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Francis SD, Kang AW, Maheta BJ, Sangalang BR, Salingaros S, Wu RT, Nazerali RS. Impact of post-operative infection on revision procedures in breast reconstruction: A marketscan database analysis. J Plast Reconstr Aesthet Surg 2024; 93:103-110. [PMID: 38678812 DOI: 10.1016/j.bjps.2024.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/05/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Esthetic complications, such as capsular contracture and soft-tissue contour defects, hinder the desired outcomes of breast reconstruction. As subclinical infection is a prevailing theory behind capsular contracture, we investigated the effects of post-operative infections on these issues and revision procedures. METHODS We conducted a retrospective database study (2007-2021) on breast reconstruction patients from the MarketScan® Databases. Esthetic complications were defined by their associated revision procedures and queried via CPT codes. Severe capsular contracture (Grade 3-4) was defined as requiring capsulotomy or capsulectomy with implant removal or replacement. Moderate and severe soft-tissue defects were determined by the need for fat grafting or breast revision, respectively. Generalized linear models were used, adjusting for comorbidities and surgical factors (p < 0.05). RESULTS We analyzed the data on 62,510 eligible patients. Post-operative infections increased the odds of capsulotomy (OR 1.59, p < 0.001) and capsulectomy (OR 2.30, p < 0.001). They also raised the odds of breast revision for severe soft-tissue defects (OR 1.21, p < 0.001). There was no significant association between infections and fat grafting for moderate defects. Patients who had post-operative infections were also more likely to experience another infection after fat grafting (OR 3.39, p = 0.0018). In two-stage reconstruction, infection after tissue expander placement was associated with greater odds of infection after implant placement. CONCLUSION Post-operative infections increase the likelihood of developing severe soft-tissue defects and capsular contracture requiring surgical revision. Our data reinforce the role of infections in the pathophysiology of capsular contracture. Additionally, infections elevate the risk of subsequent infections after fat grafting for moderate defects, further increasing patient morbidity.
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Affiliation(s)
| | | | - Bhagvat J Maheta
- California Northstate University College of Medicine, Elk Grove, CA, USA
| | - Brian R Sangalang
- University of California Riverside School of Medicine, Riverside, CA, USA
| | | | - Robin T Wu
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Rahim S Nazerali
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
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2
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Nepon H, Allgayer R, Julien C, Petrecca S, Kalashnikov N, Safran T, Murphy A, Dionisopolous T, Davison P, Cerruti M, Vorstenbosch J. Altered Foreign Body Response at the Posterior Surface Compared to the Anterior Surface of Human Silicone Breast Implants. ACS Biomater Sci Eng 2024; 10:3006-3016. [PMID: 38640484 DOI: 10.1021/acsbiomaterials.3c01961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Soft implantable devices are crucial to optimizing form and function for many patients. However, periprosthetic capsule fibrosis is one of the major challenges limiting the use of implants. Currently, little is understood about how spatial and temporal factors influence capsule physiology and how the local capsule environment affects the implant structure. In this work, we analyzed breast implant capsule specimens with staining, immunohistochemistry, and real-time polymerase chain reaction to investigate spatiotemporal differences in inflammation and fibrosis. We demonstrated that in comparison to the anterior capsule against the convex surface of breast implants, the posterior capsule against the flat surface of the breast implant displays several features of a dysregulated foreign body reaction including increased capsule thickness, abnormal extracellular remodeling, and infiltration of macrophages. Furthermore, the expression of pro-inflammatory cytokines increased in the posterior capsule across the lifespan of the device, but not in the anterior capsule. We also analyzed the surface oxidation of breast explant samples with XPS analysis. No significant differences in surface oxidation were identified either spatially or temporally. Collectively, our results support spatiotemporal heterogeneity in inflammation and fibrosis within the breast implant capsule. These findings presented here provide a more detailed picture of the complexity of the foreign body reaction surrounding implants destined for human use and could lead to key research avenues and clinical applications to treat periprosthetic fibrosis and improve device longevity.
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Affiliation(s)
- Hillary Nepon
- Division of Surgical and Interventional Sciences, McGill University, Montreal General Hospital, 1650 Cedar Avenue, Room T5-204, Montreal, Quebec H3G 1A4, Canada
- Division of Plastic & Reconstructive Surgery, McGill University, Montreal General Hospital, 1650 Cedar Avenue, Room T5-204, Montreal, Quebec H3G 1A4, Canada
| | - Raphaela Allgayer
- Department of Materials Engineering, McGill University, Wong Building, 3610 Rue University, Montreal, Quebec H3A 0C5, Canada
| | - Cedric Julien
- Research Institute of the McGill University Health Centre, McGill University, Montreal General Hospital, 1650 Cedar Avenue, Room T5-204, Montreal, Quebec H3G 1A4, Canada
| | - Sarah Petrecca
- Faculty of Medicine and Health Sciences, McGill University, 3605 de la Montagne, Montreal, Quebec H3G 1M1, Canada
| | - Nikita Kalashnikov
- Division of Surgical and Interventional Sciences, McGill University, Montreal General Hospital, 1650 Cedar Avenue, Room T5-204, Montreal, Quebec H3G 1A4, Canada
- Faculty of Medicine and Health Sciences, McGill University, 3605 de la Montagne, Montreal, Quebec H3G 1M1, Canada
| | - Tyler Safran
- Division of Plastic & Reconstructive Surgery, McGill University, Montreal General Hospital, 1650 Cedar Avenue, Room T5-204, Montreal, Quebec H3G 1A4, Canada
| | - Amanda Murphy
- Division of Plastic & Reconstructive Surgery, McGill University, Montreal General Hospital, 1650 Cedar Avenue, Room T5-204, Montreal, Quebec H3G 1A4, Canada
| | - Tassos Dionisopolous
- Division of Plastic & Reconstructive Surgery, McGill University, Montreal General Hospital, 1650 Cedar Avenue, Room T5-204, Montreal, Quebec H3G 1A4, Canada
| | - Peter Davison
- Division of Plastic & Reconstructive Surgery, McGill University, Montreal General Hospital, 1650 Cedar Avenue, Room T5-204, Montreal, Quebec H3G 1A4, Canada
| | - Marta Cerruti
- Department of Materials Engineering, McGill University, Wong Building, 3610 Rue University, Montreal, Quebec H3A 0C5, Canada
| | - Joshua Vorstenbosch
- Division of Plastic & Reconstructive Surgery, McGill University, Montreal General Hospital, 1650 Cedar Avenue, Room T5-204, Montreal, Quebec H3G 1A4, Canada
- Research Institute of the McGill University Health Centre, McGill University, Montreal General Hospital, 1650 Cedar Avenue, Room T5-204, Montreal, Quebec H3G 1A4, Canada
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Zingaretti N, Piana M, Battellino L, Galvano F, De Francesco F, Riccio M, Beorchia Y, Castriotta L, Parodi PC. Pre-pectoral Breast Reconstruction: Surgical and Patient-Reported Outcomes of Two-Stages vs Single-Stage Implant-Based Breast Reconstruction. Aesthetic Plast Surg 2024; 48:1759-1772. [PMID: 37644192 PMCID: PMC11093833 DOI: 10.1007/s00266-023-03601-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/07/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Two-stages pre-pectoral breast reconstruction may confer advantages over direct to implant (DTI) and subpectoral reconstruction in selected patients who have no indication for autologous reconstruction. The primary endpoint of the study was to evaluate and compare the incidence of capsular contracture in the pre-pectoral two-stages technique versus the direct to implant technique. Complications related to the two surgical techniques and patient satisfaction were also evaluated. METHODS A retrospective review of 45 two stages and 45 Direct-to-implant, DTI patients was completed. Acellular dermal matrix was used in all patients. An evaluation of anthropometric and clinical parameters, surgical procedures and complications was conducted. Minimum follow-up was 12 months after placement of the definitive implant. RESULTS There was no statistically significant difference in the rate of capsular contracture in the two groups. Rippling occurred more in DTI reconstruction. In the two-stages reconstruction, lipofilling was applied more often and there was a higher incidence of seroma. Patient satisfaction extrapolated from the Breast Q questionnaire was better for patients submitted to two-stage implant-based breast reconstruction. CONCLUSION Dual-stage pre-pectoral reconstruction with acellular dermal matrix appears to be a good reconstructive solution in patients with relative contraindications for one-stage heterologous reconstruction with definitive prosthesis and no desire for autologous reconstruction.
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Affiliation(s)
- Nicola Zingaretti
- Department of Medical Area (DAME), Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, University of Udine, Udine, Italy.
- Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Jesi, Italy.
| | - Michele Piana
- Department of Medical Area (DAME), Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, University of Udine, Udine, Italy
| | | | - Francesca Galvano
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Francesco De Francesco
- Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Jesi, Italy
- Department of Reconstructive Surgery and Hand Surgery, AOU "Ospedali Riuniti", Ancona, Italy
| | - Michele Riccio
- Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Jesi, Italy
- Department of Reconstructive Surgery and Hand Surgery, AOU "Ospedali Riuniti", Ancona, Italy
| | - Yvonne Beorchia
- Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy
| | - Luigi Castriotta
- Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy
| | - Pier Camillo Parodi
- Department of Medical Area (DAME), Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, University of Udine, Udine, Italy
- Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Jesi, Italy
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Chang TY, Hong YK, Kuo YL, Wu HL, Shieh SJ. CD248 Regulates Inflammation and Encapsulation in Silicone-Related Capsule Formation. Plast Reconstr Surg 2024; 153:109-120. [PMID: 36988436 DOI: 10.1097/prs.0000000000010464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
BACKGROUND Capsular contracture is the most common reason for having a secondary breast implant operation. The failure of the implanted device and discomfort are related to foreign body response, which involves a pathologic encapsulation. An up-regulated expression of CD248 was previously demonstrated to modulate inflammation and fibrosis. The authors hypothesized that CD248 contributes to foreign body reaction and contracture during silicone-stimulated capsule formation. METHODS A murine capsular contracture model was established to correlate CD248 with capsular contracture. The timing and site of CD248 expression were characterized by protein analysis and histologic examination. The capsules between wild-type mice and CD248 knockout mice were compared in this model to verify the possible role of CD248 in silicone-related capsule formation. RESULTS CD248 was expressed in the peri-silicone implant capsule by stromal fibroblast and perivascular fibroblast. CD248 was overexpressed on day 4 and down to a constant level, but it was still up-regulated through day 21 to day 56 after silicone implantation. The CD248 knockout mice showed a prolonged inflammation period, whereas the wild-type mice developed a thinner but more collagenous capsule. CONCLUSIONS In conclusion, an effective murine capsular contracture model was established to study the relationship between CD248 and capsular contracture. CD248 may play a role in inflammation and encapsulation during silicone implantation. CD248 deletion in mice contributed to a loose and irregular collagen bundle in a capsule area, implying a decrease in contracture. Therefore, CD248 could be a potential therapeutic target in capsular contracture. CLINICAL RELEVANCE STATEMENT CD248 may play a role in inflammation and encapsulation during silicone implantation. It could be a potential therapeutic target in clinical capsular contracture.
