Alteration of Fibrous Capsule Formation by Use of Immunomodulation

Abstract

The formation of symptomatic capsular contractures remains both a mystery to the plastic surgeon and a significant clinical challenge. Ninety Sprague-Dawley rats had 2 ml dimethylpolysiloxane gel-filled implants placed in two dorsal pockets. The animals were randomly assigned to three groups. One group received daily cyclosporine injections, the second group received the saline control, and the third an active human cytokine injection. One month after surgery, the intact implants and surrounding capsules were harvested. Subjective gross examination of the capsules by three different researchers showed the cyclosporine-treated capsules to be uniformly softer, looser, and thinner than those in the other groups. The cyclosporine-treated group showed a marked decrease in absolute capsular thickness (72.4 microm) as compared with both the saline solution- (97.3 microm) and the cytokine-treated (112.4 microm) control subjects. Perivascular cuffing, lymphocytic infiltrates, and collagen organization all were also significantly affected. In this article we demonstrate how alteration of T-cell function significantly affects the cellular population and collagen organization of a typical capsule.

Effects of Zafirlukast on Capsular Contracture: Controlled Study Measuring the Mammary Compliance

“…Within this biologic milieu, extrinsic factors, including the biophysical and biochemical properties of the implant, infection and hematoma, may potentiate or exaggerate the foreign-body reaction and result in the pathologic condition we recognize clinically as capsular contracture. To date, unfortunately, the etiological factors in the formation of capsular contracture, which are likely to be multiple, remain unclear in spite of an extensive body of research (7)(8).…”

“…It is possible that the fluid retained around the breast implant following surgery causes ongoing inflammation. Pharmacological inhibition of the inflammatory process has, indeed, now become the main focus of research (7)(8)(9)(10) , and LTE 4 ) and their presumed suppressive effect on myofibroblasts, two factors presumed to cause contracture (13)(14)(15)(16)(17). In November 1996, the Food and Drug Administration approved the use of zafirlukast, a leukotriene receptor antagonist (LTRA), for the treatment of asthma.…”