Cellular and molecular composition of fibrous capsules formed around silicone breast implants with special focus on local immune reactions

Wolfram, Dolores; Christian, Rainer; Niederegger, Harald; Piza, Hildegunde; Wick, Georg

doi:10.1016/j.jaut.2004.03.005

Cited by 148 publications

(53 citation statements)

References 32 publications

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“…Furthermore, the tissue specimen showed intense positive staining of fibronectin on the interface, likely mediating interactions between the silicone and macrophages, fibroblasts, and T-cells 22. To determine the specificity and function of these T-lymphocytes, Wolfram et al investigated the interplay of T-cells and their cytokine profile in capsular fibrosis 22. First, they verified that intracapsular lymphocytes were predominantly CD4 + cells producing a specific profibrotic cytokine profile, which mediates the local immune response by means of activated TH1/TH17-cells.…”

Section: Immunological Mechanismsmentioning

confidence: 99%

“…In an ongoing study, Smalley et al could further demonstrate that the T-cell activation by silicone depends on monocytes 45. The second group, led by Dolores Wolfram, studied the activity of immunological and inflammatory processes that might be involved in CC formation, focusing on immune cells, proteins of the extracellular matrix, stress proteins, and adhesion molecules 22. The highest activity could be seen in the interface of the silicone implant and the formed fibrous capsule or in its direct adjacency, where activated CD4 + T-cells, macrophages, and Langerhans-cell-like dendritic cells could be detected.…”

Section: Immunological Mechanismsmentioning

confidence: 99%

“…The highest activity could be seen in the interface of the silicone implant and the formed fibrous capsule or in its direct adjacency, where activated CD4 + T-cells, macrophages, and Langerhans-cell-like dendritic cells could be detected. Furthermore, the tissue specimen showed intense positive staining of fibronectin on the interface, likely mediating interactions between the silicone and macrophages, fibroblasts, and T-cells 22. To determine the specificity and function of these T-lymphocytes, Wolfram et al investigated the interplay of T-cells and their cytokine profile in capsular fibrosis 22.…”

Section: Immunological Mechanismsmentioning

confidence: 99%

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Capsular contracture by silicone breast implants: possible causes, biocompatibility, and prophylactic strategies

Steiert¹,

Boyce²,

Sorg³

2013

MDER

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The most common implanted material in the human body consists of silicone. Breast augmentation and breast reconstruction using silicone-based implants are procedures frequently performed by reconstructive and aesthetic surgeons. A main complication of this procedure continues to be the development of capsular contracture (CC), displaying the result of a fibrotic foreign body reaction after the implantation of silicone. For many years, experimental and clinical trials have attempted to analyze the problem of its etiology, treatment, and prophylaxis. Different theories of CC formation are known; however, the reason why different individuals develop CC in days or a month, or only after years, is unknown. Therefore, we hypothesize that CC formation, might primarily be induced by immunological mechanisms along with other reasons. This article attempts to review CC formation, with special attention paid to immunological and inflammatory reasons, as well as actual prophylactic strategies. In this context, the word “biocompatibility” has been frequently used to describe the overall biological innocuousness of silicone in the respective studies, although without clear-cut definitions of this important feature. We have therefore developed a new five-point scale with distinct key points of biocompatibility. Hence, this article might provide the basis for ongoing discussion in this field to reduce single-publication definitions as well as increase the understanding of biocompatibility.

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Section: Immunological Mechanismsmentioning

confidence: 99%

Section: Immunological Mechanismsmentioning

confidence: 99%

Section: Immunological Mechanismsmentioning

confidence: 99%

See 1 more Smart Citation

Capsular contracture by silicone breast implants: possible causes, biocompatibility, and prophylactic strategies

Steiert¹,

Boyce²,

Sorg³

2013

MDER

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“…Capsular contracture, which was significantly higher in radiated patients, did not demonstrate a statistically significant correlation with collagen type, distribution or proportion in our study. Capsular contracture is characterized by little change in the Type I to III collagen ratio 110 , despite elevated collagen concentration 110, 111 organized into thick, cable-like bundles 112 . Baker grade and other measures of breast compliance 113–116 , however, are less specific measures of capsular contracture in breast reconstruction 117 .…”

Section: Discussionmentioning

confidence: 99%

The Impact of Chemotherapy and Radiation Therapy on the Remodeling of Acellular Dermal Matrices in Staged, Prosthetic Breast Reconstruction

