael A. Brook
- School of Biomedical Engineering, McMaster University Hamilton Ontario L8S 4L7, Canada
| | - Alison C. Holloway
- Department of Obstetrics and Gynecology, McMaster University Hamilton Ontario L8S 3Z5, Canada
| | - Heather Sheardown
- School of Biomedical Engineering, McMaster University Hamilton Ontario L8S 4L7, Canada,
| |
Collapse
|
42
|
Moreira M, Fagundes DJ, Simões MDJ, Taha MO, Perez LMN, Bazotte RB. The effect of liposome-delivered prednisolone on collagen density, myofibroblasts, and fibrous capsule thickness around silicone breast implants in rats. Wound Repair Regen 2010; 18:417-25. [DOI: 10.1111/j.1524-475x.2010.00601.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
43
|
The use of acellular dermal matrix to prevent capsule formation around implants in a primate model. Plast Reconstr Surg 2010; 124:82-91. [PMID: 19568048 DOI: 10.1097/prs.0b013e3181ab112d] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Implant-based breast reconstruction is a popular option after mastectomy, but capsular contracture may detract from long-term outcomes. The authors have observed that breast implants covered with acellular dermal matrix (AlloDerm) are less likely to develop a capsule in the area where the implant is in direct contact with the acellular matrix. The authors tested this observation experimentally by comparing capsular formation around implants in the presence and absence of AlloDerm in primates. METHODS Eight smooth-surfaced tissue expanders were implanted into eight African green monkeys. In four experimental animals, a sheet of AlloDerm was draped over the tissue expander so as to cover the implant. Four control animals underwent placement of a tissue expander only. Animals were killed after 10 weeks and specimens underwent histologic and immunohistochemical analysis. RESULTS Hematoxylin and eosin staining of control specimens revealed the presence of a distinct layer of wavy, parallel arrays of collagen fibers consistent with capsule formation. Immunostaining identified abundant myofibroblasts, a profibrotic cell found in breast capsules. In the AlloDerm-covered specimens, no capsule layer was visible, and specimens stained weakly for myofibroblasts. The difference in myofibroblast staining intensity was statistically significant. CONCLUSIONS The use of AlloDerm to partially enclose implants effectively prevented formation of a capsule in areas where AlloDerm contacted the implant at 10 weeks. Long-term studies will be required to determine whether this is a durable result that can be reproduced in humans.
Collapse
|
44
|
Palhares A, Schellini SA, Pellizzon CH, Padovani CR, Dorsa P. Evaluation of low intensity laser's action on silicone mammary implant pseudocapsules in rats. Acta Cir Bras 2009; 24:7-12. [PMID: 19169535 DOI: 10.1590/s0102-86502009000100003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Accepted: 11/12/2008] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate the effect of low intensity laser on the pseudocapsule contraction that occurs around silicone implants. METHODS 60 male rats divided in two experimental groups received a silicone implant in the subcutaneous of the dorsal region. Group I: animals received implants in the subcutaneous dorsal region and did not receive any treatment; Group II: animals received seven irradiation sessions with low intensity laser after they had received subcutaneous implants. Thirty, 60 and 180 days after the surgery, tonometric evaluation of the implants was conducted. After that, the animals were sacrificed, study material was removed and prepared for histological examination. The thickness of the pseudocapsule and the inflammatory reaction were morphometrically quantified. Data obtained were statistically analyzed using the Variance method, and Tukey's Test(P<0.0 5). RESULTS Group II animals had significant lower pressure. The histological study did not show a significant difference between the groups, but only a higher number of swollen vessels in Group II. The thickness of pseudocapsule around Group II's implants lower than in Group I. CONCLUSION The low intensity laser modify tissue's reparation process around the implants suggesting it may be useful to model contractures that are formed around silicone implants.
