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Segreto F, Carotti S, Marangi GF, Francesconi M, Calia E, Cagli B, Cimmino A, Rossi C, Morini S, Persichetti P. Cathelicidin LL-37 Expression in Human Breast Implant Capsules. Plast Reconstr Surg 2024; 153:1066-1073. [PMID: 37220260 DOI: 10.1097/prs.0000000000010733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Capsular contracture is the most common complication following breast implant placement. Cathelicidin LL-37 is a cationic peptide involved in innate immunity. Initially investigated for its antimicrobial role, it was found to have pleiotropic activities, such as immunomodulation, angiogenesis stimulation, and tissue healing. The aim of the study was to investigate the expression and localization of LL-37 in human breast implant capsules and its relationship with capsular formation, remodeling, and clinical outcomes. METHODS The study enrolled 28 women (29 implants) who underwent expander substitution with definitive implant. Contracture severity was evaluated. Specimens were stained with hematoxylin and eosin, Masson trichrome, immunohistochemistry, and immunofluorescence for LL-37, CD68, α-smooth muscle actin, collagen type I and type III, CD31, and Toll-like receptor-4. RESULTS LL-37 was expressed in macrophages and myofibroblasts of capsular tissue in 10 (34%) and nine (31%) of the specimens, respectively. In eight cases (27.5%), it was expressed by both macrophages and myofibroblasts of the same specimen. In infected capsules, expression by both cell types was found in all (100%) specimens. LL-37 expression by myofibroblasts positively correlated with its expression by macrophages ( P < 0.001). Moreover, LL-37 expression by macrophages of periexpander capsules negatively correlated with the severity of capsular contracture on definitive implants ( P = 0.04). CONCLUSIONS This study demonstrates the expression of LL-37 in macrophages and myofibroblasts of capsular tissue and its negative correlation with the severity of capsular contracture following permanent implant placement. Expression or up-regulation of LL-37 may be involved in myofibroblast and macrophage modulation, thus playing a role in the pathogenic fibrotic process underlying capsular contracture. CLINICAL RELEVANCE STATEMENT This is the first study to demonstrate LL37 expression in capsular tissue and to hypothesize its role in contracture and as a prognostic marker for contracture severity. If confirmed, medical strategies or implant coating could be implemented to reduce the risk of contracture for high-risk patients.
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Affiliation(s)
- Francesco Segreto
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery
| | - Simone Carotti
- Center for Integrated Biomedical Research, Laboratory of Microscopic and Ultrastructural Anatomy
| | | | - Maria Francesconi
- Center for Integrated Biomedical Research, Laboratory of Microscopic and Ultrastructural Anatomy
| | - Eleonora Calia
- Department of Obstetrics and Gynecology, Campus Bio-Medico of Rome University
| | - Barbara Cagli
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery
| | - Andrea Cimmino
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery
| | - Caterina Rossi
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery
| | - Sergio Morini
- Center for Integrated Biomedical Research, Laboratory of Microscopic and Ultrastructural Anatomy
| | - Paolo Persichetti
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery
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Boyd CJ, Chiodo MV, Lisiecki JL, Wagner RD, Rohrich RJ. Systematic Review of Capsular Contracture Management following Breast Augmentation: An Update. Plast Reconstr Surg 2024; 153:303e-321e. [PMID: 36877620 DOI: 10.1097/prs.0000000000010358] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Capsular contracture is one of the most frequent indications for revision following breast augmentation. Management goals focus on restoring breast aesthetics and minimizing subsequent recurrence of capsular contracture. As new data emerge, close review of the data are merited to build evidence-based clinical guidelines to inform surgical practice and management of capsular contracture. METHODS A systematic review of the MEDLINE, Embase, and Cochrane Database of Systematic Reviews databases was conducted to characterize the surgical management of capsular contracture in revision breast augmentations. The primary endpoint was capsular contracture recurrence rate. RESULTS The review was conducted in November of 2021. Primary search revealed 14,163 results. Initial screening by title left 1223 articles. Abstract review left 90 articles for full-text review, of which 34 were ultimately included and were all observational in nature. CONCLUSIONS Capsular contracture management remains an important topic, with limited high-level evidence for establishing clear evidence-based treatment guidelines. Although more evidence is required to assess the effects of capsulectomy, implant exchange, and plane change, these appear to be useful mechanisms for reducing recurrent capsular contracture. There is more evidence regarding the use of acellular dermal matrix, although this still requires long-term follow-up studies. New developments regarding textured implants limit the revision breast augmentation surgeon to smooth devices.
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Affiliation(s)
- Carter J Boyd
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone
| | | | | | - Ryan D Wagner
- Division of Plastic Surgery, Baylor College of Medicine
| | - Rod J Rohrich
- Dallas Plastic Surgery Institute
- Division of Plastic Surgery, Baylor College of Medicine
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Montemurro P, Gupta T. Devil's Advocate: Evidence-Based Recommendation for "One Breast-One Insertion Funnel" Policy. Aesthet Surg J 2024; 44:160-164. [PMID: 37647888 DOI: 10.1093/asj/sjad288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/23/2023] [Accepted: 08/23/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Rates of capsular contracture have reduced significantly since the use of insertion funnels to place breast implants became routine. However, due to financial constraints, the same funnel is usually used for implantation of both sides. OBJECTIVES The aim of this study was to determine whether the risk of capsular contracture is higher for the second breast when the same insertion funnel is used for both breasts. METHODS The authors collected a sample of the insertion funnel tip immediately after removing the funnel from its sterile packaging and another tip sample after the funnel had been used to insert the first implant. These samples were sent for microbiological culture evaluations. Capsular contracture rates in the first implanted breast vs the second implanted breast were then retrospectively analyzed. RESULTS All samples taken from the funnel before the first implantation showed no bacterial growth. All 10 samples taken from the funnel after the first implantation showed organism growth (8 were positive for Staphylococcus epidermidis and 2 for Cutibacterium acnes). Retrospective analysis of the results revealed that the overall capsular contracture rate had reduced after the authors began to use insertion funnels. However, this complication was still more common on the second implanted breast. CONCLUSIONS Surgeons should consider the use of separate insertion funnels for each breast. This might help to slightly reduce the incidence of capsular contracture.See the abstract translated into Hindi, Portuguese, Korean, German, Italian, Arabic, and Chinese (Simplified and Traditional) online here: https://doi.org/10.1093/asj/sjad288. LEVEL OF EVIDENCE: 4
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Mohan AS, Sullivan J, Tenenbaum MM, Broderick KB, Myckatyn TM. Toward a Consensus Aproach for Assessing Capsular Contracture Severity and Progression: A Systematic Review. Plast Reconstr Surg 2024; 153:7-22. [PMID: 37075286 PMCID: PMC10729898 DOI: 10.1097/prs.0000000000010573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/11/2022] [Indexed: 04/21/2023]
Abstract
BACKGROUND Breast implants are the most commonly used medical devices in plastic surgery, and capsular contracture (CC) is one of the most common complications. However, our assessment of CC is based largely on Baker grade, which is problematically subjective and affords only four possible values. METHODS The authors performed a systematic review concluding in September of 2021 in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. It identified 19 articles that propose approaches to measuring CC. RESULTS In addition to Baker grade, the authors identified several modalities reported to measure CC. These included magnetic resonance imaging, ultrasonography, sonoelastography, mammacompliance measuring devices, applanation tonometry, histologic evaluation, and serology. Capsule thickness and other measures of CC inconsistently correlated with Baker grade, whereas the presence of synovial metaplasia was consistently associated with Baker grade I and II, but not III and IV capsules. CONCLUSIONS There remains no particular method to reliably and specifically measure the contracture of capsules that form around breast implants. As such, we would recommend that research investigators use more than one modality to measure CC. Other variables that can impact breast implant stiffness and associated discomfort beyond CC need to be considered when evaluating patient outcomes. Given the value placed on CC outcomes in assessing breast implant safety, and the prevalence of breast implants overall, the need for a more reliable approach to measuring this outcome persists.
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Affiliation(s)
- Abee S. Mohan
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine
| | - Janessa Sullivan
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine
| | - Marissa M. Tenenbaum
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine
| | - Kristen B. Broderick
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine
| | - Terence M. Myckatyn
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Samuels K, Millet E, Wong L. Efficacy of Acellular Dermal Matrix Type in Treatment of Capsular Contracture in Breast Augmentation: A Systematic Review and Meta-Analysis. Aesthet Surg J 2023; 44:26-35. [PMID: 37595294 DOI: 10.1093/asj/sjad265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Capsular contracture is a known complication of breast augmentation and is among the top reasons for revisional breast augmentation procedures. The use of acellular dermal matrix (ADM) has been shown to reduce the rate of capsular contracture in breast reconstruction and augmentation, theorizing that it acts as a protective barrier between the implant capsule and inflammatory process responsible for capsular contracture. The role of ADM in treatment of capsular contracture has been investigated in numerous studies, with a variety of ADMs. OBJECTIVES The aim of this study was to perform a systematic review of existing literature on the use of ADM for treatment of capsular contracture in aesthetic breast augmentation patients to investigate differences in efficacy of ADM types. METHODS The PubMed, Embase, and CINAHL databases were systematically reviewed for articles pertaining to capsular contracture, acellular dermal matrices, and breast augmentation. Number of patients, type of ADM, Baker grade, follow-up time, complication rate, and capsular contracture rate were recorded from identified articles. Data was pooled from studies to calculate a capsular contracture rate for each ADM type, with a chi-squared test performed for analysis. Identified studies with a comparative group were included in a meta-analysis utilizing risk ratio (RR) to assess the efficacy of ADM. RESULTS Nine articles including ADM for treatment of capsular contracture in breast augmentation met criteria for inclusion, with a total of 481 breasts. Strattice was the most commonly utilized ADM (n = 391), followed by AlloDerm (n = 57). There was a statistically significant difference in efficacy of ADM among the studied ADM types (P < .001). AlloDerm, FlexHD, and DermaMatrix had the lowest capsular contracture rates (0%). NeoForm and SurgiMend had the highest capsular contracture rates (each 25%, but with n = 4 and n = 8, respectively). Strattice had a capsular contracture rate of 1.53% in the pooled data, and meta-analysis showed that Strattice reduced the risk of capsular contracture (RR 0.14 [95% CI 0.06, 0.31]) compared with conventional treatment. CONCLUSIONS Acellular dermal matrices appear to be effective at treating capsular contracture after breast augmentation while maintaining a low complication rate. Overall capsular contracture rates are low with the use of ADM. There is a statistically significant difference in efficacy among ADM types. Meta-analysis shows that Strattice is effective at reducing the risk of capsular contracture in breast augmentation patients when compared to conventional treatment. Future research, especially in the form of randomized controlled trials, is needed to further investigate the efficacy of various ADMs in the treatment of capsular contracture. LEVEL OF EVIDENCE: 4
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Federica G, Tommaso F, Alessia C, Agostino C, Florian B, Antonio G, Domenico Nicola M, Abdallah R, Carmela S, Lorenzo S, Sergio B. Use of Antimicrobial Irrigation and Incidence of Capsular Contracture in Breast Augmentation and Immediate Implant-Based Breast Reconstruction. Aesthetic Plast Surg 2023; 47:2345-2350. [PMID: 37410129 PMCID: PMC10784374 DOI: 10.1007/s00266-023-03453-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/04/2023] [Indexed: 07/07/2023]
Abstract
Capsular contracture (CC) is one of the most common complications of implant-based breast reconstruction or augmentation surgery. Common risk factors of CC include biofilm, surgical site infections, history of prior CC or fibrosis, history of radiation therapy, and implant characteristics. Though bacterial contamination of breast protheses is associated with adverse sequelae, there are not universally accepted guidelines and limited best practice recommendations for antimicrobial breast pocket irrigation. Despite advanced molecular biology, the exact mechanism of this complication is not fully understood. Interventions that decrease the rate of CC include antibiotic prophylaxis or irrigation, acellular dermal matrix, leukotriene inhibitors, surgical techniques, and others. However, there is inconsistent evidence supporting these risk factors, and the current data was based on broad heterogeneous studies. The objective of this review was to provide a summary of the current data of contributing risk factors as well as preventative and treatment measures for CC.Level of Evidence III This journal requires that authors assign a level of evidence to each article. 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)
- Giuzio Federica
- Department of Sciences, University of Basilicata, Potenza, Italy
- Spinoff TNcKILLERS s.r.l, Ateneo Lucano street 10, 85100, Potenza, Italy
- U.O.C. Primary Care and Territorial Health, Social and Health Department, State Hospital, Falciano, Republic of San Marino
| | - Fabrizio Tommaso
- Department of Plastic Surgery, IRCCS, Referral Cancer Center of Basilicata, Rionero in Vulture, PZ, Italy
| | - Catalano Alessia
- Department of Pharmacy-Drug Sciences, University of Bari "Aldo Moro", Bari, Italy
| | - Ceccarini Agostino
- U.O.C. Primary Care and Territorial Health, Social and Health Department, State Hospital, Falciano, Republic of San Marino
| | - Bodog Florian
- Department of Surgery, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
| | - Giuliani Antonio
- U.O.C. of General and Emergency Surgery A.O.R. "San Carlo", Potenza, Basilicata, Italy
| | | | - Raweh Abdallah
- Cardiac Surgery Department, Yas Clinic, Abu Dhabi, United Arab Emirates
| | | | - Svolacchia Lorenzo
- Departments of Medical-Surgical Sciences and Biotechnologies, La Sapienza University, Rome, Italy
| | - Brongo Sergio
- Department of Plastic Surgery, University of Salerno, Campania, Italy.
