Bachour Yara, Verweij Stephan P, Gibbs Susan, Ket Johannes C F, Ritt Marco J P F, Niessen Frank B, Mullender Margriet G
Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands.
Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Centre, Amsterdam, The Netherlands.
J Plast Reconstr Aesthet Surg. 2018 Mar;71(3):307-317. doi: 10.1016/j.bjps.2017.12.002. Epub 2017 Dec 11.
Capsular contracture is the most frequent complication after breast augmentation or reconstruction with breast implants. The immune system plays a prominent role in capsular contracture formation, albeit to an unknown extent. Bacterial contamination in situ has been hypothesized to be causative for capsular contracture. How this relates to the immunological processes involved is unknown. This article aims to provide an overview of immunological and bacterial factors involved in development of capsular contracture.
We undertook a systematic literature review focused on immunological factors and microbiota in relation to capsular contraction around implants. This systematic review was performed in accordance with the PRISMA guidelines. PubMed, EMBASE, and the Cochrane databases were searched from inception up to October 2016. Included studies were assessed for the following variables: subject characteristics, number of capsules, primary indication for surgery, surgical procedure, follow-up or implant duration, study methods, type of antibiotics or medical therapies and outcomes related to microbiota and immunological factors.
Data on immunological factors and bacterial contamination were retrieved from 64 included studies. Notably the presence of macrophages and Staphylococcus epidermidis within capsules was often associated with capsular contracture.
This review provides a clear overview of the immunological factors associated with capsular contracture and provides a hypothetical immunological model for development of the disease. Furthermore, an overview of bacterial contamination and associations with capsular contracture has been provided. Follow-up research may result in clinical recommendations to prevent capsular contracture.
包膜挛缩是隆胸或乳房植入物重建术后最常见的并发症。免疫系统在包膜挛缩形成中起重要作用，尽管其作用程度尚不清楚。原位细菌污染被认为是包膜挛缩的病因。但其与所涉及的免疫过程之间的关系尚不清楚。本文旨在概述包膜挛缩发生过程中涉及的免疫和细菌因素。
我们进行了一项系统的文献综述，重点关注与植入物周围包膜挛缩相关的免疫因素和微生物群。该系统综述按照PRISMA指南进行。检索了从创刊到2016年10月的PubMed、EMBASE和Cochrane数据库。纳入研究的评估变量包括：受试者特征、包膜数量、手术主要指征、手术过程、随访或植入持续时间、研究方法、抗生素或药物治疗类型以及与微生物群和免疫因素相关的结果。
从64项纳入研究中检索到了关于免疫因素和细菌污染的数据。值得注意的是，包膜内巨噬细胞和表皮葡萄球菌的存在通常与包膜挛缩有关。
本综述清晰概述了与包膜挛缩相关的免疫因素，并为该疾病的发展提供了一个假设的免疫模型。此外，还提供了细菌污染及其与包膜挛缩相关性的概述。后续研究可能会产生预防包膜挛缩的临床建议。