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Affiliation(s)
- Tzu-Yen Chang
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, National Cheng Kung University Hospital
- Institute of Clinical Medicine
| | - Yi-Kai Hong
- Institute of Basic Medical Sciences
- Department of Biochemistry and Molecular Biology, College of Medicine
| | - Yao-Lung Kuo
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, National Cheng Kung University Hospital
| | - Hua-Lin Wu
- Institute of Basic Medical Sciences
- Department of Biochemistry and Molecular Biology, College of Medicine
| | - Shyh-Jou Shieh
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, National Cheng Kung University Hospital
- International Center for Wound Repair and Regeneration (iWRR)
- School of Medicine, National Cheng Kung University
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5
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Karinja SJ, Bernstein JL, Mukherjee S, Jin J, Lin A, Abadeer A, Kaymakcalan O, Veiseh O, Spector JA. An Antifibrotic Breast Implant Surface Coating Significantly Reduces Periprosthetic Capsule Formation. Plast Reconstr Surg 2023; 152:775-785. [PMID: 36847657 DOI: 10.1097/prs.0000000000010323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND The body responds to prosthetic materials with an inflammatory foreign body response and deposition of a fibrous capsule, which may be deleterious to the function of the device and cause significant discomfort for the patient. Capsular contracture (CC) is the most common complication of aesthetic and reconstructive breast surgery. The source of significant patient morbidity, it can result in pain, suboptimal aesthetic outcomes, implant failure, and increased costs. The underlying mechanism remains unknown. Treatment is limited to reoperation and capsule excision, but recurrence rates remain high. In this study, the authors altered the surface chemistry of silicone implants with a proprietary anti-inflammatory coating to reduce capsule formation. METHODS Silicone implants were coated with Met-Z2-Y12, a biocompatible, anti-inflammatory surface modification. Uncoated and Met-Z2-Y12-coated implants were implanted in C57BL/6 mice. After 21, 90, or 180 days, periprosthetic tissue was removed for histologic analysis. RESULTS The authors compared mean capsule thickness at three time points. At 21, 90, and 180 days, there was a statistically significant reduction in capsule thickness of Met-Z2-Y12-coated implants compared with uncoated implants ( P < 0.05). CONCLUSIONS Coating the surface of silicone implants with Met-Z2-Y12 significantly reduced acute and chronic capsule formation in a mouse model for implant-based breast augmentation and reconstruction. As capsule formation obligatorily precedes CC, these results suggest contracture itself may be significantly attenuated. Furthermore, as periprosthetic capsule formation is a complication without anatomical boundaries, this chemistry may have additional applications beyond breast implants, to a myriad of other implantable medical devices. CLINICAL RELEVANCE STATEMENT Coating of the silicone implant surface with Met-Z2-Y12 alters the periprosthetic capsule architecture and significantly reduces capsule thickness for at least 6 months postoperatively in a murine model. This is a promising step forward in the development of a therapy to prevent capsular contracture.
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Affiliation(s)
- Sarah J Karinja
- From the Laboratory of Bioregenerative Medicine & Surgery, Weill Cornell Medical College
- Department of Surgery, Division of Plastic Surgery
| | - Jaime L Bernstein
- From the Laboratory of Bioregenerative Medicine & Surgery, Weill Cornell Medical College
- Department of Surgery, Division of Plastic Surgery
| | | | - Julia Jin
- From the Laboratory of Bioregenerative Medicine & Surgery, Weill Cornell Medical College
- Department of Surgery, Division of Plastic Surgery
| | - Alexandra Lin
- From the Laboratory of Bioregenerative Medicine & Surgery, Weill Cornell Medical College
- Department of Surgery, Division of Plastic Surgery
| | - Andrew Abadeer
- From the Laboratory of Bioregenerative Medicine & Surgery, Weill Cornell Medical College
- Department of Surgery, Division of Plastic Surgery
| | - Omer Kaymakcalan
- From the Laboratory of Bioregenerative Medicine & Surgery, Weill Cornell Medical College
- Department of Surgery, Division of Plastic Surgery
| | - Omid Veiseh
- Department of Bioengineering, Rice University
- Sigilon Therapeutics
| | - Jason A Spector
- From the Laboratory of Bioregenerative Medicine & Surgery, Weill Cornell Medical College
- Department of Surgery, Division of Plastic Surgery
- Meinig School of Biomedical Engineering, Cornell University
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6
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Abstract
Over the years, various physical and chemical/biological methods of inhibiting adhesion formation have been developed, focusing on how to suppress healing around the tendon and not inhibit healing within the tendon. Unfortunately, however, these methods are accompanied by drawbacks, both large and small, and no absolute antiadhesion method capable of maintaining tendon repair strength has yet been developed. Recent innovations in biomaterials science and tissue engineering have produced new antiadhesion technologies, such as barriers combined with cytokines and cells, which have improved outcomes in animal models, and which may find clinical relevance in the future.
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Affiliation(s)
- Tomoyuki Kuroiwa
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, USA
| | - Peter C Amadio
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, USA.
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7
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Hwang P, Shin CM, Sherwood JA, Kim D, Vijayan VM, Josyula KC, Millican RC, Ho D, Brott BC, Thomas V, Choi CH, Oh SH, Kim DW, Jun HW. A multi-targeting bionanomatrix coating to reduce capsular contracture development on silicone implants. Biomater Res 2023; 27:34. [PMID: 37087537 PMCID: PMC10122329 DOI: 10.1186/s40824-023-00378-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 04/11/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND Capsular contracture is a critical complication of silicone implantation caused by fibrotic tissue formation from excessive foreign body responses. Various approaches have been applied, but targeting the mechanisms of capsule formation has not been completely solved. Myofibroblast differentiation through the transforming growth factor beta (TGF-β)/p-SMADs signaling is one of the key factors for capsular contracture development. In addition, biofilm formation on implants may result chronic inflammation promoting capsular fibrosis formation with subsequent contraction. To date, there have been no approaches targeting multi-facted mechanisms of capsular contracture development. METHODS In this study, we developed a multi-targeting nitric oxide (NO) releasing bionanomatrix coating to reduce capsular contracture formation by targeting myofibroblast differentiation, inflammatory responses, and infections. First, we characterized the bionanomatrix coating on silicon implants by conducting rheology test, scanning electron microcsopy analysis, nanoindentation analysis, and NO release kinetics evaluation. In addition, differentiated monocyte adhesion and S. epidermidis biofilm formation on bionanomatrix coated silicone implants were evaluated in vitro. Bionanomatrix coated silicone and uncoated silicone groups were subcutaneously implanted into a mouse model for evaluation of capsular contracture development for a month. Fibrosis formation, capsule thickness, TGF-β/SMAD 2/3 signaling cascade, NO production, and inflammatory cytokine production were evaluated using histology, immunofluorescent imaging analysis, and gene and protein expression assays. RESULTS The bionanomatrix coating maintained a uniform and smooth surface on the silicone even after mechanical stress conditions. In addition, the bionanomatrix coating showed sustained NO release for at least one month and reduction of differentiated monocyte adhesion and S. epidermidis biofilm formation on the silicone implants in vitro. In in vivo implantation studies, the bionanomatrix coated groups demonstrated significant reduction of capsule thickness surrounding the implants. This result was due to a decrease of myofibroblast differentiation and fibrous extracellular matrix production through inhibition of the TGF-β/p-SMADs signaling. Also, the bionanomatrix coated groups reduced gene expression of M1 macrophage markers and promoted M2 macrophage markers which indicated the bionanomatrix could reduce inflammation but promote healing process. CONCLUSIONS In conclusion, the bionanomatrix coating significantly reduced capsular contracture formation and promoted healing process on silicone implants by reducing myfibroblast differentiation, fibrotic tissue formation, and inflammation. A multi-targeting nitric oxide releasing bionanomatrix coating for silicone implant can reduce capsular contracture and improve healing process. The bionanomatrix coating reduces capsule thickness, α-smooth muscle actin and collagen synthesis, and myofibroblast differentiation through inhibition of TGF-β/SMADs signaling cascades in the subcutaneous mouse models for a month.
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Affiliation(s)
- Patrick Hwang
- Endomimetics, LLC, Birmingham, AL, 35242, USA
- Department of Biomedical Engineering, University of Alabama at Birmingham, 806 Shelby, 1825 University Boulevard, Birmingham, AL, 35294, USA
| | - Chung Min Shin
- Department of Plastic and Reconstructive Surgery, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea
| | | | - DongHo Kim
- Department of Microbiology, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea
| | - Vineeth M Vijayan
- Department of Biomedical Engineering, Alabama State University, Montgomery, AL, 36104, USA
| | - Krishna C Josyula
- Department of Biomedical Engineering, University of Alabama at Birmingham, 806 Shelby, 1825 University Boulevard, Birmingham, AL, 35294, USA
| | | | - Donald Ho
- Department of Pediatric Dentistry, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Brigitta C Brott
- Endomimetics, LLC, Birmingham, AL, 35242, USA
- Department of Medicine and Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Vinoy Thomas
- Department of Material Science and Engineering, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Chul Hee Choi
- Department of Microbiology, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea
| | - Sang-Ha Oh
- Department of Plastic and Reconstructive Surgery, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea
| | - Dong Woon Kim
- Department of Anatomy and Cell Biology, Brain Research Institute, College of Medicine, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea.
| | - Ho-Wook Jun
- Endomimetics, LLC, Birmingham, AL, 35242, USA.
- Department of Biomedical Engineering, University of Alabama at Birmingham, 806 Shelby, 1825 University Boulevard, Birmingham, AL, 35294, USA.
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8
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Park BY, Wu D, Kwon KR, Kim MJ, Kim TG, Lee JH, Park DY, Kim IK. Implantation and tracing of green fluorescent protein-expressing adipose-derived stem cells in peri-implant capsular fibrosis. Stem Cell Res Ther 2023; 14:22. [PMID: 36750973 PMCID: PMC9906918 DOI: 10.1186/s13287-023-03248-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 01/31/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Adipose-derived stem cells (ASCs) have been reported to reduce fibrosis in various tissues. In this study, we investigated the inhibitory role of ASCs on capsule formation by analyzing the histologic, cellular, and molecular changes in a mouse model of peri-implant fibrosis. We also investigated the fate and distribution of ASCs in the peri-implant capsule. METHODS To establish a peri-implant fibrosis model, customized silicone implants were inserted into the dorsal site of C57BL/6 wild-type mice. ASCs were harvested from the fat tissues of transgenic mice that express a green fluorescent protein (GFP-ASCs) and then injected into the peri-implant space of recipient mice. The peri-implant tissues were harvested from postoperative week 2 to 8. We measured the capsule thickness, distribution, and differentiation of GFP-ASCs, as well as the cellular and molecular changes in capsular tissue following ASC treatment. RESULTS Injected GFP-ASCs were distributed within the peri-implant capsule and proliferated. Administration of ASCs reduced the capsule thickness, decreased the number of myofibroblasts and macrophages in the capsule, and decreased the mRNA level of fibrogenic genes within the peri-implant tissue. Angiogenesis was enhanced due to trans-differentiation of ASCs into vascular endothelial cells, and tissue hypoxia was relieved upon ASC treatment. CONCLUSIONS We uncovered that implanted ASCs inhibit capsule formation around the implant by characterizing a series of biological alterations upon ASC treatment and the fate of injected ASCs. These findings highlight the value of ASCs for future clinical applications in the prevention of capsular contracture after implant-based reconstruction surgery.