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Orr JPM, Myckatyn TM. Discussion: Baker Grade IV Capsular Contracture Is Correlated with an Increased Amount of Silicone Material: An Intrapatient Study. Plast Reconstr Surg 2023; 152:1201-1202. [PMID: 38019688 DOI: 10.1097/prs.0000000000010717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Affiliation(s)
- Jonah P M Orr
- From the Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine
| | - Terence M Myckatyn
- From the Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine
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de Bakker E, Zada L, Schmidt RW, van Haasterecht L, Vethaak AD, Ariese F, Dijkman HBPM, Bult P, Gibbs S, Niessen FB. Baker Grade IV Capsular Contracture Is Correlated with an Increased Amount of Silicone Material: An Intrapatient Study. Plast Reconstr Surg 2023; 152:1191-1200. [PMID: 36877628 PMCID: PMC10666937 DOI: 10.1097/prs.0000000000010359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 10/07/2022] [Indexed: 03/07/2023]
Abstract
BACKGROUND Breast implant surgery is one of the most frequently performed procedures by plastic surgeons worldwide. However, the relationship between silicone leakage and the most common complication, capsular contracture, is far from understood. This study aimed to compare Baker grade I with Baker grade IV capsules regarding their silicone content in an intradonor setting, using two previously validated imaging techniques. METHODS Twenty-two donor-matched capsules from 11 patients experiencing unilateral complaints were included after bilateral explantation surgery. All capsules were examined using both stimulated Raman scattering (SRS) imaging and staining with modified oil red O (MORO). Evaluation was done visually for qualitative and semiquantitative assessment and automated for quantitative analysis. RESULTS Using both SRS and MORO techniques, silicone was found in more Baker grade IV capsules (eight of 11 and 11 of 11, respectively) than in Baker grade I capsules (three of 11 and five of 11, respectively). Baker grade IV capsules also showed significantly more silicone content compared with the Baker grade I capsules. This was true for semiquantitative assessment for both SRS and MORO techniques ( P = 0.019 and P = 0.006, respectively), whereas quantitative analysis proved to be significant for MORO alone ( P = 0.026 versus P = 0.248 for SRS, respectively). CONCLUSIONS In this study, a significant correlation between capsule silicone content and capsular contracture is shown. An extensive and continued foreign body response to silicone particles is likely to be responsible. Considering the widespread use of silicone breast implants, these results affect many women worldwide and warrant a more focused research effort. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Affiliation(s)
- Erik de Bakker
- From the Department of Plastic, Reconstructive and Hand Surgery
- Department of Molecular Cell Biology and Immunology, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit
| | - Liron Zada
- LaserLaB Amsterdam, Department of Physics and Astronomy, Faculty of Sciences
- Department of Environment and Health, Vrije Universiteit Amsterdam
| | - Robert W. Schmidt
- LaserLaB Amsterdam, Department of Physics and Astronomy, Faculty of Sciences
| | - Ludo van Haasterecht
- From the Department of Plastic, Reconstructive and Hand Surgery
- LaserLaB Amsterdam, Department of Physics and Astronomy, Faculty of Sciences
| | - A. Dick Vethaak
- Department of Environment and Health, Vrije Universiteit Amsterdam
- Deltares, Marine and Coastal Systems
| | - Freek Ariese
- LaserLaB Amsterdam, Department of Physics and Astronomy, Faculty of Sciences
| | | | - Peter Bult
- Department of Pathology, Radboud University Medical Center
| | - Susan Gibbs
- Department of Molecular Cell Biology and Immunology, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam
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Wright MA, Miller AJ, Dong X, Karinja SJ, Samadi A, Lara DO, Mukherjee S, Veiseh O, Spector JA. Reducing Peri-implant Capsule Thickness in Submuscular Rodent Model of Breast Reconstruction With Delayed Radiotherapy. J Surg Res 2023; 291:158-166. [PMID: 37421826 DOI: 10.1016/j.jss.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 04/05/2023] [Accepted: 04/29/2023] [Indexed: 07/10/2023]
Abstract
INTRODUCTION Capsular contracture remains the most common complication following device-based breast reconstruction, occurring in up to 50% of women who also undergo adjuvant radiotherapy either before or after device-based reconstruction. While certain risk factors for capsular contracture have been identified, there remains no clinically effective method of prevention. The purpose of the present study is to determine the effect of coating the implant with the novel small molecule Met-Z2-Y12, with and without delayed, targeted radiotherapy, on capsule thickness and morphologic change around smooth silicone implants placed under the latissimus dorsi in a rodent model. METHODS Twenty-four female Sprague Dawley rats each had 2 mL smooth round silicone breast implants implanted bilaterally under the latissimus dorsi muscle. Twelve received uncoated implants and twelve received implants coated with Met-Z2-Y12. Half of the animals from each group received targeted radiotherapy (20 Gray) on postoperative day ten. At three and 6 months after implantation, the tissue surrounding the implants was harvested for analysis of capsular histology including capsule thickness. Additionally, microCT scans were qualitatively analyzed for morphologic change. RESULTS Capsules surrounding Met-Z2-Y12-coated implants were significantly thinner (P = 0.006). The greatest difference in capsule thickness was seen in the irradiated 6-month groups, where mean capsule thickness was 79.1 ± 27.3 μm for uncoated versus 50.9 ± 9.6 μm for Met-Z2-Y12-coated implants (P = 0.038). At the time of explant, there were no capsular morphologic differences between the groups either grossly or per microCT. CONCLUSIONS Met-Z2-Y12 coating of smooth silicone breast implants significantly reduces capsule thickness in a rodent model of submuscular breast reconstruction with delayed radiotherapy.
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Affiliation(s)
- Matthew A Wright
- Laboratory of Bioregenerative Medicine and Surgery, Division of Plastic Surgery, Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Andrew J Miller
- Laboratory of Bioregenerative Medicine and Surgery, Division of Plastic Surgery, Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Xue Dong
- Laboratory of Bioregenerative Medicine and Surgery, Division of Plastic Surgery, Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Sarah J Karinja
- Laboratory of Bioregenerative Medicine and Surgery, Division of Plastic Surgery, Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Arash Samadi
- Laboratory of Bioregenerative Medicine and Surgery, Division of Plastic Surgery, Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Daniel O Lara
- Laboratory of Bioregenerative Medicine and Surgery, Division of Plastic Surgery, Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Sudip Mukherjee
- Veiseh Lab, Department of Bioengineering, Rice University, Houston, Texas
| | - Omid Veiseh
- Veiseh Lab, Department of Bioengineering, Rice University, Houston, Texas
| | - Jason A Spector
- Laboratory of Bioregenerative Medicine and Surgery, Division of Plastic Surgery, Department of Surgery, Weill Cornell Medicine, New York, New York; Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York.
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Lu Y, Chen Z, Pan Y, Qi F. Identification of Drug Compounds for Capsular Contracture Based on Text Mining and Deep Learning. Plast Reconstr Surg 2023; 152:779e-790e. [PMID: 36862957 DOI: 10.1097/prs.0000000000010350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Capsular contracture is a common and unpredictable complication after breast implant placement. Currently, the pathogenesis of capsular contracture is unclear, and the effectiveness of nonsurgical treatment is still doubtful. The authors' study aimed to investigate new drug therapies for capsular contracture by using computational methods. METHODS Genes related to capsular contracture were identified by text mining and GeneCodis. Then, the candidate key genes were selected through protein-protein interaction analysis in Search Tool for the Retrieval of Interacting Genes/Proteins and Cytoscape. Drugs targeting the candidate genes with relation to capsular contracture were screened out in Pharmaprojects. Based on the drug-target interaction analysis by DeepPurpose, candidate drugs with highest predicted binding affinity were obtained eventually. RESULTS The authors' study identified 55 genes related to capsular contracture. Gene set enrichment analysis and protein-protein interaction analysis generated eight candidate genes. One hundred drugs targeting the candidate genes were selected. The seven candidate drugs with the highest predicted binding affinity were determined by DeepPurpose, including tumor necrosis factor alpha antagonist, estrogen receptor agonist, insulin-like growth factor 1 receptor, tyrosine kinase inhibitor, and matrix metallopeptidase 1 inhibitor. CONCLUSION Text mining and DeepPurpose can be used as a promising tool for drug discovery in exploring nonsurgical treatment to capsular contracture. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
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Affiliation(s)
- Yeheng Lu
- From the Department of Plastic Surgery, Zhongshan Hospital
| | - Zhiwei Chen
- Big Data and Artificial Intelligence Center, Zhongshan Hospital, Fudan University
| | - Yuyan Pan
- From the Department of Plastic Surgery, Zhongshan Hospital
| | - Fazhi Qi
- From the Department of Plastic Surgery, Zhongshan Hospital
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Lee S, Kim M, Kim M, Ryu W, Back S. Capsular Contracture Rate in Augmentation Mammoplasty With Motiva Breast Implant Insertion: A Single-Center Experience in Korea. Aesthet Surg J 2023; 43:1248-1255. [PMID: 37254824 DOI: 10.1093/asj/sjad166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/21/2023] [Accepted: 05/30/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Capsular contracture is the most common complication following breast implant surgery, and the implant shell characteristics are important in preventing this complication. OBJECTIVES The aim of this study was to evaluate the capsular contracture rate for SmoothSilk Motiva implants (Establishment Labs Holdings Inc., New York, NY) in females who underwent primary and revisional breast augmentation over a 3-year period. METHODS A total of 1324 cases that took place from 2017 to 2020 were retrospectively analyzed, with 1027 being primary surgeries and 297 being revisional surgeries. RESULTS In the 1324 cases of augmentation mammoplasty with SmoothSilk Motiva implants, the overall capsular contracture rate was 1.8% (n = 24). The capsular contracture rate in the 1027 primary surgery cases was 1.07% (n = 11), and the capsular contracture rate in the 297 revisional surgery cases was significantly different at 4.39% (n = 13, P = .0001). More specifically, the capsular contracture rate in 182 revisional surgery for cases without capsular contracture was 1.12% (n = 2), and it showed no statistically significant difference from the rate in primary surgery cases (P = .965). However, the rate in 115 revisional surgery for cases with capsular contracture was 9.57% (n = 11), and it showed a statistically significant difference from the rate in primary surgery cases (P = .000) and the rate in revisional surgery for cases without capsular contracture (P = .001). CONCLUSIONS Augmentation mammoplasty with SmoothSilk Motiva implants demonstrated a lower rate of capsular contracture than traditional smooth or textured implants. Revisional surgery for cases without capsular contracture showed a similar rate of capsular contracture to primary surgery cases, but the rates were higher in revisional surgery for cases with capsular contracture. LEVEL OF EVIDENCE: 4
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Ali A, Picado O, Mathew PJ, Ovadia S, Thaller SR. Risk Factors for Capsular Contracture in Alloplastic Reconstructive and Augmentation Mammaplasty: Analysis of the National Surgical Quality Improvement Program (NSQIP) Database. Aesthetic Plast Surg 2023; 47:1678-1682. [PMID: 35715534 DOI: 10.1007/s00266-022-02972-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/01/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Capsular contracture is the most common complication of breast augmentation and reconstruction. It occurs in up to 45% of patients and is theorized to occur secondary to an immune reaction. It can lead to pain, dissatisfaction with aesthetic outcomes, and reoperation. The gold standard for management is capsulectomy. Prior similar studies are limited by narrow inclusion criteria, single-surgeon analysis, small sample size, or univariate analysis. The goal of the following study is to prospectively identify possible risk factors for capsular contracture using a national database. METHODS A retrospective review was conducted utilizing the National Surgical Quality Improvement Program (NSQIP) Database of prospectively collected data of patients undergoing periprosthetic and/or total capsulectomy for capsular contracture from 2013 to 2016. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for variables using a multivariable binary logistic regression model. RESULTS A total of 6547 patients underwent reconstructive or augmentation mammaplasty with a prosthetic implant, out of which 2543 (39%) underwent capsulectomy. Capsular contracture was more likely in older (OR: 1.10, 95% CI: 1.09-1.10, p<.001), overweight (OR: 1.12, 95% CI: 1.10-1.13, p<.001), and cancer patients (OR: 7.71, 95% CI: 2.22-28.8, p=0.001). Wound infection was associated with capsulectomy (OR: 6.69, 95% CI: 1.74-25.8, p<.001). CONCLUSION These identified risk factors should be comprehensively addressed with patients during the informed consent process before breast augmentation or reconstruction with implants. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. 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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Affiliation(s)
- Aleeza Ali
- Herbert Wertheim College of Medicine; Florida International University, Miami, Florida, USA
| | - Omar Picado
- Division of Plastic and Reconstructive Surgery; DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Prakash J Mathew
- Division of Plastic and Reconstructive Surgery; DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Steven Ovadia
- Division of Plastic and Reconstructive Surgery; DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Seth R Thaller
- Division of Plastic and Reconstructive Surgery; DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA.
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Berry MG, Stanek JJ. The Double Capsule Phenomenon in a Case Series and its Relationship with the Macro-Textured Breast Implant. Aesthetic Plast Surg 2023; 47:1725-1730. [PMID: 36443419 PMCID: PMC9707171 DOI: 10.1007/s00266-022-03182-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/05/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Silicone breast augmentation remains one of the most common aesthetic surgery procedures, and 2022 marks the 60th anniversary of the first case. Recent studies suggest a link between double capsule (DC) formation and macro-textured devices. METHODS Between 2010 and 2015, 268 aesthetic patients underwent bilateral mammary prosthesis exchange for indications including PIP exchange, adverse capsular contracture and ultrasonographic evidence of rupture. All surgery, in the form of implant exchange and capsulectomy, was undertaken by the senior author using standard techniques. A retrospective review was undertaken, and data analysed with descriptive statistics and Fisher's exact and Mann-Whitney U tests. RESULTS Of 268 patients identified, 40 (14.9%) showed some degree of capsular duplication and bilateral involvement was marginally more common (52.5%). Two macroscopic patterns of duplication were observed: complete and subtotal. Complete DCs correlated with a clinical triad of extreme firmness, mobility and minimal-to-no pain. Whilst a wide range of manufacturers was represented, macro-textured devices were associated with the highest DC prevalence (58.3% vs. 5.6%) (Fisher's exact test p < 0.00001). Patients with DC had been implanted for less than half the time, median 52 versus. 120 months (p = 0.0003) of those without. DISCUSSION An elevated prevalence of duplicate capsules in macro-textured prostheses is reconfirmed in addition to a novel symptom constellation that may assist with clinical diagnosis. Our study reinforces the aetiopathogenic influence of the elastomer in DC formation and reports DC for the first time in non-macrotextured implants. Single-surgeon cohort of 268 consecutive patients with 532 implants Statistically significant association of macro-textured devices with DC Statistically significant reduced duration of implantation of macro-textured devices First report of DC in non-macro-textured devices LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. 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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Affiliation(s)
- Miles G Berry
- Surgical Aesthetics, Flat 19 Milford House, 7 Queen Anne Street, London, W1G 9HN, UK.
| | - Jan J Stanek
- Surgical Aesthetics, Flat 19 Milford House, 7 Queen Anne Street, London, W1G 9HN, UK
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15
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Kuehlmann B, Bonham CA, Gurtner GC, Prantl L. Matrix Metalloproteinase-9 as a Potential Biomarker in 631 Human Implant-Induced Fibrotic Capsules: Analysis and Biomarker Study. Plast Reconstr Surg 2023; 152:637e-645e. [PMID: 36735824 DOI: 10.1097/prs.0000000000010262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Capsular fibrosis (CF) often occurs around biomedical devices following implantation causing pain, discomfort, and device failure. Breast implantation remains among the most common medical procedures worldwide. Revealing specific genes that drive fibrotic deposition will help us to garner a better understanding of the pathophysiology of this disease and develop different strategies to combat it. METHODS The authors collected 631 capsules around breast implants and were able to connect clinical baseline characteristics with histopathologic findings. In addition, the authors were able to conduct the first large systematic analysis to identify differentially expressed genes in fibrotic human tissue samples, comparing the lowest form of fibrosis with the most aggravated one. RESULTS The authors identified 2559 differentially expressed genes on which they performed a knowledge-based network generation and pathway association study to identify putative novel biomarkers for CF. The authors were able to show changes of cellular influx during progression of CF and distinguish several genes as potential clinical biomarkers and drug targets. Among these, matrix metalloproteinase-9 was one of the most up-regulated ( P = 0.006) and is attractive because of its wide detectability. CONCLUSIONS Matrix metalloproteinase-9 seems to be a potential biomarker to detect capsular fibrosis. It is a measurable indicator that can easily be detected in blood, sputum, and urine. For the diagnosis of fibrosis, this biomarker might be exceedingly beneficial to developing novel screening methods and prophylaxes. CLINICAL RELEVANCE STATEMENT Discovering biomarkers at the earliest and mildest stages for the diagnosis of fibrosis is clinically important. These results bring new hope for biomarker-based diagnosis for capsular fibrosis. CLINICAL QUESTION/LEVEL OF EVIDENCE Diagnostic, V.
