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Yi Z, Zeng J, Chen Z, Chen L, Lu HB, Zhang Q, Yang X, Qi Z. The Role of Verteporfin in Prevention of Periprosthetic Capsular Fibrosis: An Experimental Study. Aesthet Surg J 2022; 42:820-829. [PMID: 35420670 DOI: 10.1093/asj/sjac083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Capsular contracture (CC) characterized by excessive fibrosis is one of the most common complications after silicone implant surgery. Verteporfin (VP), an inhibitor of Yes-associated protein 1 (YAP1), has recently been found to reduce the fibrotic process. OBJECTIVES The aim of this study was to use an in vivo rabbit model to evaluate the efficacy of VP for the prevention of CC. METHODS Twenty-four New Zealand rabbits received 10-cc smooth saline silicone implants inserted in the dorsal skin and were randomly divided into 2 groups to receive 2 mL VP (1.5 mg/mL) or 2 mL phosphate-buffered saline solution instillation in the implant pocket. When the animals were killed on Day 60, capsule formation was observed both macroscopically and microscopically. Histologic evaluation included capsule thickness, fibrosis degree, and myofibroblast (α smooth muscle actin positive) content. In addition, the YAP1 expression level was examined by immunofluorescence staining. Transforming growth factor β1, collagen I, and connective tissue growth factor expression were measured by real-time quantitative polymerase chain reaction. RESULTS The VP-treated group exhibited thinner, more transparent capsules and less fibrosis than the control group at 60 days postsurgery (P < 0.05). Moreover, the VP treatment significantly reduced α smooth muscle actin, YAP1, transforming growth factor β1, collagen I, and connective tissue growth factor expression levels in the capsular tissues (P < 0.05). CONCLUSIONS VP reduced capsule formation after silicone implantation by inhibiting YAP1-mediated mechanical signaling, thereby attenuating excessive collagen deposition in the rabbit model. This preclinical study may provide a feasible strategy to prevent periprosthetic capsular fibrosis in clinical application.
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Affiliation(s)
- Zhen Yi
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Jinshi Zeng
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Zixiang Chen
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Lulu Chen
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Hai-bin Lu
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Qi Zhang
- Department of Plastic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Xiaonan Yang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Zuoliang Qi
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
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Maldonado-Cabrera B, Sánchez-Machado DI, López-Cervantes J, Osuna-Chávez RF, Escárcega-Galaz AA, Robles-Zepeda RE, Sanches-Silva A. Therapeutic effects of chitosan in veterinary dermatology: A systematic review of the literature. Prev Vet Med 2021; 190:105325. [PMID: 33744675 DOI: 10.1016/j.prevetmed.2021.105325] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/01/2021] [Accepted: 03/07/2021] [Indexed: 01/20/2023]
Abstract
Chitosan is a natural polysaccharide with biocompatibility, biodegradability, nontoxicity, antimicrobial, and hemostatic properties. This biopolymer has been used in different pharmaceutical forms; therefore, it has an attractive potential for dermal applications in veterinary medicine. The aim of this review is to assess the healing potential of chitosan, based on its dermatological effects on animals, to enrich the therapeutic options of veterinary clinicians. A systematic review was conducted based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) strategy, retrieving 1,032 studies and selecting 39 after the inclusion and exclusion criteria were applied. The studies included reports with confirmed positive effects (n = 46/99, 46.5 %) (P < 0.05), with positive effects (n = 49.5/99, 49.5 %), and with no effect (n = 4/99, 4 %); none of the studies reported adverse effects. There is an association between frequency of application and a decrease in healing time (P = 0.038); applying chitosan "every 48-72 hours" was the most recommended frequency (n = 10/19, 52.9 %). Chitosan, when applied to skin lesions on animals, produces positive effects on healing, potentially becoming a safe biomaterial for skin treatments in veterinary practice. As an initial protocol, we suggest applying chitosan every 48-72 hours for at least 2 weeks (7 applications).
