Capsular contracture and steroid-related complications in augmentation mammoplasty

The Effect of Omega-3 Fatty Acids on Capsular Tissue around the Breast Implants

BACKGROUND

One of the most common complications of the use of foreign material, in both reconstructive and cosmetic breast surgery, is capsular contracture. Historically, research on capsular contracture has focused mainly on reducing bacterial contamination through antibiotic solutions. Only secondary studies have focused on pharmacological control of the inflammation process, with particular attention paid to the main inflammation pathway, the arachidonic acid cascade. An important role in the arachidonic acid cascade is played by the omega-3 fatty acids, which are found mainly in oily fish and food supplements. The goal of the present study was to investigate the effects of omega-3 supplements on capsule contraction.

METHODS

Female C57BL/6 mice were implanted with custom-made silicone gel implants and divided into two groups. The treated group received omega-3 oil daily while the control group received water daily by gavage. After mice were euthanized, samples of capsules were collected to evaluate thickness and transforming growth factor (TGF)-β expression.

RESULTS

The results showed that capsules in the omega-3 group were thinner and more transparent than those found in the control group. In addition, a significant downregulation of the TGF-β2 gene transcript was observed in the omega-3 group.

CONCLUSIONS

Omega-3 supplementation seems to be effective in reducing the occurrence of capsular formation, mainly through inhibition of the TGF-β pathway and impairment of collagen deposit. Omega-3 supplementation is a simple and promising method that could be used to prevent or at least reduce capsular contracture after silicone implant surgery.

The aetiopathogenesis of capsular contracture: A systematic review of the literature

BACKGROUND

Capsular contracture is the most frequent complication after breast augmentation or reconstruction with breast implants. The immune system plays a prominent role in capsular contracture formation, albeit to an unknown extent. Bacterial contamination in situ has been hypothesized to be causative for capsular contracture. How this relates to the immunological processes involved is unknown. This article aims to provide an overview of immunological and bacterial factors involved in development of capsular contracture.

MATERIALS AND METHODS

We undertook a systematic literature review focused on immunological factors and microbiota in relation to capsular contraction around implants. This systematic review was performed in accordance with the PRISMA guidelines. PubMed, EMBASE, and the Cochrane databases were searched from inception up to October 2016. Included studies were assessed for the following variables: subject characteristics, number of capsules, primary indication for surgery, surgical procedure, follow-up or implant duration, study methods, type of antibiotics or medical therapies and outcomes related to microbiota and immunological factors.

RESULTS

Data on immunological factors and bacterial contamination were retrieved from 64 included studies. Notably the presence of macrophages and Staphylococcus epidermidis within capsules was often associated with capsular contracture.

CONCLUSION

This review provides a clear overview of the immunological factors associated with capsular contracture and provides a hypothetical immunological model for development of the disease. Furthermore, an overview of bacterial contamination and associations with capsular contracture has been provided. Follow-up research may result in clinical recommendations to prevent capsular contracture.

Histoire de l'augmentation mammaire

The history of breast augmentation started effectively after World War II. Until then, this surgery was almost irrelevant because the indications were considered very rare and technical possibilities limited. During about two decades after 1945, two types of procedures were proposed. The first ones used autologous tissue especially fat in the form of dermofatty grafts taken from the buttocks. The results were very bad and sometimes disastrous for both techniques. At the beginning of the sixties, under the impulse of the Dow Corning Company, two surgeons: Frank Gerow and Thomas Cronin from Houston (Texas, USA) proposed an implant with a sheath filled with silicone gel. This new prosthesis had an immediate success and the number of breast augmentations growed very quickly. After an optimistic period, it had to be admitted that the results were sometimes deceiving or frankly bad. The breasts were often too firm, sometimes hard and even deformed. Capsular contracture occurred around the implants. During the 70's and 80's both consistency and envelops of the implants were regularly modified. The incision and the positioning were changed. At the end of the 80's, the problem of capsular contracture seemed to be resolved with the implants used, meanwhile a controversy took place about silicone in USA. Some cases of autoimmune diseases were attributed to silicone. In spite of scientific studies that proved the contrary, silicone implants were prohibited in the United States, Canada and temporarily in France.

Voies de recherche pour la mise au point de nouvelles prothèses mammaires

Despite the improvement of breast implant quality across the last decade, the perfect implant does not exist. Therefore research should manage to improve those implants. In this article we have tried to identify different directions to investigate for better prosthesis: improvement of the shell, the filling and the form. Moreover, other targets as fat transfer or other permanent soft tissue filler also need further experimental and clinical investigation.

Passé, présent et… avenir des prothèses mammaires

The past of breast implants is well known, the techniques seem to be up to date and the future definitely optimistic. Breast implants have been at the top of the polemic due to their complications. Technical innovations allow plastic surgeons to choose adequate types of breast implants and also improve the innocuity of this surgery. Due to the last juridic reglementation and behaviour's evolution, breast augmentation will probably keep its place at the top.