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Affiliation(s)
- Britta Kuehlmann
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University
- University Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef
| | - Clark Andrew Bonham
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University
| | - Geoffrey C Gurtner
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University
| | - Lukas Prantl
- University Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef
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16
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Kim HB, Han HH, Eom JS. Difference in the Occurrence of Capsular Contracture According to Tissue Characteristics in an Irradiated Rat Model. Plast Reconstr Surg 2023; 152:655e-661e. [PMID: 36877744 DOI: 10.1097/prs.0000000000010387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND This study was performed to evaluate the hypothesis that capsule formation varies according to the radiation dose in muscle tissues; chest wall tissues, including the ribs; and acellular dermal matrices (ADM) that are in contact with the silicone implant. METHODS In this study, 20 Sprague-Dawley rats underwent submuscular plane implant reconstruction using ADM. They were divided into four groups: an unradiated control group ( n = 5), nonfractionated radiation at a dose of 10 Gy ( n = 5), nonfractionated radiation at a dose of 20 Gy ( n = 5), and fractionated radiation at a dose of 35 Gy ( n = 5). Three months after surgery, hardness was measured, and histologic and immunochemical analyses of the capsule tissues of the ADM, muscle tissues, and chest wall tissues were analyzed. RESULTS As the radiation dose increased, the silicone implant became harder, but no significant difference in capsule thickness according to the radiation dose was observed. Based on the tissue in contact with the silicone implant, ADM had a thinner capsule thickness than the muscle tissues, as well as less inflammation and less neovascularization compared with the other tissues. CONCLUSIONS This study describes a new rat model of clinically relevant implant-based breast reconstruction using a submuscular plane and ADM with irradiation. The ADM in contact with the silicone implant, even after irradiation, was protected from radiation compared with the other tissues. CLINICAL RELEVANCE STATEMENT These research results could support the use of ADM in implant-based breast reconstruction for prevention of the capsular contracture, even after radiation.
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Affiliation(s)
- Hyung Bae Kim
- From the Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Hyun Ho Han
- From the Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Jin Sup Eom
- From the Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine
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Bérniz C, Carmona-Torre F, Gómez-Martínez C, Fernéndez-Ciriza L, Del Pozo JL, Hontanilla B. Breast Implant Capsule: A Murine Model Comparing Capsular Contracture Susceptibility Among Six Breast Implants Available in the Market. Aesthetic Plast Surg 2023; 47:2093-2105. [PMID: 37022396 PMCID: PMC10582141 DOI: 10.1007/s00266-023-03323-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/08/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND Breast implant capsule development and behavior are mainly determined by implant surface combined with other external factors such as intraoperative contamination, radiation or concomitant pharmacologic treatment. Thus, there are several diseases: capsular contracture, breast implant illness or Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), that have been correlated with the specific type of implant placed. This is the first study to compare all major implant and texture models available in the market on the development and behave of the capsules. Through a histopathological analysis, we compared the behavior of different implant surfaces and how different cellular and histological properties give rise to different susceptibilities to develop capsular contracture among these devices. METHODS A total of 48 Wistar female rats were used to implant 6 different types of breast implants. Mentor®, McGhan®, Polytech polyurethane®, Xtralane®, Motiva® and Natrelle Smooth® implants were employed; 20 rats received Motiva®, Xtralane® and Polytech polyurethane®, and 28 rats received Mentor®, McGhan® and Natrelle Smooth® implants. The capsules were removed five weeks after the implants placement. Further histological analysis compared capsule composition, collagen density and cellularity. RESULTS High texturization implants showed the highest levels of collagen and cellularity along the capsule. However, polyurethane implants capsules behaved differently regarding capsule composition, with the thickest capsules but fewer collagen and myofibroblasts than expected, despite being generally considered as a macrotexturized implant. Nanotextured implants and microtextured implants histological findings showed similar characteristics and less susceptibility to develop a capsular contracture compared with smooth implants. CONCLUSIONS This study shows the relevance of the breast implant surface on the definitive capsules' development, since this is one of the most differentiated factors that determine the incidence of capsular contracture and probably other diseases like BIA-ALCL. A correlation of these findings with clinical cases will help to unify implant classification criteria based on their shell and their estimated incidence of capsule-associated pathologies. Up to this point, the establishment of additional groups is recommended as nanotexturized implants seem to behave differently to pure smooth surfaces and polyurethane implants present diverse features from macro- or microtextured implants. 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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Affiliation(s)
- Carlos Bérniz
- Department of Plastic and Reconstructive Surgery, Clinica Universidad de Navarra, Av. Pio XII 36, 31008, Pamplona, Spain
| | - Francisco Carmona-Torre
- Infectious Diseases Service, Clínica Universidad de Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Cristina Gómez-Martínez
- Department of Plastic and Reconstructive Surgery, Clinica Universidad de Navarra, Av. Pio XII 36, 31008, Pamplona, Spain
| | | | - Jose Luis Del Pozo
- Infectious Diseases Service, Clínica Universidad de Navarra, Pamplona, Spain
- Microbiology Department, Clínica Universidad de Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Bernardo Hontanilla
- Department of Plastic and Reconstructive Surgery, Clinica Universidad de Navarra, Av. Pio XII 36, 31008, Pamplona, Spain.
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Nichter LS, Hardesty RA, Zimmerman TJ. Ideal Implant Structured Breast Implants: Core Study Results through 10 Years. Plast Reconstr Surg 2023; 152:424e-432e. [PMID: 36827477 PMCID: PMC10461722 DOI: 10.1097/prs.0000000000010312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 09/15/2022] [Indexed: 02/26/2023]
Abstract
BACKGROUND The Ideal Implant structured breast implant uses different technology than unstructured saline or silicone gel implants, making it a third type of implant. U.S. Food and Drug Administration (FDA) and Health Canada granted approval in November of 2014. This saline-filled implant has an internal structure consisting of a series of nested shells that support the upper pole when upright and control movement of the saline to provide a natural feel. Because women can look in the mirror to know their implants are intact, they have peace of mind. In contrast, most women are concerned about silicone gel implant ruptures, which are silent and require FDA-recommended magnetic resonance imaging or ultrasound scans for detection. METHODS This U.S. trial enrolled 502 women: 399 for primary and 103 for revision augmentation. Investigators were 45 American Board of Plastic Surgery-certified plastic surgeons at 35 sites. Of the 502 women enrolled, 426 (84.9%) completed 10-year follow-up visits, a higher percentage than all other FDA breast implant trials. RESULTS Through 10 years of follow-up, surgeon satisfaction was 94.8% for primary and 87.4% for revision augmentation; and patient satisfaction was 92.7% for primary and 82.3% for revision augmentation. Cumulative Kaplan-Meier risk rates for two major adverse events were lower than in the silicone gel implant trials: Baker class III and IV capsular contracture was 6.6% for primary and 11.5% for revision augmentation; and rupture/deflation was 3.7% for primary and 4.7% for revision augmentation. CONCLUSION Ten-year results from 426 women show the Ideal Implant has high patient and surgeon satisfaction, a low rate of capsular contracture, and a low rate of rupture/deflation. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Larry S. Nichter
- From the Pacific Center for Plastic Surgery, University of California, Irvine, and Mission Plasticos
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20
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Cagli B, Carotti S, Segreto F, Francesconi M, Marangi GF, Tenna S, Diomedi M, Perrone G, Morini S, Persichetti P. Histologic and Immunohistochemical Evaluation of Human Breast Capsules Formed around Five Different Expander Surfaces. Plast Reconstr Surg 2023; 152:388e-397e. [PMID: 36827480 DOI: 10.1097/prs.0000000000010317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND Polyurethane (PU) coating and implant texturization were designed to reduce the incidence of capsular contracture (CC), even if the link between surface type and CC remains unclear. To date, the etiopathogenetic aspects have not been fully clarified. The aim of this study was to evaluate capsules formed around five different breast expanders. METHODS Thirty patients were divided into randomized groups implanted with five different expanders: smooth, coated with PU foam (poly), with a low-microtextured, high-microtextured, and macrotextured surface (L-micro, H-micro, macro). Specimens of the capsules were removed at implant reconstruction and evaluated for morphology and immunohistochemistry expression of α-smooth muscle actin (α-SMA), collagen type I and III, CD68, CD34, and CD3. Remodeling Combined Index was also evaluated. RESULTS Expression of α-SMA was significantly increased in smooth capsules versus poly, low-microtextured, and high-microtextured groups ( P = 0.007; P = 0.010; P = 0.028), whereas the prevalence of collagen type I in smooth capsules and collagen type III in poly capsules identified a stable versus an unstable tissue. Remodeling Combined Index and α-SMA showed an inverted correlation. CD68 and CD34 cellular expression increased significantly in poly capsules with respect to smooth ( P < 0.001; P < 0.001) and macrotextured groups ( P < 0.001; P < 0.001). CD3 showed no significant difference among the groups. CONCLUSION In this human study, the authors observed that increased tissue remodeling and reduced myofibroblast activation, along with the inflammatory infiltration and neoangiogenesis, especially in the poly and low-microtextured groups, might promote the formation of an unstable and less fibrotic capsule, lowering the risk of CC. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
| | - Simone Carotti
- Department of Medicine and Surgery, Laboratory of Microscopic and Ultrastructural Anatomy
| | | | - Maria Francesconi
- Department of Medicine and Surgery, Laboratory of Microscopic and Ultrastructural Anatomy
| | | | | | | | - Giuseppe Perrone
- Research Unit of Pathology, Campus Bio-Medico University of Rome
| | - Sergio Morini
- Department of Medicine and Surgery, Laboratory of Microscopic and Ultrastructural Anatomy
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Diehm YF, Thomé J, Will P, Kotsougiani-Fischer D, Haug VF, Siegwart LC, Kneser U, Fischer S. Stem Cell-Enriched Hybrid Breast Reconstruction Reduces Risk for Capsular Contracture in a Hybrid Breast Model. Plast Reconstr Surg 2023; 152:572-580. [PMID: 36735813 DOI: 10.1097/prs.0000000000010260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hybrid breast reconstruction (HBR) combines silicone implants with fat grafting to improve implant coverage, treating local tissue deficiencies and leading to a more natural breast appearance. Recent data also indicated less capsular contracture after HBR. The authors developed a novel technique and animal model of cell-assisted (CA) HBR to illuminate its effects on capsular contracture. METHODS Animals received silicone implants in a dorsal submuscular pocket. Although animals of the HBR group received fat grafting around the implant without stem cell enrichment, rats of the CA-HBR1 and the CA-HBR2 groups received stem cell-enriched fat grafting with 2 × 10 6 and 4 × 10 6 adipose-derived stem cells immediately after implant insertion. On day 60, animals underwent sonography and elastography imaging and were euthanized, and outcome analysis was performed by means of histology, immunohistochemistry, chemical collagen quantification, and gene expression analysis. RESULTS With this novel technique, long-term survival of adipose-derived stem cells within the implant pocket was demonstrated after 60 days after implant insertion. CA-HBR led to significantly reduced thickness and collagen density of capsular contractures. In addition, CA-HBR resulted in reduced fibrotic responses with less occurrence of collagen type I and transforming growth factor-β in capsule tissue. Moreover, the addition of stem cells suppressed fibrotic and inflammatory responses on a genetic level with significant underexpression of collagen type I and transforming growth factor-β1. CONCLUSIONS With this new technique and animal model, the authors observed a preventive effect on capsular contracture substantiating the basis of clinical outcomes of HBR. The authors propose that the addition of stem cells to HBR might booster its beneficial results. CLINICAL RELEVANCE STATEMENT Stem cell-enriched fat grafting around silicone implants may reduce the risk for capsular contracture after silicone breast implantation. While fat grafting alone already shows beneficial effects, the addition of stem cells to the fat graft can potentiate this effect.
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Affiliation(s)
- Yannick F Diehm
- From the Department of Hand, Plastic, and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen; University of Heidelberg
| | - Julia Thomé
- From the Department of Hand, Plastic, and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen; University of Heidelberg
| | - Patrick Will
- From the Department of Hand, Plastic, and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen; University of Heidelberg
| | - Dimitra Kotsougiani-Fischer
- From the Department of Hand, Plastic, and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen; University of Heidelberg
- Private Practice for Plastic and Aesthetic Surgery, Aesthetikon Mannheim and Heidelberg
| | - Valentin F Haug
- From the Department of Hand, Plastic, and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen; University of Heidelberg
| | - Laura C Siegwart
- From the Department of Hand, Plastic, and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen; University of Heidelberg
| | - Ulrich Kneser
- From the Department of Hand, Plastic, and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen; University of Heidelberg
| | - Sebastian Fischer
- From the Department of Hand, Plastic, and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen; University of Heidelberg
- Private Practice for Plastic and Aesthetic Surgery, Aesthetikon Mannheim and Heidelberg
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Swanson E. Incision and Capsular Contracture Risk: Is There a Relationship in Breast Augmentation and Augmentation/Mastopexy? Ann Plast Surg 2023; 90:389-391. [PMID: 37093773 PMCID: PMC10090333 DOI: 10.1097/sap.0000000000003437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/11/2022] [Indexed: 02/24/2023]
Abstract
BACKGROUND Breast implants can be introduced through a variety of incisions, most commonly an inframammary incision, but also a periareolar incision or an axillary incision. Usually, the implant is inserted through the same incision used in performing an augmentation/mastopexy. Some authors use a separate inframammary incision. Capsular contracture is the most common complication of breast augmentation. One theory holds that it is caused by an infected biofilm, prompting surgeons to minimize implant handling, known as the "no touch" technique. This review was undertaken to investigate the relationship, if any, between the access incision and the risk of capsular contracture. METHODS An electronic literature search was conducted to identify publications comparing capsular contracture rates by the access incision. RESULTS Ten studies were evaluated. Most were retrospective series. Three were prospective core studies. Some studies reported an increased risk of capsular contracture for a periareolar incision; a similar number did not. One study supported a separate inframammary incision at the time of vertical augmentation/mastopexy. DISCUSSION Bacterial studies in the last decade show that the resident bacteria on the skin surface and within breast tissue are similar. Sophisticated microbiological evaluation of breast capsules reveals that the microbiome relates to the patient, as opposed to a specific bacterial profile for capsular contracture. A review of the statistics used in determining an advantage for a separate incision at the time of vertical augmentation/mastopexy reveals that there is no statistically significant risk reduction when using an additional inframammary incision, which adds an unnecessary scar. CONCLUSIONS The access incision at the time of breast augmentation or augmentation/mastopexy is unlikely to affect the capsular contracture risk. There is no need to make a separate incision to insert the implant at the time of augmentation/mastopexy, or to isolate the implant from contact with breast parenchyma. Little evidence supports the "no touch" technique. The etiology of capsular contracture remains unknown.
