The peri-implant breast capsule: An immunophenotypic study of capsules taken at explantation surgery

Abstract

Silicone-based breast implants continue to be the focus of many studies attempting to correlate implant failure to clinical and pathological factors. Routine pathology of peri-implant capsule is extensively described in the literature. The actual significance of the cellular events remains unconfirmed, particularly with reference to clinical outcome. This study reviews our experience with explanted capsules. The study makes specific reference to the immunohistochemistry of the cells participating in the capsule and the significance of the immunophenotypic characterization of these cells to clinical outcome. The use of a wide selection of immunomarkers for T and B lymphocytes and histiocytes provided no supporting evidence for local cell participation in the capsule, which may indicate the presence of an immunological reaction present in the capsule at the time of explantation. One was only able to confirm the presence of a low grade inflammatory process and progression to fibrosis and calcification over time. Statistical correlation was obtained only between Baker grade of capsular contracture and CD3/CD68 immunomarker positivity. CD45RO did show correlation with pain. No correlation was demonstrated with calcification. The results obtained in this study highlighted the need for further investigations into the mechanism of histiocyte and fibrocyte recruitment and activation in the capsule, a possible source of pain and contracture, which is a serious long-term clinical finding leading to the necessity for explantation.

Spider Silk Coatings as a Bioshield to Reduce Periprosthetic Fibrous Capsule Formation

“…The critical steps during development of foreign body-associated fi brosis are triggered by the members of the TGFβ growth factor superfamily, [ 18 ] with TGFβ1 playing a dominant role in case of silicone. [ 19,20 ] We observed a strongly reduced expression of TGFβ1 and a reduced abundance of TGFβ1-positive cells in the presence of spider silk-coated implants when compared to uncoated equivalents. Accordingly, the level of CTGF which is implicated in various fi brotic disorders and induced in fi broblasts after activation with TGFβ mediating capsule formation [ 21 ] and fi brosis persistence [ 22 ] was signifi cantly lower in the presence of silk coated silicone implants.…”

“…Especially, TNF-α expression which correlates with the degree of severity of foreign body-associated capsule formation, [ 17 ] was signifi cantly lower even twelve months after implantation. CD68+ cells, also related with severity of fi brosis, [ 19 ] showed reduced proliferation on silk-coated silicone surfaces in vitro and in vivo. The critical steps during development of foreign body-associated fi brosis are triggered by the members of the TGFβ growth factor superfamily, [ 18 ] with TGFβ1 playing a dominant role in case of silicone.…”

Altered systemic serologic parameters in patients with silicone mammary implants

“…The most common complication is capsular contracture resulting in excessive firmness and pain [1][2][3]. In general, connective tissue capsules develop around every foreign body, including silicone breast implants [4].…”

Effect of propranolol on capsular reaction around silicone implants in guinea pigs

“…Nowadays, the use of implants with smooth surfaces is no longer acceptable due to the fact that they behave differently regarding the occurrence of capsular contracture 11 Therefore, it was decided to use one type of textured prostheses so that responses to the use of propranolol could be verified efficiently without excessive number of variables. In this study, all samples from both groups exhibited a tri-layered capsule as described elsewhere by several scholars in human capsules and animal capsules surrounding textured implants 11,[33][34][35][36][37] .…”

“…The use of conventional histology method to assess inflammation was necessary because it remains the most utilized method to assess capsular inflammation [32][33][34][35][36][37] . Baker's classification and applanation tonometry did not seem very appropriate to investigate contractures or fibrosis in rodent models [16][17] .…”