Characterization of the Capsule Surrounding Smooth and Textured Tissue Expanders and Correlation with Contracture

Abstract

Background:Capsular contracture is a common complication after breast augmentation surgery. This study pathologically evaluated the soft-tissue response to surface modifications in both smooth and textured tissue expander prostheses.Methods:Smooth tissue expanders and textured tissue expanders in 5 cases each were used for breast reconstruction after mastectomy. Histological samples were harvested from the capsules when the tissue expanders were replaced by silicone implants. Collagen orientation and cellular responses were assessed histologically. Capsular contracture was evaluated using the Baker classification 6 months and 2 years after the removal of the tissue expander.Results:The capsules surrounding the smooth tissue expanders tended to produce more contracture than those surrounding the textured tissue expanders. The collagen architecture of the capsules of the smooth tissue expanders showed random orientation with fragmentation. Conversely, the capsules of the textured tissue expanders showed parallel orientation with collagen bundles of almost normal structure. Significantly more fibrils of elastin and myofibroblasts were found in the capsules surrounding the smooth tissue than in those surrounding the textured ones.Conclusions:The collagen fibers surrounding the smooth tissue expanders could be cracked during expansion, which may lead to scarring and contracture. Conversely, the collagen orientation surrounding the textured tissue expanders was excellent. Moreover, the increase in elastic fibers and myofibroblasts in the capsules surrounding the smooth tissue expanders may be associated with in vivo contraction patterns. Therefore, the surface type of tissue expanders affects capsular contraction after replacement with definitive implants.

Comparison of inflammatory response and synovial metaplasia in immediate breast reconstruction with a synthetic and a biological mesh: a randomized controlled clinical trial

“…In that study [35], significantly more fibroblasts were seen around smooth expanders than around textured expanders. The expanders were replaced by the same textured permanent silicone implants in both groups and at a clinical two-year follow-up there were more capsular contracture in the group initially operated on with smooth expanders [35]. Therefore, the initial tissue reaction, and amount of myofibroblasts, could be significant for the later capsular contracture rates.…”

“…It has also been hypothesized that the collagen orientation plays a key role in capsular formation [34]. The study [35], described above, comparing textured and smooth expanders, showed that collagen fiber orientation was irregular in the capsule surrounding the smooth expanders and regularly arranged and with a more even thickness in the textured implants [35]. On the other hand, highly aligned collagen fibers could lead to a greater force of contracture and capsular formation [31,34], whereas uncontracted capsule have more loosely arranged, multidirectional collagen fibers [34].…”

“…The stronger myofibroblast reaction and scar formation seen in the biological meshes could merely indicate that it is integrated faster than the synthetic mesh. On the other hand, a study [35] comparing textured and smooth expanders, where biopsies were taken during the exchange to a permanent implant, suggested that an early difference in occurrence of myofibroblast could explain later capsular contracture. In that study [35], significantly more fibroblasts were seen around smooth expanders than around textured expanders.…”

“…On the other hand, a study [35] comparing textured and smooth expanders, where biopsies were taken during the exchange to a permanent implant, suggested that an early difference in occurrence of myofibroblast could explain later capsular contracture. In that study [35], significantly more fibroblasts were seen around smooth expanders than around textured expanders. The expanders were replaced by the same textured permanent silicone implants in both groups and at a clinical two-year follow-up there were more capsular contracture in the group initially operated on with smooth expanders [35].…”

“…A strength of this study is that it compares synthetic and biological meshes in the same patients and patient related factors affecting healing and scar formation should be of little importance when the results are evaluated. In addition, the same type of implants were used in all breasts, which is a strength as implant texture seems to influence the tissue reaction [35]. Moreover, both histological and clinical evaluations have been performed.…”