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Affiliation(s)
| | | | | | | | | | | | - Ana Sanches-Silva
- National Institute of Agrarian and Veterinary Research, Vila do Conde, Portugal; Center for Study in Animal Science (CECA), University of Oporto, Oporto, Portugal
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Albayati A, Ozkan B, Atilgan AO, Sencelikel T, Uysal CA, Ertas NM. Does methylene blue increases capsular contracture in immediate breast reconstruction with silicone implant? An experimental study. J Plast Surg Hand Surg 2021; 55:56-65. [PMID: 33030384 DOI: 10.1080/2000656x.2020.1828901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/25/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
Recently, most of the immediate breast reconstructions following mastectomy are being carried out with the use of silicone implants. In these patients, methylene blue is being used for the detection of sentinel lymph nodes. This experimental study was performed to determine the effect of methylene blue on capsular contracture around breast implants. Thirty-two Sprague Dawley rats were divided into 4 groups. Custom made silicone blocks were placed on the back of animals. In group 1, the incision was closed without performing any additional procedure. In group 2 (control), 0.1 mL of 0.9% normal saline was instilled into the pocket. Group 3 and 4 (study groups) received 0.1 and 0.2 mL of 1% methylene blue, respectively. On postoperative day 60, implants and capsular tissue were extracted. Capsule formation was evaluated both macroscopically and microscopically. The histological evaluation included capsule thickness, inflammation, neovascularization, and fibrosis gradients. Regarding capsule thickness, there were statistically significant differences between groups 1-3, 1-4, 2-3, and 2-4. Although there were more moderate and severe inflammation gradients in groups III and IV, there was no significant difference regarding inflammation severity between control and study groups. In respect of vascular proliferation, there was a statistically significant difference between control and study groups. Similarly, fibrosis gradients were higher in both groups 3 and 4. The study showed that the injection of methylene blue around silicone implants enhanced the formation of capsular contracture. In this case, the degree of contracture was independent of the dose given. Abbreviations: CC: capsular contracture; MM: methylene blue; SLNB: sentinel lymph node biopsy; NS: normal saline; H&E: hematoxylin and eosin; D: dorsal; V: ventral; L: lateral; n: frequency.
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Affiliation(s)
- Abbas Albayati
- Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Burak Ozkan
- Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Alev O Atilgan
- Department of Clinical Pathology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Tugce Sencelikel
- Department of Biostatistics, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Cagri A Uysal
- Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Nilgun M Ertas
- Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Baskent University, Ankara, Turkey
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de Bakker E, van den Broek LJ, Ritt MJPF, Gibbs S, Niessen FB. The Histological Composition of Capsular Contracture Focussed on the Inner Layer of the Capsule: An Intra-Donor Baker-I Versus Baker-IV Comparison. Aesthetic Plast Surg 2018; 42:1485-1491. [PMID: 30187083 PMCID: PMC6280822 DOI: 10.1007/s00266-018-1211-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 08/05/2018] [Indexed: 11/28/2022]
Abstract
Background Capsular contracture remains one of the major complications after breast implantation surgery. The extent of capsular contraction is scored using the Baker scale. The aim of this study was to compare intra-individual Baker-I with Baker-IV capsules, and in particular the prevalence and histological properties of the inner capsule layer. Methods Twenty capsules from ten patients were included after bilateral explantation surgery due to unilateral capsular contracture (Baker-IV) after cosmetic augmentation with textured implants. All capsules underwent (immune-)histochemical analysis: haematoxylin–eosin (morphology), CD68 (macrophages), cytokeratin (epithelial cells) and vimentin (fibroblasts), and were visually scored for cell density and the presence of an inner layer and measured for thickness. Results Baker-IV (n = 10) capsules were significantly thicker compared to Baker-I (n = 10) capsules (P = 0.004). An inner layer was present in 8 Baker-I capsules. All Baker-I capsules were vimentin and CD68-positive and cytokeratin-negative. Positive vimentin was seen throughout the inner layer, and CD-68 staining was observed adjacent to the intermediate capsule layer. In contrast, only 2 Baker-IV capsules had an inner layer, of which only 1 showed the same profile as Baker-I capsules (P = 0.016). No cytokeratin positivity was seen in any capsule. In Baker-IV capsules, outer layers showed more positivity for both vimentin and CD68. Conclusion The inner layer is morphologically consistent with synovial metaplasia and is more prevalent in healthy, uncontracted Baker-I capsules. This inverse relation between the presence of the inner layer and higher Baker classification or pathological contracture could indicate a protective role of the inner layer against capsular contracture formation. Level of Evidence III 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.
