Histologic and Immunohistochemical Evaluation of Human Breast Capsules Formed around Five Different Expander Surfaces

Author:

Cagli Barbara1,Carotti Simone2,Segreto Francesco1,Francesconi Maria2,Marangi Giovanni F.1,Tenna Stefania1,Diomedi Michele1,Perrone Giuseppe3,Morini Sergio2,Persichetti Paolo1

Affiliation:

1. Unit of Plastic and Reconstructive Surgery

2. Department of Medicine and Surgery, Laboratory of Microscopic and Ultrastructural Anatomy

3. Research Unit of Pathology, Campus Bio-Medico University of Rome.

Abstract

Background: Polyurethane (PU) coating and implant texturization were designed to reduce the incidence of capsular contracture (CC), even if the link between surface type and CC remains unclear. To date, the etiopathogenetic aspects have not been fully clarified. The aim of this study was to evaluate capsules formed around five different breast expanders. Methods: Thirty patients were divided into randomized groups implanted with five different expanders: smooth, coated with PU foam (poly), with a low-microtextured, high-microtextured, and macrotextured surface (L-micro, H-micro, macro). Specimens of the capsules were removed at implant reconstruction and evaluated for morphology and immunohistochemistry expression of α-smooth muscle actin (α-SMA), collagen type I and III, CD68, CD34, and CD3. Remodeling Combined Index was also evaluated. Results: Expression of α-SMA was significantly increased in smooth capsules versus poly, low-microtextured, and high-microtextured groups (P = 0.007; P = 0.010; P = 0.028), whereas the prevalence of collagen type I in smooth capsules and collagen type III in poly capsules identified a stable versus an unstable tissue. Remodeling Combined Index and α-SMA showed an inverted correlation. CD68 and CD34 cellular expression increased significantly in poly capsules with respect to smooth (P < 0.001; P < 0.001) and macrotextured groups (P < 0.001; P < 0.001). CD3 showed no significant difference among the groups. Conclusion: In this human study, the authors observed that increased tissue remodeling and reduced myofibroblast activation, along with the inflammatory infiltration and neoangiogenesis, especially in the poly and low-microtextured groups, might promote the formation of an unstable and less fibrotic capsule, lowering the risk of CC. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Surgery

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