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Affiliation(s)
- Eric Swanson
- From the Plastic Surgery Private Practice, Leawood, KS
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Venkataram A, Lahar N, Adams WP. Enhancing Patient Outcomes in Aesthetic Breast Implant Procedures Using Proven Antimicrobial Breast Pocket Irrigations: A 20-Year Follow-up. Aesthet Surg J 2023; 43:66-73. [PMID: 36039664 DOI: 10.1093/asj/sjac238] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/31/2022] [Accepted: 08/01/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Capsular contracture (CC) remains the most common complication of implant-based aesthetic and reconstructive breast surgery. With subclinical infection proven to be the primary etiology, antimicrobial breast pocket irrigation has been recommended as the key step to reduce CC but has not been universally adopted. OBJECTIVES The purpose of this study was to review the rates of CC observed when applying proven antimicrobial breast pocket irrigations. METHODS Data from patients undergoing cosmetic breast augmentation were recorded prospectively from 1997 to 2017. The irrigation was performed with either a Betadine-containing (50% Betadine or "Betadine triple") or a non-Betadine triple antibiotic regimen. The database was assessed to determine the type of implant used, the incidence of CC, and possible contributing factors. The degree of CC was recorded according to the Baker classification. RESULTS A 20-year prospective data collection yielded 2088 patients with 4176 implants; of these patients, 826 had textured implants and 1262 had smooth implants. The incidence of Grade III/IV CC was found to be 0.57% in all patients undergoing primary breast augmentation (1.21% in textured implants and 0.16% in smooth implants). CONCLUSIONS This study constitutes the largest and longest review of CC in a controlled, single-surgeon setting. The incidence of CC is low and reinforces the efficacy/utility of antimicrobial breast pocket irrigation. Both the Betadine and non-Betadine antibiotic regimens were found to be effective, with the Betadine regimen being preferred. Universal adoption of Betadine-containing antimicrobial breast pocket irrigation is recommended to reduce CC and other device-associated infections. LEVEL OF EVIDENCE: 4
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Bassetto F, Pandis L, Azzena GP, De Antoni E, Crema A, Scortecci L, Brambullo T, Pavan C, Marini M, Facchin F, Vindigni V. Complete Implant Wrapping with Porcine-Derived Acellular Dermal Matrix for the Treatment of Capsular Contracture in Breast Reconstruction: A Case-Control Study. Aesthetic Plast Surg 2022; 46:1575-1584. [PMID: 35352159 PMCID: PMC9512749 DOI: 10.1007/s00266-022-02826-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/31/2022] [Indexed: 02/06/2023]
Abstract
Background Capsular contracture (CC) represents one of the most common complications in breast reconstruction surgery, impairing final result and patients’ well-being. The role of acellular dermal matrixes (ADM) has been widely described for the treatment and prevention of contracture. The aim of the study was to evaluate the efficacy and safety of complete implant coverage with porcine-derived ADM in preventing CC limiting complications. In addition, patients’ reported outcomes were evaluated in order to define the role of ADM in improving sexual, physical and psychosocial well-being and satisfaction. Methods 42 patients who underwent surgical treatment of 46 contracted reconstructed breasts from May 2018th to May 2019th were collected in the two groups (ADM group vs. Control group). Results The ADM group showed lower rate of CC recurrence and a higher rate of implant losses and minor complications. A significant difference was observed in red breast syndrome (27.3% in the ADM group vs. absent in control the group) and skin ulceration rates (18.2% in the ADM group vs. 4.18% in the control group). As for patients’ perceived outcomes, the ADM group showed a statistically significant higher postoperative Satisfaction of Breast Scale score compared to the control group. In addition, a significant difference was observed in the improvement of Physical Well-Being of the Chest Scale and the Satisfaction of Breast Scale after surgery, in favor to the ADM group. Conclusion Complete implant coverage with ADM may reduce the risk of CC recurrence in breast reconstruction. An accurate patient selection allows minimizing complications improving patient well-being and satisfaction. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. 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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Affiliation(s)
- Franco Bassetto
- Plastic and Reconstructive Surgery Unit, Neuroscience Department, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Laura Pandis
- Plastic and Reconstructive Surgery Unit, Neuroscience Department, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Gian Paolo Azzena
- Plastic and Reconstructive Surgery Unit, Neuroscience Department, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Eleonora De Antoni
- Plastic and Reconstructive Surgery Unit, Neuroscience Department, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Alberto Crema
- Plastic and Reconstructive Surgery Unit, Neuroscience Department, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Leonardo Scortecci
- Plastic and Reconstructive Surgery Unit, Neuroscience Department, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Tito Brambullo
- Plastic and Reconstructive Surgery Unit, Neuroscience Department, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Chiara Pavan
- Psychiatric Clinic, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Massimo Marini
- Psychiatric Clinic, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Federico Facchin
- Plastic and Reconstructive Surgery Unit, Neuroscience Department, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
- Plastic Surgery Unit, San Bortolo Hospital, Vicenza, Viale Rodolfi 37, 36100 Vicenza, Italy
| | - Vincenzo Vindigni
- Plastic and Reconstructive Surgery Unit, Neuroscience Department, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
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Huang SQ, Chen Y, Zhu Q, Zhang YM, Lei ZY, Zhou X, Fan DL. In Vivo and In Vitro Fibroblasts' Behavior and Capsular Formation in Correlation with Smooth and Textured Silicone Surfaces. Aesthetic Plast Surg 2022; 46:1164-1177. [PMID: 35237878 DOI: 10.1007/s00266-022-02769-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/04/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND As the most principal complication following breast augmentation with silicone breast implants, capsular contracture is greatly influenced by surface texture. However, there have long been widespread debates on the function of smooth or textured surface implants in reducing capsular contracture. MATERIALS AND METHODS Three commercially available silicone breast implants with smooth and textured surfaces were subjected to surface characterization, and in vitro and in vivo assessments were then implemented to investigate the effect of these different surfaces on the biological behaviors of fibroblasts and capsular formation in rat models. RESULTS Surface characterization demonstrated that all three samples were hydrophobic with distinct roughness values. Comparing the interactions of fibroblasts or tissues with different surfaces, we observed that as surface roughness increased, the adhesion and cell spreading of fibroblasts, the level of echogenicity, the density of collagen and α-SMA-positive immunoreactivity decreased, while the proliferation of fibroblasts and capsule thickness increased. CONCLUSIONS Our findings elucidated that the effect of silicone implant surface texture on fibroblasts' behaviors and capsular formation was associated with variations in surface roughness, and the number of myofibroblasts may have a more significant influence on the process of contracture than capsule thickness in the early stage of capsular formation. These results highlight that targeting myofibroblasts may be wielded in the prevention and treatment strategies of capsular contracture clinically. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. 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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Affiliation(s)
- Shu-Qing Huang
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, Army Medical University, Xinqiao Road, Sha Ping Ba District, Chongqing, 400037, People's Republic of China
| | - Yao Chen
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, Army Medical University, Xinqiao Road, Sha Ping Ba District, Chongqing, 400037, People's Republic of China
| | - Qiong Zhu
- Department of Ultrasound, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yi-Ming Zhang
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, Army Medical University, Xinqiao Road, Sha Ping Ba District, Chongqing, 400037, People's Republic of China
| | - Ze-Yuan Lei
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, Army Medical University, Xinqiao Road, Sha Ping Ba District, Chongqing, 400037, People's Republic of China
| | - Xin Zhou
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, Army Medical University, Xinqiao Road, Sha Ping Ba District, Chongqing, 400037, People's Republic of China.
| | - Dong-Li Fan
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, Army Medical University, Xinqiao Road, Sha Ping Ba District, Chongqing, 400037, People's Republic of China.
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Zogheib S, Hanna C, Daou B, Mjaess G, Nasr M. Breast Implant-associated Double Capsules: What Do We Know So Far? A Systematic Review of the Literature. Aesthetic Plast Surg 2022; 46:35-42. [PMID: 34231019 DOI: 10.1007/s00266-021-02443-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/19/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION A double capsule is a recently described rare occurrence following breast implant placement in which an inner capsule envelope totally or partially adheres to the implant surface while a distinct outer capsule adheres to surrounding tissues, with an intercapsular space developing between the two. The objective of this study is to review all available literature related to formation of double capsules and propose a treatment algorithm. METHODS AND MATERIALS A systematic review of the literature was conducted using Embase, Medline, and Cochrane databases. Articles reporting management of breast implant-associated double capsules were included in this review. RESULTS A total of 9 studies (68 implants) were included in the review. 94.1% of double capsules occurred with textured Biocell shaped and round implants independently from implant pocket (p value=0.64). In all cases, double capsules were diagnosed fortuitously intra-operatively for another surgical indication. Capsular contracture was present in 50% of double capsules patients and was the most common indication for secondary breast surgery, 81.5% of which being clinically evident (p value<0.001). Treatment consisted in 84.4% in an inner capsulectomy with smooth implants exchange, and management of the outer capsule as per the capsular contracture algorithm. CONCLUSION Double capsule formation is caused by delamination of a tight adhering capsule to a textured implant surface into two layers and continuous micro-shearing forces, and the probable contribution of bacterial biofilm. The only treatment reported so far includes inner with or without outer capsulectomy with smooth implant exchange. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. 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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Affiliation(s)
- Serge Zogheib
- Department of Plastic, Reconstructive and Cranio-Maxillo-Facial Surgery, Faculty of Medicine, Hotel Dieu de France University Hospital, Saint Joseph University, Damascus street, Achrafieh, P.O. Box:17-5208, Beirut, Lebanon.
| | - Cyril Hanna
- Department of Plastic, Reconstructive and Cranio-Maxillo-Facial Surgery, Faculty of Medicine, Hotel Dieu de France University Hospital, Saint Joseph University, Damascus street, Achrafieh, P.O. Box:17-5208, Beirut, Lebanon
| | - Bechara Daou
- Department of Plastic, Reconstructive and Cranio-Maxillo-Facial Surgery, Faculty of Medicine, Hotel Dieu de France University Hospital, Saint Joseph University, Damascus street, Achrafieh, P.O. Box:17-5208, Beirut, Lebanon
| | - Georges Mjaess
- Department of Plastic, Reconstructive and Cranio-Maxillo-Facial Surgery, Faculty of Medicine, Hotel Dieu de France University Hospital, Saint Joseph University, Damascus street, Achrafieh, P.O. Box:17-5208, Beirut, Lebanon
| | - Marwan Nasr
- Department of Plastic, Reconstructive and Cranio-Maxillo-Facial Surgery, Faculty of Medicine, Hotel Dieu de France University Hospital, Saint Joseph University, Damascus street, Achrafieh, P.O. Box:17-5208, Beirut, Lebanon
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27
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Affiliation(s)
- Eric Swanson
- Swanson Center, 11413 Ash St, Leawood, KS, 66211, USA.
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28
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Larsen A, Rasmussen LE, Rasmussen LF, Weltz TK, Hemmingsen MN, Poulsen SS, Jacobsen JCB, Vester-Glowinski P, Herly M. Histological Analyses of Capsular Contracture and Associated Risk Factors: A Systematic Review. Aesthetic Plast Surg 2021; 45:2714-2728. [PMID: 34312696 DOI: 10.1007/s00266-021-02473-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Capsular contracture is a severe complication to breast surgery with implants. Previous studies suggest multiple risk factors are associated with capsular contracture, but the etiology is still unknown. We performed a literature review to investigate existing studies on histological analyses of breast implant capsules and how clinical risk factors impact the capsule morphology. METHODS The literature search was conducted in PubMed. Studies that performed histological analyses of breast implant capsules were included. Animal studies or studies with a study population of less than five patients were excluded. RESULTS Fifty-two studies were included. The histological analyses showed that the breast implant capsules were organized in multiple layers with an inner layer of synovial-like metaplasia which was reported to diminish in capsules with capsular contracture. The remaining layers of the capsule mostly consisted of collagen. The alignment of the collagen fibers differed between contracted and non-contracted capsules, and capsules with higher Baker grade were generally thickest and contained more tissue inflammation. Studies investigating capsules affected by radiotherapy found a more pronounced inflammatory response and the capsules were generally thicker and fibrotic compared with nonirradiated capsules. CONCLUSIONS The included studies offer valuable insights into the histological changes caused by capsular contracture and their relation to clinical risk factors. Further studies with larger sample sizes and more strict inclusion criteria are needed to further investigate implant capsules and the role of the synovial-like metaplasia for the development of capsular contracture. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com/00266 .