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Affiliation(s)
- E de Bakker
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
- Department of Dermatology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - L J van den Broek
- Department of Dermatology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - M J P F Ritt
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - S Gibbs
- Department of Dermatology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - F B Niessen
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
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Acuner B, Baser NT, Aslan G, Terzioglu A, Caydere M, Ustun H, Görgü M. The Effects of Colchicine-Impregnated Oxidized Regenerated Cellulose on Capsular Contracture. Surg Innov 2017; 24:417-422. [PMID: 28681666 DOI: 10.1177/1553350617718915] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Capsular contracture is the most common complication of breast augmentation. Oxidized regenerated cellulose can be used as a matrix for drug transport. Colchicine is an antimitotic drug that interferes with various steps of wound healing. The aim of this study was to evaluate the effects of oxidized regenerated cellulose alone or in combination with colchicine on capsular contracture. Twenty-one adult female Wistar-Albino rats were divided into 3 groups. In group 1 silicone blocks only, in group 2 oxidized regenerated cellulose-wrapped silicone blocks, and in group 3 colchicine-impregnated oxidized regenerated cellulose-wrapped silicone blocks were inserted in the dorsal region. Four weeks later, implants were removed and histopathological examination was performed. Capsular thickness, inflammatory infiltrate degree, collagen fiber organization, and myofibroblast density were evaluated. Macroscopic examination revealed a distinct capsule formation only in group 1 animals, with average measurement being 134.65 µm on histopathological examination. In groups 2 and 3 animals, no distinct capsule formation was seen. Inflammatory infiltrate degree was found to be less in groups 2 and 3 animals than in group 1 animals. Collagen fiber organization around the implants was found to be parallel and organized in group 1 animals, whereas it was random and disorganized in animals in both groups 2 and 3. High myofibroblast density was observed in animals in groups 1 and 2, while no myofibroblast was found in animals in group 3. The results of our study suggest that coating silicone implants with oxidized regenerated cellulose or with colchicine-impregnated oxidized regenerated cellulose may be effective in preventing capsular contracture.
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Affiliation(s)
| | | | - Gurcan Aslan
- 3 Ankara Training and Research Hospital, Ankara, Turkey
| | - Ahmet Terzioglu
- 4 Near East University, Plastic Surgery Department, Nicosia-Cyprus, Turkey
| | | | - Huseyın Ustun
- 3 Ankara Training and Research Hospital, Ankara, Turkey
| | - Metin Görgü
- 5 Abant Izzet Baysal University, Bolu, Turkey
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Effects of Medical Chitosan on Capsular Formation Following Silicone Implant Insertion in a Rabbit Model. Aesthetic Plast Surg 2016; 40:613-24. [PMID: 27302415 DOI: 10.1007/s00266-016-0664-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 05/25/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Capsular contracture is a serious complication that occurs after breast implant surgery. This study was performed to confirm that medical chitosan (MC) affects capsule formation and elucidates a possible mechanism. MATERIALS AND METHODS In this study, we used 18 female adult New Zealand White rabbits. In each rabbit, two silicone implants were placed under the pectoralis muscle layer on both sides (one side was included in the experimental group and the other side was included in the control group). MC was applied around the silicone implant of the experiment group, while the control group received no treatment. The capsular thickness was calculated by Masson's trichrome stain. The expression of MMPs and TIMPs were determined by real-time PCR, Western blotting, and immunohistochemistry. RESULTS Compared to the control group, the capsular thickness of the MC group was significantly reduced at 4, 8, and 12 weeks after the operation (4 week: 229.3 ± 72.2 vs 76.1 ± 12.6 µm, p < 0.05; 8 week: 326.0 ± 53.8 vs 155.4 ± 61.7 µm, p < 0.0.5; 12 week: 151.2 ± 52.5 vs 60.0 ± 22.0 µm, p < 0.05). Compared to the control group, the MC group had significantly lower expressions of TIMP-1 and TIMP-2 (p < 0.05). However, compared to the control group, there was no statistically significant difference in the expressions of MMP-2 and MMP-9 in the experiment group (p > 0.05). CONCLUSION MC reduced the risk of developing capsular contracture around silicone implants, possibly by blocking the signaling pathway of TIMPs. 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 www.springer.com/00266.
