Effects of Medical Chitosan on Capsular Formation Following Silicone Implant Insertion in a Rabbit Model

Li, Shasha; Ren, Liwen; Xu, Haiqian; Jia, Di; Luo, Sai; Hao, Lijun; Yang, Dan

doi:10.1007/s00266-016-0664-3

Cited by 6 publications

(7 citation statements)

References 55 publications

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“…Our previous study demonstrated that carboxymethyl chitin could inhibit the expression of TIMP-1 in the capsule around silicone implants in a rabbit model. 16 Therefore, the inhibitory effect of carboxymethyl chitin on the expression of collagen type III in vivo might be related to the down-regulation of TIMP-1.…”

Section: Discussionmentioning

confidence: 99%

“…The results confirmed that carboxymethyl chitin decreased the thickness of the capsule at these three time points. 16 In this study, we chose 8 weeks as the observation time point because the capsular tissue was thicker at this time point than at the other two time points, and it is better to obtain ideal histologic specimens. However, to better understand the effect of carboxymethyl chitin on α-SMA and collagen expression in the capsular tissue, it is reasonable to include more time points, such as 4 weeks, 3 months, or even 6 months.…”

Section: Could Inhibit the Expressionmentioning

confidence: 99%

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The effect of carboxymethyl chitin on capsule formation around silicone implants: an in vivo and in vitro study

Ren

Jia

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Capsular contracture is a serious complication that occurs after augmentation mammaplasty. The authors previously identified that carboxymethyl chitin had an inhibitory effect on capsule formation. This study was performed to elucidate the possible molecular mechanisms through which carboxymethyl chitin inhibits the formation of a capsule around silicone implants. Methods: In this study, the authors cultured human dermal fibroblasts and treated them with carboxymethyl chitin in vitro. The difference in proliferation between treated and untreated cells was analyzed through the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. Protein levels of transforming growth factor beta-1 and alpha smooth muscle actin (α-SMA) were examined by Western blot analysis. Expression levels of type I and type III collagen were checked by enzyme-linked immunosorbent assay. In vivo, silicone implants were placed under the pectoralis muscle in 12 female rabbits. The thickness of the capsule was measured by histologic analysis, and the effect of carboxymethyl chitin on α-SMA, collagen type I and III expression levels was evaluated by real-time polymerase chain reaction analysis, enzyme-linked immunosorbent assay, Western blot, and immunofluorescence analysis. Results: In the in vitro study, we confirmed that carboxymethyl chitin inhibited the proliferation of fibroblasts. The protein expression levels of collagen type I, transforming growth factor beta-1, and α-SMA were inhibited by carboxymethyl chitin treatment. In vivo, carboxymethyl chitin treatment reduced capsular thickness and the expression of α-SMA and collagen types I and III in capsules around silicone implants. Conclusion: The authors’ results showed that carboxymethyl chitin could influence capsule formation around silicone implants by inhibiting the fibroblast activity, interrupting fibroblast-to-myofibroblast differentiation, and decreasing collagen synthesis. Clinical Relevance Statement: Carboxymethyl chitin influence capsule formation around silicone implants. Although more clinical studies are needed to verify the effect of carboxymethyl chitin on capsular contracture, the authors believe that it will play an effective role in the clinical application of reducing the occurrence of capsular contracture.

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Section: Discussionmentioning

confidence: 99%

Section: Could Inhibit the Expressionmentioning

confidence: 99%

The effect of carboxymethyl chitin on capsule formation around silicone implants: an in vivo and in vitro study

Ren

Jia

et al. 2022

Plastic &Amp; Reconstructive Surgery

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“…Previously, several preclinical studies using other AAAs, including poloxamer, 14 hyaluronate with carboxymethyl cellulose, 13,15,34 chitosan, 35 and amniotic fluid, 36 have been reported. Using a rat 13,34,36 or rabbit 14,15,35 model for conducting silicone implant insertion, previous studies demonstrated that the experimental group using AAA developed a thinner periprosthetic capsule than did the control group. As a further study based on several preclinical studies, we conducted the first prospective clinical study on the use of AAA in implant-based breast reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Effects of an anti-adhesive agent on capsule formation in implant-based breast reconstruction: A randomized controlled trial

Hong

Kim

Sakong

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Although implant-based breast reconstruction is a common surgical modality, a periprosthetic capsule inevitably forms and worsens in cases of postmastectomy radiation therapy. Previous animal studies have reported that antiadhesive agents (AAAs) inhibit periprosthetic capsule formation. The authors prospectively examined the clinical effects of an AAA (Mediclore) on capsule formation in implant-based breast reconstruction. Methods: The authors analyzed patients who underwent immediate two-stage implant-based breast reconstruction following total mastectomy for breast malignancy between November of 2018 and March of 2019. Each patient was randomly allocated to the control or AAA group. After inserting the breast expander and acellular dermal matrix, AAA was applied around the expander before skin closure. The capsule specimen was obtained during the expander-implant change; capsule thickness and immunohistochemistry were investigated. Results: A total of 48 patients were enrolled and allocated to the control (n = 22) and AAA (n = 26) groups. There were no significant differences in patient- and operation-related characteristics. Submuscular capsule thickness was significantly reduced in the AAA group compared with the control group. The levels of pro–capsular-forming cells (myofibroblasts, fibroblasts, and M1 macrophages) in the capsule were significantly lower in the AAA group than in the control group. Conclusions: AAA reduced the thickness of periprosthetic capsules and changed the profiles of cells involved in capsule formation during the tissue expansion. These findings demonstrate the clinical value of AAA for mitigating capsule formation in implant-based breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

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“…83 Additionally, studies in animal models suggest that various medications such as Vitamin E, colchicine, botox, chitosan, collagenases, omega 3, and doxycycline could potentially be used to prevent the development of capsular contracture. [84][85][86][87][88][89][90] Despite the promise of these experimental therapies, most have not yet been explored in human trials. Continued investigations into novel therapies such as those described here are exciting and could help to substantially improve biologic response to implants and in turn reduce morbidity associated with periprosthetic fibrosis.…”

Section: Experimental/medical Preventionsmentioning

confidence: 99%

Current Concepts in Capsular Contracture: Pathophysiology, Prevention, and Management

et al. 2021

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Over 400,000 women in the United States alone will have breast implant surgery each year. Although capsular contracture represents the most common complication of breast implant surgery, surgeons continue to debate the precise etiology. General agreement exists concerning the inflammatory origin of capsular fibrosis, but the inciting events triggering the inflammatory cascade appear to be multifactorial, making it difficult to predict why one patient may develop capsular contracture while another will not. Accordingly, researchers have explored many different surgical, biomaterial, and medical therapies to address these multiple factors in an attempt to prevent and treat capsular contracture. In the current paper, we aim to inform the reader on the most up-to-date understanding of the pathophysiology, prevention, and treatment of capsular contracture.

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Effects of Medical Chitosan on Capsular Formation Following Silicone Implant Insertion in a Rabbit Model

Cited by 6 publications

References 55 publications

The effect of carboxymethyl chitin on capsule formation around silicone implants: an in vivo and in vitro study

The effect of carboxymethyl chitin on capsule formation around silicone implants: an in vivo and in vitro study

Effects of an anti-adhesive agent on capsule formation in implant-based breast reconstruction: A randomized controlled trial

Current Concepts in Capsular Contracture: Pathophysiology, Prevention, and Management

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