Abstract:Breast augmentation with silicone implants is one of the most common procedures performed by plastic surgeons around the world. Capsular contracture is a frequent complication in breast augmentation and reconstructive surgery, that requires invasive intervention. The inflammatory response to implanted mammary prostheses appears to be directly associated to capsular contracture. This review discusses the evidences from rat models studies, on the role of inflammation and fibrosis in capsular contraction and its … Show more
“…This fact might be due to the still widely unknown detailed causes of capsular contracture. Although several coinciding and influencing factors have been described [9, 24-26], exact processes regarding development of capsular contracture and, hence, exact measures for prevention of occurrence have yet to be discovered and understood with certainty [24, 27].…”
<b><i>Introduction:</i></b> Capsular contracture most often leads to implant revision surgery for aesthetic or reconstructive purposes. However, little is known about which operation is chosen when revision surgery has to be performed. We performed analysis of revision indications and performed revision surgery considering implant removal or replacement and additional surgical procedures. To our knowledge, this study presents the largest German single-center analysis regarding implant revision surgery after the onset of complications. <b><i>Methods:</i></b> Retrospective 10-year data analysis of a single-center population undergoing breast implant revision surgery. <b><i>Results:</i></b> Capsular contracture was the most frequent finding before reoperation, both removal and replacement (<i>p</i> < 0.05). It was linked to longer duration of in situ implant placement (<i>p</i> < 0.05) and more frequently in reconstructive patients (<i>p</i> < 0.05). Implant replacement was performed more often before definite implant removal for reconstructive patients (<i>p</i> < 0.05). Mean duration of in situ implant placement before definite removal was lower for reconstructive patients (<i>p</i> = 0.005). Overall reconstructive patients were older than aesthetic patients (<i>p</i> < 0.05). After implant removal, 61.7% of aesthetic patients chose to undergo mastopexy, 54.7% of reconstructive patients opted for autologous breast reconstruction, and 25.4% did not choose an additional surgical procedure after implant removal. <b><i>Conclusion:</i></b> Significant differences are observed for reconstructive and aesthetic patients regarding indication leading to revision surgery, time of revision surgery, and the type of performed revision surgery itself. After implant removal, more than 60% of aesthetic patients undergo mastopexy, more than half of reconstructive patients choose autologous breast reconstruction, and over a quarter of patients choose no additional surgical procedures.
“…This fact might be due to the still widely unknown detailed causes of capsular contracture. Although several coinciding and influencing factors have been described [9, 24-26], exact processes regarding development of capsular contracture and, hence, exact measures for prevention of occurrence have yet to be discovered and understood with certainty [24, 27].…”
<b><i>Introduction:</i></b> Capsular contracture most often leads to implant revision surgery for aesthetic or reconstructive purposes. However, little is known about which operation is chosen when revision surgery has to be performed. We performed analysis of revision indications and performed revision surgery considering implant removal or replacement and additional surgical procedures. To our knowledge, this study presents the largest German single-center analysis regarding implant revision surgery after the onset of complications. <b><i>Methods:</i></b> Retrospective 10-year data analysis of a single-center population undergoing breast implant revision surgery. <b><i>Results:</i></b> Capsular contracture was the most frequent finding before reoperation, both removal and replacement (<i>p</i> < 0.05). It was linked to longer duration of in situ implant placement (<i>p</i> < 0.05) and more frequently in reconstructive patients (<i>p</i> < 0.05). Implant replacement was performed more often before definite implant removal for reconstructive patients (<i>p</i> < 0.05). Mean duration of in situ implant placement before definite removal was lower for reconstructive patients (<i>p</i> = 0.005). Overall reconstructive patients were older than aesthetic patients (<i>p</i> < 0.05). After implant removal, 61.7% of aesthetic patients chose to undergo mastopexy, 54.7% of reconstructive patients opted for autologous breast reconstruction, and 25.4% did not choose an additional surgical procedure after implant removal. <b><i>Conclusion:</i></b> Significant differences are observed for reconstructive and aesthetic patients regarding indication leading to revision surgery, time of revision surgery, and the type of performed revision surgery itself. After implant removal, more than 60% of aesthetic patients undergo mastopexy, more than half of reconstructive patients choose autologous breast reconstruction, and over a quarter of patients choose no additional surgical procedures.
“…Although the cause of capsular contracture in breast implants is still controversial, there have been many attempts to explain the phenomenological mechanism [ 26 ]. Host reactions following the implantation of biomaterials such as breast silicone implants include five steps: blood/material interaction induced by vascularized connective tissue injury, early inflammation, late inflammation, granulation tissue development, and fibrosis/fibrous capsule development [ 27 ].…”
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.
The interactions at the graft–tissue interfaces are critical for the results of engraftments post-implantation. To improve the success rate of the implantations, as well as the quality of the patients' life, understanding the possible reactions between artificial materials and the host tissues is helpful in designing new generations of material-based grafts aiming at inducing specific responses from surrounding tissues for their own reparation and regeneration. To help researchers understand the complicated interactions that occur after implantations and to promote the development of better-designed grafts with improved biocompatibility and patient responses, in this review, the topics will be discussed from the basic reactions that occur chronologically at the graft–tissue interfaces after implantations to the existing and potential applications of the mechanisms of such reactions in designing of grafts. It offers a chance to bring up-to-date advances in the field and new strategies of controlling the graft–tissue interfaces.
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