Histologic, Molecular, and Clinical Evaluation of Explanted Breast Prostheses, Capsules, and Acellular Dermal Matrices for Bacteria

Poppler, Louis H.; Cohen, Justin B.; Dölen, Utku Can; Schriefer, Andrew E.; Tenenbaum, M; Deeken, Corey R.; Chole, Richard A.; Myckatyn, Terence M.

doi:10.1093/asj/sjv017

Cited by 33 publications

(25 citation statements)

References 104 publications

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“…Curiously, a histological study 42 found that mast cells, the predominant inflammatory cell in hypertrophic scars, disappear as the capsular contracture becomes more severe. Poppler et al, 43 using specialized cultures and scanning electron microscopy in women undergoing expander/implant exchange, were unable to find a correlation between biofilm formation and capsular contracture. These investigators 43 theorize that stressful stimuli might lead independently to inflammation and a biofilm.…”

Section: Discussionmentioning

confidence: 99%

“…Poppler et al, 43 using specialized cultures and scanning electron microscopy in women undergoing expander/implant exchange, were unable to find a correlation between biofilm formation and capsular contracture. These investigators 43 theorize that stressful stimuli might lead independently to inflammation and a biofilm. Paradoxically, antimicrobial therapy may even induce biofilm formation to confer resistance.…”

Section: Discussionmentioning

confidence: 99%

“…Another theory for capsular contracture is based on the mechanical action of myofibroblasts 1,7,9,43,46,47 and abnormal collagen deposition. 9,42,43 A capsulotomy breaks this mechanical force.…”

Section: Discussionmentioning

confidence: 99%

“…9,42,43 A capsulotomy breaks this mechanical force. 7 It is possible, although unproven, that nonpathogenic bacteria may be protective against pathogens 38 (similar to the flora of the digestive tract) and attempts to alter the microbial environment with antibiotics may be counterproductive.…”

Section: Discussionmentioning

confidence: 99%

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Open Capsulotomy: An Effective but Overlooked Treatment for Capsular Contracture after Breast Augmentation

Swanson

2016

Plastic and Reconstructive Surgery - Global Open

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Background:The prevailing theory for capsular contracture after breast augmentation is a subclinical capsular infection. A capsulectomy, site change, and implant replacement are recommended. An open capsulotomy leaves the capsule in the patient. Theoretically, such a procedure would be ineffective because it does not remove the infected tissue. Recurrences occurred frequently in women treated in the 1970s when leaky silicone gel implants were in use. Open capsulotomy has not been studied in women implanted with third-generation devices.Methods:Seventy-five consecutive women with Baker III/IV capsular contractures after breast augmentation treated with open capsulotomies between 1996 and 2016 were retrospectively evaluated. The original implants were usually saline-filled (72.2%). Replacements were all smooth and round, and 92.6% were also saline-filled.Results:Seventeen women (22.7%) developed a recurrent capsular contracture. Two patients (2.7%) experienced a second recurrence. Patients with ruptured silicone gel implants (n = 13) had a significantly greater risk of recurrence (P = 0.01). There was no significant difference in recurrence rates comparing patients whose intact implants were reinserted (12.5%) with women whose intact implants were replaced (18.2%). Povidone–iodine irrigation did not affect the recurrence rate. Capsular contracture was corrected with 1 procedure in 77.3% of patients and 2 procedures in 97.3% of patients.Conclusions:Open capsulotomy is a safe and effective treatment that avoids the additional morbidity and cost of a capsulectomy. The findings challenge the infected biofilm theory of capsular contracture. Open capsulotomy deserves reconsideration by plastic surgeons.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Open Capsulotomy: An Effective but Overlooked Treatment for Capsular Contracture after Breast Augmentation

Swanson

2016

Plastic and Reconstructive Surgery - Global Open

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“…It must also be noticed that not all capsules are associated with biofilm. 43 The reason to perform this technique is 2-fold. Firstly, to have the implant lie on a "new" raw surface, even in cases that present with no complication (ie, size change).…”

Section: Discussionmentioning

confidence: 99%

Autologous Collagen Matrix (ACM): Lower Pole Support With a Supero-Anterior Capsular Flap in Secondary Subpectoral Breast Augmentation

Montemurro¹,

Cheema²,

Hedén³

et al. 2017

Aesthetic Surgery Journal

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Background: Secondary aesthetic breast surgery is a complex and challenging scenario. It requires the surgeon to identify contributing factors, provide patient education, make a further management plan, and optimize the conditions for a favorable result. Various techniques have been described in literature but the rate of reoperation is still high. The first author has been using a supero-anterior capsular flap with a neopectoral subcapsular pocket and an implant change in these cases. Objectives: To review the patient characteristics, indications, and early results of using part of the existing implant capsule for secondary subpectoral breast augmentations. Methods: All patients who underwent secondary breast augmentation, over a period of 2 years by the first author (P.M.), using the supero-anterior capsular flap technique were included. The technique involves dissection of a new subpectoral pocket and uses the existing implant capsule as an internal brassiere. Results: A total of 36 patients were operated by this technique. Of these, 17 patients had developed a complication while 19 patients wanted a change in size only. At a mean follow up of 10.2 months, there was no bottoming out, double bubble, or capsular contracture. Conclusions: This reliable technique provides stable results as shown by low rate of complications with the existing follow up.

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Semiautomated quantification of the fibrous tissue response to complex three‐dimensional filamentous scaffolds using digital image analysis

Barsch

Mamilos

Babel

et al. 2021

J Biomedical Materials Res

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Fibrosis represents a relevant response to the implantation of biomaterials, which occurs not only at the tissue–material interface (fibrotic encapsulation) but also within the void fraction of complex three‐dimensional (3D) biomaterial constructions (fibrotic ingrowth). Usual evaluation of the biocompatibility mostly depicts fibrosis at the interface of the biomaterial using semiquantitative scores. Here, the relations between encapsulation and infiltrating fibrotic growth are poorly represented. Virtual pathology and digital image analysis provide new strategies to assess fibrosis in a more differentiated way. In this study, we adopted a method previously used to quantify fibrosis in visceral organs to the quantification of fibrosis to 3D biomaterials. In a proof‐of‐concept study, we transferred the “Collagen Proportionate Area” (CPA) analysis from hepatology to the field of biomaterials. As one task of an experimental animal study, we used CPA analysis to quantify the fibrotic ingrowth into a filamentous scaffold after subcutaneous implantation. We were able to demonstrate that the application of the CPA analysis is well suited as an additional fibrosis evaluation strategy for new biomaterial constructions. The CPA method can contribute to a better understanding of the fibrotic interactions between 3D scaffolds and the host tissue responses.

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Histologic, Molecular, and Clinical Evaluation of Explanted Breast Prostheses, Capsules, and Acellular Dermal Matrices for Bacteria

Abstract: 4 Therapeutic.

Cited by 33 publications

References 104 publications

Open Capsulotomy: An Effective but Overlooked Treatment for Capsular Contracture after Breast Augmentation

Open Capsulotomy: An Effective but Overlooked Treatment for Capsular Contracture after Breast Augmentation

Autologous Collagen Matrix (ACM): Lower Pole Support With a Supero-Anterior Capsular Flap in Secondary Subpectoral Breast Augmentation

Semiautomated quantification of the fibrous tissue response to complex three‐dimensional filamentous scaffolds using digital image analysis

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