Effects of Silicone Breast Implants on Human Cell Types In Vitro: A Closer Look on Host and Implant

Abstract

Background Silicone (gel) breast implants (SBI) are used world-wide for breast augmentation, and reconstruction or to correct breast deformities. They consist of two compounds: an elastomer silicone shell (envelope) and a silicone gel filler (core). Breast Implant Illness (BII) is a term used for women with SBI, who suffer from various of symptoms including myalgia, arthralgia, fatigue, fever, dry eyes and/or dry mouth (sicca), as well as cognitive disturbances, which are rated by these woman as response to SBI. The pathogenesis of these adverse effects as well as the histocompatibility and the SBI-cell interaction of silicone and its surrounding tissue (implant-host tissue interface) is a subject of current research. The main purpose of this review is to provide an overview of the current knowledge regarding the effects of silicone (gel and elastomer surfaces) of a SBI on different human cell types from experimental - in vitro - models. Methods A comprehensive research was conducted by two independent reviewers in March and July of 2020 in the PubMed, MEDLINE, and Cochrane databases. Results A number of 1328 articles on this topic were initially identified, of which 62 could be finally included an analysed in this review. Conclusion SBI may lead to a physiologic pro-inflammatory and foreign body host response with fibrous encapsulation accompanied by a disturbed Th17/Treg balance and IL-17 production. No causal relationship is known for systemic symptoms and/or autoimmune outcomes in the context of BII. 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.

A Histological Evaluation of the Efficiency of Using Periprosthetic Autologous Fat to Prevent Capsular Contracture Compared to Other Known Methods—An Experimental Study

“…Unilateral capsule formation may primarily result from the formation of a hematoma or particles of devitalized tissue following trauma caused by an inadequate dissection or an excessive cauterization for hemostasis [ 18 , 30 , 31 ]. The silicone implant, considered a foreign body by the organism, triggers a periprosthetic capsular reaction, which is a natural response [ 32 ]. However, the reasons why some capsules contract remain partially unknown and are intensely studied [ 16 , 22 ].…”

A Platform for Testing the Biocompatibility of Implants: Silicone Induces a Proinflammatory Response in a 3D Skin Equivalent

“…Silicone seemed particularly fitting for this study for several reasons: It is a widely used material for implants, which are mostly intended to be kept inside the body for as long as possible, and due to its elasticity, it seemed well manageable for the first trials with foreign materials in our 3D skin model. Furthermore, the immunologic response of in vitro keratinocytes and fibroblasts to silicone has not been reported yet despite silicone implants often being inserted into areas with little subcutaneous tissue coverage such as digits and mammae [27].…”

“…The cytotoxicity and inflammatory activity of silicone have been studied in vitro and in vivo using murine models [26]. In vitro studies on different cell types (macrophages, monocytes, fibroblasts, umbilical vein endothelial cells) confronted with silicone have been performed [27]. Keratinocytes, which play an important role as an immunologic barrier,…”

Hydrophilic Modification Strategies to Enhance the Surface Biocompatibility of Poly(dimethylsiloxane)‐Based Biomaterials for Medical Applications

“…At the macro-(100 µm to 1 mm), micro-(100 nm to 100 µm), and nano-(1-100 nm) scales, adding topographical characteristics such as nodes, wells, pores, steps, ridges, and grooves to the surface of the target biomaterial can mediate the cell response. [120][121][122] Both the nano-and microtopographies of the ECM have a role in cell contact and signaling. [123] As cells respond naturally to surrounding structures, the nano-and microtopographical surfaces naturally influence cell attachment, adhesion, morphology, alignment, proliferation, polarization, and migration at the nano-and microscale.…”

“…Veiseh et al [165] reported that sharp features, corners, and acute angles in an implant cause more acute reactions than smooth, well-contoured surfaces. [165] Colaris et al [122] suggested that the morphology of the PDMS implant surface (such as texture, size, and shape) and the manufacturing process must be taken into account when looking for potential triggers for pathological effects, particularly in cases where an inflammatory or immune response is known to have occurred. Furthermore, stiffness also influences the capability of a material to modulate the immune response.…”