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Affiliation(s)
- Andreas Larsen
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Louise E Rasmussen
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Leonia F Rasmussen
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Tim K Weltz
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Mathilde N Hemmingsen
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Steen S Poulsen
- Department of Biomedical Sciences, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens C B Jacobsen
- Department of Biomedical Sciences, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Vester-Glowinski
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Mikkel Herly
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
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Swanson E. Is Acellular Dermal Matrix Really an Essential Part of the Management of Capsular Contracture of the Breast? Aesthet Surg J 2021; 41:NP1255-NP1258. [PMID: 33623994 DOI: 10.1093/asj/sjab103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Montemurro P, Pellegatta T, Pafitanis G. The effect of implant surface on the recurrence rates of capsular contracture following revision breast surgery: Early results from a single surgeon retrospective comparative study. J Plast Reconstr Aesthet Surg 2021; 74:3307-3315. [PMID: 34210625 DOI: 10.1016/j.bjps.2021.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 03/20/2021] [Accepted: 05/24/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This retrospective comparative study aimed to evaluate the effect of implant surface in two cohorts of consecutive patients who underwent revision surgery following capsular contracture (Baker III-IV) after primary breast augmentation with textured implants. METHODS All patients underwent the same surgical procedure (capsulectomy - pocket plane change - implant exchange) and the only difference was that two different types of implants were used during the implant exchange: textured(Group A - biocell) or nanotextured(Group B - silksurface). A comparative analysis was performed using the following parameters: patients' demographics, age, the time between the primary breast augmentation and the revision surgery, the surgical and follow-up outcomes; and the incidence, timing, and capsular contracture recurrence. RESULTS Eighty consecutive females were included, Group A(textured): age of 35(19-65) years and time between primary and secondary surgery of 59(6-209) months; and Group B(nanotextured): age of 39(26-58) years and time between primary and secondary surgery of 65(7-218) months. For both groups, at a mean follow-up of 25(21-36) months for Group A(textured), and at a mean follow-up of 24(21-34) months for Group B(nanotextured); capsular contracture reoccurred in 3 cases (7.5%), at 7, 10, and 14 months in Group A and in 3 cases (7,5%), at 9, 10, and 16 months in Group B, post revision surgery. Students' t-test demonstrated no statistically significant differences between the recurrences of the two implant surfaces (p-value>0.05). CONCLUSION In capsular contracture revision surgery, the type of implant surface (textured or nanotextured) does not appear to influence recurrence rates. Further studies are required to identify the clinical impact on the implant surface in long-term outcomes of capsular contracture breast surgery.
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Affiliation(s)
- Paolo Montemurro
- Akademikliniken,Storängsvägen 10, 11452 Stockholm, Stockholm, Sweden.
| | | | - Georgios Pafitanis
- Akademikliniken,Storängsvägen 10, 11452 Stockholm, Stockholm, Sweden; Group for Academic Plastic Surgery, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Diehm YF, Jost Y, Kotsougiani-Fischer D, Haug V, Splinter M, Häring P, Berger MR, Debus J, Kneser U, Fischer S. The Treatment of Capsular Contracture Around Breast Implants Induced by Fractionated Irradiation: The Collagenase of the Bacterium Clostridium Histolyticum as a Novel Therapeutic Approach. Aesthetic Plast Surg 2021; 45:1273-1281. [PMID: 32968820 DOI: 10.1007/s00266-020-01970-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/07/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Irradiation therapy limits the utilization of silicone implants for breast reconstruction due to a significant risk for capsular contracture. The injection of the collagenase of the bacterium Clostridium histolyticum (CCH) might trivialize this risk by providing a minimal-invasive treatment option by capsular contracture degradation. However, efficacy in degrading breast implant capsules induced by fractionated irradiation remains unclear. METHODS Twenty-four rats in three groups received miniature silicone implants in a submuscular pocket. After 3D dose calculation and treatment field definition, rats of two groups underwent fractionated radiotherapy (6 × 8 Gy) using a linear accelerator. A third group served as control. On day 120, one irradiated group received injections of 0.3 mg/ml collagenase. Administration of plain solvent solution served as control in the two other groups. Outcome parameters included CT-imaging, histology, vessel wall analysis, immunohistochemistry, chemical collagen quantification and gene expression analysis. RESULTS Fractioned irradiation leads to a significant increase in collagen deposition around silicone implants with higher capsule thickness and collagen density when comparing all groups. Additionally, significant alterations of collagen fiber deposition were evident. Vessel wall thickness was significantly increased after radiotherapy. The injection of collagenase led to a significant reduction of capsule thickness, collagen density and content. However, the collagenase application induced a significant overexpression of TGFβ1. No side effects were monitored. CONCLUSIONS The CCH proved to be a safe and effective approach to degrade capsule tissue induced by fractionated irradiation in an animal model. This may pave its way for clinical application in implant-based breast reconstruction patients. LEVEL OF EVIDENCE 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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Affiliation(s)
- Yannick F Diehm
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, 02115, USA
| | - Yanic Jost
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
| | - Dimitra Kotsougiani-Fischer
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
| | - Valentin Haug
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, 02115, USA
| | - Mona Splinter
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 223, 69120, Heidelberg, Germany
| | - Peter Häring
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 223, 69120, Heidelberg, Germany
| | - Martin R Berger
- Toxicology and Chemotherapy Unit, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Jürgen Debus
- Department of Clinical Radiology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Ulrich Kneser
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
| | - Sebastian Fischer
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany.
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Bachour Y. Capsular Contracture in Breast Implant Surgery: Where Are We Now and Where Are We Going? Aesthetic Plast Surg 2021; 45:1328-1337. [PMID: 33559094 DOI: 10.1007/s00266-021-02141-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/13/2021] [Indexed: 11/25/2022]
Abstract
Capsular contracture is the leading complication after surgery with breast implants. A lot of progress has been made investigating this complication over the years, and knowledge has been gained on this complication. Currently, the exact cause for capsular contracture is still unclear. It has been hypothesized that immunobiological factors (i.e., immunological and bacterial factors) and several risk factors play a central role in its development. In this paper, we give an overview of the known immunological factors that have been investigated in contracted and non-contracted capsules, as well as the role of bacterial formation around breast implants. We also report on risk factors that might increase the risk of capsular development. Lastly, it provides the latest research on this matter and discusses future perspectives as follow-up research is needed to unravel the pathogenic process leading to capsular contracture. This knowledge is of interest to establish medical therapies in order to prevent such side effects. Overall, capsular contracture seems to be a multifactorial condition consisting of several risk factors. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. 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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Affiliation(s)
- Yara Bachour
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC- location VUmc, De Boelelaan 1117, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
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Abstract
INTRODUCTION Radiation therapy is a known risk factor for capsular contracture formation after implant-based breast reconstruction. Although autologous fat grafting (AFG) has been shown to reverse radiation-induced tissue fibrosis, its use as a prophylactic agent against capsular contraction has not been assessed in the clinical setting. In the setting of 2-stage implant-based reconstruction and postmastectomy radiation therapy, we explored the effect AFG has on the prevalence of capsular contracture. MATERIALS AND METHODS A retrospective chart review of patients who underwent immediate tissue expander (TE) placement followed by postmastectomy radiation therapy and secondary implant-based reconstruction at our institution between January 2012 and December 2019 was performed. Patients were divided into 2 cohorts based on whether or not AFG was performed at the time of secondary reconstruction. The primary outcome of interest was the occurrence of capsular contracture after TE exchange. RESULTS Overall 57 patients (57 breasts) were included, 33 of whom received AFG at the time of TE exchange. All but 1 patient underwent submuscular implant placement, and the mean follow-up was 1.96 years. There was no significant difference in the prevalence of medical comorbidities between the study groups.Capsular contracture occurred in 24 patients (42.1%). Seventeen of these patients had undergone AFG at the time of TE exchange (17/33 patients, 51.5%), and 7 of these patients had not (7/24 patients, 29.2%). Most of the capsular contracture cases were Baker grades III or IV (14 patients, 58.3%), and 50% of patients with capsular contracture of any grade ultimately required operative intervention. Multivariate logistic regression analysis demonstrated that AFG did not significantly influence the occurrence or severity of capsular contracture, or did not impact the need for operative intervention in this patient population. CONCLUSIONS Implant-based reconstruction of the irradiated breast is associated with high postoperative capsular contracture rates. Although AFG has shown promise in reversing radiation-induced dermal fibrosis, no protective effect on the development of capsular contracture after stage 2 reconstruction was observed in this study population. Further investigation in the form of randomized, prospective studies is needed to better assess the utility of AFG in preventing capsular contracture in irradiated patients.
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Affiliation(s)
- Shanique Martin
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA
| | - Lawrence Cai
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Stanford, CA
| | - Amit Beniwal
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Stanford, CA
| | - Ruth Tevlin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Stanford, CA
| | - Gordon Lee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Stanford, CA
| | - Rahim S Nazerali
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Stanford, CA
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Bengtson BP. Commentary on: Capsulectomy, Implant Exchange, and Placement of Acellular Dermal Matrix is Effective in Treating Capsular Contracture in Breast Augmentation Patients. Aesthet Surg J 2021; 41:313-317. [PMID: 33346784 DOI: 10.1093/asj/sjaa267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Loreti A, Siri G, De Carli M, Fanelli B, Arelli F, Spallone D, Abate O, La Pinta M, Manna E, Meli EZ, Costarelli L, Andrulli D, Broglia L, Scavina P, Fortunato L. Immediate Breast Reconstruction after mastectomy with polyurethane implants versus textured implants: A retrospective study with focus on capsular contracture. Breast 2020; 54:127-132. [PMID: 33010626 PMCID: PMC7529839 DOI: 10.1016/j.breast.2020.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/06/2020] [Accepted: 09/22/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Capsular contracture (CC) is the most common complication following Immediate Breast Reconstruction (IBR) with breast implants. Different implant surfaces were developed aiming to reduce the incidence of CC. We evaluated the incidence and degree of CC after Direct-to-Implant (DTI) IBR with insertion of textured (TE) or polyurethane (PU) covered implants. METHODS A retrospective review of consecutive patients treated at our Institution with mastectomy and one-stage IBR and implant reconstruction between 2013 and 2018, with or without post mastectomy radiation therapy (PMRT), was conducted. Immediate breast reconstruction was performed by implanting 186 PU covered implants and 172 TE implants. RESULTS Three-hundred-twelve women underwent 358 DTI IBR with PU or TE implants, were analyzed with a median follow-up time of 2.3 years (range 1.0-3.0). The overall rate of CC Baker grade III and IV was 11.8% (95%CI: 8.4-16.3), while, after PU and TE implant placement it was 8.1% (95% CI: 4.1-15.7) and 15.8% (95% CI: 4.1-15.7) [p = 0.009]), respectively. Irradiated breasts developed CC more frequently rather than non-irradiated breasts (HR = 12.5, p < 0.001), and the relative risk was higher in the TE group compared with the PU group (HR = 0.3, p = 0.003). CONCLUSIONS After mastectomy and one-stage IBR, the use of PU covered implants is associated with a lower incidence of CC compared to TE implants. This advantage is amplified several folds for patients who necessitate PMRT. Footnote: Capsular contracture (CC); Immediate Breast Reconstruction (IBR); Directto- Implant (DTI); Textured (TE); Polyurethane (PU); Post mastectomy radiation therapy (PMRT); Nipple Sparing mastectomy (NSM).
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Affiliation(s)
- Andrea Loreti
- Plastic and Reconstructive Surgery Division, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy.
| | - Giacomo Siri
- Department of Mathematics, University of Genoa, Genoa, Italy
| | - Matteo De Carli
- Plastic and Reconstructive Surgery Division, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
| | - Benedetta Fanelli
- Plastic and Reconstructive Surgery Division, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
| | - Floriana Arelli
- Plastic and Reconstructive Surgery Division, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
| | - Diana Spallone
- Plastic and Reconstructive Surgery Division, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
| | - Ornella Abate
- Plastic and Reconstructive Surgery Division, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
| | - Massimo La Pinta
- Breast Unit, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
| | - Elena Manna
- Breast Unit, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
| | - Emanuele Zarba Meli
- Breast Unit, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
| | - Leopoldo Costarelli
- Pathology Division, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
| | - Damiana Andrulli
- Radiation Oncology Division, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
| | - Laura Broglia
- Breast Radiology Division, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
| | - Paola Scavina
- Oncology Division, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
| | - Lucio Fortunato
- Breast Unit, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
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Swanson E. A Rebuttal of Antibiotic Irrigation as a Method to Reduce Risk of Capsular Contracture and Breast Implant-Associated Anaplastic Large-Cell Lymphoma. Ann Plast Surg 2020; 85:461-463. [PMID: 31855865 PMCID: PMC7547873 DOI: 10.1097/sap.0000000000002230] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/13/2019] [Indexed: 11/26/2022]
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Seok J, Woo SH, Kwon TR, Kim JH, Jeong GJ, Li K, Kim WS, Kim BJ. Role of mechanical and thermal damage in pericapsular inflammatory response to injectable silicone in a rabbit model. PLoS One 2019; 14:e0216926. [PMID: 31086403 PMCID: PMC6516732 DOI: 10.1371/journal.pone.0216926] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 05/01/2019] [Indexed: 11/19/2022] Open
Abstract
Silicone is used widely for tissue augmentation in humans. However, late complications, such as delayed inflammation and capsular contracture, remain uncharacterized, despite their importance. In the present study, we aimed to determine whether mechanical and thermal damage induce capsular inflammation around a foreign body, and elucidate the biological mechanism underlying this phenomenon. We injected silicone into the subcutaneous layer of the skin of New Zealand white rabbits. The rabbits were divided into two groups: the control group received no treatment; in the experimental group, external force was applied near the injection silicone using high-intensity focused ultrasound (HIFU). Tissues near the injected silicone were harvested from both groups on Days 4, 7, and 30 after HIFU treatment for comparative analysis. Visual and histological examinations showed clearly increased inflammation in the experimental group compared with that in the control group. Furthermore, capsular tissue from the experimental group displayed markedly increased collagen production. Immunofluorescence revealed marked activation of macrophages in the early stages of inflammation (Days 4 and 7 after HIFU treatment), which decreased on Day 30. Assessment of cytokine activation showed significantly increased expression of heat shock protein (HSP)27, HSP60, HSP70, toll-like receptor (TLR)2, TLR4, and interleukin-8 in the experimental group. The expression of transforming growth factor-β1 did not increase significantly in the experimental group. In conclusion, damage to tissues around the injected silicone induced capsular inflammation. Macrophages and damage-associated molecular pattern molecules were involved in the early stages of inflammation. HSP release activated TLRs, which subsequently activated innate immunity and induced the inflammatory response.
