School of Pharmacy, Queen's University Belfast, Belfast, UK.
NuSil Technology LLC, Carpinteria, California.
J Surg Res. 2022 Dec;280:129-150. doi: 10.1016/j.jss.2022.06.073. Epub 2022 Aug 12.
Capsular contracture is a common complication associated with breast implants following reconstructive or aesthetic surgery in which a tight or constricting scar tissue capsule forms around the implant, often distorting the breast shape and resulting in chronic pain. Capsulectomy (involving full removal of the capsule surrounding the implant) and capsulotomy (where the capsule is released and/or partly removed to create more space for the implant) are the most common surgical procedures used to treat capsular contracture. Various structural modifications of the implant device (including use of textured implants, submuscular placement of the implant, and the use of polyurethane-coated implants) and surgical strategies (including pre-operative skin washing and irrigation of the implant pocket with antibiotics) have been and/or are currently used to help reduce the incidence of capsular contracture. In this article, we review the pharmacological approaches-both commonly practiced in the clinic and experimental-reported in the scientific and clinical literature aimed at either preventing or treating capsular contracture, including (i) pre- and post-operative intravenous administration of drug substances, (ii) systemic (usually oral) administration of drugs before and after surgery, (iii) modification of the implant surface with grafted drug substances, (iv) irrigation of the implant or peri-implant tissue with drugs prior to implantation, and (v) incorporation of drugs into the implant shell or filler prior to surgery followed by drug release in situ after implantation.
包膜挛缩是重建或美容手术后乳房植入物常见的并发症，其特征是在植入物周围形成紧绷或收缩的疤痕组织囊，常导致乳房形状变形，并引起慢性疼痛。囊切除术（包括完全切除植入物周围的囊）和囊切开术（释放和/或部分切除囊以在植入物周围创造更多空间）是治疗包膜挛缩最常见的手术方法。各种植入物装置的结构修改（包括使用纹理植入物、植入物置于肌肉下、使用涂有聚氨酯的植入物）和手术策略（包括术前皮肤清洗和用抗生素冲洗植入物口袋）已经和/或目前正在用于帮助降低包膜挛缩的发生率。在本文中，我们综述了药理学方法——包括在临床实践中常用的和在科学和临床文献中报道的旨在预防或治疗包膜挛缩的方法，包括：（i） 药物的术前和术后静脉内给药；（ii） 手术前后全身（通常口服）给予药物；（iii） 通过接枝药物对植入物表面进行修饰；（iv） 在植入前用药物冲洗植入物或植入物周围组织；（v） 在手术前将药物掺入植入物外壳或填充物中，并在植入后在原位释放药物。