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Effects of Different Concentrations of Injectable Collagenase Enzyme on Capsular Tissue Around Silicone Implants: A Preliminary Experimental Study for the Development of a New Treatment Strategy. Aesthetic Plast Surg 2016; 40:164-73. [PMID: 26715576 DOI: 10.1007/s00266-015-0600-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES In recent studies, collagen organization was blamed for the formation of capsular contracture which is still a challenging problem after silicone implant-based breast operations. In this study, effects of different concentrations of collagenase enzyme derived from Clostridium histolyticum on the capsular tissue formation around the silicone implants were investigated. The injectable form of collagenase has a routine clinical use in the treatment of both Dupuytren's and Peyronie's diseases. MATERIALS AND METHODS Thirty-two Wistar albino rats were randomized into four groups. A 2 × 1 × 0.3-cm-sized silicone block was inserted inside a dorsal subcutaneous pocket in all groups. After 2 months of insertion, capsule thicknesses around the implants were detected under ultrasonography. This was followed by injection of isotonic saline, 150, 300, and 600 IU in Gr-1, 2, 3, and 4, respectively. All the animals were sacrificed at the end of the first week for histologic sampling to determine fibroblast proliferation, vessel density of the tissue, necrosis, edema, inflammation, and capsule thickness. All the data were statistically analyzed using Kruskal-Wallis and Mann-Whitney U tests and compared for significance of the results. RESULTS There was no significant difference in terms of capsule thinning between the 300 and 600 IU groups but in both groups thinning was significantly higher than the sham group. In the 150 IU group there was no significant thinning as compared to the sham group (p > 0.05). However, complications such as skin necrosis, infection, and seroma formation were seen only in the 600 IU injection group. The optimal safe and effective dose of the enzyme was accepted as 300 IU. The 300 IU injection provided up to 89 % thinning in the capsule tissue. There was thinning of the collagen bundles parallel to capsule thickness. In the 600 IU group, micro-pores were encountered at the thinnest points. CONCLUSION However, the late results and recurrence rates of capsular contracture were not included in this study; collagenase seemed effective for the reduction of capsular tissue around the implants. 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 www.springer.com/00266.
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Poppler L, Cohen J, Dolen UC, Schriefer AE, Tenenbaum MM, Deeken C, Chole RA, Myckatyn TM. Histologic, Molecular, and Clinical Evaluation of Explanted Breast Prostheses, Capsules, and Acellular Dermal Matrices for Bacteria. Aesthet Surg J 2015; 35:653-68. [PMID: 26229126 PMCID: PMC4649701 DOI: 10.1093/asj/sjv017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Subclinical infections, manifest as biofilms, are considered an important cause of capsular contracture. Acellular dermal matrices (ADMs) are frequently used in revision surgery to prevent recurrent capsular contractures. OBJECTIVE We sought to identify an association between capsular contracture and biofilm formation on breast prostheses, capsules, and ADMs in a tissue expander/implant (TE/I) exchange clinical paradigm. METHODS Biopsies of the prosthesis, capsule, and ADM from patients (N = 26) undergoing TE/I exchange for permanent breast implant were evaluated for subclinical infection. Capsular contracture was quantified with Baker Grade and intramammary pressure. Biofilm formation was evaluated with specialized cultures, rtPCR, bacterial taxonomy, live:dead staining, and scanning electron microscopy (SEM). Collagen distribution, capsular histology, and ADM remodeling were quantified following fluorescent and light microscopy. RESULTS Prosthetic devices were implanted from 91 to 1115 days. Intramammary pressure increased with Baker Grade. Of 26 patients evaluated, one patient had a positive culture and one patient demonstrated convincing evidence of biofilm morphology on SEM. Following PCR amplification 5 samples randomly selected for 16S rRNA gene sequencing demonstrated an abundance of suborder Micrococcineae, consistent with contamination. CONCLUSIONS Our data suggest that bacterial biofilms likely contribute to a proportion, but not all diagnosed capsular contractures. Biofilm formation does not appear to differ significantly between ADMs or capsules. While capsular contracture remains an incompletely understood but common problem in breast implant surgery, advances in imaging, diagnostic, and molecular techniques can now provide more sophisticated insights into the pathophysiology of capsular contracture. LEVEL OF EVIDENCE 4 Therapeutic.