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Affiliation(s)
- Joon Seok
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Republic of Korea
- Graduate School of Medical Science & Engineering, KAIST, Daejeon, Republic of Korea
| | - Soo Hyun Woo
- Department of Plastic and Reconstructive Surgery, Chung-Ang University Graduate School of Medicine, Seoul, Republic of Korea
| | - Tae Rin Kwon
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Jong Hwan Kim
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Guk Jin Jeong
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Kapsok Li
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Woo Seob Kim
- Department of Plastic and Reconstructive Surgery, Chung-Ang University Graduate School of Medicine, Seoul, Republic of Korea
| | - Beom Joon Kim
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Republic of Korea
- * E-mail:
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Silva EN, Ribas-Filho JM, Tabushi FI, Silva MAP, Siqueira EBD, de Noronha L, da Silva ABD, Lipinski LC, Guth I, Vosgerau LM. Smooth Muscle Alpha Actin Immunoexpression (α-Sma) and CD-117 Antibody (C-Kit) in Capsules Formed by Polyurethane Foam-Coated Silicone Implants and with Textured Surface: A Study on Rats. Aesthetic Plast Surg 2019; 43:233-242. [PMID: 30276460 DOI: 10.1007/s00266-018-1238-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/09/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND One of the undesirable complications that might occur after breast augmentation with silicone implants is capsular contracture. In its etiology, the relations between mast cells and myofibroblasts play an important role in collagen synthesis. Mast cells are able to activate fibroblasts into myofibroblasts, through paracrine secretions, inducing collagen production. The objectives of this study were to analyze the myofibroblast concentration through the α-SMA immunomarker and evaluate the intensity of mast cell expression against the C-Kit immunomarker. MATERIAL AND METHOD Sixty-four Wistar rats were used, divided into two groups (polyurethane foam and textured surface) with 32 animals in each. The animals received silicone implants on the back, below the panniculus carnosus, and after the determined period, they were killed and the capsules formed around the implants were studied. The capsules were analyzed employing the immunohistochemical technique, with the α-SMA and C-Kit immunomarkers in subgroups of 30, 50, 70 and 90 days. RESULTS The myofibroblast concentration was higher in the polyurethane group when compared to the textured group (30 days p = 0.105; 50 days p = 0.247; 70 days p = 0.014 and 90 days p = 0.536). The intensity of mast cell expression was more pronounced in the polyurethane group when compared to the textured group (30 days p = 0.798; 50 days p = 0.537; 70 days p = 0.094 and 90 days p = 0.536). CONCLUSIONS Polyurethane-coated implants induced higher concentrations of myofibroblasts and higher expression of mast cells, when compared to the textured surface implants. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each article. 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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Affiliation(s)
- Eduardo Nascimento Silva
- Evangelical Faculty of Medicine of Paraná (FEPAR), Evangelical University Hospital of Curitiba (HUEC) and Institute for Medical Research (IPEM), Curitiba, PR, Brazil.
- Plastic Surgery and Anatomy, State University of Ponta Grossa (UEPG), Avenida Doutor Francisco Búrzio, 991, 84010-200, Ponta Grossa, PR, Brazil.
| | - Jurandir Marcondes Ribas-Filho
- Evangelical Faculty of Medicine of Paraná (FEPAR), Evangelical University Hospital of Curitiba (HUEC) and Institute for Medical Research (IPEM), Curitiba, PR, Brazil
| | - Fernando Issamu Tabushi
- Evangelical Faculty of Medicine of Paraná (FEPAR), Evangelical University Hospital of Curitiba (HUEC) and Institute for Medical Research (IPEM), Curitiba, PR, Brazil
| | | | - Elisa Beatriz Dalledone Siqueira
- Evangelical Faculty of Medicine of Paraná (FEPAR), Evangelical University Hospital of Curitiba (HUEC) and Institute for Medical Research (IPEM), Curitiba, PR, Brazil
| | - Lucia de Noronha
- Anatomical Pathology, Pontifical Catholic University of Paraná (PUC-PR), Curitiba, PR, Brazil
| | - Alfredo Benjamim Duarte da Silva
- Plastic Surgery and Anatomy, State University of Ponta Grossa (UEPG), Avenida Doutor Francisco Búrzio, 991, 84010-200, Ponta Grossa, PR, Brazil
- Operative Technique, Federal University of Paraná (UFPR), Curitiba, PR, Brazil
| | | | - Isabelle Guth
- Evangelical Faculty of Medicine of Paraná (FEPAR), Evangelical University Hospital of Curitiba (HUEC) and Institute for Medical Research (IPEM), Curitiba, PR, Brazil
| | - Larissa Maria Vosgerau
- Evangelical Faculty of Medicine of Paraná (FEPAR), Evangelical University Hospital of Curitiba (HUEC) and Institute for Medical Research (IPEM), Curitiba, PR, Brazil
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Brown T, Harvie F, Stewart S. A Different Perspective on Breast Implant Surface Texturization and Anaplastic Large Cell Lymphoma (ALCL). Aesthet Surg J 2019; 39:56-63. [PMID: 29659699 DOI: 10.1093/asj/sjy091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Anaplastic large cell lymphoma (ALCL) is a rare form of lymphoma involving cells of the immune system. It is currently gaining interest because of an association between the development of ALCL and an increased risk in women who have had breast implant surgery. Although not confirmed, many theories exist as to the etiology of this association in women, and there is growing concern that ALCL is more prevalent in women with textured breast implants. In particular, the risk of developing ALCL appears to be related to increasing implant texturization or "surface roughness." This paper examines the current manner of defining and characterizing breast implant surface texture and challenges the appropriateness of applying this technology and linking it to ALCL. It is not a comprehensive review of the etiology of capsular contracture and ALCL, but it proposes an alternative perspective on surface texture measurements from that currently employed and its role in researching the etiology of ALCL. The authors hope that their article will provoke thought and reflection when considering the issues currently being highlighted with regard to texturing of breast implants.
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Affiliation(s)
- Tim Brown
- private practice in Berwick, Australia
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Colak O, Ozer K, Dikmen A, Ozakinci H, Ozkaya O. Evaluation of Safe Systemic Immunosuppression Created with Dexamethasone in Prevention of Capsular Contracture: A Glance to Distinct Perspectives with Toll-Like Receptors. Aesthetic Plast Surg 2018; 42:1133-1143. [PMID: 29564486 DOI: 10.1007/s00266-018-1119-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 03/07/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE The toll-like receptors (TLRs) stand at the interface of innate immune activation. We hypothesize to decrease the response of innate immunity activated by TLR4 by a safe, short-term, systemic immunosuppression. METHODS Two silicone block implants were placed into two dorsal subcutaneous pockets in 32 rats that were subdivided into four groups: The two study groups were the IV DEX group (single intravenous injection of dexamethasone 1 h before surgery) and the IV DEX + IP DEX group (in addition to a single intravenous injection of dexamethasone 1 h before surgery, intraperitoneal dexamethasone was administered for 10 days after surgery), and the two control groups were the untreated control group and the saline-treated control group. After 10 weeks, all animals were killed to determine capsular thickness, inflammatory cell density, presence of pseudoepitheliomatous hyperplasia, edema, necrosis, vascularization, TLR4 expression and myofibroblast proliferation. RESULTS No significant difference was observed in any parameter between the untreated and saline-treated control groups (p > 0.05). Capsular thickness, myofibroblast proliferation, TLR4 expression density were statistically different among study groups compared to control (p < 0.05). CONCLUSIONS This study demonstrates the relationship between toll-like receptors and fibrous capsule after implant surgery. Decreasing the innate immunity by a safe, short-term perioperative systemic immunosuppression resulted in decreased TLR4 expression and myofibroblast differentiation which could be a new research field in profibrotic pathophysiology underlying breast capsule formation. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each article. 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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Affiliation(s)
- Ozlem Colak
- Istanbul Okmeydani Training and Research Hospital, Plastic, Reconstructive and Aesthetic Surgery Clinic, 34384, Istanbul, Turkey
| | - Kadri Ozer
- Aydin State Hospital, Plastic, Reconstructive and Aesthetic Surgery Clinic, 09100, Aydın, Turkey.
| | - Adile Dikmen
- Sinop Ataturk State Hospital, Plastic, Reconstructive and Aesthetic Surgery Clinic, Sinop, Turkey
| | - Hilal Ozakinci
- Department of Pathology, Ankara 29 Mayis State Hospital, Ankara, Turkey
| | - Ozay Ozkaya
- Istanbul Okmeydani Training and Research Hospital, Plastic, Reconstructive and Aesthetic Surgery Clinic, 34384, Istanbul, Turkey
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Abstract
In the fourth quarter of 2017, the US FDA reviewed and approved a request by one of the breast implant manufacturers for a change in the Directions for Use (DFU) that removed warnings regarding the use of Betadine (povidone-iodine [PI] 10% solution, 1% available iodine [Purdue Frederick Company, Stamford, CT], also available in generic formulations [Aplicare, Inc., Meriden, CT]). Previously, in 2000, there were concerns by the FDA that PI would degrade the silicone elastomer shell. This change in the DFU represents an important advance that will benefit patients through the permitted use of PI to reduce the risk of bacterial contamination of implant surfaces. What was formerly an off-label practice can be openly practiced by plastic surgeons as an anti-infective and biofilm-mitigation strategy. PI has an ideal spectrum effect for gram-positive and gram-negative organisms. Gram-positive organisms have been linked to capsular contracture and gram-negative Ralstonia picketti to breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). R picketti is resistant to aminoglycoside antibiotics, but it is susceptible to at least a 50% solution of PI. We believe that the strategy of antisepsis and biofilm mitigation is an integral part of a contemporary approach for breast augmentation. This is beneficial regarding reduction of the risk of surgical infection, capsular contracture, and BIA-ALCL. Outcome data so far indicate that antibiotics/anti-infectives seem to reduce the incidence of these adverse events that lead to reoperation and increased costs. It behooves plastic surgeons to take all actionable steps that enhance the quality of breast implant outcomes and reduce the rate of reoperation.
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Montemurro P, Agko M, Quattrini Li A, Avvedimento S, Hedén P. Implementation of an Integrated Biodimensional Method of Breast Augmentation with Anatomic, Highly Cohesive Silicone Gel Implants: Short-Term Results With the First 620 Consecutive Cases. Aesthet Surg J 2017; 37:782-792. [PMID: 28333220 DOI: 10.1093/asj/sjx024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The previously described Akademikliniken (AK) method is a comprehensive approach to breast augmentation with form stable implants that has been shown to afford favorable outcomes when applied by experienced surgeons. OBJECTIVES To evaluate outcomes of a surgeon newly adopting this method at the beginning of his career. METHODS A retrospective review of patients undergoing dual plane subpectoral augmentation with Style 410 implants between April 2009 and December 2014 was undertaken. The review was performed one year after the last operation. The first author (P.M.) performed all operations. Complications and reoperation rates were analyzed and correlated with patient and implant characteristics using the chi-square or Fisher's exact test, as appropriate. RESULTS A total of 620 consecutive patients met the inclusion criteria with a mean follow up of 8 months (range, 1 week-60 months). Complications occurred in 14.8% of the patients: request for larger size (3.3%), rotation (3%), and Baker III/IV capsular contracture (2.2%) were the most common ones. Low implant projection was a statistically significant risk factor (P < 0.05) for the most common complication - request for a larger size. The overall reoperation rate was 8.7%. The most common indication for reoperation was request for larger size (2.2%) followed by rotation (2.2%) and capsular contracture (2%). CONCLUSIONS Breast augmentation with form stable anatomical implants requires a considerably different process. By implementing a systematic approach such as the AK method, novices in this terrain can expect to achieve reasonable outcomes. LEVEL OF EVIDENCE 4.
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Pompei S, Evangelidou D, Arelli F, Ferrante G. The Modern Polyurethane-Coated Implant in Breast Augmentation: Long-Term Clinical Experience. Aesthet Surg J 2016; 36:1124-1129. [PMID: 27677825 DOI: 10.1093/asj/sjw171] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND First-generation polyurethane foam-coated breast implants were associated with a low risk of capsular contracture (CC), but the risk of CC with modern polyurethane-coated silicone implants has not been established. OBJECTIVES The authors sought to determine the long-term rates of CC after primary breast augmentation with Microthane, a polyurethane-coated silicone gel implant. METHODS A total of 131 patients (255 breasts) were evaluated in a retrospective study. Data were compiled from postoperative follow-up sessions at 2 weeks; 1, 3, 6, and 12 months; and annually thereafter. Rates of various complications, including CC, were determined. RESULTS CC developed in 3 of the 255 implanted breasts (1.2%; Baker grade III or IV), and postoperative hematoma occurred in 2 implanted breasts (0.8%). Spontaneous CC that was not associated with other complications was observed in 1 implanted breast (0.4%). All instances of CC occurred before the 31st postoperative month. CONCLUSIONS For patients who undergo primary breast augmentation with modern polyurethane-coated implants, the long-term risk of CC is low. LEVEL OF EVIDENCE 3 Therapeutic.
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Affiliation(s)
- Stefano Pompei
- Dr Pompei is Unit Head and Dr Arelli is a Plastic Surgeon, San Camillo Plastic and Reconstructive Surgery Unit, Rome, Italy. Dr Evangelidou is a Plastic Surgeon, Emirates Hospital Group Plastic and Reconstructive Surgery Department, Dubai, United Arab Emirates. Dr Ferrante is a Researcher, National Center of Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Dora Evangelidou
- Dr Pompei is Unit Head and Dr Arelli is a Plastic Surgeon, San Camillo Plastic and Reconstructive Surgery Unit, Rome, Italy. Dr Evangelidou is a Plastic Surgeon, Emirates Hospital Group Plastic and Reconstructive Surgery Department, Dubai, United Arab Emirates. Dr Ferrante is a Researcher, National Center of Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Floriana Arelli
- Dr Pompei is Unit Head and Dr Arelli is a Plastic Surgeon, San Camillo Plastic and Reconstructive Surgery Unit, Rome, Italy. Dr Evangelidou is a Plastic Surgeon, Emirates Hospital Group Plastic and Reconstructive Surgery Department, Dubai, United Arab Emirates. Dr Ferrante is a Researcher, National Center of Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Gianluigi Ferrante
- Dr Pompei is Unit Head and Dr Arelli is a Plastic Surgeon, San Camillo Plastic and Reconstructive Surgery Unit, Rome, Italy. Dr Evangelidou is a Plastic Surgeon, Emirates Hospital Group Plastic and Reconstructive Surgery Department, Dubai, United Arab Emirates. Dr Ferrante is a Researcher, National Center of Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
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Fischer S, Hirche C, Diehm Y, Nuutila K, Kiefer J, Gazyakan E, Bueno EM, Kremer T, Kneser U, Pomahac B. Efficacy and Safety of the Collagenase of the Bacterium Clostridium Histolyticum for the Treatment of Capsular Contracture after Silicone Implants: Ex-Vivo Study on Human Tissue. PLoS One 2016; 11:e0156428. [PMID: 27232716 PMCID: PMC4883774 DOI: 10.1371/journal.pone.0156428] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 05/14/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The fibrotic capsule that surrounds silicone implants consists mainly of collagen. The FDA-approved collagenase of the bacterium clostridium histolyticum provides a reasonable treatment option. Safety and efficacy at the female breast site must be evaluated before clinical utilization. MATERIALS AND METHODS We incubated 20 samples of fibrotic capsule as well as 12 full thickness skin grafts harvested from the female breast site for 24 hours with different doses of collagenase. Outcome measures involved histological assessment of thickness and density of the capsule tissue as well as the skin grafts. Furthermore, we performed a collagen assay and immunohistochemistry staining for collagen subtypes. RESULTS Collagenase treatment was able to degrade human capsule contracture tissue ex-vivo. The remaining collagen subtype after degradation was type 4 only. 0.3 mg/ml of collagenase was most effective in reducing capsule thickness when compared with higher concentrations. Of note, effectiveness was inversely related to capsule density, such that there was less reduction in thickness with higher capsule densities and vice versa. Furthermore, the application of 0.3mg/ml collagenase did not lead to thinning or perforation of full thickness skin grafts. CONCLUSION Adjustment of collagenase dose will depend on thickness and density of the contracted capsule. A concentration of 0.3mg/ml seems to be safe and effective in an ex-vivo setting. The remaining collagen subtype 4 is suitable to serve as a neo-capsule/acellular tissue matrix. Collagenase treatment for capsular contracture may soon become a clinical reality.
