From the Department of Plastic, Reconstructive and Hand Surgery.
Department of Molecular Cell Biology and Immunology, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit.
Plast Reconstr Surg. 2023 Dec 1;152(6):1191-1200. doi: 10.1097/PRS.0000000000010359. Epub 2023 Mar 7.
Breast implant surgery is one of the most frequently performed procedures by plastic surgeons worldwide. However, the relationship between silicone leakage and the most common complication, capsular contracture, is far from understood. This study aimed to compare Baker grade I with Baker grade IV capsules regarding their silicone content in an intradonor setting, using two previously validated imaging techniques.
Twenty-two donor-matched capsules from 11 patients experiencing unilateral complaints were included after bilateral explantation surgery. All capsules were examined using both stimulated Raman scattering (SRS) imaging and staining with modified oil red O (MORO). Evaluation was done visually for qualitative and semiquantitative assessment and automated for quantitative analysis.
Using both SRS and MORO techniques, silicone was found in more Baker grade IV capsules (eight of 11 and 11 of 11, respectively) than in Baker grade I capsules (three of 11 and five of 11, respectively). Baker grade IV capsules also showed significantly more silicone content compared with the Baker grade I capsules. This was true for semiquantitative assessment for both SRS and MORO techniques ( P = 0.019 and P = 0.006, respectively), whereas quantitative analysis proved to be significant for MORO alone ( P = 0.026 versus P = 0.248 for SRS, respectively).
In this study, a significant correlation between capsule silicone content and capsular contracture is shown. An extensive and continued foreign body response to silicone particles is likely to be responsible. Considering the widespread use of silicone breast implants, these results affect many women worldwide and warrant a more focused research effort.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
乳房植入手术是全球整形医生最常进行的手术之一。然而，硅酮泄漏与最常见的并发症包膜挛缩之间的关系还远未被理解。本研究旨在比较贝克 I 级和贝克 IV 级包膜，在同种异体供体环境中，使用两种先前验证的成像技术比较它们的硅酮含量。
在双侧取出手术后，从 11 名单侧有症状的患者中纳入了 22 对供体匹配的包膜。所有包膜均使用受激拉曼散射（SRS）成像和改良油红 O（MORO）染色进行检查。评估采用视觉定性和半定量评估以及自动定量分析进行。
使用 SRS 和 MORO 技术，在贝克 IV 级包膜中发现了更多的硅酮（分别为 11 个中的 8 个和 11 个中的 11 个），而在贝克 I 级包膜中发现的较少（分别为 11 个中的 3 个和 11 个中的 5 个）。贝克 IV 级包膜的硅酮含量也明显高于贝克 I 级包膜。这对于 SRS 和 MORO 技术的半定量评估都是正确的（P=0.019 和 P=0.006），而定量分析仅证明 MORO 是显著的（P=0.026 与 P=0.248 相比，SRS）。
在这项研究中，显示包膜的硅酮含量与包膜挛缩之间存在显著相关性。对硅酮颗粒的广泛和持续的异物反应可能是造成这种情况的原因。考虑到硅酮乳房植入物的广泛使用，这些结果影响到全球许多女性，值得更集中的研究努力。
临床问题/证据水平：风险，III 级。