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Affiliation(s)
- Louis Poppler
- Drs Poppler and Dr Cohen are Residents, Dr Dolen is a Breast Fellow, Dr Tenenbaum is Residency Program Director and Assistant Professor, and Dr Myckatyn is Breast Fellowship Director and Associate Professor, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO. Mr. Schriefer is a Physicist, Genome Technology Access Center, Department of Genetics, Washington University School of Medicine, Saint Louis, MO. Dr Deeken is Director of Biomedical Engineering and Biomaterials Laboratory, Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, Saint Louis, MO. and Dr Chole is Lindburg Professor and Chairman, Department of Otolaryngology, and Director of the Biofilm Core Facility, Washington University School of Medicine, Saint Louis, MO
| | - Justin Cohen
- Drs Poppler and Dr Cohen are Residents, Dr Dolen is a Breast Fellow, Dr Tenenbaum is Residency Program Director and Assistant Professor, and Dr Myckatyn is Breast Fellowship Director and Associate Professor, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO. Mr. Schriefer is a Physicist, Genome Technology Access Center, Department of Genetics, Washington University School of Medicine, Saint Louis, MO. Dr Deeken is Director of Biomedical Engineering and Biomaterials Laboratory, Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, Saint Louis, MO. and Dr Chole is Lindburg Professor and Chairman, Department of Otolaryngology, and Director of the Biofilm Core Facility, Washington University School of Medicine, Saint Louis, MO
| | - Utku Can Dolen
- Drs Poppler and Dr Cohen are Residents, Dr Dolen is a Breast Fellow, Dr Tenenbaum is Residency Program Director and Assistant Professor, and Dr Myckatyn is Breast Fellowship Director and Associate Professor, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO. Mr. Schriefer is a Physicist, Genome Technology Access Center, Department of Genetics, Washington University School of Medicine, Saint Louis, MO. Dr Deeken is Director of Biomedical Engineering and Biomaterials Laboratory, Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, Saint Louis, MO. and Dr Chole is Lindburg Professor and Chairman, Department of Otolaryngology, and Director of the Biofilm Core Facility, Washington University School of Medicine, Saint Louis, MO
| | - Andrew E Schriefer
- Drs Poppler and Dr Cohen are Residents, Dr Dolen is a Breast Fellow, Dr Tenenbaum is Residency Program Director and Assistant Professor, and Dr Myckatyn is Breast Fellowship Director and Associate Professor, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO. Mr. Schriefer is a Physicist, Genome Technology Access Center, Department of Genetics, Washington University School of Medicine, Saint Louis, MO. Dr Deeken is Director of Biomedical Engineering and Biomaterials Laboratory, Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, Saint Louis, MO. and Dr Chole is Lindburg Professor and Chairman, Department of Otolaryngology, and Director of the Biofilm Core Facility, Washington University School of Medicine, Saint Louis, MO
| | - Marissa M Tenenbaum
- Drs Poppler and Dr Cohen are Residents, Dr Dolen is a Breast Fellow, Dr Tenenbaum is Residency Program Director and Assistant Professor, and Dr Myckatyn is Breast Fellowship Director and Associate Professor, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO. Mr. Schriefer is a Physicist, Genome Technology Access Center, Department of Genetics, Washington University School of Medicine, Saint Louis, MO. Dr Deeken is Director of Biomedical Engineering and Biomaterials Laboratory, Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, Saint Louis, MO. and Dr Chole is Lindburg Professor and Chairman, Department of Otolaryngology, and Director of the Biofilm Core Facility, Washington University School of Medicine, Saint Louis, MO
| | - Corey Deeken
- Drs Poppler and Dr Cohen are Residents, Dr Dolen is a Breast Fellow, Dr Tenenbaum is Residency Program Director and Assistant Professor, and Dr Myckatyn is Breast Fellowship Director and Associate Professor, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO. Mr. Schriefer is a Physicist, Genome Technology Access Center, Department of Genetics, Washington University School of Medicine, Saint Louis, MO. Dr Deeken is Director of Biomedical Engineering and Biomaterials Laboratory, Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, Saint Louis, MO. and Dr Chole is Lindburg Professor and Chairman, Department of Otolaryngology, and Director of the Biofilm Core Facility, Washington University School of Medicine, Saint Louis, MO
| | - Richard A Chole
- Drs Poppler and Dr Cohen are Residents, Dr Dolen is a Breast Fellow, Dr Tenenbaum is Residency Program Director and Assistant Professor, and Dr Myckatyn is Breast Fellowship Director and Associate Professor, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO. Mr. Schriefer is a Physicist, Genome Technology Access Center, Department of Genetics, Washington University School of Medicine, Saint Louis, MO. Dr Deeken is Director of Biomedical Engineering and Biomaterials Laboratory, Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, Saint Louis, MO. and Dr Chole is Lindburg Professor and Chairman, Department of Otolaryngology, and Director of the Biofilm Core Facility, Washington University School of Medicine, Saint Louis, MO