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Affiliation(s)
- Sebastian Fischer
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
- * E-mail:
| | - Christoph Hirche
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Yannick Diehm
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Kristo Nuutila
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jurij Kiefer
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Emre Gazyakan
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Ericka M. Bueno
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Thomas Kremer
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Ulrich Kneser
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Bohdan Pomahac
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
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Flugstad NA, Pozner JN, Baxter RA, Creasman C, Egrari S, Martin S, Messa CA, Oliva A, Schlesinger SL, Kortesis BG. Does Implant Insertion with a Funnel Decrease Capsular Contracture? A Preliminary Report. Aesthet Surg J 2016; 36:550-6. [PMID: 26672104 DOI: 10.1093/asj/sjv237] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Capsular contracture remains a common and dreaded complication of breast augmentation. The etiology of capsular contracture is believed to be multi-factorial, and its causes may include biofilm formation due to implant/pocket contamination with skin flora. It has been shown that insertion funnel use reduces skin contact and potential contamination by 27-fold in a cadaver model. After incorporating the funnel into our surgical protocols, we anecdotally believed we were experiencing fewer capsular contractures in our augmentation practices. OBJECTIVES The purpose of this study was to test the hypothesis that capsular contracture related reoperation rates decreased after insertion funnel adoption using data from multiple practices. METHODS At seven participating centers, we retrospectively reviewed the surgical records from March 2006 to December 2012 for female patients who had undergone primary breast augmentation with silicone gel implants. Group 1 consisted of consecutive augmentations done without the insertion funnel, and Group 2 consisted of consecutive augmentations done with the insertion funnel. The primary outcome variable was development of grade III or IV capsular contracture that led to reoperation within 12 months. RESULTS A total of 1177 breast augmentations met inclusion criteria for Group 1 and 1620 breast augmentations for Group 2. The rate of reoperation due to capsular contracture was higher without use of the insertion funnel (1.49%), compared to Group 2 with funnel use (0.68%), a 54% reduction (P = 0.004). CONCLUSIONS The insertion funnel group experienced a statistically significant reduction in the incidence of reoperations performed due to capsular contracture within 12 months of primary breast augmentation.
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Affiliation(s)
- Nicholas A Flugstad
- Dr Flugstad is a fellow in private practice in Huntersville, NC. Dr Pozner is a plastic surgeon in private practice in Boca Raton, FL. Dr Baxter is a plastic surgeon in private practice in Mountlake Terrace, WA. Dr Creasman is a plastic surgeon in private practice in San Jose, CA. Dr Egrari is a plastic surgeon in private practice in Bellevue, WA. Dr Martin is a plastic surgeon in private practice in Las Cruces, NM. Dr Messa III is a plastic surgeon in private practice in Weston, FL. Dr Oliva is a plastic surgeon in private practice in Spokane, WA. Dr Schlesinger is a plastic surgeon in private practice in Honolulu, HI. Dr Kortesis is a plastic surgeon in private practice in Huntersville, NC
| | - Jason N Pozner
- Dr Flugstad is a fellow in private practice in Huntersville, NC. Dr Pozner is a plastic surgeon in private practice in Boca Raton, FL. Dr Baxter is a plastic surgeon in private practice in Mountlake Terrace, WA. Dr Creasman is a plastic surgeon in private practice in San Jose, CA. Dr Egrari is a plastic surgeon in private practice in Bellevue, WA. Dr Martin is a plastic surgeon in private practice in Las Cruces, NM. Dr Messa III is a plastic surgeon in private practice in Weston, FL. Dr Oliva is a plastic surgeon in private practice in Spokane, WA. Dr Schlesinger is a plastic surgeon in private practice in Honolulu, HI. Dr Kortesis is a plastic surgeon in private practice in Huntersville, NC
| | - Richard A Baxter
- Dr Flugstad is a fellow in private practice in Huntersville, NC. Dr Pozner is a plastic surgeon in private practice in Boca Raton, FL. Dr Baxter is a plastic surgeon in private practice in Mountlake Terrace, WA. Dr Creasman is a plastic surgeon in private practice in San Jose, CA. Dr Egrari is a plastic surgeon in private practice in Bellevue, WA. Dr Martin is a plastic surgeon in private practice in Las Cruces, NM. Dr Messa III is a plastic surgeon in private practice in Weston, FL. Dr Oliva is a plastic surgeon in private practice in Spokane, WA. Dr Schlesinger is a plastic surgeon in private practice in Honolulu, HI. Dr Kortesis is a plastic surgeon in private practice in Huntersville, NC
| | - Craig Creasman
- Dr Flugstad is a fellow in private practice in Huntersville, NC. Dr Pozner is a plastic surgeon in private practice in Boca Raton, FL. Dr Baxter is a plastic surgeon in private practice in Mountlake Terrace, WA. Dr Creasman is a plastic surgeon in private practice in San Jose, CA. Dr Egrari is a plastic surgeon in private practice in Bellevue, WA. Dr Martin is a plastic surgeon in private practice in Las Cruces, NM. Dr Messa III is a plastic surgeon in private practice in Weston, FL. Dr Oliva is a plastic surgeon in private practice in Spokane, WA. Dr Schlesinger is a plastic surgeon in private practice in Honolulu, HI. Dr Kortesis is a plastic surgeon in private practice in Huntersville, NC
| | - Sepehr Egrari
- Dr Flugstad is a fellow in private practice in Huntersville, NC. Dr Pozner is a plastic surgeon in private practice in Boca Raton, FL. Dr Baxter is a plastic surgeon in private practice in Mountlake Terrace, WA. Dr Creasman is a plastic surgeon in private practice in San Jose, CA. Dr Egrari is a plastic surgeon in private practice in Bellevue, WA. Dr Martin is a plastic surgeon in private practice in Las Cruces, NM. Dr Messa III is a plastic surgeon in private practice in Weston, FL. Dr Oliva is a plastic surgeon in private practice in Spokane, WA. Dr Schlesinger is a plastic surgeon in private practice in Honolulu, HI. Dr Kortesis is a plastic surgeon in private practice in Huntersville, NC
| | - Scot Martin
- Dr Flugstad is a fellow in private practice in Huntersville, NC. Dr Pozner is a plastic surgeon in private practice in Boca Raton, FL. Dr Baxter is a plastic surgeon in private practice in Mountlake Terrace, WA. Dr Creasman is a plastic surgeon in private practice in San Jose, CA. Dr Egrari is a plastic surgeon in private practice in Bellevue, WA. Dr Martin is a plastic surgeon in private practice in Las Cruces, NM. Dr Messa III is a plastic surgeon in private practice in Weston, FL. Dr Oliva is a plastic surgeon in private practice in Spokane, WA. Dr Schlesinger is a plastic surgeon in private practice in Honolulu, HI. Dr Kortesis is a plastic surgeon in private practice in Huntersville, NC
| | - Charles A Messa
- Dr Flugstad is a fellow in private practice in Huntersville, NC. Dr Pozner is a plastic surgeon in private practice in Boca Raton, FL. Dr Baxter is a plastic surgeon in private practice in Mountlake Terrace, WA. Dr Creasman is a plastic surgeon in private practice in San Jose, CA. Dr Egrari is a plastic surgeon in private practice in Bellevue, WA. Dr Martin is a plastic surgeon in private practice in Las Cruces, NM. Dr Messa III is a plastic surgeon in private practice in Weston, FL. Dr Oliva is a plastic surgeon in private practice in Spokane, WA. Dr Schlesinger is a plastic surgeon in private practice in Honolulu, HI. Dr Kortesis is a plastic surgeon in private practice in Huntersville, NC
| | - Alfonso Oliva
- Dr Flugstad is a fellow in private practice in Huntersville, NC. Dr Pozner is a plastic surgeon in private practice in Boca Raton, FL. Dr Baxter is a plastic surgeon in private practice in Mountlake Terrace, WA. Dr Creasman is a plastic surgeon in private practice in San Jose, CA. Dr Egrari is a plastic surgeon in private practice in Bellevue, WA. Dr Martin is a plastic surgeon in private practice in Las Cruces, NM. Dr Messa III is a plastic surgeon in private practice in Weston, FL. Dr Oliva is a plastic surgeon in private practice in Spokane, WA. Dr Schlesinger is a plastic surgeon in private practice in Honolulu, HI. Dr Kortesis is a plastic surgeon in private practice in Huntersville, NC
| | - S Larry Schlesinger
- Dr Flugstad is a fellow in private practice in Huntersville, NC. Dr Pozner is a plastic surgeon in private practice in Boca Raton, FL. Dr Baxter is a plastic surgeon in private practice in Mountlake Terrace, WA. Dr Creasman is a plastic surgeon in private practice in San Jose, CA. Dr Egrari is a plastic surgeon in private practice in Bellevue, WA. Dr Martin is a plastic surgeon in private practice in Las Cruces, NM. Dr Messa III is a plastic surgeon in private practice in Weston, FL. Dr Oliva is a plastic surgeon in private practice in Spokane, WA. Dr Schlesinger is a plastic surgeon in private practice in Honolulu, HI. Dr Kortesis is a plastic surgeon in private practice in Huntersville, NC
| | - Bill G Kortesis
- Dr Flugstad is a fellow in private practice in Huntersville, NC. Dr Pozner is a plastic surgeon in private practice in Boca Raton, FL. Dr Baxter is a plastic surgeon in private practice in Mountlake Terrace, WA. Dr Creasman is a plastic surgeon in private practice in San Jose, CA. Dr Egrari is a plastic surgeon in private practice in Bellevue, WA. Dr Martin is a plastic surgeon in private practice in Las Cruces, NM. Dr Messa III is a plastic surgeon in private practice in Weston, FL. Dr Oliva is a plastic surgeon in private practice in Spokane, WA. Dr Schlesinger is a plastic surgeon in private practice in Honolulu, HI. Dr Kortesis is a plastic surgeon in private practice in Huntersville, NC
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Stevens WG, Calobrace MB, Harrington J, Alizadeh K, Zeidler KR, d'Incelli RC. Nine-Year Core Study Data for Sientra's FDA-Approved Round and Shaped Implants with High-Strength Cohesive Silicone Gel. Aesthet Surg J 2016; 36:404-16. [PMID: 26961987 DOI: 10.1093/asj/sjw015] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Since approval in March 2012, data on Sientra's (Santa Barbara, CA) silicone gel implants have been updated and published regularly to provide immediate visibility to the continued safety and performance of these devices. The 9 year follow-up data support the previously published data confirming the ongoing safety and efficacy of Sientra silicone gel breast implants. OBJECTIVES The authors provide updated 9 year study data for Sientra's round and shaped silicone gel breast implants. METHODS The Core Study is an ongoing 10 year study that enrolled 1788 patients with 3506 Sientra implants across four indications (primary augmentation, revision-augmentation, primary reconstruction, and revision-reconstruction). For the safety analysis, Kaplan-Meier risk rates were calculated to evaluate postoperative complications, including all breast implant-related adverse effects. For the effectiveness analyses, results were presented through 8 years as patient satisfaction scores were assessed at even years. RESULTS Through 9 years, the overall risk of capsular contracture was 12.6%. Smooth devices (16.6%, 95% CI, 14.2%, 19.5%) had a statistically significantly higher rate of capsular contracture compared to textured devices (8.0%, 95% CI, 6.2%, 10.4%). Out of the 610 reoperations in 477 patients, over half of all reoperations were due to cosmetic reasons (n = 315; 51.6%). Patient satisfaction remains high through 8 years, with 90% of primary augmentation patients indicating their breast implants look natural and feel soft. CONCLUSIONS The 9-year follow-up data from the ongoing Core Study of the Sientra portfolio of HSC and HSC+ silicone gel breast implants reaffirm the very strong safety profile as well as continued patient satisfaction. LEVEL OF EVIDENCE 2 Therapeutic.
