Tumour Necrosis Factor-α Expression Is Associated with Increased Severity of Periprosthetic Breast Capsular Contracture

Abstract

Background: The pathogenesis of periprosthetic capsular contracture following breast implant surgery is unclear. The aim of this study was to identify the expression of tumour necrosis factor-α (TNF-α), collagen type III α₁ (COL3A1), transforming growth factor-β₁ (TGF-β₁) and connective tissue growth factor (CTGF) in different Baker grades of breast capsular contracture. Methods: Seven periprosthetic breast capsule specimens were collected from 6 patients. TNF-α, COL3A1, TGF-β₁ and CTGF gene expression were analysed using real-time quantitative polymerase chain reaction. Immunohistolocalisation of TNF-α was performed on paraffin-embedded sections. Significant correlations were analysed using the Pearson correlation coefficient. Results: TNF-α expression was associated with increased Baker grade of capsular contracture (Pearson correlation, r = 0.558; p = 0.02). COL3A1 gene expression was reduced with increasing severity of contracture (r = –0.490; p = 0.05). There were no significant correlations between TGF-β₁ and CTGF expression with Baker grade. Positive TNF-α staining in breast capsules was localised to fibroblasts, macrophages, and extracellularly close to the prosthesis. Conclusion: The increased expression of TNF-α may play a key role in the inflammatory response associated with capsular contracture. The corresponding decrease in COL3A1 may contribute to the change in capsular physical properties seen in capsular contracture.

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

“…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.…”

Foreign body response induced by tissue expander implantation

“…Activation of these pathways triggers downstream signaling cascades that lead to the production of pro-inflammatory cytokines which are important mediators of acute and chronic inflammation, FBR and cell apoptosis (24,25). In addition, a previous study has reported that TNF-α expression was associated with an increased Baker grade of periprosthetic capsular contracture following breast implant surgery, and positive TNF-α staining in breast capsules was localized to fibroblasts, macrophages and were extracellularly close to the prosthesis (26).…”

Risk Factor Analysis for Capsular Contracture

“…The prospective cohort study design was nonrandomized and some previously hypothesized factors were not included in the analysis; examples include genetic disposition, nipple shields, and blood loss. 6,8,28,29 These factors were not included because they were unmeasured. In addition, to provide an overall risk profile, the analysis did not include separate models for early and late contractures.…”