| | - Terence M Myckatyn
- Drs Poppler and Dr Cohen are Residents, Dr Dolen is a Breast Fellow, Dr Tenenbaum is Residency Program Director and Assistant Professor, and Dr Myckatyn is Breast Fellowship Director and Associate Professor, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO. Mr. Schriefer is a Physicist, Genome Technology Access Center, Department of Genetics, Washington University School of Medicine, Saint Louis, MO. Dr Deeken is Director of Biomedical Engineering and Biomaterials Laboratory, Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, Saint Louis, MO. and Dr Chole is Lindburg Professor and Chairman, Department of Otolaryngology, and Director of the Biofilm Core Facility, Washington University School of Medicine, Saint Louis, MO
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Chronic biofilm infection in breast implants is associated with an increased T-cell lymphocytic infiltrate: implications for breast implant-associated lymphoma. Plast Reconstr Surg 2015; 135:319-329. [PMID: 25383716 DOI: 10.1097/prs.0000000000000886] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Biofilm infection of breast implants significantly potentiates capsular contracture. This study investigated whether chronic biofilm infection could promote T-cell hyperplasia. METHODS In the pig study, 12 textured and 12 smooth implants were inserted into three adult pigs. Implants were left in situ for a mean period of 8.75 months. In the human study, 57 capsules from patients with Baker grade IV contracture were collected prospectively over a 4-year period. Biofilm and surrounding lymphocytes were analyzed using culture, nucleic acid, and visualization techniques. RESULTS In the pig study, all samples were positive for bacterial biofilm. There was a significant correlation between the bacterial numbers and grade of capsular contracture (p = 0.04). Quantitative real-time polymerase chain reaction showed that all lymphocytes were significantly more numerous on textured compared with smooth implants (p < 0.001). T cells accounted for the majority of the lymphocytic infiltrate. Imaging confirmed the presence of activated lymphocytes. In the human study, all capsules were positive for biofilm. Analysis of lymphocyte numbers showed a T-cell predominance (p < 0.001). There was a significant linear correlation between the number of T and B cells and the number of detected bacteria (p < 0.001). Subset analysis showed a significantly higher number of bacteria for polyurethane implants (p < 0.005). CONCLUSIONS Chronic biofilm infection around breast prostheses produces an increased T-cell response both in the pig and in humans. A possible link between bacterial biofilm and T-cell hyperplasia is significant in light of breast implant-associated anaplastic large-cell lymphoma. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, V.
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Botulinum Toxin A Affects Early Capsule Formation Around Silicone Implants in a Rat Model. Ann Plast Surg 2015; 74:488-95. [DOI: 10.1097/sap.0b013e318295de95] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Correia-Sá I, Rodrigues-Pereira P, Marques M. The "PIP problem": clinical and histologic characteristics. Aesthetic Plast Surg 2013; 37:936-40. [PMID: 23943050 DOI: 10.1007/s00266-013-0196-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 07/11/2013] [Indexed: 11/26/2022]
Abstract
Implants from Poly Implant Prothése (PIP), the French manufacturer, showed increased risk of implant rupture and silicone leakage through the shell. Concerns also exist about the potential irritant behavior of silicone gel filler in these implants. This report presents the clinical, histologic, and microbiologic characteristics of a capsule and a siliconoma from a patient with a ruptured PIP implant. A 41-year-old woman submitted to breast augmentation in 2005 with PIP silicone gel implants presented with a recent history of progressive asymmetric breast enlargement and an enlarged lymph node on her right axilla. No capsular contracture was observed. A breast ultrasonography showed intra- and extracapsular ruptures of the right implant. The woman underwent explantation. Histologic analysis of the breast capsules showed a thin capsule with a chronic, mild inflammatory response. Microbiologic analysis showed no bacterial agent. The irritant behavior of the PIP silicone gel previously described was not able to produce capsular contracture or an exuberant inflammatory reaction. Studies to evaluate the potential risks of the silicone gel and to define the hazards for women implanted with those prostheses are urgently needed.