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Affiliation(s)
- W Grant Stevens
- Dr Stevens is a Clinical Professor of Surgery, Division of Plastic Surgery, University of Southern California School of Medicine; and Director of the University of Southern California - Marina del Rey Aesthetic Surgery Fellowship Program, Los Angeles, CA. Dr Calobrace is a Gratis Clinical Faculty Member, Division of Plastic Surgery, University of Louisville, Louisville, KY, and Clinical Faculty Member, Division of Plastic Surgery, University of Kentucky, Lexington, KY. Dr Harrington is an Adjunct Professor of Surgery, Division of Plastic and Reconstructive Surgery, University of Minnesota, Minneapolis, MN, and Director of Plastic and Microvascular Surgery at North Memorial Hospital, Robbinsdale, MN. Dr Alizadeh is the Chief of Plastic and Reconstructive Surgery, Division of Plastic and Reconstructive Surgery, Westchester Medical Center and New York Medical College, Valhalla, NY. Dr Zeidler is a plastic surgeon in private practice in Campbell, CA. Ms d'Incelli is Vice President, Clinical Operations, Sientra, Inc., Santa Barbara, CA
| | - M Bradley Calobrace
- Dr Stevens is a Clinical Professor of Surgery, Division of Plastic Surgery, University of Southern California School of Medicine; and Director of the University of Southern California - Marina del Rey Aesthetic Surgery Fellowship Program, Los Angeles, CA. Dr Calobrace is a Gratis Clinical Faculty Member, Division of Plastic Surgery, University of Louisville, Louisville, KY, and Clinical Faculty Member, Division of Plastic Surgery, University of Kentucky, Lexington, KY. Dr Harrington is an Adjunct Professor of Surgery, Division of Plastic and Reconstructive Surgery, University of Minnesota, Minneapolis, MN, and Director of Plastic and Microvascular Surgery at North Memorial Hospital, Robbinsdale, MN. Dr Alizadeh is the Chief of Plastic and Reconstructive Surgery, Division of Plastic and Reconstructive Surgery, Westchester Medical Center and New York Medical College, Valhalla, NY. Dr Zeidler is a plastic surgeon in private practice in Campbell, CA. Ms d'Incelli is Vice President, Clinical Operations, Sientra, Inc., Santa Barbara, CA
| | - Jennifer Harrington
- Dr Stevens is a Clinical Professor of Surgery, Division of Plastic Surgery, University of Southern California School of Medicine; and Director of the University of Southern California - Marina del Rey Aesthetic Surgery Fellowship Program, Los Angeles, CA. Dr Calobrace is a Gratis Clinical Faculty Member, Division of Plastic Surgery, University of Louisville, Louisville, KY, and Clinical Faculty Member, Division of Plastic Surgery, University of Kentucky, Lexington, KY. Dr Harrington is an Adjunct Professor of Surgery, Division of Plastic and Reconstructive Surgery, University of Minnesota, Minneapolis, MN, and Director of Plastic and Microvascular Surgery at North Memorial Hospital, Robbinsdale, MN. Dr Alizadeh is the Chief of Plastic and Reconstructive Surgery, Division of Plastic and Reconstructive Surgery, Westchester Medical Center and New York Medical College, Valhalla, NY. Dr Zeidler is a plastic surgeon in private practice in Campbell, CA. Ms d'Incelli is Vice President, Clinical Operations, Sientra, Inc., Santa Barbara, CA
| | - Kaveh Alizadeh
- Dr Stevens is a Clinical Professor of Surgery, Division of Plastic Surgery, University of Southern California School of Medicine; and Director of the University of Southern California - Marina del Rey Aesthetic Surgery Fellowship Program, Los Angeles, CA. Dr Calobrace is a Gratis Clinical Faculty Member, Division of Plastic Surgery, University of Louisville, Louisville, KY, and Clinical Faculty Member, Division of Plastic Surgery, University of Kentucky, Lexington, KY. Dr Harrington is an Adjunct Professor of Surgery, Division of Plastic and Reconstructive Surgery, University of Minnesota, Minneapolis, MN, and Director of Plastic and Microvascular Surgery at North Memorial Hospital, Robbinsdale, MN. Dr Alizadeh is the Chief of Plastic and Reconstructive Surgery, Division of Plastic and Reconstructive Surgery, Westchester Medical Center and New York Medical College, Valhalla, NY. Dr Zeidler is a plastic surgeon in private practice in Campbell, CA. Ms d'Incelli is Vice President, Clinical Operations, Sientra, Inc., Santa Barbara, CA
| | - Kamakshi R Zeidler
- Dr Stevens is a Clinical Professor of Surgery, Division of Plastic Surgery, University of Southern California School of Medicine; and Director of the University of Southern California - Marina del Rey Aesthetic Surgery Fellowship Program, Los Angeles, CA. Dr Calobrace is a Gratis Clinical Faculty Member, Division of Plastic Surgery, University of Louisville, Louisville, KY, and Clinical Faculty Member, Division of Plastic Surgery, University of Kentucky, Lexington, KY. Dr Harrington is an Adjunct Professor of Surgery, Division of Plastic and Reconstructive Surgery, University of Minnesota, Minneapolis, MN, and Director of Plastic and Microvascular Surgery at North Memorial Hospital, Robbinsdale, MN. Dr Alizadeh is the Chief of Plastic and Reconstructive Surgery, Division of Plastic and Reconstructive Surgery, Westchester Medical Center and New York Medical College, Valhalla, NY. Dr Zeidler is a plastic surgeon in private practice in Campbell, CA. Ms d'Incelli is Vice President, Clinical Operations, Sientra, Inc., Santa Barbara, CA
| | - Rosalyn C d'Incelli
- Dr Stevens is a Clinical Professor of Surgery, Division of Plastic Surgery, University of Southern California School of Medicine; and Director of the University of Southern California - Marina del Rey Aesthetic Surgery Fellowship Program, Los Angeles, CA. Dr Calobrace is a Gratis Clinical Faculty Member, Division of Plastic Surgery, University of Louisville, Louisville, KY, and Clinical Faculty Member, Division of Plastic Surgery, University of Kentucky, Lexington, KY. Dr Harrington is an Adjunct Professor of Surgery, Division of Plastic and Reconstructive Surgery, University of Minnesota, Minneapolis, MN, and Director of Plastic and Microvascular Surgery at North Memorial Hospital, Robbinsdale, MN. Dr Alizadeh is the Chief of Plastic and Reconstructive Surgery, Division of Plastic and Reconstructive Surgery, Westchester Medical Center and New York Medical College, Valhalla, NY. Dr Zeidler is a plastic surgeon in private practice in Campbell, CA. Ms d'Incelli is Vice President, Clinical Operations, Sientra, Inc., Santa Barbara, CA
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Schweitzer C, Tellouck L, Gaboriau T, Leger F. Anterior capsule contraction treated by femtosecond laser capsulotomy. J Refract Surg 2015; 31:202-4. [PMID: 25751838 DOI: 10.3928/1081597x-20150224-04] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 01/30/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe a new method to treat severe anterior capsule contraction using a femtosecond laser anterior capsulotomy. METHODS Case report. RESULTS A 48-year-old woman with a history of myotonic dystrophy experienced a severe contraction of the anterior capsule following an uneventful phacoemulsification cataract surgery with a hydrophilic acrylic intraocular lens implanted in the capsular bag. A femtosecond laser anterior capsulotomy was performed using a non-applanating fluid-filled interface. The spectral-domain optical coherence tomography imaging system associated with the laser enabled precise centration and location of the capsulotomy with a posterior cut located between the anterior surface of the intraocular lens and the anterior capsule inner surface. The free-floating capsulotomy was easily removed after the laser procedure, and 8 days postoperatively visual acuity recovered and myopic shift regressed with an intraocular lens centered in the capsular bag. CONCLUSIONS Femtosecond laser assisted by a high-resolution imaging system appears to be a safe and efficient treatment for severe anterior capsule contraction.
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Stevens WG, Calobrace MB, Cohen R, Fiorillo MA, Kortesis BG. Sientra high-strength cohesive textured round implant technique: roundtable discussion. Aesthet Surg J 2015; 35 Suppl 1:S11-21. [PMID: 25948655 DOI: 10.1093/asj/sjv025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED : A panel of board-certified plastic surgeons chaired by Dr Grant Stevens convened to discuss their respective experiences with the Sientra High-Strength Cohesive (HSC) Textured Round silicone gel breast implants. The authors have implanted a combined total of approximately 2100 patients. Surgical pearls, complication avoidance, and practice integration tips are among the topics reviewed. The surgeons also present challenging cases and describe how the HSC textured implants helped them achieve a successful outcome. LEVEL OF EVIDENCE 5 Therapeutic.
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Affiliation(s)
- W Grant Stevens
- Dr Stevens is Clinical Professor of Surgery, Division of Plastic Surgery, University of Southern California School of Medicine, and Director of the University of Southern California-Marina del Rey Aesthetic Surgery Fellowship Program, Los Angeles, California. Dr Calobrace is a plastic surgeon in private practice in Louisville, Kentucky. Dr Cohen is a plastic surgeon in private practice in Paradise Valley, Arizona. Dr Fiorillo is a plastic surgeon in private practice in Pearl River, New York. Dr Kortesis is a plastic surgeon in private practice in Charlotte, North Carolina
| | - M Bradley Calobrace
- Dr Stevens is Clinical Professor of Surgery, Division of Plastic Surgery, University of Southern California School of Medicine, and Director of the University of Southern California-Marina del Rey Aesthetic Surgery Fellowship Program, Los Angeles, California. Dr Calobrace is a plastic surgeon in private practice in Louisville, Kentucky. Dr Cohen is a plastic surgeon in private practice in Paradise Valley, Arizona. Dr Fiorillo is a plastic surgeon in private practice in Pearl River, New York. Dr Kortesis is a plastic surgeon in private practice in Charlotte, North Carolina
| | - Robert Cohen
- Dr Stevens is Clinical Professor of Surgery, Division of Plastic Surgery, University of Southern California School of Medicine, and Director of the University of Southern California-Marina del Rey Aesthetic Surgery Fellowship Program, Los Angeles, California. Dr Calobrace is a plastic surgeon in private practice in Louisville, Kentucky. Dr Cohen is a plastic surgeon in private practice in Paradise Valley, Arizona. Dr Fiorillo is a plastic surgeon in private practice in Pearl River, New York. Dr Kortesis is a plastic surgeon in private practice in Charlotte, North Carolina
| | - Michael A Fiorillo
- Dr Stevens is Clinical Professor of Surgery, Division of Plastic Surgery, University of Southern California School of Medicine, and Director of the University of Southern California-Marina del Rey Aesthetic Surgery Fellowship Program, Los Angeles, California. Dr Calobrace is a plastic surgeon in private practice in Louisville, Kentucky. Dr Cohen is a plastic surgeon in private practice in Paradise Valley, Arizona. Dr Fiorillo is a plastic surgeon in private practice in Pearl River, New York. Dr Kortesis is a plastic surgeon in private practice in Charlotte, North Carolina
| | - Bill G Kortesis
- Dr Stevens is Clinical Professor of Surgery, Division of Plastic Surgery, University of Southern California School of Medicine, and Director of the University of Southern California-Marina del Rey Aesthetic Surgery Fellowship Program, Los Angeles, California. Dr Calobrace is a plastic surgeon in private practice in Louisville, Kentucky. Dr Cohen is a plastic surgeon in private practice in Paradise Valley, Arizona. Dr Fiorillo is a plastic surgeon in private practice in Pearl River, New York. Dr Kortesis is a plastic surgeon in private practice in Charlotte, North Carolina
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Liu X, Zhou L, Pan F, Gao Y, Yuan X, Fan D. Comparison of the postoperative incidence rate of capsular contracture among different breast implants: a cumulative meta-analysis. PLoS One 2015; 10:e0116071. [PMID: 25680100 PMCID: PMC4332657 DOI: 10.1371/journal.pone.0116071] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 12/05/2014] [Indexed: 11/18/2022] Open
Abstract
Background A large number of clinical studies have reported that the different materials used in breast implants were a possible cause of the different incidence rates of capsular contracture observed in patients after implantation. However, this theory lacks comprehensive support from evidence-based medicine, and considerable controversy remains. Objectives In this study, a cumulative systematic review examined breast augmentation that used implants with textured or smooth surfaces to analyze the effects of these two types of implants on the occurrence of postoperative capsular contracture. Methods We conducted a comprehensive search of literature databases, including PubMed and EMBASE, for clinical reports on the incidence of capsular contracture after the implantation of breast prostheses. We performed a cumulative meta-analysis on the incidence of capsular contracture in order from small to large sample sizes and conducted subgroup analyses according to the prosthetic material used, the implant pocket placement, the incision type and the duration of follow-up. Relative risks (RR) and 95% confidence intervals (CI) were used as the final pooled statistics. Results This meta-analysis included 16 randomized controlled trials (RCTs) and two retrospective studies. The cumulative comparison of textured and smooth breast implants showed statistical significance at 2.13 (95% CI, 1.18-3.86) when the fourth study was entered into the analysis. With the inclusion of more reports, the final results indicated that smooth breast implants were more likely to be associated with capsular contracture, with statistical significance at 3.10 (95% CI, 2.23-4.33). In the subgroup analyses, the subgroups based on implant materials included the silicone implant group and the saline implant group, with significant pooled statistical levels of 4.05 (95% CI, 1.97-8.31) and 3.12 (95% CI, 2.19-4.42), respectively. According to implant pocket placement, a subglandular group and a submuscular group were included in the analyses, and only the subglandular group had a statistically significant pooled result of 3.59 (95% CI, 2.43-5.30). Four subgroups were included in the analyses according to incision type: the inframammary incision group, the periareolar incision group, the transaxillary incision group and the mastectomy incision group. Among these groups, only the pooled results of the inframammary and mastectomy incision groups were statistically significant, at 2.82 (95% CI, 1.30-6.11) and 2.30 (95% CI, 1.17-4.50), respectively. Three follow-up duration subgroups were included in the analyses: the one-year group, the two- to three-year group and the ≥five-year group. These subgroups had statistically significant results of 4.67 (95% CI, 2.35-9.28), 3.42 (95% CI, 2.26-5.16) and 2.71 (95% CI, 1.64-4.49), respectively. Conclusion In mammaplasty, the use of textured implants reduces the incidence of postoperative capsular contracture. Differences in implant pocket placement and incision type are also likely to affect the incidence of capsular contracture; however, this conclusion awaits further study.
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Affiliation(s)
- Xing Liu
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing, China 400037
| | - Liang Zhou
- Department of Health Statistics, College of Preventive Medicine, Third Military Medical University, Chongqing, China 400038
| | - Fuqiang Pan
- Department of Plastic and Aesthetic Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China 400038
| | - Yang Gao
- Department of Plastic and Cosmetic Surgery, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, China 400042
| | - Xi Yuan
- Department of Plastic and Aesthetic Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China 400038
| | - Dongli Fan
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing, China 400037
- * E-mail:
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50
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Maxwell GP, Scheflan M, Spear S, Nava MB, Hedén P. Benefits and Limitations of Macrotextured Breast Implants and Consensus Recommendations for Optimizing Their Effectiveness. Aesthet Surg J 2014; 34:876-81. [PMID: 25024450 DOI: 10.1177/1090820x14538635] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2013] [Indexed: 11/17/2022] Open
Abstract
Implant texture is an important factor influencing implant selection for breast augmentation. Natrelle Biocell implants are characterized by macrotextured shell surfaces containing irregularly arranged concavities with large open-pore diameters and depths. These properties facilitate adhesion of the implant to the surrounding tissue, thereby promoting implant immobilization. Relative to implants with other surfaces, macrotextured implants offer low rates of capsular contracture; low rates of malposition, rotation, and rippling; and high rates of patient satisfaction. However, macrotextured implants are associated with a slightly higher risk of double capsule and late seroma. The surgeon can minimize these risks with straightforward techniques that encourage tissue adhesion. This report presents experience-based recommendations to optimize the effectiveness of Biocell anatomic implants. The authors discuss the application of best practices to all aspects of the breast implantation process, from implant selection and surgical planning to operative technique and postoperative management. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- G Patrick Maxwell
- Dr Maxwell is a Clinical Professor of Plastic Surgery at the Loma Linda School of Medicine, Loma Linda, California
| | - Michael Scheflan
- Dr Scheflan is a plastic surgeon in private practice in Tel Aviv, Israel
| | - Scott Spear
- Dr Spear is a Professor and Chairman of the Department of Plastic Surgery, Georgetown University Hospital, Washington, DC
| | - Maurizio B Nava
- Dr Nava is a plastic surgeon and Head of the Plastic Unit, IRCCS Foundation, National Cancer Institute, Milan, Italy
| | - Per Hedén
- Dr Hedén is an Associate Professor of Plastic Surgery at Akademikliniken, Stockholm, Sweden
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