Yang J-D, Kwon O-H, Lee J-W, Chung H-Y, Cho B-C, Park H-Y, Kim T-G
Department of Plastic and Reconstructive Surgery, Kyungpook National University, Daegu, Korea.
Eur Surg Res. 2013;51(3-4):146-55. doi: 10.1159/000356443. Epub 2013 Dec 20.
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.
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.
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.
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.
包膜挛缩是硅胶植入乳房手术后可能出现的最严重并发症之一。本研究的目的是探讨孟鲁司特和抗粘连屏障溶液（AABS）对减少包膜形成的作用及其可能的协同作用。
本研究经动物伦理委员会批准（参考编号：KNU 2012 - 33），并按照庆北国立大学 - 实验动物管理与使用委员会、动物伦理委员会的规定进行。本研究中的实验在4组、每组24只大鼠体内进行。植入硅胶后，在囊袋内注射不同药物。第一组（对照组）在囊袋内注射生理盐水并喂食纯水。第二组在囊袋内注射AABS并喂食纯水。第三组在实验期间在囊袋内注射生理盐水并给予孟鲁司特药物。第四组在术后在囊袋内注射AABS并给予孟鲁司特药物。8周后切除植入物周围的包膜，评估其透明度、炎性细胞含量、包膜厚度、胶原模式和转化生长因子-β（TGF-β）表达。
实验组（即第二至四组）的包膜比第一组（对照组）明显更透明（p < 0.05，学生t检验）。第二组（296 ± 14.76μm）、第三组（280 ± 14.77μm）和第四组（276 ± 39.28μm）的平均包膜厚度小于对照组第一组（361 ± 35.43μm）。与对照组相比，实验组的组织学结果表明植入物周围包膜的炎症反应减少，表现为血管化程度较低、肥大细胞和巨噬细胞数量减少。实验组的胶原模式密度低于对照组，前者显示出疏松、整齐的胶原模式。对照组中TGF-β和I型胶原的含量高于实验组。第四组（协同作用组）对所有检测参数的影响比单独给药的第二组和第三组更显著。
在该大鼠模型中，孟鲁司特和AABS降低了硅胶植入物周围植入物包膜的厚度、炎性细胞浸润和成肌纤维细胞含量。它们降低了纤维化介质TGF-β的表达，抑制了植入物周围包膜纤维化。因此，孟鲁司特和AABS在减少硅胶诱导的植入物周围包膜形成方面有效。