Collapse
Affiliation(s)
- Aristides Palhares
- Department of Surgery and Orthopedic, Botucatu Faculty of Medicine, State University of Sao Paulo, Brazil.
| | | | | | | | | |
Collapse
|
45
|
Moreira M, Fagundes DJ, de Jesus Simões M, de Oliveira MCBM, Dos Santos Previdelli IT, Moreira AC. Zafirlukast pocket delivery impairs the capsule healing around textured implants in rats. Aesthetic Plast Surg 2009; 33:90-7. [PMID: 19011932 DOI: 10.1007/s00266-008-9245-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2008] [Accepted: 08/27/2008] [Indexed: 11/24/2022]
Abstract
BACKGROUND The aim of this study was to investigate the effects of zafirlukast on capsule thickness, collagen fiber density, and myofibroblast cell count of the healing tissue around silicone textured implants in rats. METHODS Thirty-six male Wistar rats were divided (n = 18) into two groups. In one group, two parallel incisions (1.5 cm long) were made into the right and left sides of the spine. Two pockets were then created in which shell-shaped textured implants were inserted. The left-side pocket was injected with 0.2 ml of saline solution (SSG) and the right-side pocket with a dose of 1.25 mg/kg of zafirlukast (ZLG). The other 18 rats (sham, SG) had only one pocket created, followed by the placement of an implant and injection of 0.2 ml of saline solution. The rats were euthanized on the 7th, 35th, or 90th days followed by careful dissection of the implant. The capsules and peri-implant tissues were prepared for histologic analysis. An ANOVA test and Tukey test were applied (p < 0.05). RESULTS ZL was effective in impairing the capsule thickness on the 35th and 90th days compared to the other two groups (sham and saline). Not only was it effective in impairing the collagen density on the 35th and 90th days, but it also showed the same effect in the SSG (systemic); fewer myofibroblasts were counted on the 90th day in the ZLG compared to the SG group; the number of myofibroblasts was significantly lower in the ZLG than in the SSG. CONCLUSIONS Pocket delivery of one dose of Zafirlukast was effective in impairing capsule formation around the textured implant.
Collapse
Affiliation(s)
- Marcio Moreira
- Plastic Surgery Brazilian Society (SBCP), Maringa, PR, Brazil,
| | | | | | | | | | | |
Collapse
|
46
|
Grella E, Grella R, D'Andrea F. Histologic Analysis of Zafirlukast's Effect on Capsule Formation Around Silicone Implants: some considerations. Aesthetic Plast Surg 2008; 32:179-80. [PMID: 17876657 DOI: 10.1007/s00266-007-9029-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Accepted: 07/17/2007] [Indexed: 10/22/2022]
|
47
|
Abstract
BACKGROUND Pirfenidone (PFD), a new antifibrotic and antiinflammatory agent, prevents and resolves fibrous tissue. This study evaluated the effect of PFD on adverse events in mammary implants using an animal model. Mammary implantation, the most frequent aesthetic surgery, may present several complications after surgery such as swelling, capsule contracture, hardness, and pain. METHODS Wistar rats underwent submammary implantation with either smooth or textured silicone gel implants and were administrated 200 mg/kg of PFD daily. The control group received saline. The animals were killed at 8 weeks. The capsular tissue of both implants was removed for histologic and molecular analyses. RESULTS Typical postaugmentation periimplant capsules with opacity on adjacent tissues developed 8 weeks after silicone implantation. No significant differences were observed between the textured and smooth implants in any analyzed parameter. Clearly, PFD reduced capsule thickness around submmamary tissue, fibroblast-like cell proliferation, and recruitment of inflammatory cells. The total cell numbers per field were reduced as well. In contrast, the control group presented abundant mononuclear cell infiltration and fibroblast-like cell proliferation. The total content of collagen in the PFD group was 50% less than in the control group. Fibroblast cells displayed 45% less activated phenotype in the PFD group than in the control group, as determined by immunohistochemistry techniques. In the PFD animals, transforming growth factor-beta (TGF-beta) decreased 85% and collagen 1 gene expression 60%, compared with the control group. CONCLUSION The findings show a positive effect of PFD on mammary contracture in 10 rats. Despite the small number of animals, the differences found in 10 control rats encourage the authors to propose a larger study later and to suggest PFD as a potential preventive strategy in human mammary implantation surgery.
Collapse
|