The aetiopathogenesis of capsular contracture: A systematic review of the literature

Bachour, Yara; Verweij, Stephan P.; Gibbs, Susan; Ket, Hans; Ritt, Marco J.P.F.; Niessen, Frank B.; Mullender, Margriet G.

doi:10.1016/j.bjps.2017.12.002

Cited by 57 publications

(49 citation statements)

References 112 publications

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“…Silicone implants induce a mild inflammatory response, followed by the formation of a thin dense fibrous capsule that surrounds the implant itself, ensuring a high degree of stability. Even though the inflammatory response could exceed, causing capsular contracture and has been thoroughly reported for soft tissue implants (mostly breast implants), there is little to no report in the literature of capsular contracture in facial implants [14]. Our experience conforms to the literature.…”

Section: Discussionsupporting

confidence: 83%

An Easy and Effective Technique for Silicone Facial Implant Insertion and Fixation to Periosteum

et al. 2020

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In this paper, we present a simple way to place the implant into a harvested pocket and to subsequently fix it percutaneously. Eighteen patients (1 male, 13 females, 4 transgender), underwent facial implant placement; a total of 31 implants were placed (1 pair of angles of the mandible implants, 12 pairs of malar/sub-malar implants, and 5 chin implants). The intraoral approach was performed on 15 patients, and on the remaining three patients, the sub-ciliary lower lid approach was preferred. Patients were followed up for at least one year with a maximum follow-up of seven years (mean 1.8 years). In all the cases, except one, patients healed without complications. One case of implant displacement and infection was recorded. No other complication was documented. The technique described is similar to the one suggested by Peled, although some useful tips were added, namely the use of sutures, not only to fix the implant but also to drive it into the harvested pocket. In addition, larger absorbable “left in place” sutures were used, avoiding accidental implant dislocation during their removal. Further studies are required to gain a more complete understanding of the effectiveness and reproducibility of this surgical technique.

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Section: Discussionsupporting

confidence: 83%

An Easy and Effective Technique for Silicone Facial Implant Insertion and Fixation to Periosteum

et al. 2020

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“…This state‐of‐affairs favors a stiff‐scar plate, nerve entrapments, chronic pain, migration, or erosion of adjacent structures (Glazener et al, 2017). The long‐term safety of medical devices such as surgical meshes (Klosterhalfen & Klinge, 2013; Nolfi et al, 2016) or breast implants (Bachour et al, 2018) is decisively determined by the reaction of the host at the interface, in most cases forming a foreign body granuloma (FBG), with adjacent mononuclear inflammatory infiltrate and a surrounding fibrotic capsule (Figure 1). For decades, macrophages have been considered as the dominant immune cell subset in this chronic inflammation, usually being identified by their morphology and surface markers, such as CD68, CD86, or CD206 (Kunisch et al, 2004).…”

Section: Introductionmentioning

confidence: 99%

CD68+ macrophages as crucial components of the foreign body reaction demonstrate an unconventional pattern of functional markers quantified by analysis with double fluorescence staining

et al. 2020

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Implants like meshes for the reinforcement of tissues implement the formation of a persistent inflammation with an ambient fibrotic reaction. In the inflammatory infiltrate several distinct cell types have been identified, but CD68+ macrophages are supposed to be most important. To investigate the collaboration among the various cell types within the infiltrate we performed at explanted meshes from humans double fluorescence staining with CD68 as a constant marker and a variety of other antibodies as the second marker. The list of second markers includes lymphocytes (CD3, CD4, CD8, CD16, CD56, FoxP3, and CD11b) stem cells (CD34), leucocytes (CD45, CD15), macrophages (CD86, CD105, CD163, and CD206); deposition of EC matrix (collagen-I, collagen-III, MMP2, and MMP8); Ki67 as a marker for proliferation; and the tyrosine-protein kinase receptor AXL. The present study demonstrates within the inflammatory infiltrate the abundant capability of CD68+ cells to co-express a huge variety of other markers, including those of lymphocytes, varying between 5 and 83% of investigated cells. The observation of co-staining was not restricted to a specific polymer but was seen with polypropylene fibers as well as with fibers made of polyvinylidene fluoride, although with differences in co-expression rates. The persisting variability of these cells without the functional reduction toward differentiated mature cell types may favor the lack of healing at the interface of meshes.

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“…It is possible that the limitations in ADLs were due to other complications specific to implant patients that were not measured, such as capsular contracture or animation deformity. [30][31][32][33] This study only included patients who underwent subpectoral implantbased reconstruction, a variable that can be an important risk factor in the development of complications such as animation deformity. 34,35 Future studies in this area could provide valuable insight into why implant patients might experience more difficulties with ADLs than flap patients.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Upper Extremity Function in Implant and Autologous Breast Reconstruction

Alba

Schultz

Qin

et al. 2019

J reconstr Microsurg

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Background After mastectomy and breast reconstruction, many patients experience upper extremity complications, such as pain, restriction in motion, and lymphedema. Despite an aesthetically satisfactory outcome, these occurrences can diminish a patient's postoperative quality of life. Several studies have investigated the causes and incidence of these complications. However, there is currently a paucity of data comparing postoperative upper extremity function according to reconstruction technique. Methods A review was performed of patients enrolled in a physical therapy (PT) program after mastectomy and immediate breast reconstruction. PT initial encounter evaluations were used to gather data on patients' postoperative upper extremity function. Hospital records were used to gather surgical and demographic data. For each patient, data were collected for each upper extremity that was ipsilateral to a reconstructed breast. Data were then compared between patients who underwent implant-based versus autologous deep inferior epigastric perforator flap reconstruction. Results A total of 72 patients were identified, including 39 autologous and 33 implant-based reconstruction cases. Proportions of patients who underwent sentinel lymph node biopsies and axillary lymph node dissections were similar between the two groups. The autologous-based reconstruction patients had significantly higher arm pain at rest (p = 0.004) and with activity (p = 0.031) compared with implant patients. Shoulder range of motion and manual muscle test results were similar between groups, with the exception of elbow flexion, which was weaker in implant patients (p = 0.030). Implant patients were also more likely to report “severe difficulty” or “inability” to perform activities of daily living (p = 0.022). Edema/swelling, axillary cording, and lymphedema girth measurements were similar between the two groups. Conclusion Different techniques of breast reconstruction can result in different postoperative upper extremity complications. These data show specific areas where postoperative care and PT can be customized according to reconstruction type. Investigation is currently underway to determine the effect of PT on upper extremity function in these patients.

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The aetiopathogenesis of capsular contracture: A systematic review of the literature

Cited by 57 publications

References 112 publications

An Easy and Effective Technique for Silicone Facial Implant Insertion and Fixation to Periosteum

An Easy and Effective Technique for Silicone Facial Implant Insertion and Fixation to Periosteum

CD68+ macrophages as crucial components of the foreign body reaction demonstrate an unconventional pattern of functional markers quantified by analysis with double fluorescence staining

Postoperative Upper Extremity Function in Implant and Autologous Breast Reconstruction

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