Morphometric evaluation of collagen fibril dimensions in expanded human breast skin

A comparison of the capsules around smooth and textured silicone prostheses used for breast reconstruction. A light and electron microscopic study

A total of 18 women who had undergone modified radical mastectomy and tissue expansion for breast reconstruction were studied. When the expanders were replaced, nine patients had received smooth, gel-filled permanent prostheses and nine had received textured, gel-filled permanent prostheses. For medical reasons, e.g. capsular contraction, incorrectly placed or sized implant, an additional operation was performed, and then biopsy specimens from the capsules around the prostheses were taken and subsequently examined with the aid of the light and transmission electron microscope (TEM). A histologist was able to classify blindly 11 capsules out of 13 which were investigated by light microscopy in the correct groups and several differences between the capsules were found. Capsules around the smooth implants had a clear line of separation between the inner surface and the prosthesis, and formed a single collageneous layer. They were sparse in fibroblasts, which were long and thin. Capsules around textured implants consisted of two layers, the outer layer being compact with long, slender fibroblasts, and the inner one looking rugged with wavy bundles of collagen often splitting from each other, and with shorter and more rounded fibroblasts. The overall thickness seemed greater compared to the capsules around the smooth prostheses, which, on the other hand, showed a greater variation in thickness. To analyze collagen fibril diameters, sample sections were photographed at magnification 22,000 x in the TEM. The fibril diameters were measured with an interactive image analysis system (IBAS). The mean diameter of the collagen fibrils was 47.2 nm in the capsules around the smooth prostheses and 51.7 nm in the capsules around the textured prostheses.(ABSTRACT TRUNCATED AT 250 WORDS)

Dimensions of capsular collagen fibrils: image analysis of rapid compared with slow tissue expansion for breast reconstruction

Thirty women who were to undergo breast reconstruction by tissue expansion were randomly divided into two groups. Those in the first group were to undergo expansion once a day (rapid expansion) and the second group once a week (slow expansion). When the expanders were replaced by permanent prostheses, biopsy specimens were taken from the capsules around the expanders, and were examined by transmission electron microscopy at a magnification x 22,000. The diameters of the collagen fibrils in the capsules were analysed by an interactive image analysis system and measured. An analysis of variance was performed on a test series to optimize the sample. Ninety fibrils from each patient (two patients were excluded), were analysed and there were no significant differences in collagen fibrillar diameters (about 50 nm) between those who had undergone rapid or slow expansion, or between patients who had also undergone radiotherapy to the chest wall and those who had not. These results indicate that the collagen fibrils may still be in a transitional stage, and that further longer term studies are desirable. It is difficult, however, to see how they could be justified ethically in patients who are otherwise well.