Myckatyn

Cavallo

Sharma

et al. 2015

Plastic and Reconstructive Surgery

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Background An acellular dermal matrix (ADM) used in prosthetic breast reconstruction will typically incorporate, in time, with the overlying mastectomy skin flap. This remodeling process may be adversely impacted in patients that require chemotherapy and radiation therapies that influence neovascularization and cellular proliferation. Methods Multiple biopsies of the submuscular capsule and ADM were procured from 86 women (N=94 breasts) undergoing exchange of a tissue expander for a breast implant. These were divided by biopsy location : submuscular capsule (control) as well as superiorly, centrally and inferiorly along the ADM. Specimens were assessed grossly for incorporation and semi-quantitatively for cellular infiltration, cell type, fibrous encapsulation, scaffold degradation, extracellular matrix deposition, neovascularization, mean composite remodeling score, as well as Type I and III collagen area and ratio. Five oncologic treatment groups were compared : no adjuvant therapy (untreated), neoadjuvant chemotherapy ± radiation ; and chemotherapy ± radiation. Results ADM and submuscular capsule biopsies were procured 45 to 1805 days after ADM insertion and demonstrated a significant reduction in Type I collagen over time. Chemotherapy adversely impacted fibrous encapsulation relative to the untreated group (p=0.03). Chemotherapy with or without radiation adversely impacted Type I collagen area (p=0.02), cellular infiltration (p<0.01), extracellular matrix deposition (p<0.04), and neovascularization (p<0.01). Radiation exacerbated the adverse impact of chemotherapy for gross incorporation as well as several remodeling parameters. Neoadjuvant chemotherapy also caused a reduction in Type I (p=0.01) and III collagen (p=0.05), extracellular matrix deposition (p=0.03), and scaffold degradation (p=0.02). Conclusions Chemotherapy and radiation therapy limit ADM remodeling.

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“…During the 1970s, Heppleston and Styles 17) proved that silica stimulation causes macrophages to produce TGF-β, while Dolores et al 18) reported that silicone not only induced proliferation of granulation tissue in response to foreign bodies, but also elicited strong immunoreactions consisting mostly of T lymphocytes. In the present study, white blood cells invading the capsule were mostly lymphocytes and eosinophils, with few neutrophils.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Capsular Morphology between two Different Surface Structures of Silicone Implants

Kurihara

Takeuchi

Sasaki

2010

Nichidai Igaku Zasshi

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In Japan, the incidence of breast cancer is increasing every year, and the necessity for breast reconstruction using silicone implants is thus increasing. Such reconstructions result in a foreign body response, with formation of a fibrous capsule and thickening, resulting in capsular contracture during shrinkage, which are often accompanied by marked transformation and pain. The mechanisms underlying this phenomenon are unclear, although one report has described decreased capsular contracture following the use of an implant with a processed surface displaying enhanced ruggedness. The present study examined whether capsular contracture would be decreased by changing the outer structure of the silicone implant. Smooth-and textured-type implants were implanted dorsally in rats. Gross and histopathological examinations (hematoxylin and eosin staining, Masson's trichrome staining, transforming growth factor (TGF)-β -staining, a-smooth muscle actin (α-SMA) staining, and collagen I and III staining) were performed at weeks 1, 2, 4 and 8 after implantation to examine capsule thickness. The textured-type implant showed a thinner capsule than the smooth type at weeks 4 and 8. The fibrous layer of the capsule was particularly thin. Moreover, TGF-β -positive cells decreased gradually with the smooth-type implant, while TGF-β -positive cells remained evident upon histopathological examination of the textured-type implant. For textured-type implants, α-SMA-positive cells gradually decreased and type III collagen fibers predominated, while smooth-type implants showed a gradual increase in α-SMA-positive cells and a predominance of type I collagen fibers. Based on these findings, the characteristics of the capsule for textured implants with irregular surfaces can be summarized as follows: 1) during the early stage after implantation, stronger inflammatory reactions are induced compared with the smooth type, and because the inflammation becomes chronic, remodeling from type III collagen to type I collagen is decreased, resulting in a type III collagen-dominant capsule; and 2) as irregular structures buffer the tension applied to the capsule due to body movement, the degree of increase in α-SMA-positive cells is lower compared with the smooth type. As a result, a thin capsule that is less likely to contract is formed. These factors are mostly responsible for reducing capsular contracture for textured implants.

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Cellular and molecular composition of fibrous capsules formed around silicone breast implants with special focus on local immune reactions

Cited by 148 publications

References 32 publications

Capsular contracture by silicone breast implants: possible causes, biocompatibility, and prophylactic strategies

Capsular contracture by silicone breast implants: possible causes, biocompatibility, and prophylactic strategies

The Impact of Chemotherapy and Radiation Therapy on the Remodeling of Acellular Dermal Matrices in Staged, Prosthetic Breast Reconstruction

Comparison of Capsular Morphology between two Different Surface Structures of Silicone Implants

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