The Effect of Montelukast and Antiadhesion Barrier Solution on the Capsule Formation after Insertion of Silicone Implants in a White Rat Model

Abstract

Background and Purposes: Capsular contracture is one of the most severe complications that can occur in breast surgery following silicone implant insertion. The purpose of this study was to investigate the effect of montelukast and antiadhesion barrier solution (AABS) on reducing capsular formation and their possible synergism. Materials andMethods: This study was approved by the Animal Ethics Committee (Reference No. KNU 2012-33) and was conducted in accordance with the Kyungpook National University - Institutional Animal Care and Use Committee, Animal Ethics Committee. The experiments in this study were conducted in vivo in 4 groups of 24 rats. Following silicone implant insertion, the pocket was injected with different agents. Group I (control group) was given normal saline injections into the pocket and fed with pure water. Group II was given injections of AABS and fed with pure water. Group III was given injections of normal saline and the medication montelukast during the experimental period. Group IV was given injections of AABS and montelukast as postoperative medication. Peri-implant capsules were excised after 8 weeks and were evaluated for transparency, inflammatory cell content, capsule thickness, collagen pattern and TGF-β expression. Results: The capsules in the experimental groups (i.e., groups II-IV) were significantly more transparent than those in group I (controls; p < 0.05, Student's t test). The mean capsule thickness of the experimental groups II (296 ± 14.76 μm), III (280 ± 14.77 μm) and IV (276 ± 39.28 μm) was smaller than that of the control group I (361 ± 35.43 μm). Compared to the control group, the histologic findings in the experimental groups suggested a decreased inflammatory response occurring in the peri-implant capsules as they exhibited minor vascularization and a reduced number of mast cells and macrophages. The collagen patterns in the experimental groups were of a lower density than in the control group with the former showing a loose, tidy collagen pattern. The amounts of TGF-β and collagen I were higher in the control group than in the experimental groups. Group IV (the synergic effect group) had a more pronounced effect on all the parameters examined than that in groups II and III with separate drug administration. Conclusions: Montelukast and AABS reduced the thickness, the inflammatory cell infiltrate and the myofibroblast content of the peri-implant capsules around silicone implants in this white rat model. They lowered the expression of the fibrotic mediator, TGF-β, and inhibited the peri-implant capsular fibrosis. Therefore, montelukast and AABS are effective in the reduction of silicone-induced peri-implant capsular formation.

Thermogel Loaded with Low-Dose Paclitaxel as a Facile Coating to Alleviate Periprosthetic Fibrous Capsule Formation

“…As shown in Figure 7A, the thickness of the fibrous capsule was measured every 150 μm and the average value of 10 sites was defined as the thickness of the tested capsule. 47 In consistency with the morphological observations shown in Figure 6, the PTX 40 group exhibited the thinnest capsule thickness among the five groups (Figure 7B). Compared with the capsule formed in the PTX 40 group, the average capsule thickness was increased by 62% in the NS group, by 21% in the Gel group, by 33% in the PTX 20 group, and by 66% in the PTX 80 group.…”

“…The capsule thickness around the implants was measured according to the previous publication with modifications. 47 Briefly, the thicknesses of 10 sites, which were designated every 150 μm, were measured using the software Image J (NIH). The capsule thickness for each specimen was obtained by calculating the average of the thickness.…”

Functionalization of Silicone Surface with Drugs and Polymers for Regulation of Capsular Contracture

“…Moreover, the thickness of the capsule and the intensity of collagen were significantly reduced. These results were observed in a previous study [ 48 ]. This demonstrates that the use of the surface modification of implants with montelukast is effective at reducing the development of breast capsular contracture.…”

Current Approaches Including Novel Nano/Microtechniques to Reduce Silicone Implant-Induced Contracture with Adverse Immune Responses

“…Anti-adhesion agents can reduce capsule thickness and the myofibroblast ratio [ 77 ]. Moreover, leukotriene receptor antagonists reduce silicone-induced peri-implant capsule formation in both white rabbit and rat models [ 78 , 79 ].…”