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Affiliation(s)
- Bo-Yoon Park
- grid.413028.c0000 0001 0674 4447Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, 170, Hyeonchung-ro, Nam-gu, Daegu, 42415 Korea
| | - Dirong Wu
- grid.413028.c0000 0001 0674 4447Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, 170, Hyeonchung-ro, Nam-gu, Daegu, 42415 Korea
| | - Kyoo-Ri Kwon
- grid.413028.c0000 0001 0674 4447Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, 170, Hyeonchung-ro, Nam-gu, Daegu, 42415 Korea
| | - Mi-Jin Kim
- grid.413028.c0000 0001 0674 4447Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, 170, Hyeonchung-ro, Nam-gu, Daegu, 42415 Korea
| | - Tae-Gon Kim
- grid.413028.c0000 0001 0674 4447Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, 170, Hyeonchung-ro, Nam-gu, Daegu, 42415 Korea
| | - Jun-Ho Lee
- grid.413028.c0000 0001 0674 4447Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, 170, Hyeonchung-ro, Nam-gu, Daegu, 42415 Korea
| | - Do Young Park
- Department of Ophthalmology, Yeungnam University College of Medicine, 170, Hyeonchung-ro, Nam-gu, Daegu, 42415, Korea.
| | - Il-Kug Kim
- Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, 170, Hyeonchung-ro, Nam-gu, Daegu, 42415, Korea.
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9
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Zheng Y, Hu YY, Zhao WY, Wang XF, Fang QQ, Lv X, Xiang C, Yao JM, Tan WQ. Case Report: Improved surgical treatment for breast capsular contracture by the punctiform-incision approach through the nipple. Front Surg 2022; 9:984732. [DOI: 10.3389/fsurg.2022.984732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Capsular contracture is one of the most common complications of breast implants, which often leads to secondary surgery. Patients with unconspicuous breast contracture do not need treatment, while for those with severe symptoms, a capsule revision surgery is of great necessity, including a total periprosthetic capsulectomy and replacement with a new implant. However, if the capsular contracture happens in the submuscular space, it will be very difficult to release it completely, and it may lead to more complications such as damage to surrounding tissue. The new method of pouch can create a new subpectoral plane for the insertion of a new implant instead of a total capsulectomy, but this method is unsuitable for patients who have little breast tissue or thin skin. To solve this thorny clinical problem, we invented a double-headed separating instrument and came up with a novel operation method to release the capsular contracture, which opened from the nipple by the punctiform-incision approach and caused only a mild and undetectable trauma. This operation went off without a hitch, and the postoperative breast shape was good, and the breast felt and moved naturally. In addition, there were no significant complications throughout the one-year follow-up period. This case was an excellent demonstration of the novel breast capsular contracture release surgery using our optimized double-headed capsule contracture separator.
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10
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Zhou Y, Pang H, Wang J, Wu H, Xu Z, Liu X, Xiao Z. Progranulin Promotes the Formation and Development of Capsules Caused by Silicone in Sprague-Dawley Rats. Clin Cosmet Investig Dermatol 2022; 15:1561-1573. [PMID: 35967917 PMCID: PMC9365064 DOI: 10.2147/ccid.s374128] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 07/28/2022] [Indexed: 11/23/2022]
Abstract
Background Silicone implants are currently the most widely used artificial materials in plastic surgery. Capsule formation following implant application is unavoidable. When the capsule is excessively thick and strongly contracted, it can lead to obvious symptoms, clinically known as capsular contracture. Biological factors have always been the focus of research on the capsule formation. As a growth factor, progranulin (PGRN) plays an important regulatory role in wound healing, tissue fibrosis, tumor proliferation and invasion, and inflammation regulation. At present, the research on the capsule mainly involves the regulation of tissue healing and fibrosis under the influence of inflammation. Because PGRN has a regulatory role in these processes, we believe that the study of both can provide a new theoretical basis and intervention sites for monitoring and inhibiting the development of the capsule. Methods In this experiment, the effects of different surgical operations on the content of PGRN in the surgical site and plasma of rats were detected. Sprague-Dawley (SD) rat dermal fibroblasts were co-cultured by recombinant PGRN. The effects of r-PGRN on fibroblasts were detected by 5-ethynyl-2’-deoxyuridine (EdU) assay, wound healing assay and Western blot assay. Finally, the effect of PGRN on capsule formation and contracture was studied by changing the content of PGRN in the prosthesis in rats after operation. Results Surgical trauma and silicone implant increased plasma and local PGRN levels in SD rats. PGRN can activate the TGF-β/SMAD signaling pathway in a dose-dependent manner, thereby promoting fibroblast proliferation, differentiation and migration and inhibiting apoptosis and enhancing cell function, thereby promoting capsule formation and contracture. Conclusion PGRN promotes the formation and contracture of the silicone implant capsule in SD rats by activating the TGF-β/SMAD signaling pathway. This discovery may provide new therapeutic targets and detection indicators.
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Affiliation(s)
- Yongting Zhou
- Department of Plastic Surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Hao Pang
- Department of Plastic Surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Jie Wang
- Department of Plastic Surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Hao Wu
- Department of Plastic Surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Zidi Xu
- Department of Plastic Surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Xueyi Liu
- Department of Plastic Surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Zhibo Xiao
- Department of Plastic Surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
- Correspondence: Zhibo Xiao, Email
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11
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Pagani A, Aitzetmüller MM, Larcher L. A Forgotten Entity following Breast Implant Contracture: Does Baker Need a Change? Arch Plast Surg 2022; 49:360-364. [PMID: 35832169 PMCID: PMC9142220 DOI: 10.1055/s-0042-1744409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
AbstractAlthough capsular contracture represents one of the most important complications after breast augmentation, local inflammation and fibrosis can lead, in very rare cases, to capsular calcification, an often-forgotten radiological sign of capsular contracture. In this article, the authors present a clinical case of breast implant calcification in an 81-year-old patient. Although this complication has been rarely described, the literature was reviewed to clarify the role of the local microenvironment in capsular contracture and calcification. At present, capsular contracture patients are classified using the conventional Baker score and the histological Wilflingseder classification. As it was not possible to consider capsular calcification when classifying our patient using the traditional scores, the authors propose an updated version of the current scale.
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Affiliation(s)
- Andrea Pagani
- Clinic and Policlinic of Plastic, Reconstructive and Hand Surgery, Klinikum Rechts der Isar–Technische Universität München, München, Germany
| | - Matthias M. Aitzetmüller
- Section of Plastic Surgery, Department for Traumatology and Hand Surgery, University Hospital Münster, Münster, Germany
- Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Münster, Germany
| | - Lorenz Larcher
- Plastic and Reconstructive Surgery Unit, SABES (South Tyrolean Health Care System), Bressanone, Italy
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12
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Liu X, Song YJ, Chen X, Huang MY, Zhao CX, Zhou X, Zhou X. Asiaticoside Combined With Carbon Ion Implantation to Improve the Biocompatibility of Silicone Rubber and to Reduce the Risk of Capsule Contracture. Front Bioeng Biotechnol 2022; 10:810244. [PMID: 35646845 PMCID: PMC9133697 DOI: 10.3389/fbioe.2022.810244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/25/2022] [Indexed: 11/19/2022] Open
Abstract
Capsular contracture caused by silicone rubber is a critical issue in plastic surgery that urgently needs to be solved. Studies have shown that carbon ion implant in silicone rubber (carbon silicone rubber, C-SR) can significantly improve the capsular structure, but the effect of this improvement only appear 2months or later. In this study, asiaticoside combined with carbon silicone rubber was used to explore the changes in the capsule to provide a reference for the treatment of capsule contracture. Human fibroblasts (HFF-1) were used for in vitro experiments. The combined effect of asiaticoside and carbon silicone rubber on cell proliferation was determined by the CCK8 method, cell migration changes were measured by Transwell assays, cell cycle changes were measured by flow cytometry, and the expression levels of fibroblast transformation markers (vimentin and α-SMA), collagen (Col-1A1) and TGF-β/Smad signaling pathway-related proteins (TGF-β1, TβRI, TβRII and Smad2/3) were detected by immunofluorescence. In vivo experiments were carried out by subcutaneous implantation of the material in SD rats, and asiaticoside was oral administered simultaneously. WB and ELISA were used to detect changes in the expression of TGF-β/Smad signaling pathway-related proteins. TGF-β/Smad signaling pathway proteins were then detected and confirmed by HE, Masson and immunohistochemical staining. The results shown that asiaticoside combined with carbon ion implantation inhibited the viability, proliferation and migration of fibroblasts on silicone rubber. In vitro immunofluorescence showed that the secretion levels of α-SMA and Col-1A1 were significantly decreased, the transformation of fibroblasts into myofibroblasts was weakened, and the TGF-β/Smad signaling pathway was inhibited. In vivo experimental results showed that asiaticoside combined with carbon silicone rubber inhibited TGF-β1 secretion and inhibited the TGF-β/Smad signaling pathway, reducing the thickness of the capsule and collagen deposition. These results imply that carbon silicone rubber combined with asiaticoside can regulate the viability, proliferation and migration of fibroblasts by inhibiting the TGF-β/Smad signaling pathway and reduce capsule thickness and collagen deposition, which greatly reduces the incidence of capsule contracture.