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Affiliation(s)
- Inês Correia-Sá
- Department of Plastic and Reconstructive Surgery, Centro Hospitalar S. João, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal,
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Li Y, Liu H, Xu QS, Du YG, Xu J. Chitosan oligosaccharides block LPS-induced O-GlcNAcylation of NF-κB and endothelial inflammatory response. Carbohydr Polym 2013; 99:568-78. [PMID: 24274545 DOI: 10.1016/j.carbpol.2013.08.082] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 08/23/2013] [Accepted: 08/24/2013] [Indexed: 02/06/2023]
Abstract
It is known that chitosan oligosaccharides (COS) suppress LPS-induced vascular endothelial inflammatory response by mechanism involving NF-κB blockade. It remains unknown how COS inhibit NF-κB. We provided evidence both in cultured endothelial cells and mouse model supporting a new mechanism. Regardless of the endothelial cell types, the LPS-induced NF-κB-dependent inflammatory gene expression was suppressed by COS, which was associated with reduced NF-κB nucleus translocation. LPS enhanced O-GlcNAc modification of NF-κB/p65 and activated NF-κB pathway, which could be prevented either by siRNA knockdown of O-GlcNAc transferase (OGT) or pretreatment with COS. Inhibition of either mitogen-activated protein kinase or superoxide generation abolishes LPS-induced NF-κB O-GlcNAcylation. Consistently, aortic tissues from LPS-treated mice presented enhanced NF-κB/p65 O-GlcNAcylation in association with upregulated gene expression of inflammatory cytokines in vascular tissues; however, pre-administration of COS prevented these responses. In conclusion, COS decreased OGT-dependent O-GlcNAcylation of NF-κB and thereby attenuated LPS-induced vascular endothelial inflammatory response.
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Affiliation(s)
- Yu Li
- Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian 116023, China; University of Chinese Academy of Sciences, Beijing 100049, China; Department of Medicine, University of Oklahoma Health Sciences Center, 941 Stanton L. Young Boulevard, Oklahoma City, OK 73104, USA
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Marques M, Brown S, Correia-Sá I, D S Cordeiro MN, Rodrigues-Pereira P, Gonçalves-Rodrigues A, Amarante J. The impact of triamcinolone acetonide in early breast capsule formation in a rabbit model. Aesthetic Plast Surg 2012; 36:986-94. [PMID: 22476517 DOI: 10.1007/s00266-012-9888-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Accepted: 02/27/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND The etiology and clinical treatment of capsular contracture remain unresolved as the causes may be multifactorial. Triamcinolone acetonide applied in the pocket during surgery was reported to be ineffective in prevention of capsular contracture. However, if injected 4-6 weeks after surgery or as a treatment for capsular contracture, decreased applanation tonometry measurements and pain were observed. It was assumed that intraoperative application of triamcinolone was not effective because its effect does not last long enough. However, betadine, antibiotics, and fibrin were found to be effective in preventing capsular contracture with intraoperative applications and are more effective in the early phases of wound healing than in later stages. The role of triamcinolone acetonide in capsule formation is unknown. The purpose of this study was to determine if triamcinolone acetonide modulates breast capsule formation or capsular contracture in the early phases of wound healing in a rabbit model. METHODS Rabbits (n=19) were implanted with one tissue expander and two breast implants and were killed at 4 weeks. Implant pocket groups were (1) Control (n=10) and (2) Triamcinolone (n=9). Pressure/volume curves and histological, immunological, and microbiological evaluations were performed. Operating room air samples and contact skin samples were collected for microbiological evaluation. RESULTS In the triamcinolone group, a decreased capsular thickness, mild and mononuclear inflammation, and negative or mild angiogenesis were observed. There were no significant differences in intracapsular pressure, fusiform cell density, connective tissue, organization of collagen fibers, and microbiological results between the groups. There was no significant difference in the dialysate levels of IL-8 and TNF-α, but correlation between IL-8 and TNF-α was observed. CONCLUSION Triamcinolone acetonide during breast implantation influences early capsule formation and may reduce capsular contracture. LEVEL OF EVIDENCE III 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 at www.springer.com/00266.
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Affiliation(s)
- Marisa Marques
- Faculty of Medicine, University of Oporto, Porto, Portugal,
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