J I Efanov1, J P Giot2, J Fernandez3, M A Danino4. 1. Division of plastic surgery, department of surgery, CHUM Montreal university health center, 1650, Sherbrooke East, Montreal, Quebec, H2L 4M1, Canada. 2. Division of plastic and maxillo-facial surgery, CHU Grenoble Alpes, avenue Maquis-du-Grésivaudan, 38700 La-Tronche, France. 3. Division of plastic, reconstructive and aesthetic surgery, hôpital Saint-Roch, CHU de Nice, 5, rue Pierre-Dévoluy, 06000 Nice, France. 4. Division of plastic surgery, department of surgery, CHUM Montreal university health center, 1650, Sherbrooke East, Montreal, Quebec, H2L 4M1, Canada. Electronic address: michel.alain.danino@umontreal.ca.
Abstract
BACKGROUND: Macro-texturing of breast implants was developed with the double goal of improving implant stabilization within the breast cavity and decreasing the rate of capsular contractures. However, recent evidence suggests that double capsular formation, a potentially worrisome phenomenon associated with late seromas and biofilms, occurs with preponderance in macro-textured implants. Our objective was to analyze histologically different regions of double capsules to determine if they are more prone to mechanical movements. METHODS: A prospective analysis including patients undergoing second-stage expander to definitive breast-implant reconstruction post-mastectomy was conducted after intraoperative identification of the double capsule phenomenon. Two samples were collected from each capsules around the implant, located centrally and laterally. The specimens were sent for histological analysis by the institution's pathologist. RESULTS: In total, 10 patients were identified intraoperatively with partial double capsule phenomenon. Among samples retrieved from the lateral aspect of the breast implant, all were associated with delamination and fractures in the collagen matrix of the double capsules. This phenomenon was not observed in any sample from the dome of the breast. CONCLUSIONS: Breast-implant macro-texturing plays an important role on delamination of capsules on lateral portions of the breast, which may have an etiologic role in double capsule formation. Manufacturing implants with macro-texturing on one side and smooth surface on the other could diminish mechanical shear forces responsible for these findings.
BACKGROUND: Macro-texturing of breast implants was developed with the double goal of improving implant stabilization within the breast cavity and decreasing the rate of capsular contractures. However, recent evidence suggests that double capsular formation, a potentially worrisome phenomenon associated with late seromas and biofilms, occurs with preponderance in macro-textured implants. Our objective was to analyze histologically different regions of double capsules to determine if they are more prone to mechanical movements. METHODS: A prospective analysis including patients undergoing second-stage expander to definitive breast-implant reconstruction post-mastectomy was conducted after intraoperative identification of the double capsule phenomenon. Two samples were collected from each capsules around the implant, located centrally and laterally. The specimens were sent for histological analysis by the institution's pathologist. RESULTS: In total, 10 patients were identified intraoperatively with partial double capsule phenomenon. Among samples retrieved from the lateral aspect of the breast implant, all were associated with delamination and fractures in the collagen matrix of the double capsules. This phenomenon was not observed in any sample from the dome of the breast. CONCLUSIONS: Breast-implant macro-texturing plays an important role on delamination of capsules on lateral portions of the breast, which may have an etiologic role in double capsule formation. Manufacturing implants with macro-texturing on one side and smooth surface on the other could diminish mechanical shear forces responsible for these findings.
Authors: Tessa L St Cyr; Barbara A Pockaj; Donald W Northfelt; Fiona E Craig; Mark W Clemens; Raman C Mahabir Journal: Plast Surg (Oakv) Date: 2020-05-21 Impact factor: 0.947
Authors: Joshua C Doloff; Omid Veiseh; Roberto de Mezerville; Marcos Sforza; Tracy Ann Perry; Jennifer Haupt; Morgan Jamiel; Courtney Chambers; Amanda Nash; Samira Aghlara-Fotovat; Jessica L Stelzel; Stuart J Bauer; Sarah Y Neshat; John Hancock; Natalia Araujo Romero; Yessica Elizondo Hidalgo; Isaac Mora Leiva; Alexandre Mendonça Munhoz; Ardeshir Bayat; Brian M Kinney; H Courtney Hodges; Roberto N Miranda; Mark W Clemens; Robert Langer Journal: Nat Biomed Eng Date: 2021-06-21 Impact factor: 25.671
Authors: Andreas Larsen; Louise E Rasmussen; Leonia F Rasmussen; Tim K Weltz; Mathilde N Hemmingsen; Steen S Poulsen; Jens C B Jacobsen; Peter Vester-Glowinski; Mikkel Herly Journal: Aesthetic Plast Surg Date: 2021-07-26 Impact factor: 2.326