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Affiliation(s)
- Xing Liu
- Department of Cosmetology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Ya-Jun Song
- Department of Urology, Xinqiao Hospital, The Army Medical University, Chongqing, China
| | - Xing Chen
- Department of Cosmetology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Meng-Ya Huang
- Department of Cosmetology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Chen-Xi Zhao
- Department of Cosmetology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Xun Zhou
- Department of Cosmetology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
- *Correspondence: Xun Zhou, ; Xin Zhou,
| | - Xin Zhou
- Department of Pathology, Bishan Hospital, The Chongqing Medical University, Chongqing, China
- *Correspondence: Xun Zhou, ; Xin Zhou,
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13
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Influence of Irradiation on Capsules of Silicone Implants Covered with Acellular Dermal Matrix in Mice. Aesthetic Plast Surg 2022; 46:937-946. [PMID: 34761289 DOI: 10.1007/s00266-021-02618-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/27/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND In advanced breast cancer, radiotherapy is recommended as adjuvant therapy following breast reconstructive surgery. This inevitably led to growing concerns over possible complications of radiotherapy on implants. In this experimental animal study, we investigated the utility of acellular dermal matrix (ADM) wraps around implants as preventive management for radiotherapy complications. METHODS Black mice (C57NL6; n = 32) were assigned to groups that either received radiation or did not: groups A and B underwent surgery using implants without radiotherapy; while groups C and D underwent surgery using implants with radiotherapy for one and three months, respectively. The hemispheric silicone implants with an 0.8-cm-diameter were inserted on the left back of each mouse, and implants wrapped by ADM were inserted on the right back. The Clinic 23EX LINAC model was used for irradiation at 10 Gy. The samples were evaluated by gross assessment, histological analysis, immunohistochemical analysis, and the Western blotting test. RESULTS The H&E staining analysis showed that membrane thickness is smallest in group A, followed by groups C, D, and B. In a Masson trichrome histological analysis, collagen fibers became less dense and more widespread over time in the groups that received an ADM. Immunohistochemistry findings were similarly constant. However, the expression of TGF-β1 was increased in the irradiated groups, whereas it was decreased in the non-irradiated groups as observed over time. CONCLUSIONS Radiotherapy was shown to increase risk factors for capsular contracture, including inflammatory response, pseudoepithelium, thinning of membrane, and TGF-β1 expression over time; however, the accompanying framework using an ADM as a barrier between implant and tissue was shown to be effective in alleviating these risks. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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14
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Shi XH, Zhou X, Lei ZY, Tian Y, Chen Y, Zhang YM, Mao TC, Fan DL, Zhou SW. Novel silicone rubber with carboxyl grafted polyhedral oligomeric silsesquioxane (POSS-COOH) as a potential scaffold for soft tissue filling. INT J POLYM MATER PO 2021. [DOI: 10.1080/00914037.2021.1999951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Xiao-hua Shi
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Army Medical University, Chong Qing, China
- Base for Drug Clinical Trial, Xinqiao Hospital, The Army Medical University, Chong Qing, China
| | - Xin Zhou
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Army Medical University, Chong Qing, China
| | - Ze-yuan Lei
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Army Medical University, Chong Qing, China
| | - Yuan Tian
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Army Medical University, Chong Qing, China
| | - Yao Chen
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Army Medical University, Chong Qing, China
| | - Yi-ming Zhang
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Army Medical University, Chong Qing, China
| | - Tong-chun Mao
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Army Medical University, Chong Qing, China
| | - Dong-li Fan
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Army Medical University, Chong Qing, China
| | - Shi-wen Zhou
- Base for Drug Clinical Trial, Xinqiao Hospital, The Army Medical University, Chong Qing, China
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15
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Pagliara D, Vitagliano S, Mangialardi ML, Pino V, Santoro A, Mulè A, Barone Adesi L, Salgarello M. The role of fat grafting on contracted breast implant capsules: A retrospective comparative histological and immunohistochemical study. J Plast Reconstr Aesthet Surg 2021; 75:1083-1093. [PMID: 34838502 DOI: 10.1016/j.bjps.2021.09.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/13/2021] [Accepted: 09/27/2021] [Indexed: 12/12/2022]
Abstract
Capsular contracture, a common complication of breast implant reconstruction following postmastectomy radiotherapy (PMRT), represents a challenge for plastic surgeons. Regenerative surgery with multiple autologous fat grafts (lipobed) before replacing the implant has been proven to be a satisfactory approach in the radio-damaged breast. Currently, in literature, there are no data available on the histological features of irradiated capsules after regenerative surgery. We enrolled 80 patients after immediate subpectoral alloplastic breast reconstruction, with indication for revision surgery due to grade IV capsular contracture developed after PMRT. Forty patients were undergoing multiple fat grafting (lipobed group, mean age 48) and 40 patients were not undergoing multiple fat grafting (non-regenerative surgery (NRS) group, mean age 49). The removed capsules were addressed to histological and immunohistochemical assessment. The capsules of the lipobed group patients compared with NRS group patients showed: a lower mean thickness (602.17 versus 670.43 µm; P = 0.013), a lower collagen fiber alignment (median value of angle deviation: 30.34 versus 18.38; P = 0.001), a lower immunohistochemical positivity for myofibroblasts (α-smooth muscle actin [α-SMA] expression: 12.5% versus 52.5%; P = 0.00), a higher immunohistochemical positivity for estrogen receptor-β (ER-β; 80% versus 20%; P = 0.00), and a lower immunohistochemical positivity for estrogen receptor-α (ER-α; 53.3% versus 16.7%; P = 0.00). The histological and immunohistochemical differences found are possibly due to alterations in the extracellular microenvironment determined by grafted fat.
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Affiliation(s)
- Domenico Pagliara
- Mater Olbia Hospital, Strada Statale 125 Orientale Sarda, Olbia 07026, Italy.
| | - Stefano Vitagliano
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Dipartimento Scienze della Salute della Donna e del Bambino, Unità di Chirurgia Plastica, Largo Francesco Vito 1, Roma 00168, Italy
| | - Maria Lucia Mangialardi
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Dipartimento Scienze della Salute della Donna e del Bambino, Unità di Chirurgia Plastica, Largo Francesco Vito 1, Roma 00168, Italy
| | - Valentina Pino
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Dipartimento Scienze della Salute della Donna e del Bambino, Unità di Chirurgia Plastica, Largo Francesco Vito 1, Roma 00168, Italy
| | - Angela Santoro
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Dipartimento Scienze della Salute della Donna e del Bambino, Unità di Gineco-Patologia e Patologia Mammaria, Largo Francesco Vito 1, Roma 00168, Italy
| | - Antonino Mulè
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Dipartimento Scienze della Salute della Donna e del Bambino, Unità di Gineco-Patologia e Patologia Mammaria, Largo Francesco Vito 1, Roma 00168, Italy
| | - Liliana Barone Adesi
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Dipartimento Scienze della Salute della Donna e del Bambino, Unità di Chirurgia Plastica, Largo Francesco Vito 1, Roma 00168, Italy
| | - Marzia Salgarello
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Dipartimento Scienze della Salute della Donna e del Bambino, Unità di Chirurgia Plastica, Largo Francesco Vito 1, Roma 00168, Italy
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16
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Nepon H, Safran T, Reece EM, Murphy AM, Vorstenbosch J, Davison PG. Radiation-Induced Tissue Damage: Clinical Consequences and Current Treatment Options. Semin Plast Surg 2021; 35:181-188. [PMID: 34526866 PMCID: PMC8432995 DOI: 10.1055/s-0041-1731464] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Radiation therapy is a valuable tool in the treatment of numerous malignancies but, in certain cases, can also causes significant acute and chronic damage to noncancerous neighboring tissues. This review focuses on the pathophysiology of radiation-induced damage and the clinical implications it has for plastic surgeons across breast reconstruction, osteoradionecrosis, radiation-induced skin cancers, and wound healing. The current understanding of treatment modalities presented here include hyperbaric oxygen therapy, autologous fat grafting and stem cells, and pharmaceutical agents.
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Affiliation(s)
- Hillary Nepon
- Division of Experimental Surgery, McGill University, Montreal, Quebec, Canada
| | - Tyler Safran
- Division of Plastic Surgery, McGill University, Montreal, Quebec, Canada
| | - Edward M. Reece
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
| | - Amanda M. Murphy
- Division of Plastic Surgery, McGill University, Montreal, Quebec, Canada
| | | | - Peter G. Davison
- Division of Plastic Surgery, McGill University, Montreal, Quebec, Canada
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17
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Silicone Breast Implant Coated with Triamcinolone Inhibited Breast-Implant-Induced Fibrosis in a Porcine Model. MATERIALS 2021; 14:ma14143917. [PMID: 34300843 PMCID: PMC8307199 DOI: 10.3390/ma14143917] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 12/23/2022]
Abstract
Cosmetic silicone implants for breast reconstruction often lead to medical complications, such as abnormally excessive fibrosis driven by foreign body granulomatous inflammation. The purpose of this study was to develop a silicone breast implant capable of local and controlled release of a glucocorticoid drug triamcinolone acetonide (TA) for the prevention of silicone-breast-implant-induced fibrosis in a Yorkshire pig model (in vivo). Implants were dip-coated in a TA solution to load 1.85 μg/cm2 of TA in the implant shell, which could release the drug in a sustained manner for over 50 days. Immunohistochemical analysis for 12 weeks showed a decline in tumor necrosis factor-α expression, capsule thickness, and collagen density by 82.2%, 55.2%, and 32.3%, respectively. Furthermore, the counts of fibroblasts, macrophages, and myofibroblasts in the TA-coated implants were drastically reduced by 57.78%, 48.8%, and 64.02%, respectively. The TA-coated implants also lowered the expression of vimentin and α-smooth muscle actin proteins, the major profibrotic fibroblast and myofibroblast markers, respectively. Our findings suggest that TA-coated silicone breast implants can be a promising strategy for safely preventing fibrosis around the implants.
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18
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Angiotensin-Converting Enzyme Inhibitor Reduces Radiation-Induced Periprosthetic Capsular Fibrosis. J Surg Res 2021; 263:167-175. [PMID: 33667872 DOI: 10.1016/j.jss.2021.01.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 01/12/2021] [Accepted: 01/31/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The capsular contracture is one of the main complications after radiotherapy in patients with implant-based reconstruction. The aim of this study is to evaluate the efficacy of ramipril for the prevention of radiation-induced fibrosis around the silicone implant. MATERIALS AND METHODS Thirty Wistar rats in 5 groups were used. Group 1: implant; group 2: implant + radiation; group 3: ramipril + implant; group 4: ramipril + implant + radiation; group 5: sham. Ramipril treatment was started 5 d before surgery and continued for 12 wk after surgery. A mini silicone implant was placed in the back of the rats. A single fraction of 21.5 Gy radiation was applied. Tissues were examined histologically and immunohistochemically (TGF-β1, MMP-2, and TIMP-2 expression). The alteration of plasma TGF-β1 levels was examined before and after the experiment. RESULTS After applying implant or implant + radiation, capsular thickness, percentage of fibrotic area, tissue and plasma TGF-β1 levels significantly increased, and MMP-2/TIMP-2 ratio significantly decreased compared with the sham group. In ramipril-treated groups, the decrease in capsular thickness, fibrosis, TGF-β1 positivity, and an increase in MMP-2/TIMP-2 ratio were found significant. In the ramipril + implant + radiation group, the alteration values of TGF-β1 dramatically decreased. CONCLUSIONS Our results show that ramipril reduces radiation-induced fibrosis and contracture. The results of our study may be important for the design of the clinical trials required to investigate the effective and safe doses of ramipril, which is an inexpensive and easily tolerated drug, on humans.
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19
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DeFazio MV, Clemens MW. Commentary on: Pro-Fibrotic CD26-Positive Fibroblasts Are Present in Greater Abundance in Breast Capsule Tissue of Irradiated Breasts. Aesthet Surg J 2020; 40:380-382. [PMID: 31201772 DOI: 10.1093/asj/sjz134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Michael V DeFazio
- Department of Plastic Surgery, MD Anderson Cancer Center, Houston, TX
| | - Mark W Clemens
- Department of Plastic Surgery, MD Anderson Cancer Center, Houston, TX
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20
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Borrelli MR, Irizzary D, Patel RA, Nguyen D, Momeni A, Longaker MT, Wan DC. Pro-Fibrotic CD26-Positive Fibroblasts Are Present in Greater Abundance in Breast Capsule Tissue of Irradiated Breasts. Aesthet Surg J 2020; 40:369-379. [PMID: 30972420 PMCID: PMC7317086 DOI: 10.1093/asj/sjz109] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Breast capsular contracture is a major problem following implant-based breast reconstruction, particularly in the setting of radiation therapy. Recent work has identified a fibrogenic fibroblast subpopulation characterized by CD26 surface marker expression. OBJECTIVES This work aimed to investigate the role of CD26-positive fibroblasts in the formation of breast implant capsules following radiation therapy. METHODS Breast capsule specimens were obtained from irradiated and nonirradiated breasts of 10 patients following bilateral mastectomy and unilateral irradiation at the time of expander-implant exchange, under institutional review board approval. Specimens were processed for hematoxylin and eosin staining as well as for immunohistochemistry and fluorescence activated cell sorting for CD26-positive fibroblasts. Expression of fibrotic genes and production of collagen were compared between CD26-positive, CD26-negative, and unsorted fibroblasts. RESULTS Capsule specimens from irradiated breast tissue were thicker and had greater CD26-postive cells on immunofluorescence imaging and on fluorescence activated cell sorting analysis than did capsule specimens from the nonirradiated breast. Compared with CD26-negative fibroblasts, CD26-positive fibroblasts produced more collagen and had increased expression of the profibrotic genes IL8, TGF-β1, COL1A1, and TIMP4. CONCLUSIONS CD26-positive fibroblasts were found in a significantly greater abundance in capsules of irradiated compared with nonirradiated breasts and demonstrated greater fibrotic potential. This fibrogenic fibroblast subpopulation may play an important role in the development of capsular contracture following irradiation, and its targeted depletion or moderation may represent a potential therapeutic option. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- Mimi R Borrelli
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, Stanford, CA
| | - Dre Irizzary
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, Stanford, CA
| | - Ronak A Patel
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, Stanford, CA
| | - Dung Nguyen
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, Stanford, CA
| | - Arash Momeni
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, Stanford, CA
| | - Michael T Longaker
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, Stanford, CA
| | - Derrick C Wan
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, Stanford, CA
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21
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Tolksdorf J, Horch RE, Grüner JS, Schmid R, Kengelbach-Weigand A, Schubert DW, Werner S, Schneidereit D, Friedrich O, Ludolph I. Size matters-in vitro behaviour of human fibroblasts on textured silicone surfaces with different pore sizes. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2020; 31:23. [PMID: 32016560 PMCID: PMC6997250 DOI: 10.1007/s10856-020-6360-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/07/2020] [Indexed: 05/14/2023]
Abstract
Capsular contracture remains a challenge in plastic surgery and represents one of the most common postoperative complications following alloplastic breast reconstruction. The impact of the surface structure of silicone implants on the foreign body reaction and the behaviour of connective tissue-producing cells has already been discussed. The aim of this study was to investigate different pore sizes of silicone surfaces and their influence on human fibroblasts in an in vitro model. Four different textures (no, fine, medium and coarse texture) produced with the salt-loss technique, have been assessed in an in vitro model. Human fibroblasts were seeded onto silicone sheets and evaluated after 1, 4 and 7 days microscopically, with viability assay and gene expression analysis. Comparing the growth behaviour and adhesion of the fibroblasts on the four different textures, a dense cell layer, good adhesion and bridge-building ability of the cells could be observed for the fine and medium texture. Cell number and viability of the cells were increasing during the time course of experiments on every texture. TGFß1 was lowest expressed on the fine and medium texture indicating a trend for decreased fibrotic activity. For silicone surfaces produced with the salt-loss technique, we were able to show an antifibrotic effect of smaller sized pores. These findings underline the hypothesis of a key role of the implant surface and the pore size and pore structure in preventing capsular contracture.
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Affiliation(s)
- Julia Tolksdorf
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital of Erlangen Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Raymund E Horch
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital of Erlangen Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Jasmin S Grüner
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital of Erlangen Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Rafael Schmid
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital of Erlangen Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Annika Kengelbach-Weigand
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital of Erlangen Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Dirk W Schubert
- Institute of Polymer Materials, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Martensstrasse 7, 91058, Erlangen, Germany
| | - Siegfried Werner
- Institute of Polymer Materials, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Martensstrasse 7, 91058, Erlangen, Germany
| | - Dominik Schneidereit
- Institute of Medical Biotechnology, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Paul-Gordan-Str. 3, 91052, Erlangen, Germany
| | - Oliver Friedrich
- Institute of Medical Biotechnology, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Paul-Gordan-Str. 3, 91052, Erlangen, Germany
| | - Ingo Ludolph
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital of Erlangen Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Germany.
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Conrad S, Weber K, Walliser U, Geburek F, Skutella T. Stem Cell Therapy for Tendon Regeneration: Current Status and Future Directions. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1084:61-93. [PMID: 30043235 DOI: 10.1007/5584_2018_194] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In adults the healing tendon generates fibrovascular scar tissue and recovers never histologically, mechanically, and functionally which leads to chronic and to degenerative diseases. In this review, the processes and mechanisms of tendon development and fetal regeneration in comparison to adult defect repair and degeneration are discussed in relation to regenerative therapeutic options. We focused on the application of stem cells, growth factors, transcription factors, and gene therapy in tendon injury therapies in order to intervene the scarring process and to induce functional regeneration of the lesioned tissue. Outlines for future therapeutic approaches for tendon injuries will be provided.
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Affiliation(s)
| | - Kathrin Weber
- Tierärztliches Zentrum für Pferde in Kirchheim Altano GmbH, Kirchheim unter Teck, Germany
| | - Ulrich Walliser
- Tierärztliches Zentrum für Pferde in Kirchheim Altano GmbH, Kirchheim unter Teck, Germany
| | - Florian Geburek
- Justus-Liebig-University Giessen, Faculty of Veterinary Medicine, Clinic for Horses - Department of Surgery, Giessen, Germany
| | - Thomas Skutella
- Institute for Anatomy and Cell Biology, Medical Faculty, University of Heidelberg, Heidelberg, Germany.
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Ludolph I, Gruener J, Kengelbach-Weigand A, Fiessler C, Horch R, Schmitz M. Long-term studies on the integration of acellular porcine dermis as an implant shell and the effect on capsular fibrosis around silicone implants in a rat model. J Plast Reconstr Aesthet Surg 2019; 72:1555-1563. [DOI: 10.1016/j.bjps.2019.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 03/20/2019] [Accepted: 04/23/2019] [Indexed: 01/19/2023]
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Grieco MP, Simonacci F, Bertozzi N, Grignaffini E, Raposio E. Breast reconstruction with breast implants. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 89:457-462. [PMID: 30657111 PMCID: PMC6502088 DOI: 10.23750/abm.v89i4.5748] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 09/14/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Breast cancer is the most common noncutaneous malignancy among women worldwide. After a breast cancer removal procedure, women are asked to decide about breast reconstruction, mainly to improve their life quality, and they can choose from among many options. Broadly, there are two different types of breast reconstruction procedures: prosthetic implant-based reconstruction and autologous tissue-based reconstruction. METHODS Implant-breast reconstruction is a minimally invasive procedure compared with autologous breast reconstruction. It is associated with fewer short- and long-term complications. RESULTS The ideal candidates for implant-based reconstruction are patients with non-redundant soft tissue coverage, who desire a moderate sized non-ptotic breast and have not been previously irradiated. CONCLUSION The state of the art for implant-breast reconstruction is briefly described in this article.
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Affiliation(s)
- Michele Pio Grieco
- Department of Surgical Sciences, Plastic Surgery Division, University of Parma, Parma, Italy Cutaneous, Regenerative, Mininvasive and Plastic Surgery Unit, Parma University Hospital, Italy.
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Yoo BY, Kim BH, Lee JS, Shin BH, Kwon H, Koh WG, Heo CY. Dual surface modification of PDMS-based silicone implants to suppress capsular contracture. Acta Biomater 2018; 76:56-70. [PMID: 29908334 DOI: 10.1016/j.actbio.2018.06.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 05/26/2018] [Accepted: 06/12/2018] [Indexed: 12/19/2022]
Abstract
In this study, we report a new physicochemical surface on poly(dimethylsiloxane) (PDMS)-based silicone implants in an effort to minimize capsular contracture. Two different surface modification strategies, namely, microtexturing as a physical cue and multilayer coating as a chemical cue, were combined to achieve synergistic effects. The deposition of uniformly sized microparticles onto uncured PDMS surfaces and the subsequent removal after curing generated microtextured surfaces with concave hemisphere micropatterns. The size of the individual micropattern was controlled by the microparticle size. Micropatterns of three different sizes (37.16, 70.22, and 97.64 μm) smaller than 100 μm were produced for potential application to smooth and round-shaped breast implants. The PDMS surface was further chemically modified by layer-by-layer (LbL) deposition of poly-l-lysine and hyaluronic acid. Short-term in vitro experiments demonstrated that all the PDMS samples were cytocompatible. However, lower expression of TGF-β and α-SMA, the major profibrotic cytokine and myofibroblast marker, respectively, was observed in only multilayer-coated PDMS samples with larger size micropatterns (70.22 and 97.64 μm), thereby confirming the synergistic effects of physical and chemical cues. An in vivo study conducted for 8 weeks after implantation in rats also indicated that PDMS samples with larger size micropatterns and multilayer coating most effectively inhibited capsular contracture based on analyses of tissue inflammation, number of macrophage, fibroblast and myofibroblast, TGF-β expression, collagen density, and capsule thickness. STATEMENT OF SIGNIFICANCE Although poly(dimethylsiloxane) (PDMS)-based silicone implants have been widely used for various applications including breast implants, they usually cause typical side effects called as capsular contracture. Prior studies have shown that microtexturing and surface coating could reduce capsular contracture. However, previous methods are limited in their scope for application, and it is difficult to obtain FDA approval because of the large and nonuniform size of the microtexture as well as the use of toxic chemical components. Herein, those issues could be addressed by creating a microtexture of size less than 100 m, with a narrow size distribution and using layer-by-layer deposition of a biocompatible polymer without using any toxic compounds. Furthermore, this is the first attempt to combine microtexture with multilayer coating to obtain synergetic effects in minimizing the capsular contracture.
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Kim IK, Park SO, Chang H, Jin US. Inhibition Mechanism of Acellular Dermal Matrix on Capsule Formation in Expander-Implant Breast Reconstruction After Postmastectomy Radiotherapy. Ann Surg Oncol 2018; 25:2279-2287. [PMID: 29855829 DOI: 10.1245/s10434-018-6549-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Capsular contracture is one of the most common complications of expander-implant breast reconstruction. Recently, clinical reports have shown that use of an acellular dermal matrix (ADM) to cover breast implants decreases incidence of capsular contracture, but the underlying mechanism is unclear. Here, we examine how ADM reduces capsular formation in expander-implant breast reconstruction and identify cellular and molecular mechanisms of ADM-mediated reduction of capsular contracture in nonirradiated and irradiated patients. METHODS Thirty patients who underwent immediate two-stage implant-based breast reconstruction were included; 15 received radiotherapy. While the tissue expander was changed to permanent silicone implant, biopsies of the subpectoral capsule and ADM capsule were performed. Capsule thickness, immunohistochemistry of α-smooth muscle actin (αSMA), vimentin, CD31, F4/80 expression, αSMA and CD31 coexpression, and relative gene expression levels of transforming growth factor (TGF)-β1 and platelet-derived growth factor (PDGF)-B were investigated. RESULTS Irradiated submuscular capsules were thicker than nonirradiated submuscular capsules, but the thickness of ADM capsules did not significantly differ between nonirradiated and irradiated groups. Levels of myofibroblasts, fibroblasts, vascularity, EndoMT, and macrophages were significantly lower in ADM capsules than in submuscular capsules. With the exception of EndoMT, all others were increased in irradiated submuscular capsules compared with nonirradiated submuscular capsule, while none significantly differed between nonirradiated and irradiated ADM capsules. CONCLUSIONS Use of ADM reduced myofibroblasts, vascularity, fibroblasts, and EndoMT in capsule tissues. Moreover, ADM use decreased macrophages, a key regulator of tissue fibrosis, as well as TGF-β1 and PDGF-B expression. We hope that these results provide basic concepts important for prevention of capsular contracture.
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Affiliation(s)
- Il-Kug Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seong Oh Park
- Department of Plastic and Reconstructive Surgery, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Korea
| | - Hak Chang
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Ung Sik Jin
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Korea.
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In Search of a Murine Model of Radiation-Induced Periprosthetic Capsular Fibrosis. Ann Plast Surg 2018; 80:S204-S210. [DOI: 10.1097/sap.0000000000001362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Moyer HR, Hart AM, Yeager J, Losken A. A Histological Comparison of Two Human Acellular Dermal Matrix Products in Prosthetic-Based Breast Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1576. [PMID: 29632762 PMCID: PMC5889434 DOI: 10.1097/gox.0000000000001576] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 09/29/2017] [Indexed: 12/22/2022]
Abstract
Background Acellular dermal matrices (ADMs) are an integral component of breast reconstruction. The ideal matrix would be relatively immuno-inert, allow rapid vascularization, and be affordable. The purpose of this study was to histologically compare 2 commonly used ADM products. Methods This is a prospective histological study of 17 patients (20 breasts) following prosthetic-based breast reconstruction with ADM: Alloderm (LifeCell Corp, Branchburg, N.J.) or Cortiva (RTI Surgical, Alachua Fla.). Biopsies were taken from the dermal matrix and natural capsules surrounding the expander/implant during secondary surgery [Range, 72-694 days (mean, 217 days)]. Biopsy specimens were prepared via hematoxylin and eosin, Masson's trichrome, elastin, and transforming growth factor (TGF)-1 stains. Quantitative analysis of staining was performed with ImageJ software. The clinical outcome of each patient is analyzed in relation to capsule architecture and ADM performance. Results There were 7 breasts in the Alloderm group and 13 in the Cortiva group. Both groups had similar demographic, aesthetic results, and complication profiles. The TGF-1 staining demonstrated significantly lower levels in the Cortiva capsules (P = 0.0139). The percentage of elastin and collagen are similar in the Cortiva, Alloderm, and natural peri-implant capsules. The native capsules show a significantly greater number of blood vessels when compared with Cortiva and Alloderm (P = 0.0371 and P = 0.0347, respectively); however, there is no difference in vascular pattern between the 2 dermal matrices. Discussion Postoperatively, Cortiva demonstrates equal vascularity with less TGF-1 activation compared with Alloderm. The clinical success and complication profile were similar between the Alloderm and Cortiva patients.
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Affiliation(s)
- Hunter R Moyer
- Emory University, Division of Plastic and Reconstructive Surgery, Atlanta, Ga.; Atlanta Plastic Surgery, Atlanta, Ga
| | - Alexandra M Hart
- Emory University, Division of Plastic and Reconstructive Surgery, Atlanta, Ga.; Atlanta Plastic Surgery, Atlanta, Ga
| | - Jessica Yeager
- Emory University, Division of Plastic and Reconstructive Surgery, Atlanta, Ga.; Atlanta Plastic Surgery, Atlanta, Ga
| | - Albert Losken
- Emory University, Division of Plastic and Reconstructive Surgery, Atlanta, Ga.; Atlanta Plastic Surgery, Atlanta, Ga
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The aetiopathogenesis of capsular contracture: A systematic review of the literature. J Plast Reconstr Aesthet Surg 2017; 71:307-317. [PMID: 29301730 DOI: 10.1016/j.bjps.2017.12.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 10/05/2017] [Accepted: 12/05/2017] [Indexed: 01/03/2023]
Abstract
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.
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Thy1 (CD90) Expression Is Elevated in Radiation-Induced Periprosthetic Capsular Contracture: Implication for Novel Therapeutics. Plast Reconstr Surg 2017; 140:316-326. [PMID: 28746279 DOI: 10.1097/prs.0000000000003542] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Capsular contracture is a devastating complication of postmastectomy implant-based breast reconstruction. Unfortunately, capsular contracture rates are drastically increased by targeted radiotherapy, a standard postmastectomy treatment. Thy1 (also called CD90) is important in myofibroblast differentiation and scar tissue formation. However, the impact of radiotherapy on Thy1 expression and the role of Thy1 in capsular contracture are unknown. METHODS The authors analyzed Thy1 expression in primary human capsular tissue and primary fibroblast explants by real-time quantitative polymerase chain reaction, Western blotting, and immunohistochemistry. Thy1 was depleted using RNA interference to determine whether Thy1 expression was essential for the myofibroblast phenotype in capsular fibroblasts. Furthermore, human capsular fibroblasts were treated with a new antiscarring compound, salinomycin, to determine whether Thy1 expression and myofibroblast formation were blocked by salinomycin. RESULTS In this article, the authors show that radiation therapy significantly increased Thy1 mRNA and protein expression in periimplant scar tissue. Capsular fibroblasts explanted from scar tissue retained the ability to make the myofibroblast-produced scar-forming components collagen I and α-smooth muscle actin. Depletion of Thy1 decreased the fibrotic morphology of capsular fibroblasts and significantly decreased α-smooth muscle actin and collagen levels. Furthermore, the authors show for the first time that salinomycin decreased Thy1 expression and prevented myofibroblast formation in capsular fibroblasts. CONCLUSIONS These data reveal that ionizing radiation-induced Thy1 overexpression may contribute to increased capsular contracture severity, and fibroblast scar production can be ameliorated through targeting Thy1 expression. Importantly, the authors' new results show promise for the antiscarring ability of salinomycin in radiation-induced capsular contracture. CLINCAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
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31
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Legrand A, Kaufman Y, Long C, Fox PM. Molecular Biology of Flexor Tendon Healing in Relation to Reduction of Tendon Adhesions. J Hand Surg Am 2017; 42:722-726. [PMID: 28709791 DOI: 10.1016/j.jhsa.2017.06.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 06/12/2017] [Indexed: 02/02/2023]
Abstract
Tendon injuries are encountered after major and minor hand trauma. Despite meticulous repair technique, adhesion formation can occur, limiting recovery. Although a great deal of progress has been made toward understanding the mechanism of tendon healing and adhesions, clinically applicable solutions to prevent adhesions remain elusive. The goal of this paper is to review the most recent literature relating to the tendon healing and adhesion prevention.
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Affiliation(s)
- Anais Legrand
- Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA; Division of Plastic Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Yoav Kaufman
- Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA; Division of Plastic Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Chao Long
- Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA; Division of Plastic Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Paige M Fox
- Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA; Division of Plastic Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA.
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Evaluation of Antibiotic Irrigation Versus Saline Irrigation in Reducing the Long-Term Incidence and Severity of Capsular Contraction After Primary Augmentation Mammoplasty. Ann Plast Surg 2017; 77:32-6. [PMID: 25144414 DOI: 10.1097/sap.0000000000000302] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Capsular contracture is the most frequent complication after primary augmentation mammoplasty. The practice of irrigating implant pockets with a triple antibiotic solution has been widely adopted in an attempt to prevent capsular contracture, despite a limited understanding of the inciting pathophysiology. Capsular contracture is commonly attributed to subclinical infection, immunologic response to breast implants, and chronic inflammatory changes caused by the presence of the implants. The purpose of this study was to evaluate if antibiotic irrigation was superior to saline in reducing the long-term incidence and severity of capsular contracture after primary augmentation mammoplasty. METHODS A retrospective cohort study enrolling patients having undergone primary augmentation mammoplasty by the authors between 2011 and 2012 for all women satisfying inclusion and exclusion criteria was conducted using prospectively collected quality assurance data. Surgical technique between surgeons was controlled such that the only difference was the use of antibiotic irrigation in the treatment group. Analysis with predetermined 95% confidence intervals was performed using χ test and analysis of variance. RESULTS Fifty-five patients underwent surgery. Twenty-eight patients treated with saline (control) were included, ranging in age from 22 to 50 years with a mean follow-up time of 2.8 years. Twenty-seven patients were treated with triple antibiotic solution (treatment) ranging in age from 22 to 56 years with a mean follow-up time of 2.6 years. Rates of capsular contracture were 3.6% (control group) and 3.7% (treatment group). χ statistic was found to be 0.0014 (P = 0.97) and analysis of variance F value was 1 (P = 0.39). CONCLUSIONS There was no difference between triple antibiotic and saline irrigation in the incidence or severity of capsular contracture at 2.8 years follow-up when high-quality surgical technique is used.
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Zhan W, Lu F. Activated macrophages as key mediators of capsule formation on adipose constructs in tissue engineering chamber models. Cell Biol Int 2017; 41:354-360. [DOI: 10.1002/cbin.10731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 01/15/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Weiqing Zhan
- Department of Plastic and Cosmetic Surgery; Nanfang Hospital, Southern Medical University, Guang Zhou; Guang Dong People's Republic of China
- O'Brien Institute Department; St Vincent's Institute of Medical Research; Victoria Australia
| | - Feng Lu
- Department of Plastic and Cosmetic Surgery; Nanfang Hospital, Southern Medical University, Guang Zhou; Guang Dong People's Republic of China
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Chung KJ, Park KR, Lee JH, Kim TG, Kim YH. Simvastatin Reduces Capsular Fibrosis around Silicone Implants. J Korean Med Sci 2016; 31:1273-8. [PMID: 27478339 PMCID: PMC4951558 DOI: 10.3346/jkms.2016.31.8.1273] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 04/10/2016] [Indexed: 11/29/2022] Open
Abstract
Capsular fibrosis and contracture occurs in most breast reconstruction patients who undergo radiotherapy, and there is no definitive solution for its prevention. Simvastatin was effective at reducing fibrosis in various models. Peri-implant capsular formation is the result of tissue fibrosis development in irradiated breasts. The purpose of this study was to examine the effect of simvastatin on peri-implant fibrosis in rats. Eighteen male Sprague-Dawley rats were allocated to an experimental group (9 rats, 18 implants) or a control group (9 rats, 18 implants). Two hemispherical silicone implants, 10 mm in diameter, were inserted in subpanniculus pockets in each rat. The next day, 10-Gy of radiation from a clinical accelerator was targeted at the implants. Simvastatin (15 mg/kg/day) was administered by oral gavage in the experimental group, while animals in the control group received water. At 12 weeks post-implantation, peri-implant capsules were harvested and examined histologically and by real-time polymerase chain reaction. The average capsular thickness was 371.2 μm in the simvastatin group and 491.2 μm in the control group. The fibrosis ratio was significantly different, with 32.33% in the simvastatin group and 58.44% in the control group (P < 0.001). Connective tissue growth factor (CTGF) and transforming growth factor (TGF)-β1 gene expression decreased significantly in the simvastatin group compared to the control group (P < 0.001). This study shows that simvastatin reduces radiation-induced capsular fibrosis around silicone implants in rats. This finding offers an alternative therapeutic strategy for reducing capsular fibrosis and contracture after implant-based breast reconstruction.
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Affiliation(s)
- Kyu Jin Chung
- Department of Plastic and Reconstructive Surgery, College of Medicine, Yeungnam University, Daegu, Korea
| | | | - Jun Ho Lee
- Department of Plastic and Reconstructive Surgery, College of Medicine, Yeungnam University, Daegu, Korea
| | - Tae Gon Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Yeungnam University, Daegu, Korea
| | - Yong-Ha Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Yeungnam University, Daegu, Korea
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Capsular Contracture after Breast Augmentation: An Update for Clinical Practice. Arch Plast Surg 2015; 42:532-43. [PMID: 26430623 PMCID: PMC4579163 DOI: 10.5999/aps.2015.42.5.532] [Citation(s) in RCA: 199] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 04/09/2015] [Accepted: 04/13/2015] [Indexed: 01/17/2023] Open
Abstract
Capsular contracture is the most common complication following implant based breast surgery and is one of the most common reasons for reoperation. Therefore, it is important to try and understand why this happens, and what can be done to reduce its incidence. A literature search using the MEDLINE database was conducted including search terms 'capsular contracture breast augmentation', 'capsular contracture pathogenesis', 'capsular contracture incidence', and 'capsular contracture management', which yielded 82 results which met inclusion criteria. Capsular contracture is caused by an excessive fibrotic reaction to a foreign body (the implant) and has an overall incidence of 10.6%. Risk factors that were identified included the use of smooth (vs. textured) implants, a subglandular (vs. submuscular) placement, use of a silicone (vs. saline) filled implant and previous radiotherapy to the breast. The standard management of capsular contracture is surgical via a capsulectomy or capsulotomy. Medical treatment using the off-label leukotriene receptor antagonist Zafirlukast has been reported to reduce severity and help prevent capsular contracture from forming, as has the use of acellular dermal matrices, botox and neopocket formation. However, nearly all therapeutic approaches are associated with a significant rate of recurrence. Capsular contracture is a multifactorial fibrotic process the precise cause of which is still unknown. The incidence of contracture developing is lower with the use of textured implants, submuscular placement and the use of polyurethane coated implants. Symptomatic capsular contracture is usually managed surgically, however recent research has focussed on preventing capsular contracture from occurring, or treating it with autologous fat transfer.
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Poppler L, Cohen J, Dolen UC, Schriefer AE, Tenenbaum MM, Deeken C, Chole RA, Myckatyn TM. Histologic, Molecular, and Clinical Evaluation of Explanted Breast Prostheses, Capsules, and Acellular Dermal Matrices for Bacteria. Aesthet Surg J 2015; 35:653-68. [PMID: 26229126 PMCID: PMC4649701 DOI: 10.1093/asj/sjv017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Subclinical infections, manifest as biofilms, are considered an important cause of capsular contracture. Acellular dermal matrices (ADMs) are frequently used in revision surgery to prevent recurrent capsular contractures. OBJECTIVE We sought to identify an association between capsular contracture and biofilm formation on breast prostheses, capsules, and ADMs in a tissue expander/implant (TE/I) exchange clinical paradigm. METHODS Biopsies of the prosthesis, capsule, and ADM from patients (N = 26) undergoing TE/I exchange for permanent breast implant were evaluated for subclinical infection. Capsular contracture was quantified with Baker Grade and intramammary pressure. Biofilm formation was evaluated with specialized cultures, rtPCR, bacterial taxonomy, live:dead staining, and scanning electron microscopy (SEM). Collagen distribution, capsular histology, and ADM remodeling were quantified following fluorescent and light microscopy. RESULTS Prosthetic devices were implanted from 91 to 1115 days. Intramammary pressure increased with Baker Grade. Of 26 patients evaluated, one patient had a positive culture and one patient demonstrated convincing evidence of biofilm morphology on SEM. Following PCR amplification 5 samples randomly selected for 16S rRNA gene sequencing demonstrated an abundance of suborder Micrococcineae, consistent with contamination. CONCLUSIONS Our data suggest that bacterial biofilms likely contribute to a proportion, but not all diagnosed capsular contractures. Biofilm formation does not appear to differ significantly between ADMs or capsules. While capsular contracture remains an incompletely understood but common problem in breast implant surgery, advances in imaging, diagnostic, and molecular techniques can now provide more sophisticated insights into the pathophysiology of capsular contracture. LEVEL OF EVIDENCE 4 Therapeutic.
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Affiliation(s)
- Louis Poppler
- Drs Poppler and Dr Cohen are Residents, Dr Dolen is a Breast Fellow, Dr Tenenbaum is Residency Program Director and Assistant Professor, and Dr Myckatyn is Breast Fellowship Director and Associate Professor, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO. Mr. Schriefer is a Physicist, Genome Technology Access Center, Department of Genetics, Washington University School of Medicine, Saint Louis, MO. Dr Deeken is Director of Biomedical Engineering and Biomaterials Laboratory, Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, Saint Louis, MO. and Dr Chole is Lindburg Professor and Chairman, Department of Otolaryngology, and Director of the Biofilm Core Facility, Washington University School of Medicine, Saint Louis, MO
| | - Justin Cohen
- Drs Poppler and Dr Cohen are Residents, Dr Dolen is a Breast Fellow, Dr Tenenbaum is Residency Program Director and Assistant Professor, and Dr Myckatyn is Breast Fellowship Director and Associate Professor, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO. Mr. Schriefer is a Physicist, Genome Technology Access Center, Department of Genetics, Washington University School of Medicine, Saint Louis, MO. Dr Deeken is Director of Biomedical Engineering and Biomaterials Laboratory, Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, Saint Louis, MO. and Dr Chole is Lindburg Professor and Chairman, Department of Otolaryngology, and Director of the Biofilm Core Facility, Washington University School of Medicine, Saint Louis, MO
| | - Utku Can Dolen
- Drs Poppler and Dr Cohen are Residents, Dr Dolen is a Breast Fellow, Dr Tenenbaum is Residency Program Director and Assistant Professor, and Dr Myckatyn is Breast Fellowship Director and Associate Professor, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO. Mr. Schriefer is a Physicist, Genome Technology Access Center, Department of Genetics, Washington University School of Medicine, Saint Louis, MO. Dr Deeken is Director of Biomedical Engineering and Biomaterials Laboratory, Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, Saint Louis, MO. and Dr Chole is Lindburg Professor and Chairman, Department of Otolaryngology, and Director of the Biofilm Core Facility, Washington University School of Medicine, Saint Louis, MO
| | - Andrew E Schriefer
- Drs Poppler and Dr Cohen are Residents, Dr Dolen is a Breast Fellow, Dr Tenenbaum is Residency Program Director and Assistant Professor, and Dr Myckatyn is Breast Fellowship Director and Associate Professor, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO. Mr. Schriefer is a Physicist, Genome Technology Access Center, Department of Genetics, Washington University School of Medicine, Saint Louis, MO. Dr Deeken is Director of Biomedical Engineering and Biomaterials Laboratory, Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, Saint Louis, MO. and Dr Chole is Lindburg Professor and Chairman, Department of Otolaryngology, and Director of the Biofilm Core Facility, Washington University School of Medicine, Saint Louis, MO
| | - Marissa M Tenenbaum
- Drs Poppler and Dr Cohen are Residents, Dr Dolen is a Breast Fellow, Dr Tenenbaum is Residency Program Director and Assistant Professor, and Dr Myckatyn is Breast Fellowship Director and Associate Professor, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO. Mr. Schriefer is a Physicist, Genome Technology Access Center, Department of Genetics, Washington University School of Medicine, Saint Louis, MO. Dr Deeken is Director of Biomedical Engineering and Biomaterials Laboratory, Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, Saint Louis, MO. and Dr Chole is Lindburg Professor and Chairman, Department of Otolaryngology, and Director of the Biofilm Core Facility, Washington University School of Medicine, Saint Louis, MO
| | - Corey Deeken
- Drs Poppler and Dr Cohen are Residents, Dr Dolen is a Breast Fellow, Dr Tenenbaum is Residency Program Director and Assistant Professor, and Dr Myckatyn is Breast Fellowship Director and Associate Professor, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO. Mr. Schriefer is a Physicist, Genome Technology Access Center, Department of Genetics, Washington University School of Medicine, Saint Louis, MO. Dr Deeken is Director of Biomedical Engineering and Biomaterials Laboratory, Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, Saint Louis, MO. and Dr Chole is Lindburg Professor and Chairman, Department of Otolaryngology, and Director of the Biofilm Core Facility, Washington University School of Medicine, Saint Louis, MO
| | - Richard A Chole
- Drs Poppler and Dr Cohen are Residents, Dr Dolen is a Breast Fellow, Dr Tenenbaum is Residency Program Director and Assistant Professor, and Dr Myckatyn is Breast Fellowship Director and Associate Professor, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO. Mr. Schriefer is a Physicist, Genome Technology Access Center, Department of Genetics, Washington University School of Medicine, Saint Louis, MO. Dr Deeken is Director of Biomedical Engineering and Biomaterials Laboratory, Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, Saint Louis, MO. and Dr Chole is Lindburg Professor and Chairman, Department of Otolaryngology, and Director of the Biofilm Core Facility, Washington University School of Medicine, Saint Louis, MO
| | - Terence M Myckatyn
- Drs Poppler and Dr Cohen are Residents, Dr Dolen is a Breast Fellow, Dr Tenenbaum is Residency Program Director and Assistant Professor, and Dr Myckatyn is Breast Fellowship Director and Associate Professor, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO. Mr. Schriefer is a Physicist, Genome Technology Access Center, Department of Genetics, Washington University School of Medicine, Saint Louis, MO. Dr Deeken is Director of Biomedical Engineering and Biomaterials Laboratory, Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, Saint Louis, MO. and Dr Chole is Lindburg Professor and Chairman, Department of Otolaryngology, and Director of the Biofilm Core Facility, Washington University School of Medicine, Saint Louis, MO
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Enhanced Contraction of a Normal Breast-Derived Fibroblast-Populated Three-Dimensional Collagen Lattice via Contracted Capsule Fibroblast-Derived Paracrine Factors: Functional Significance in Capsular Contracture Formation. Plast Reconstr Surg 2015; 135:1413-1429. [PMID: 25919257 DOI: 10.1097/prs.0000000000001177] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND The authors' aim was to identify morphological, genotypic, and cytokine profiles of normal breast-derived fibroblasts, noncontracted breast implant capsule (Baker grades 1 and 2) fibroblasts, and contracted breast implant capsule (Baker grades 3 and 4) fibroblasts, and to investigate the paracrine effects of contracted breast capsule fibroblast--conditioned media on a breast-derived fibroblast-populated three-dimensional collagen lattice. METHODS Primary breast-derived fibroblasts (n = 5), noncontracted breast capsule fibroblasts (n = 5), and contracted breast capsule fibroblasts (n = 5) were cultured, and conditioned media were obtained from passage 1 cells. Cells were immunostained for alpha smooth muscle actin to identify myofibroblasts. A panel of 16 inflammatory, fibrosis, extracellular matrix, and tissue remodeling-related genes were investigated using quantitative reverse transcriptase polymerase chain reaction and cytokine arrays. Fibroblast-populated collagen lattices were fabricated and treated with conditioned media, and lattice contracture was measured over 5 days. RESULTS Several inflammatory and fibrotic genes were significantly dysregulated in contracted breast capsule fibroblasts compared with noncontracted breast capsule fibroblasts and breast-derived fibroblasts (p < 0.05). Breast-derived fibroblast-populated collagen lattices treated with contracted breast capsule fibroblast-conditioned media demonstrated increased lattice contraction compared with treatment with normal 10% serum media (control), breast-derived fibroblasts, or noncontracted breast capsule fibroblast-conditioned media (p < 0.05). Breast-derived fibroblasts supplemented with contracted breast capsule fibroblast-conditioned media transformed into a contracted breast capsule fibroblast-like cell (p < 0.05). CONCLUSION The authors show that contracted breast capsule-derived fibroblasts induce normal breast fibroblast transformation and contraction via paracrine signaling, which may contribute to capsular contracture formation.
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Abstract
Clinicians and investigators have been implanting biomedical devices into patients and experimental animals for centuries. There is a characteristic complex inflammatory response to the presence of the biomedical device with diverse cell signaling, followed by migration of fibroblasts to the implant surface and the eventual walling off of the implant in a collagen capsule. If the device is to interact with the surrounding tissues, the collagen envelope will eventually incapacitate the device or myofibroblasts can cause capsular contracture with resulting distortion, migration, or firmness. This review analyzes the various tactics used in the past to modify or control capsule formation with suggestions for future investigative approaches.
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Korpela E, Liu SK. Endothelial perturbations and therapeutic strategies in normal tissue radiation damage. Radiat Oncol 2014; 9:266. [PMID: 25518850 PMCID: PMC4279961 DOI: 10.1186/s13014-014-0266-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 11/18/2014] [Indexed: 02/08/2023] Open
Abstract
Most cancer patients are treated with radiotherapy, but the treatment can also damage the surrounding normal tissue. Radiotherapy side-effects diminish patients’ quality of life, yet effective biological interventions for normal tissue damage are lacking. Protecting microvascular endothelial cells from the effects of irradiation is emerging as a targeted damage-reduction strategy. We illustrate the concept of the microvasculature as a mediator of overall normal tissue radiation toxicity through cell death, vascular inflammation (hemodynamic and molecular changes) and a change in functional capacity. Endothelial cell targeted therapies that protect against such endothelial cell perturbations and the development of acute normal tissue damage are mostly under preclinical development. Since acute radiation toxicity is a common clinical problem in cutaneous, gastrointestinal and mucosal tissues, we also focus on damage in these tissues.
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Affiliation(s)
- Elina Korpela
- Biological Sciences, Sunnybrook Research Institute and Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Toronto, M4N 3M5, Canada. .,Department of Medical Biophysics, University of Toronto, 101 College St., Toronto, M5G 1L7, Canada.
| | - Stanley K Liu
- Biological Sciences, Sunnybrook Research Institute and Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Toronto, M4N 3M5, Canada. .,Department of Medical Biophysics, University of Toronto, 101 College St., Toronto, M5G 1L7, Canada. .,Department of Radiation Oncology, University of Toronto, 149 College St., Toronto, M5T 1P5, Canada.
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Korpela E, Yohan D, Chin LC, Kim A, Huang X, Sade S, Van Slyke P, Dumont DJ, Liu SK. Vasculotide, an Angiopoietin-1 mimetic, reduces acute skin ionizing radiation damage in a preclinical mouse model. BMC Cancer 2014; 14:614. [PMID: 25159192 PMCID: PMC4159535 DOI: 10.1186/1471-2407-14-614] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 08/20/2014] [Indexed: 11/24/2022] Open
Abstract
Background Most cancer patients are treated with radiotherapy, but the treatment can also damage the surrounding normal tissue. Acute skin damage from cancer radiotherapy diminishes patients’ quality of life, yet effective biological interventions for this damage are lacking. Protecting microvascular endothelial cells from irradiation-induced perturbations is emerging as a targeted damage-reduction strategy. Since Angiopoetin-1 signaling through the Tie2 receptor on endothelial cells opposes microvascular perturbations in other disease contexts, we used a preclinical Angiopoietin-1 mimic called Vasculotide to investigate its effect on skin radiation toxicity using a preclinical model. Methods Athymic mice were treated intraperitoneally with saline or Vasculotide and their flank skin was irradiated with a single large dose of ionizing radiation. Acute cutaneous damage and wound healing were evaluated by clinical skin grading, histology and immunostaining. Diffuse reflectance optical spectroscopy, myeloperoxidase-dependent bioluminescence imaging of neutrophils and a serum cytokine array were used to assess inflammation. Microvascular endothelial cell response to radiation was tested with in vitro clonogenic and Matrigel tubule formation assays. Tumour xenograft growth delay experiments were also performed. Appreciable differences between treatment groups were assessed mainly using parametric and non-parametric statistical tests comparing areas under curves, followed by post-hoc comparisons. Results In vivo, different schedules of Vasculotide treatment reduced the size of the irradiation-induced wound. Although skin damage scores remained similar on individual days, Vasculotide administered post irradiation resulted in less skin damage overall. Vasculotide alleviated irradiation-induced inflammation in the form of reduced levels of oxygenated hemoglobin, myeloperoxidase bioluminescence and chemokine MIP-2. Surprisingly, Vasculotide-treated animals also had higher microvascular endothelial cell density in wound granulation tissue. In vitro, Vasculotide enhanced the survival and function of irradiated endothelial cells. Conclusions Vasculotide administration reduces acute skin radiation damage in mice, and may do so by affecting several biological processes. This radiation protection approach may have clinical impact for cancer radiotherapy patients by reducing the severity of their acute skin radiation damage. Electronic supplementary material The online version of this article (doi:10.1186/1471-2407-14-614) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Stanley K Liu
- Biological Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada.
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Brazin J, Malliaris S, Groh B, Mehrara B, Hidalgo D, Otterburn D, Silver RB, Spector JA. Mast cells in the periprosthetic breast capsule. Aesthetic Plast Surg 2014; 38:592-601. [PMID: 24811971 DOI: 10.1007/s00266-014-0318-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Accepted: 04/01/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Symptomatic capsular contracture occurs in about 10 % of primary breast augmentations and in more than double that rate in reconstruction after mastectomy, especially in the setting of radiation. Mast cells, traditionally associated with immune response and inflammation, secrete profibrotic mediators and may play a role in capsule formation and contracture. We analyzed the mast cell and fibroblast populations in breast capsule tissue from patients who underwent capsular excision. METHODS Capsule tissue was collected from patients who underwent exchange of tissue expanders for permanent implants, revision of reconstruction, or revision augmentation. Breast capsule tissues were prepared for histological analyses of mast cells, fibroblasts, and collagen. Mast cells and fibroblasts were isolated from capsule tissue and screened for mediators and receptor expression. RESULTS In breast capsule tissue, the average numbers of mast cells and fibroblasts were 9 ± 1/mm(2) and 33 ± 10/mm(2), respectively. There were significantly more mast cells on the posterior side than on the anterior side of the capsule tissue (12 ± 2 vs. 6 ± 1/mm(2), p < 0.01). Baker grade IV capsules had an increased number of fibroblasts compared to Baker grade I capsules (93 ± 9 vs. 40 ± 19/mm(2), p < 0.001). In breast capsule tissue, mast cells contained renin, histamine, and TGF-β, and their respective receptors, AT1R, H1R, and TGF-βRI were expressed by fibroblasts. CONCLUSION These data indicate that within breast capsule tissue mast cells contain mediators that may activate neighboring fibroblasts. Understanding the role of mast cells in pathologic periprosthetic breast capsule formation may lead to novel therapies to prevent and treat capsular contracture. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266.
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Affiliation(s)
- Jacqueline Brazin
- Department of Physiology and Biophysics, Weill Cornell Medical College, New York, NY, 10065, USA
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The effect of radiation on acellular dermal matrix and capsule formation in breast reconstruction: clinical outcomes and histologic analysis. Plast Reconstr Surg 2014; 133:214-221. [PMID: 24469157 DOI: 10.1097/01.prs.0000437255.01199.42] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The authors compared clinical outcomes to determine whether acellular dermal matrix altered the capsular tissue architecture in irradiated and nonirradiated breasts following matrix-assisted expander reconstruction. METHODS Part I included all 27 patients who underwent bilateral tissue expander reconstruction with acellular dermal matrix between 2007 and 2012 and subsequent unilateral radiation therapy. Part II included a subset of patients with capsular biopsy specimens taken at the time of implant exchange for histologic analysis. Specimens included irradiated and nonirradiated acellular dermal matrix and irradiated and nonirradiated native capsule. Clinical outcomes were analyzed in relation to capsule architecture and acellular dermal matrix performance. RESULTS In part I, mean follow-up was 28 months. Grade III/IV contractures were identified in nine patients (all on the irradiated side), and 12 developed noncontracture complications (75 percent on the irradiated side). Nine patients were unable to continue with implant reconstruction and required salvage with autologous tissue. In part II, postirradiation biopsy specimens were taken of the peri-implant capsule in six patients at the time of secondary surgery. Elastin content and the total cellular infiltrate were significantly greater in the irradiated versus nonirradiated native capsules (p = 0.0015). Conversely, the irradiated matrix capsule was composed of similar amounts of cellular infiltrate and collagen as the nonirradiated matrix capsules and nonirradiated native capsules. Irradiated acellular dermal matrix showed the least amount of alpha-smooth actin staining but a similar number of blood vessels. CONCLUSION Acellular dermal matrix appears to limit the elastosis and chronic inflammation seen in irradiated implant reconstructions and is potentially beneficial in these patients. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Revisiting Triple Antibiotic Irrigation of Breast Implant Pockets: A Placebo-controlled Single Practice Cohort Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2013; 1:e55. [PMID: 25289250 PMCID: PMC4174057 DOI: 10.1097/gox.0b013e3182aa8760] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 08/28/2013] [Indexed: 11/26/2022]
Abstract
Background: Capsular contracture is the most common complication following primary augmentation mammoplasty. It remains poorly understood but is attributed to subclinical infection, immunologic response to breast implants, and chronic inflammatory changes caused by the presence of the implants. The infectious theory of contracture has lead to the practice of irrigating implant pockets with a triple antibiotic solution. The purpose of this study was to determine if antibiotic irrigation reduced the incidence and severity of capsular contracture compared with saline irrigation. Methods: A cohort study enrolling all patients having undergone primary augmentation mammoplasty performed by surgeon A and surgeon B between 2011 and 2012 for all women satisfying inclusion and exclusion criteria was conducted. The only difference in surgical technique was the use of antibiotic irrigation by surgeon B. A chi-square test and analysis of variance with predetermined 95% confidence intervals were performed. Results: Fifty-five patients were operated on. Twenty-eight of surgeon A’s patients were included, ranging in age from 22 to 50 with a mean follow-up time of 1.8 years. Twenty-seven of surgeon B’s patients were included, ranging in age from 22 to 56 with a mean follow-up time of 1.6 years. Rate of capsular contracture was 3.6% (surgeon A) and 3.7% (surgeon B). Chi-square statistic was found to be 0.0014 (P = 0.97) and analysis of variance F value was 1 (P = 0.39). Conclusions: Triple antibiotic breast irrigation is not associated with a significant reduction in the incidence or severity of capsular contracture compared with sterile saline when high-quality surgical technique is used.
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Namnoum JD, Moyer HR. The Role of Acellular Dermal Matrix in the Treatment of Capsular Contracture. Clin Plast Surg 2012; 39:127-136. [DOI: 10.1016/j.cps.2012.02.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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